Towards Equitable Health Care Access: Community Participatory Research Exploring Unmet Health Care Needs of Homeless Individuals

Abstract

Community and health services often overlook health care needs of persons experiencing homelessness, which leads to deterioration in health and increased utilization of emergency services. Since homeless people are underrepresented in health service research, little is known about their unmet health care needs, particularly in smaller cities where resources are limited. This community-based participatory research explored the experiences of small-city homeless service users (HSUs) with unmet health care needs and community service providers (CSPs) who work with them to determine barriers to health care access affecting them. Structured interviews were conducted with 65 HSUs and 15 CSPs in interior British Columbia, Canada. These interviews were audio-recorded, and the retrieved data were analyzed thematically. The three themes uncovered included: a lack of access to health care and risk of stigma, a lack of trust and fear of discrimination, and a need for community navigation and social support. The findings indicate that HSUs do not receive equitable care and face challenges in accessing appropriate and timely foot care, which contributes to increased foot-related emergency visits, loss of trust in the health care system, and disabilities due to worsening foot conditions. Various social determinants of health also impact HSUs, such as low socioeconomic status, lack of housing, decreased social support, unhealthy behaviors, and inequitable access to health services. By collaborating with HSUs, community and health services need to develop innovative outreach programs that provide better community resources as the first step toward equitable access to health care.

Street Clinics and the Healthcare of Vulnerable Homeless Communities in Brazil: A Qualitative Study

“…Worldwide, homeless persons experience social problems resulting from a financial, mental, cognitive, behavioral or physical situation, sleep in temporary shelters or live in inadequate or insecure housing [ 1 , 2 ].…”

“…There are reports of homeless persons who feel neglected, stigmatized and discriminated against by health professionals, choosing not to seek help from health services. It should be noted that the intersections of class, race and gender permeate the profile of the homeless population, aggravating discrimination [ 2 ].…”

“…"They [homeless population] are very badly treated when they arrive at the hospital, in many ways they are neglected, abused, left aside, it's a life that we realize that is not worth investment in both in terms of health and all other other spheres of [social] care." (2) "You already see the extreme condition, you know, you don't get it from the beginning, you get a diabetic with diabetes at 600, you can hardly identify it, the device doesn't read it. "(5)…”

The Health Needs of Regionally Based Individuals Who Experience Homelessness: Perspectives of Service Providers

“…This non-engagement with services often means that individuals experiencing homelessness become more seriously ill and are more likely to experience premature death than the general population [ 39 , 40 ]. Reduced utilisation of healthcare services can largely be attributed to often insurmountable barriers, which this population faces across all levels [ 41 ], including challenges related to access, experiencing stigma and discrimination [ 42 ], financial constraints, inadequate transportation [ 43 , 44 , 45 ] and low health literacy [ 46 ]. The issue of access to free or affordable health care repeatedly arises as a key barrier for individuals experiencing homelessness [ 19 , 47 ].…”

Health Care Needs of Young Adults Who Have Experienced Homelessness

“…The Gelberg-Andersen model conceptualizes health care utilization in terms of characteristics that influence one's propensity for seeking services (ie, predisposing characteristics), aspects that may facilitate or impede care (ie, enabling characteristics), and health conditions that may motivate care (ie, unmet needs). 15 While several studies explore the correlates of unmet health care needs among adults experiencing homelessness, [16][17][18][19][20][21] the majority of participants in these studies are aged 40 years and older, leaving the experiences of unmet health care need among youth and younger adults understudied. To our knowledge, only one published study explores the correlates of unmet health care need among youth experiencing homelessness; in this study of people experiencing homelessness with mental illness and entering Housing First in Canada, youth (under age 25) had similar rates of perceived unmet need for health care as adults, and being nonmale and White were statistically significant correlates of unmet health care need in models adjusting for demographics, mental health, substance use disorder, and access to care.…”