Transcultural Concepts in Nursing Care

Evidence-Based Practice 11-5

Experiences of Adult Men Who Are Homeless Accessing Care: A Qualitative Study

This study described the perceptions of individuals experiencing homelessness, related to their health and experiences accessing care. They experienced difficulties accessing care and poor health out comes compounded by social and economic fac tors, such as housing insecurity, unemployment, and limited social support. Individuals who are homeless report increased rates of chronic physi cal and mental health conditions, including cardio vascular disease, mental illness, and substance use disorders. Despite increased morbidity rates, these individuals have difficulty accessing pri mary and specialty care services and emergency departments are their most accessible source of care. Some authors have argued that homeless ness, using transcultural theory, can be viewed as a culture based on the shared beliefs, norms, and patterns of living that exist among homeless popu lations. Three important themes emerged in this study.

function and independence. They wanted the healthcare system to provide care that matched their culture, priorities, and lifestyle. Participants wanted care that addressed their presenting prob lem and considered issues such as spirituality, fam ily issues, daily activities, and mental well-being. Functionality was one of the most important priori ties for the participants in this study. Patients said negative experiences had driven them to seek epi sodic care at emergency departments. Many participants identified care coordination issues as either a limiting or facilitating factor in their receiving healthcare. They wanted assistance in coordinating care and navigating the healthcare sys tem. Participants with various chronic diseases and conditions including hepatitis C, diabetes, asthma, and cardiac disease. These diseases require care from a multidisciplinary team; but working with such teams was very difficult. They wanted care that was a positive transaction toward their individual goals but reported that they did not receive the care they wanted. A central location was important to those without a stable home location. “Access to Care is Limited by Insurance Accepted by Providers, Transportation, and Appointment Availability” was also identified as an important sub-theme. Several factors, includ ing health insurance, transportation, and avail ability of appointments, were identified as barriers to care with health insurance being the most fre quently named barrier. Although all individuals in the study had health insurance through a public program, they still had problems finding providers who accepted their insurance coverage. Transportation was another factor that affected access to care for the participants. Access to public transportation or difficulties of using a van for individuals with disabilities negatively affect ing their ability to receive care. A final factor was the availability of an appointment at times that Theme 3: Care Coordination Resources Are Inadequate

Theme 1: Men Who Are Homeless Experience Bias Throughout Their Healthcare and Interpersonal Relationships

Participants reported that some providers speak down to them and seem to have negative attitudes toward them because they are homeless. They explained that this perceived disrespect dissuades them from seeking care when necessary, even in urgent situations. Participants described inappro priate interactions because they lived in a home less shelter. This affected their likelihood of seeking care instead opting to self-treat until their symp toms became unmanageable and then they would present at the emergency department.

Copyright © 2023 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

Theme 2: The Best Care Is Person Centered and Considers Patients’ Priorities

Participants wanted person-centered care focus ing on their individual needs that increased their