Table 6 Sample of user opinions
Barrier | Responses | |
|---|---|---|
Personal resources | Economic capacity | (1) P.2 “I don’t earn anything, not a cent. But I don’t care, I don’t eat much, I don’t care if they don’t give me anything”. (2) P.11 “A lot of the medicines we take aren’t covered by social security [medical card].” (3) P.5 “I don’t get paid any money, the social worker told me that with a few papers I could get that PIRMI1, but I don’t want anything, I go round the street cafés and ask for some cigarettes and that’s it.” (4) P.6 “I don’t eat much, but sometimes a little grandmother brings me food.” (5) P.10 “I go to the Red Cross and there they give me medicines when I need them, I can’t pay for them.” |
Cognitive capacity, healthcare culture and understanding of the sysm | (6) P.1 “A morito (…) stole my wallet and [medical] card (…).” (7) P.4 “Yes, I have a medical card, but I’m not going back to the doctor, what I want is to die.” (8) P.17 “I have a medical card, but I don’t go to the doctor. And when I see that I’m going to die, two days before I’ll throw my ID card in the trash, I don’t want them to know who died, nobody cares. They ignore me? Fine, I don’t need anything.” | |
Mobility, personal autonomy and social support | (9) P.5 “I was lying in the street and I couldn’t even move and the ambulance [workers] didn’t want to pick me up. Yet later, later in the hospital they were very good to me, but in the ambulance it was as bad as it gets.” (10) P.1 “Once they had to call the police because the ambulance didn’t want to come for me. And with the police there and everything they didn’t want to take me. Why is that?” (11) P.4 “Look at me, in a wheelchair, I can’t move … and when I go to ask for something [public assistance] they ask me for a work contract. Do you think they’ll give me a work contract in my state?” (12) P.14 What do you mean am I feeling ok? Don’t you see me? Out here, in the cold? I sleep here, on this bench, every day, I always sleep here, you can always find me here.” | |
Adaptation and lack of resources in the healthcare system | (13) P.10 “I have no complaints about Seguridad Social [state health care], we just have to adapt to the system.” (14) P.4 “In the hospital they send us street people from one place to another, no one wants to help us, they don’t want to work or bother with us.” | |
The role of healthcare professionals | External appearance of the user and attitudes of healthcare professionals | (15) P.6 “When I go to the doctor, I always go cleaned up and they always treat me well, but other people, I don’t know, people complain about it.” (16) P.14 “They treat you bad, they smell [alcohol on] my breath and send me back out the door to the street.” (17) P.15 “I went to pick up an x-ray and the first thing the doctor had written on the report: ‘alcoholic’.” (18) P.9 “When you go to the doctor, as a general rule, you say that it hurts here or it hurts there, and the first thing they say is: ‘do you drink? Then it’s your liver’.” (19) P.7 “As soon as I entered the hospital, they told me that they’d see me after I’ve sobered up.” (20) P.2 “They treat you bad, they kick you out as soon as they see you because they know you have drinking problems. And then you think, ‘why go to the doctor if I’m going to keep on drinking?’” |
Information provided by the system and professionals | (21) P.8 “If the doctor explains things to me, I understand them, but they don’t explain anything to me.” | |
Attitudes and habits related to health | Health status, perceived health and use of public health services | (22) P.12 “I broke this finger here, but it will heal, I never go to the doctor, never, no doctor. If I get really bad one day and they take me to the hospital… fine, but I never go to the doctor. Why would I? What I want is to die.” (23) P.9 I have been really ill, with high fever, and that was when I went to the doctor. But I waited until the last moment. Not because of laziness, but so I wouldn’t have to stop drinking. And then you go to the doctor and you’re not going to tell them ‘look, I just like to get drunk’. It’s embarrassing, it’s hard to do.” (24) P.3 “Me, as long as I can manage on my own… If one day I have an attack or something, well, I’ll have to go to the doctor, but for now…” (25) P.11 “I never go to the doctor, an ambulance comes at the last moment if someone from the neighborhood who knows me sees me and calls, when I can’t stand up, but I never go and never call the ambulance.” (26) P.17 “I don’t want to care for myself, what for? What I want is to die, what can I do? Nothing, I’m good for nothing, what I want is to die.” (27) P.13 “If the ambulance doesn’t come for me I won’t go to the hospital on my own, even if I’m really bad off.” (28) P.2 “To go to the doctor I have to be really sick. It’s true that sometimes doctors come around here, but I don’t go myself, if I die, they’ll just have to bury me.” (29) P.9 “I don’t want to know anything about doctors, the only thing that has held up at this point is my health, I don’t have any problems.” |
Following protocols and continuity of care | (30) P.13 “I’m diabetic, but I don’t take the pills anymore, they cost almost 5 euro and I don’t have money. My legs and arms swell up with the diabetes, but what can I do? (31) P.14 “You don’t follow the treatments. You take [the medicine for] two or three days, mixed with booze… or you don’t.” (32) P.3 “I see poorly, because I haven’t changed my lenses for 8 or 10 years, I don’t have money.” (33) P.8 “There’s no problem, you can get the medicines anywhere, there are some nuns that I go to see and they give me the medicines I need.” (34) P.15 “On the streets, you don’t take your medications, I speak for myself and for the others, no one takes them.” (35) P.12 “We’re people who are here today and there tomorrow, we move around constantly and it’s a hassle to carry your medicine around. Call it laziness, or lack of interest, but you don’t take it and you don’t follow through on the therapies like you should.” (36) P.16 “If the medications are not covered by state insurance and I can’t pay for them, they don’t get taken.” | |
Perceived quality of care | (37) P.17 “I have a lot of problems because a security guard beat me in the hospital. And with the doctors, it goes in one ear and out the other.” (38) P.16 “They stabbed me three times, it was nighttime and they took me to hospital. And at 1 in the morning, when they had finished treating me, they can’t think of anything better to do, on a cold night like tonight, than ‘out you go, back on the street with you’. Raining, with no clothes and nothing. Then I had terrible anemia, I was in hospital for six days, and they were very decent, as good as it gets, I had everything I needed.” (39) P.7 The doctor who saw me is one of the worst I’ve had in my life, had no manners, no shame, no humanity. The first thing they should have is humanity. I don’t want to go back to the doctor again, I want to die as soon as possible.” (40) P.1 “I was bleeding from the nose and mouth, and the only thing he could say to me, this man from the hospital at three in the morning, was that I had go back out on the street. I asked if I could talk to someone, because I have nowhere to sleep and with all this I get dizzy and I might die and they’d have to pick up my cadaver. And they said I couldn’t stay, because there were no beds. At least let me stay in the waiting room until morning and then I can go myself!” | |