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Homeless People’s Perceptions of Welcomeness and Unwelcomeness in Healthcare Encounters

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Abstract

Background

Homeless people face many barriers to obtaining health care, and their attitudes toward seeking health care services may be shaped in part by previous encounters with health care providers.

Objective

To examine how homeless persons experienced “welcomeness” and “unwelcomeness” in past encounters with health care providers and to characterize their perceptions of these interactions.

Design

Qualitative content analysis of 17 in-depth interviews.

Participants

Seventeen homeless men and women, aged 29–62 years, residing at 5 shelters in Toronto, Canada.

Approach

Interpretive content analysis was performed using iterative stages of inductive coding. Interview transcripts were analyzed using Buber’s philosophical conceptualization of ways of relating as “I–It” (the way persons relate to objects) and “I–You” (the way persons relate to dynamic beings).

Results

Most participants perceived their experiences of unwelcomeness as acts of discrimination. Homelessness and low social class were most commonly cited as the perceived basis for discriminatory treatment. Many participants reported intense emotional responses to unwelcoming experiences, which negatively influenced their desire to seek health care in the future. Participants’ descriptions of unwelcoming health care encounters were consistent with “I–It” ways of relating in that they felt dehumanized, not listened to, or disempowered. Welcoming experiences were consistent with “I–You” ways of relating, in that patients felt valued as a person, truly listened to, or empowered.

Conclusions

Homeless people’s perceptions of welcomeness and unwelcomeness are an important aspect of their encounters with health care providers. Buber’s “I–It” and “I–You” concepts are potentially useful aids to health care providers who wish to understand how welcoming and unwelcoming interactions are fostered.

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Acknowledgments

Dr. Hudak is a recipient of a Career Scientist Award from the Ontario Ministry of Health and Long-Term Care. Dr. Hwang is a recipient of a New Investigator Award from the Canadian Institutes of Health Research. The Center for Research on Inner City Health is supported in part by a grant from the Ontario Ministry of Health and Long-Term Care. We wish to thank Evie Gogosis and Shirley Chiu at the Center for Research on Inner City Health for their expert assistance, and the staff of the Determinants of Community Health course, Faculty of Medicine, University of Toronto. The results and conclusions are those of the authors, and no official endorsement by the above organizations is intended or should be inferred.

Conflict of Interest

None disclosed.

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Correspondence to Stephen W. Hwang MD, MPH.

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Wen, C.K., Hudak, P.L. & Hwang, S.W. Homeless People’s Perceptions of Welcomeness and Unwelcomeness in Healthcare Encounters. J GEN INTERN MED 22, 1011–1017 (2007). https://doi.org/10.1007/s11606-007-0183-7

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  • DOI: https://doi.org/10.1007/s11606-007-0183-7

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