Feeling "Unwelcome" a Barrier to Homeless Seeking Health Care: Toronto Study

Homeless people who have felt unwelcomed during past health care encounters are more likely to avoid health care institutions, according to a new study by St. Michael’s Hospital researchers.

The qualitative study of 17 homeless men and women at five shelters in Toronto found respondents often reported that unwelcoming experiences prompted strong emotional responses, making it less likely they seek health care in the future.

“The preliminary findings offer a new and unexplored way of thinking about patient-health professional interactions,” study author and St. Michael’s Hospital researcher Dr. Stephen Hwang explained. “While the concept of unwelcomeness being tied to accessibility of health care has been relatively unexplored, it is no less important.”

Following audiotaped in-depth interviews of study subjects, researchers found most participants perceived their experiences of unwelcomeness as acts of discrimination based on homelessness and low social class, lead author Chuck Wen explained.

“Participants characterized these health care experiences as dehumanizing,” he said. “The patients conveyed a sense that the health care provider reduced them to an object, did not empathize with them, ignored or failed to listen to them, and felt brushed aside, rushed, and treated rudely.”

Intense emotional responses associated with these feelings of unwelcomeness have created for some individuals a strong distrust of health care workers and avoidance of health care institutions, St. Michael’s Hospital researcher Pamela Hudak said.

“The results of the study encourage health-care professionals to approach each patient with openness and receptiveness,” she said. “Welcomeness brings to mind the idea of hospitality, a concept that differs from patient satisfaction and that could usefully be incorporated by health care professionals as part of their stance towards not only homeless people but patients in general.”

The study was published in the Journal of General Internal Medicine.