Health care among street-involved women: the perpetuation of health inequity

Qual Health Res. 2013 Aug;23(8):1016-26. doi: 10.1177/1049732313493352. Epub 2013 Jun 12.


I present the findings from a study that explored the experiences and decision making of street-involved women navigating the health care system. Data were drawn from a larger qualitative study situated in a western Canadian inner-city neighborhood that examined the health-management strategies of street-involved women with a history of crack cocaine use. Data were collected over a 17-month period and included ethnographic methods of participant observation, group interviews (n = 57), and in-depth interviews (n = 10). Inductive thematic analysis derived two major themes: power and punishment, and organization and delivery of care. The themes illustrate how women's experiences and decision making were located within a nexus of power relations that operated across women's shared social location as downtown eastsiders. Implications of the findings are discussed in relation to supporting women's efforts and improving health outcomes.

Keywords: addiction / substance use; critical methods; decision making; health care disparities; health care, access to; homelessness; interviews; poverty; power / empowerment; relationships, health care; social identity; urban health; vulnerable populations; women’s health.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anthropology, Cultural / methods
  • Attitude of Health Personnel
  • British Columbia
  • Cocaine-Related Disorders / economics
  • Cocaine-Related Disorders / psychology
  • Cocaine-Related Disorders / rehabilitation
  • Decision Making
  • Drug Users / psychology*
  • Female
  • Health Services Accessibility* / economics
  • Health Status Disparities*
  • Healthcare Disparities* / economics
  • Homeless Persons / psychology*
  • Humans
  • Interviews as Topic
  • Observation
  • Poverty
  • Power, Psychological*
  • Professional-Patient Relations
  • Qualitative Research
  • Social Control, Informal / methods
  • Urban Health
  • Women's Health