NDLI: Making sense of street chaos: an ethnographic exploration of homeless people’s health service utilization

Content Provider	Springer Nature : BioMed Central
Author	O’Carroll, Austin Wainwright, David
Abstract	Background Homeless people have poor health and mortality indices. Despite this they make poor usage of health services. This study sought to understand why they use health services differently from the domiciled population. Methods Ethnographic observations were conducted at several homeless services, in Dublin. This was supplemented with 47 semi-structured interviews with homeless people and two focus groups of homeless people and hospital doctors. A critical-realist approach was adopted for interpretation of the data. Results Homeless people tended to present late in their illness; default early from treatment; have low usage of primary-care, preventative and outpatient services; have high usage of Emergency and Inpatient services; and poor compliance with medication. They tended to avoid psychiatric services. A number of external barriers were identified. These were classified as physical (distance) administrative (application process for medical care; appointments; queues; the management of addiction in hospital; rules of service; and information providing processes); and attitudinal (stigma; differing attitudes as to appropriate use of services. A new form of barrier, Conversations of Exclusion was identified and described. Internalised barriers were identified which were in nature, either cognitive (fatalistic, denial, deferral to future, presumption of poor treatment or discrimination, self blame and survival cognitions) or emotional (fear; embarrassment, hopelessness and poor self-esteem). Generative mechanisms for these factors were identified which either affected participants prior to homelessness (marginalization causing hopelessness, familial dysfunction, substance misuse, fear of authority, illiteracy; mental health; and poor English) or after becoming homeless (homelessness; ubiquity of premature death; substance misuse; prioritization of survival over health; threat of violence; chaotic nature of homelessness; negative experiences of authority; and stigma. Conclusions An explanatory critical realist model integrating the identified generative mechanisms, external and internalised barriers was developed to explain why the Health service Utilization of homeless people differs from the domiciled populations. This new model has implications for health service policy makers and providers in how they design and deliver accessible health services to homeless people.
Related Links	https://equityhealthj.biomedcentral.com/counter/pdf/10.1186/s12939-019-1002-6.pdf
Ending Page	22
Page Count	22
Starting Page	1
File Format	HTM / HTML
ISSN	14759276
DOI	10.1186/s12939-019-1002-6
Journal	International Journal for Equity in Health
Issue Number	1
Volume Number	18
Language	English
Publisher	BioMed Central
Publisher Date	2019-07-23
Access Restriction	Open
Subject Keyword	Public Health Health Promotion and Disease Prevention Health Services Research Health Policy Social Justice Equality and Human Rights Social Policy
Content Type	Text
Resource Type	Article
Subject	Health Policy Public Health, Environmental and Occupational Health
Journal Impact Factor	4.5/2023
5-Year Journal Impact Factor	4.7/2023

Sl.	Authority	Responsibilities	Communication Details
1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
2	Indian Institute of Technology Kharagpur	Host Institute of the Project: The host institute of the project is responsible for providing infrastructure support and hosting the project	https://www.iitkgp.ac.in
3	National Digital Library of India Office, Indian Institute of Technology Kharagpur	The administrative and infrastructural headquarters of the project	Dr. B. Sutradhar bsutra@ndl.gov.in
4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
5	Website/Portal (Helpdesk)	Queries regarding NDLI and its services	support@ndl.gov.in
6	Contents and Copyright Issues	Queries related to content curation and copyright issues	content@ndl.gov.in
7	National Digital Library of India Club (NDLI Club)	Queries related to NDLI Club formation, support, user awareness program, seminar/symposium, collaboration, social media, promotion, and outreach	clubsupport@ndl.gov.in
8	Digital Preservation Centre (DPC)	Assistance with digitizing and archiving copyright-free printed books	dpc@ndl.gov.in
9	IDR Setup or Support	Queries related to establishment and support of Institutional Digital Repository (IDR) and IDR workshops	idr@ndl.gov.in

A longitudinal analysis of violence and healthcare service utilization in Mexico

Investigating people’s attitudes towards participating in longitudinal health research: an intersectionality-informed perspective

From office to digital primary care services: analysing income-related inequalities in utilization

Health service utilization by indigenous cancer patients in Queensland: a descriptive study

Inequity in health care utilization in Ecuador: an analysis of current issues and potential solutions

An economy-related equity analysis of health service utilization by women in economically underdeveloped regions of western China

Health service access and utilization among Syrian refugees in Jordan

Influencing factors of inequity in health services utilization among the elderly in China

Community perceptions and factors influencing utilization of health services in Uganda

Making sense of street chaos: an ethnographic exploration of homeless people’s health service utilization

Similar Documents

A longitudinal analysis of violence and healthcare service utilization in Mexico

Investigating people’s attitudes towards participating in longitudinal health research: an intersectionality-informed perspective

From office to digital primary care services: analysing income-related inequalities in utilization

Health service utilization by indigenous cancer patients in Queensland: a descriptive study

Inequity in health care utilization in Ecuador: an analysis of current issues and potential solutions

An economy-related equity analysis of health service utilization by women in economically underdeveloped regions of western China

Health service access and utilization among Syrian refugees in Jordan

Influencing factors of inequity in health services utilization among the elderly in China

Community perceptions and factors influencing utilization of health services in Uganda

Making sense of street chaos: an ethnographic exploration of homeless people’s health service utilization