Marginalised young people’s healthcare journeys: Professionals’ perspectives

Abstract

Introduction: The pursuit of social justice includes a commitment to health equity for marginalised young people. Health professionals are central to marginalised young people’s engagement and access to health care and their navigation of health systems. They are also uniquely positioned to shed insight into structures and inefficiencies within the health system, including the role of technology, and to advocate for system change. Methods: This qualitative cross-sectional study employed in-depth semi-structured interviews with 22 health service managers and experienced clinicians to better understand service providers’ perspectives. The sampling frame comprised professionals from different sectors and levels of the health system. Analysis used Grounded Theory methods. Results: Three major themes were identified in the data: (1) intersectionalities – understanding the complexity of multiple disadvantage; (2) health system fragmentation – leading to inefficiencies, inertia and advocacy; and (3) services needing to be ‘turned on their head’ – rethinking service delivery and models of care. Conclusion: A better understanding of marginalised young people’s healthcare experiences, including the complexities of multiple disadvantage, and how this contributes to health inequalities could lead to more welcoming and respectful services. Services can reconceptualise their roles by reaching out to young people, both physically and online, to make the navigation of the health system easier. Marginalised young people’s healthcare journeys can be supported by advocates that help them navigate the health system.

Health care equity and access for marginalised young people: a longitudinal qualitative study exploring health system navigation in Australia

“…Out of pocket costs and varying governance structures between services (due to different funding, management and operational systems within the Australian health system) as well as variable intake criteria for health services, led to fragmentation of care. Yet in a related study cost was frequently overlooked by health professionals [26]. Our findings suggest that health professionals can play a more active role in facilitating access and supporting navigation by providing better information about cost, service approach, practical advice about attending face-to-face services and online interventions.…”

“…In a related study, health professionals identified the need for health system reform to better support young people, particluuarly those who are marginalised [26]. Participants views were consistent with the views of professionals, that health services need to embrace technology, better engage diverse groups and support young peoples’ health system navigation.…”

“…Professionals should look beyond single encounters to consider young people’s holistic health and wellbeing needs by playing a more significant advocacy role so marginalised young people can access affordable services (e.g. by negotiating free access to referred services) [26]. Entry points into the health system (e.g.…”

Predictors of young people's healthcare access in the digital age

“…Further, young people from higher socioeconomic areas may be more likely to be in full‐time education, restricting their ability to work. In our related Access 3 study of health professionals, we found they commonly overlooked cost as a barrier 22 . Cost has been identified as the primary barrier by in‐school New Zealand adolescents 16 and was a significant access barrier for marginalised young people, including sexuality diverse young people in Canada 23 and young people with substance use issues in the US 24 …”

Intersectionality: Social Marginalisation and Self-Reported Health Status in Young People

“…Health care providers may not always have the knowledge or tools to address these social identities. In a related qualitative Access 3 study with health professionals, the possibility and impact of young people belonging to multiple marginalised groups was largely overlooked [38]. An intersectional approach may lead to recognition of the additional needs of marginalised young people and, together with the provision of non-judgmental and respectful services, professionals will be better able to respond to the health care needs of the marginalised and vulnerable.…”