Abstract
IntroductionEnsuring access to timely and appropriate primary healthcare for deprived patients is an issue facing all countries, even those with universal healthcare systems. There is a paucity of information on how patients living in a context of material and social deprivation perceive barriers in the healthcare system. This study combines the perspectives of persons living in poverty and of healthcare providers to explore barriers to responsive care for underserved persons with a view to developing equity-focused primary care.MethodsIn this participatory action research we used photovoice, together with a method known as ‘merging of knowledge and practice’ developed by ATD Fourth World, an international community organization working to eradicate poverty. The study was conducted in two teaching primary care practices in the Canadian province of Quebec. Participants consisted of 15 health professionals and six members of ATD Fourth World; approximately 60 group meetings were held. Data were analyzed through thematic analysis, in part with the involvement of persons living in poverty.ResultsThree main barriers to responsive care in a context of poverty were highlighted by all participants: the difficult living conditions of people living in poverty, the poor quality of interactions between providers and underserved patients, and the complexity of healthcare system organization and functioning.ConclusionOur research revealed that unhealthy living conditions prevent persons living in poverty from accessing quality healthcare and maintaining good health. Also, the complexity of the healthcare system’s organization and functioning has a negative impact on the interactions with healthcare providers. Changes in policy and practice are needed to address those barriers and to achieve greater equity and provide more responsive care for persons living in poverty.
Highlights
Ensuring access to timely and appropriate primary healthcare for deprived patients is an issue facing all countries, even those with universal healthcare systems
We developed EQUIhealThY, a participatory research project looking at primary care practices, in collaboration with ATD (All Together in Dignity) Fourth World, an international community organization devoted to supporting actions to eradicate poverty around the world
PLPs explained that it is impossible to maintain good health when living on social assistance, which, as of January 2013, provided $604 for a person living alone
Summary
Ensuring access to timely and appropriate primary healthcare for deprived patients is an issue facing all countries, even those with universal healthcare systems. This study combines the perspectives of persons living in poverty and of healthcare providers to explore barriers to responsive care for underserved persons with a view to developing equity-focused primary care. Healthcare systems can increase health inequalities if they do not take into account the needs and socioeconomic living conditions of underserved populations [1,2]. Adequately responding to these needs is often challenging for front-line healthcare providers (HCPs), family physicians and primary care teams [20,21,22,23]. A deeper understanding of barriers to healthcare access, as well as of their causes and impacts on PLPs’ experience of care would help HCPs overcome these challenges and provide socially responsive care. PLPs believe their poverty affects the quality of care they receive and that they are mistreated, marginalized, and discriminated against because of their financial situation [24,26,27,28]
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