旧金山米申区无家可归者的未满足健康需求和医疗保健障碍：一项定性研究。
Unmet health needs and barriers to health care among people experiencing homelessness in San Francisco's Mission District: a qualitative study.
机构信息
The University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA.
出版信息
BMC Public Health. 2022 May 30;22(1):1071. doi: 10.1186/s12889-022-13499-w.
BACKGROUND
People experiencing homelessness have unique health needs and barriers to medical and behavioral health care (mental health, substance use disorder, and overall well-being) compared to housed people. It remains unclear why many people experiencing homelessness do not access care when community-based homeless health care resources are available at low or no cost. This qualitative study examined perspectives of people experiencing homelessness and staff members at community-based homeless health and service organizations in San Francisco's Mission District on unmet medical and behavioral health needs and barriers to accessing care.
METHODS
We conducted 34 interviews between September and November 2020: 23 with people experiencing homelessness and 11 with staff at community-based homeless health and service organizations in the Mission District. Qualitative interviews were transcribed, coded, and analyzed using the Framework Method on NVivo Qualitative Data Analysis Software.
RESULTS
Both staff and homeless participants reported unmet and common health needs of mental illness, physical injury and disability, food and nutrition insecurity, and substance use disorder. Barriers to care included negative prior health care experiences, competing priorities, and provider turnover. Recommendations for improving services included building more trust with people experiencing homelessness by training clinic staff to treat patients with respect and patience and expanding clinical outreach and health education programs.
CONCLUSIONS
People experiencing homelessness face many different health needs and barriers to care, some of which community-based organizations have the ability to address. These findings can help inform future strategies for homeless health care programs to identify and target the specific unmet health needs and barriers to care of people experiencing homelessness in their communities.
背景
与有住房的人相比，无家可归者在医疗和行为健康护理（心理健康、药物使用障碍和整体健康）方面有独特的健康需求和障碍。尽管社区提供的无家可归者健康护理资源费用低廉甚至免费，但仍不清楚为什么许多无家可归者没有利用这些资源获得护理。这项定性研究调查了旧金山米申区社区无家可归者健康和服务组织的无家可归者和工作人员对未满足的医疗和行为健康需求以及获得护理的障碍的看法。
方法
我们在 2020 年 9 月至 11 月期间进行了 34 次访谈：23 次与无家可归者进行，11 次与社区无家可归者健康和服务组织的工作人员进行。对定性访谈进行了转录、编码，并使用 NVivo 定性数据分析软件中的框架方法进行了分析。
结果
工作人员和无家可归者都报告了心理健康、身体受伤和残疾、食物和营养不安全以及药物使用障碍等未满足和常见的健康需求。护理障碍包括负面的既往医疗保健体验、竞争的优先事项和提供者的更替。改善服务的建议包括通过培训诊所工作人员以尊重和耐心对待患者，扩大临床外展和健康教育计划，与无家可归者建立更多的信任。
结论
无家可归者面临许多不同的健康需求和护理障碍，其中一些社区组织有能力解决。这些发现可以帮助为未来的无家可归者医疗保健计划提供信息，以确定和针对其社区中无家可归者的具体未满足的健康需求和护理障碍。
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