Factors associated with access to health services by Winnipeg street youth

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Backe, Horst Werner
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This study identifies factors associated with access to health services by Winnipeg street youth. A framework for understanding access to health services by Winnipeg street youth is developed based on these factors. Access to health services is particularly important in light of an extensive Canadian literature review which shows that street youth have numerous health problems at rates higher than their non-street-involved peers. Using a mini-ethnographic approach, semi-structured interviews and direct observations were used to gather data from street youth recruited through youth-serving agencies. Five major categories were identified from the analysis: (a) helping system characteristic, (b) provider characteristics, (c) street youth characteristics, (d) their social environment, and (e) satisfaction. Health care system characteri tics which facilitate access to health care included: affordability, immediacy, practical assistance, safety, and tailored services. Proximity, more often than not, facilitated access. Imposed services, more often than not, were barriers to use of health services. Provider characteristics found to facilitate access to health services included: caring relationships, providing continuous services and respect for client control. There was disagreement about the importance of provider age and gender. SY characteristics which facilitated access to health care include: knowing about services, crisis orientation and experiencing pain. Barriers to access included: deferral of care, substance use, travel, environmental constraints, and various internal motivators (i.e., fear of pain, depression, and lack of trust in others). Experiencing a non-acute physical or emotional condition was more often than not a facilitator of, rather than a barrier to access. The social environment around SY including the influence of family, friends and acquaintances enhanced access to services. Satisfaction with health care encounters facilitated repeated use of services, while dissatisfaction did the opposite. The study's findings are discussed and recommendations made.