Qualitative analysis of barriers and facilitators to healthcare engagement for people with injecting-related invasive infections using a social ecological framework.

Abstract

Background and aims: Injecting-related bacterial infections are increasing in many countries. Systemic infections often require prolonged treatment. Evidence suggests that people who inject drugs who have invasive infections are less likely to complete antimicrobial treatment and have poorer outcomes than patients without a history of injecting drug use. We used a social ecological model to identify critical barriers and facilitators that impact healthcare service access for people who inject drugs with an invasive infection.

Design: A qualitative study using semi-structured interviews.

Setting: Melbourne, Victoria, Australia in 2023.

Participants: Twenty participants were recruited from SuperMIX, a longitudinal cohort of people who inject drugs.

Measurements: Thematic analysis used inductive coding to chart themes onto the core domains of the social ecological model.

Findings: Participant experiences informed five key themes. (1) Health literacy influenced how participants responded to the physical and experiential embodiment of symptoms. (2) The intersection between drug use and marginalisation created compounding barriers to care. (3) Familial and social embeddedness of participants could both enable or restrict their healthcare access. (4) The use of patient-centred care to respond to intersecting needs directly contributed to healthcare engagement outcomes. Finally, (5) trust was a critical dimension that influenced participants' experiences of healthcare access. While its presence or absence was felt at intrapersonal and interpersonal levels, cultivating or discouraging trust had its roots at the societal and institutional level.

Conclusions: Among people who inject drugs, facilitators and barriers to seeking healthcare for invasive infections appear to be influenced by factors at all levels of the social ecological model (intrapersonal, interpersonal, institutional and societal).