Tackling Inequalities in Access to Medicines for People Experiencing Homelessness: A Meta-Ethnography and Qualitative Systematic Review

IF 3 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Expectations Pub Date : 2024-10-25 DOI:10.1111/hex.70076

Tasnim Begum, Kylie Murrell, Anna Robinson-Barella

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引用次数: 0

Abstract

Introduction

Despite increased awareness of the detrimental relationship between homelessness and health, people experiencing homelessness remain an underserved population in health and social care research. Due to barriers affecting the accessibility of medicine and healthcare services, as well as reported competing priorities such as food and shelter, evidence has demonstrated that people experiencing homelessness are less likely to undergo routine examinations, receive diagnoses and adhere to prescribed medical treatments. To enhance service design and access for those experiencing homelessness, it is critical to better recognise, understand and address the barriers these individuals face. This meta-ethnography aims to identify barriers, enablers and interventions to begin addressing this inequality gap.

Methods

A systematic literature search was undertaken in October and re-ran in December 2023 across four databases: MEDLINE, Embase, CINAHL and Scopus. Qualitative studies were included if they addressed barriers, enablers and interventions aimed at tackling medicines and health service inequalities among populations experiencing homelessness. Study quality was assessed using the Joanna Briggs Institute critical appraisal checklist. Data were synthesised using a meta-ethnographic approach, as outlined by Noblit and Hare. The review was registered on PROSPERO (CRD42024511502) and performed according to PRISMA guidelines.

Results

This meta-ethnographic systematic review synthesised data from eight studies across multiple countries. Three overarching third-order constructs (termed ‘themes’) were developed through reciprocal translation and centred around: recognising and acknowledging the discrimination, stigma and barriers experienced when using current services; exploring safe and practical use of medicines and the promotion of general health education and appreciating strategies to tackle inequalities, namely community outreach programmes designed for homeless communities.

Conclusion

This work highlighted the barriers, enablers and interventions that sought to address the inequalities affecting people experiencing homelessness in accessing medication and healthcare services. Future research should utilise lived-experience narratives and co-design to further explore ways to tackle wider healthcare accessibility inequalities for this minoritised population.

Trial Registration

Not applicable, as this is a systematic review.

Patient or Public Contribution

Public contributors (minority research champions and one public health research champion, H.K.G. and T.G.) informed and shaped this project during study design and conceptualisation. They helped to ensure that the study was conducted, and the findings were reported with sensitivity.

Abstract Image

查看原文本刊更多论文

解决无家可归者在获取药物方面的不平等问题：元人类学和定性系统综述》（Meta-Ethnography and Qualitative Systematic Review）。

导言：尽管人们越来越意识到无家可归与健康之间的不利关系，但在健康和社会护理研究中，无家可归者仍然是一个服务不足的群体。有证据表明，无家可归者不太可能接受常规检查、接受诊断和遵医嘱治疗。为了加强对无家可归者的服务设计和提供，必须更好地认识、理解和解决这些人面临的障碍。本荟萃文献旨在确定障碍、促进因素和干预措施，以着手解决这一不平等差距：我们于 2023 年 10 月在四个数据库中进行了系统的文献检索，并于 12 月重新进行了检索：MEDLINE、Embase、CINAHL 和 Scopus。如果定性研究涉及了旨在解决无家可归人群中的药品和医疗服务不平等问题的障碍、促进因素和干预措施，则将其纳入研究范围。研究质量采用乔安娜-布里格斯研究所（Joanna Briggs Institute）的关键评估清单进行评估。按照 Noblit 和 Hare 所述，采用元人种学方法对数据进行了综合。综述已在 PROSPERO（CRD42024511502）上注册，并按照 PRISMA 指南执行：本元人种学系统综述综合了多个国家八项研究的数据。通过相互转换，形成了三个重要的三阶建构（称为 "主题"），其核心是：认识并承认在使用当前服务时遇到的歧视、污名化和障碍；探索安全实用的用药方法，推广普通健康教育，以及了解解决不平等问题的策略，即针对无家可归者社区设计的社区外联计划：这项工作强调了障碍、促进因素和干预措施，旨在解决影响无家可归者获得药物和医疗保健服务的不平等问题。未来的研究应利用生活经验叙事和共同设计进一步探讨如何解决这一少数群体在获得医疗服务方面的不平等问题：不适用，因为这是一篇系统性综述：公众贡献者（少数群体研究拥护者和一名公共卫生研究拥护者，H.K.G. 和 T.G.）在研究设计和概念化过程中为本项目提供了信息和建议。他们帮助确保了研究的进行，并以敏感的态度报告了研究结果。

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来源期刊

Health Expectations 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.20

自引率

9.40%

发文量

251

审稿时长

>12 weeks

期刊介绍： Health Expectations promotes critical thinking and informed debate about all aspects of patient and public involvement and engagement (PPIE) in health and social care, health policy and health services research including: • Person-centred care and quality improvement • Patients'' participation in decisions about disease prevention and management • Public perceptions of health services • Citizen involvement in health care policy making and priority-setting • Methods for monitoring and evaluating participation • Empowerment and consumerism • Patients'' role in safety and quality • Patient and public role in health services research • Co-production (researchers working with patients and the public) of research, health care and policy Health Expectations is a quarterly, peer-reviewed journal publishing original research, review articles and critical commentaries. It includes papers which clarify concepts, develop theories, and critically analyse and evaluate specific policies and practices. The Journal provides an inter-disciplinary and international forum in which researchers (including PPIE researchers) from a range of backgrounds and expertise can present their work to other researchers, policy-makers, health care professionals, managers, patients and consumer advocates.