Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland.
Our Lady of Lourdes Hospital, Royal College of Surgeons Hospital Group, Dublin, Ireland.
Health Soc Care Community. 2020 Sep;28(5):1380-1393. doi: 10.1111/hsc.12972. Epub 2020 Mar 8.
Evidence indicates that homelessness is increasing within Europe and the United States (US), particularly for women. Pregnancy rates among homeless women are exceptionally high compared to their housed counterparts and homeless women engage poorly with antenatal care. The aim of this review is to explore the barriers and facilitators perceived by homeless women, while pregnant, or within six weeks postpartum in accessing antenatal and/or postnatal healthcare. A qualitative systematic review and synthesis was conducted. Key words and search terms were derived using the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) framework. Titles and abstracts were screened in accordance with inclusion and exclusion criteria. The methodological quality of included papers was assessed using criteria described by the Critical Appraisal Skills Programme (CASP) with data analysis using thematic synthesis. Two primary linked themes were generated: (a) lack of person-centred care; (b) complexity of survival. At an organisational level, a fragmented health service and accessibility to the health system were barriers, and resulted in poor person-centred care. At a clinical level, attitude & treatment from healthcare providers together with health knowledge all combined to illustrate poor person-centred care as barriers to homeless women accessing antenatal/postnatal healthcare. Sub-themes associated with complexity of survival included: disillusion with life, distrust of services, competing lifestyle demands and support and relationships. The findings of this review highlight that poor engagement may be partly explained by the complex interplay between both the healthcare system (person-centred care) and the individual (complexity of survival). Future services should be delivered in a way that recognises homeless people's complex and diverse needs, and should be reconfigured in order to try to meet them, through decreasing fragmentation of health services and staff training.
有证据表明，欧洲和美国（美国）的无家可归者人数正在增加，尤其是女性。与有住房的同龄人相比，无家可归的孕妇的怀孕率异常高，而且无家可归的孕妇接受产前护理的情况不佳。本综述的目的是探讨孕妇或产后六周内的无家可归妇女在接受产前和/或产后保健方面所面临的障碍和促进因素。进行了定性系统评价和综合。使用 SPIDER（样本，感兴趣的现象，设计，评估，研究类型）框架得出了关键词和搜索词。根据纳入和排除标准筛选标题和摘要。使用批判性评估技能计划（CASP）描述的标准评估纳入论文的方法学质量，并使用主题综合进行数据分析。生成了两个主要的相关主题：（a）缺乏以人为中心的护理；（b）生存的复杂性。在组织层面上，分散的卫生服务和获得卫生系统的机会是障碍，导致以人为中心的护理不佳。在临床层面上，医护人员的态度和治疗以及健康知识都说明了以人为中心的护理不善是无家可归的孕妇获得产前/产后保健的障碍。与生存复杂性相关的子主题包括：对生活的幻灭，对服务的不信任，竞争的生活方式需求以及支持和关系。这项研究的结果表明，参与度低可能部分可以解释为医疗保健系统（以人为中心的护理）和个人（生存的复杂性）之间的复杂相互作用。未来的服务应以一种认识到无家可归者的复杂和多样化需求的方式提供，并应通过减少卫生服务的碎片化和员工培训来重新配置，以尝试满足这些需求。
