"Stripped of dignity" -- Women in homelessness and their perspectives of healthcare services: A qualitative study.

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Publisher: Elsevier B.V.
Document Type: Report
Length: 453 words

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(d) Keywords Co-production; Health inequity; Homelessness; Human rights; Inclusion health; Nursing; Women Abstract Background A much more substantial European evidence base on the accessibility of healthcare services among women experiencing homelessness across healthcare systems in Europe is warranted. Objective To give voice to women with experiences of homelessness, and to explore their perspectives of healthcare services in an EU country with universal healthcare. Design The study is part of a research program striving to promote equal healthcare through co-production with women in homelessness. An advisory board of women with lived experience of homelessness was established and a qualitative, interpretive and exploratory design was employed. Participants 26 women with experience of homelessness were interviewed. Their median age was 46 years (range 42) and 70% were roofless/houseless. Methods Data were analyzed with content analysis. Co-production and joint analyses were conducted by researchers and three women with experience of homelessness, using the DEPICT model for collaborative analysis. Results The analysis resulted in one overall theme: Visiting healthcare from the outskirts of society, comprising three sub-themes: Demand for a life in order - Exclusion in action; Unwell, unsafe and a woman - Multifaceted needs challenge healthcare; and Abuse versus humanity -- power of healthcare encounters to raise or reduce. Women's experiences of care encounters were disparate, with prevalent control, mistrust and stigma, yet healthcare professionals that demonstrated respect for the woman's human dignity was described both as life-altering and lifesaving. Conclusions Women in homelessness live on the outskirts of society and have multiple experiences of exclusion and loss of dignity within healthcare services. The multifaceted care needs challenge healthcare, leading to women feeling alienated, invisible, disconnected and worthless. We urge registered nurses to take actions for inclusion health, i.e. focusing health efforts of people experiencing extreme health inequities. We can lead the way by speaking up and confronting discriminating behaviors, protecting and restoring human dignity in caring relationships, and framing healthcare services for all citizens. Tweetable abstract: Women in homelessness have multiple experiences of exclusion and loss of dignity within healthcare services. Nurses must frame healthcare to include all citizens. Author Affiliation: (a) Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Stigbergsgatan 30, Box 111 89, 100 61, Stockholm, Sweden (b) Uppsala University, Department of Women's and Children's Health, Clinical psychology in healthcare, 751 85, Uppsala, Sweden (c) University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Sciences, 801 76, Gävle, Sweden (d) Ersta Möjlighet, Stockholm, Sweden * Corresponding author at: Erstagatan 1C, 116 28 Stockholm, Sweden. Article History: Received 25 January 2021; Revised 28 April 2021; Accepted 28 April 2021 (footnote)1 Shared first authorship Byline: Åsa Kneck [asa.kneck@esh.se] (a,1), Elisabet Mattsson [elisabet.mattsson@esh.se] (a,b,1), Martin Salzmann-Erikson [martin.salzmann@hig.se] (c), Anna Klarare [anna.klarare@kbh.uu.se] (a,b,*)

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Gale Document Number: GALE|A667643829