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Perceived barriers and facilitators to accessing and utilising sexual and reproductive healthcare for people who experience homelessness: a systematic review
  1. Martha Paisi1,2,
  2. Jane March-McDonald1,
  3. Lorna Burns3,
  4. Erna Snelgrove-Clarke4,
  5. Lyndsey Withers5,
  6. Jill Shawe1
  1. 1School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
  2. 2Peninsula Dental Social Enterprise, Peninsula Dental School, University of Plymouth, Plymouth, UK
  3. 3Peninsula Dental School, University of Plymouth, Plymouth, UK
  4. 4School of Nursing, Queen's University, Kingston, Ontario, Canada
  5. 5Well Connected (Charity), Plymouth, UK
  1. Correspondence to Dr Martha Paisi, School of Nursing and Midwifery, University of Plymouth, Plymouth PL4 8AA, UK; martha.paisi{at}plymouth.ac.uk

Abstract

Introduction People who experience homelessness face disproportionately poor reproductive health and adverse pregnancy outcomes, including but not limited to unintended pregnancy, abortion, low birth weight and preterm birth, as well as a higher risk of sexually transmitted infections (STIs). Precarious living conditions are known to contribute to poor uptake and engagement with sexual and reproductive healthcare (SRH) for this population.

Aim To identify and understand the perceived barriers and facilitators for accessing and utilising SRH for people who experience homelessness from their perspective, and the perspective of support staff/volunteers and healthcare professionals.

Methods Electronic databases and online sources were searched. Two reviewers independently carried out the screening, data extraction, critical appraisal, data synthesis and thematic analysis of findings.

Results Following deduplication and screening, 23 papers/reports were considered eligible for the review. Barriers for people experiencing homelessness to accessing and utilising SRH were identified within the themes of complexity, feelings and knowledge (ie, individual-level factors), as well as patient/provider interaction and healthcare system (ie, organisational factors). Facilitators were identified within all of the above themes except for complexity.

Conclusions Both population characteristics and attributes of the healthcare system influence access and utilisation of SRH by people experiencing homelessness. Given the complexity of living conditions associated with homelessness, greater efforts to improve access should be placed on healthcare systems and aspects of care delivery. This systematic review highlights current gaps in the literature and provides recommendations for enhancing future research and practice to meet the needs of this vulnerable group more effectively.

  • reproductive health
  • sexual health
  • contraception
  • barrier
  • contraception behavior
  • reproductive health services
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Footnotes

  • Twitter @MarthaPaisi, @ijanemcdonald, @kterna, @LyndseyWithers, @ProfJShawe

  • Contributors MP was responsible for the conception and design of the study, acquisition of data, data analysis and interpretation, and drafting the article. JMM was responsible for the conception and design of the study, acquisition of data, data analysis and interpretation, and critically reviewing the article. LB was responsible for the design of the study, acquisition of data, and critically reviewing the article. ESC was responsible for the design of the study and critically reviewing the article. LW was responsible for data interpretation, critically reviewing the article, and advising on dissemination plans. JS was responsible for the conception and design of the study and critically reviewing the article. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JS is a member of the Faculty of Sexual and Reproductive Healthcare (FSRH) Sexual and Reproductive Health Clinical Studies Group (SRH CSG).

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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