Hatton D C
Hahn School of Nursing and Health Science, University of San Diego, CA 92110, USA.
Women Health. 2001;33(3-4):149-62. doi: 10.1300/J013v33n03_09.
Homeless women experience more severe physical and mental health problems than women in the general population. Under-utilization of health services complicates these health conditions. The study reported here explored how homeless women access health services within the context of shelter living and emerging managed care systems. Informed by grounded theory and dimensional analysis, the investigator conducted in-depth interviews with 19 homeless women, 6 staff from agencies serving homeless women, and 2 community health nurses. Findings revealed that homeless women usually had circuitous rather than direct routes to health services. First, they typically found a social network opportunity structure where brokers could assist them into the health care system. The first tiers of access included a domestic violence shelter, a shelter for single homeless women, and a cafe offering low-cost meals to an inner city homeless population. Even after locating this opportunity structure, the conditions of managed care, with its mechanisms of referral and unfamiliarity with the needs of impoverished women, complicated access. Thus, access requires policies that address not only the availability of health professionals, but also tiers of access that include a social network opportunity structure where women can interact with advocates who broker their entry into the health care system.
无家可归的女性比普通女性经历更严重的身心健康问题。医疗服务利用不足使这些健康状况更加复杂。本文报道的研究探讨了无家可归的女性在庇护所生活和新兴的管理式医疗系统背景下如何获得医疗服务。在扎根理论和维度分析的指导下，研究者对19名无家可归的女性、6名服务无家可归女性的机构工作人员以及2名社区健康护士进行了深入访谈。研究结果显示，无家可归的女性通常通往医疗服务的途径迂回而非直接。首先，她们通常会找到一个社会网络机会结构，其中的中间人可以帮助她们进入医疗保健系统。最初的获取层级包括一个家庭暴力庇护所、一个单身无家可归女性庇护所，以及一家为市中心无家可归者提供低价餐食的咖啡馆。即使找到了这个机会结构，管理式医疗的状况及其转诊机制以及对贫困女性需求的不熟悉，也使获取医疗服务变得复杂。因此，获取医疗服务需要的政策不仅要解决医疗专业人员的可获得性问题，还要解决获取层级问题，其中包括一个社会网络机会结构，女性可以在其中与促成她们进入医疗保健系统的倡导者互动。
