Exploring levers and barriers to accessing primary care for marginalised groups and identifying their priorities for primary care provision: a participatory learning and action research study.

Austin O’Carroll,Edel Tierney,Anne MacFarlane,Diane Nurse,Patrick O’Donnell

doi:10.1186/s12939-016-0487-5

Abstract

BackgroundThe involvement of patients and the public in healthcare has grown significantly in recent decades and is documented in health policy documents internationally. Many benefits of involving these groups in primary care planning have been reported. However, these benefits are rarely felt by those considered marginalised in society and they are often excluded from participating in the process of planning primary care. It has been recommended to employ suitable approaches, such as co-operative and participatory initiatives, to enable marginalised groups to highlight their priorities for care.MethodsThis Participatory Learning and Action (PLA) research study involved 21 members of various marginalised groups who contributed their views about access to primary care. Using a series of PLA techniques for data generation and co-analysis, we explored barriers and facilitators to primary healthcare access from the perspective of migrants, Irish Travellers, homeless people, drug users, sex workers and people living in deprivation, and identified their priorities for action with regard to primary care provision.ResultsFour overarching themes were identified: the home environment, the effects of the ‘two-tier’ healthcare system on engagement, healthcare encounters, and the complex health needs of many in those groups. The study demonstrates that there are many complicated personal and structural barriers to accessing primary healthcare for marginalised groups. There were shared and differential experiences across the groups. Participants also expressed shared priorities for action in the planning and running of primary care services.ConclusionsMembers of marginalised groups have shared priorities for action to improve their access to primary care. If steps are taken to address these, there is scope to impact on more than one marginalised group and to address the existing health inequities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0487-5) contains supplementary material, which is available to authorized users.

Highlights

The involvement of patients and the public in healthcare has grown significantly in recent decades and is documented in health policy documents internationally
This paper reports on the levers and barriers to accessing primary care among a heterogeneous population of marginalised groups, examining a number of shared and differential experiences of accessing primary care and identified priorities for action with regard to that primary care provision
The Partnership for Health Equity (PHE) is an innovative collaboration which engages medical educators, researchers, clinicians and health service planners from across Ireland in collaboration to work on projects seeking to improve healthcare for marginalised groups

Summary

Introduction

The involvement of patients and the public in healthcare has grown significantly in recent decades and is documented in health policy documents internationally. Many benefits of patient and community participation in healthcare planning have been reported, including the improved provision and uptake of initiatives to address health inequalities, the increased acceptance and effectiveness of healthcare services and closer attention to community priorities, and there is evidence that participatory processes can increase community cohesion and leadership [13,14,15,16,17,18] These benefits, are not experienced by all, and access to the processes of participation is difficult for many members of society deemed to be ‘marginalised’. This situation resonates with Tudor Hart’s inverse care law [30] - those most in need of attention by health services are often the least likely to receive that care

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Conclusion