People experiencing homelessness also experience poorer health and frequently attend acute care settings when primary health care would be better equipped to meet their needs. A complex mix of individual and structural-level factors is regarded as affecting this pattern of primary health care engagement, for example stigmatisation, health-seeking behaviours, and financial and practical barriers. We add to this knowledge, by exploring caring practices and relations afforded within the space and time constraints of primary health care provision in Australia.
The present study was undertaken in 2022 at an inclusive health centre (‘the Centre’), a not-for-profit health service providing care to marginalized people at multiple sites across an urban location in Southeast Queensland, Australia. The Centre was established with the purpose of overcoming health inequalities and is structured to be a health resource within the community for people experiencing one or more of the following: homelessness, disability, poverty, mental illness, chronic disease and/or substance use. This study took an ethnographic approach with multiple stakeholders, analysing interview, observational and visual data. Here, we present findings on three interrelated themes: staying safe, feeling welcome and being seen.
Staying safe describes the perceptions and practices around safety, which can sit in tension with making service users feel welcome, that is the sense of being invited to use services free of judgment. In turn, the ability to see (and be seen by) health service providers within the primary care setting is multi-layered; it captures the capacity to seek advice and treatment as permitted within practice hours, that is timely and affordable. It also means to be able to feel understood within the complexity of one’s lived experience and with a degree of ownership over how care is done. This study’s findings indicate that spatial and temporal configurations are important but must be interpreted within their capacity to affect relations of care. Rigid approaches to delivering health care, for example at a certain time, for a determined duration and at a designated location can undermine the reciprocal relationships between services users and providers that foster feelings of welcomeness. The findings also indicate viable alternatives to punitive responses to challenging behaviours or missed appointments (i.e., the exclusion from services) where trusted relationships are nurtured and scaffolded. We conclude that flexible service configurations can leverage a relational model of care.