Medical homelessness and candidacy: women transiting between prison and community health care

International Journal for Equity in Health

Research

Joyce Davison¹  Penelope Abbott¹  Parker Magin²  Wendy Hu³ 

[1] Department of General Practice, Western Sydney University, Locked Bag 1797, 2751, Penrith, Australia;Discipline of General Practice, University of Newcastle, Newbolds Bldg, University Drive, 2308, Newcastle, Australia;Medical Education Unit, Western Sydney University, Locked Bag 1797, 2751, Penrith, Australia;

关键词: Prisoner;    Health care access;    Health services accessibility;    Substance misuse;    Primary health care;    Stigma;    Candidacy;    Prescription drug misuse;    Qualitative research (3–10 keywords);   

DOI  :  10.1186/s12939-017-0627-6

 received in 2017-02-15, accepted in 2017-07-12,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundWomen in contact with the prison system have high health needs. Short periods in prison and serial incarcerations are common. Examination of their experiences of health care both in prison and in the community may assist in better supporting their wellbeing and, ultimately, decrease their risk of returning to prison.MethodsWe interviewed women in prisons in Sydney, Australia, using pre-release and post-release interviews. We undertook thematic analysis of the combined interviews, considering them as continuing narratives of their healthcare experiences. We further reviewed the findings using the theoretical lens of candidacy to generate additional insights on healthcare access.ResultsSixty-nine interviews were conducted with 40 women pre-release and 29 of these post-release. Most had histories of substance misuse. Women saw prison as an opportunity to address neglected health problems, but long waiting lists impeded healthcare delivery. Both in prison and in the community, the dual stigmas of substance misuse and being a prisoner could lead to provider judgements that their claims to care were not legitimate. They feared they would be blocked from care even if seriously ill. Family support, self-efficacy, assertiveness, overcoming substance misuse, compliance with health system rules and transitional care programs increased their personal capacity to access health care.ConclusionsFor women in transition between prison and community, healthcare access could be experienced as ‘medical homelessness’ in which women felt caught in a perpetual state of waiting and exclusion during cycles of prison- and community-based care. Their healthcare experiences were characterized by ineffectual attempts to access care, transient relationships with healthcare providers, disrupted medical management and a fear that stigma would prevent candidacy to health care even in the event of serious illness. Consideration of the vulnerabilities and likely points of exclusion for women in contact with the criminal justice system will assist in increasing healthcare access for this marginalised population.

【 授权许可】

CC BY   
© The Author(s). 2017