Engaging the citizenship of the homeless: a qualitative study of specialist primary care providers

BACKGROUND: Homeless patients have complex health needs. They also often describe difficulty accessing and maintaining access to clinical services. Although engagement with health care has been explored from the patient perspective, little is known about how health care professionals conceptualize, assess and promote engagement with health care among homeless persons.

AIM: To examine how health professionals working in services for homeless persons view their patients' engagement with health care and explore how these views influence their practice.

METHODS: Semi-structured phone interviews were conducted with health professionals who had experience working with homeless patients. Purposive sampling aimed to cover a range of location, practice type and duration of professional experience. Thematic analysis was undertaken on interview transcripts.

RESULTS: Thirteen interviews were conducted. Four themes were explored relating to engagement of homeless persons with health care: (i) systematic barriers to engagement; (ii) difficulties engaging with professionals; (iii) system approaches to facilitate engagement and (iv) relationship approaches to facilitate engagement. In addition, a fifth theme emerged relating to the interaction between practices and networks of homeless persons in which practices were perceived as a key resource for a citizenship of the homeless.

CONCLUSION: Primary care practices providing services for homeless people aim to promote engagement with health care by maximizing flexibility and fostering relationships between patients and the clinical team. In doing so they produce a paradox, whereby they function as a key hub within a citizenship of homeless persons while simultaneously aiming to help people move out of homelessness into a more settled state.