Contrasting Barriers to Care Identified by Homeless Women and their Clinic Managers

There is a mismatch between homeless women's poor health status and their use of medical care services. Homeless women's perceived barriers to obtaining medical care influence whether they obtain needed medical care. Little is known about whether clinic directors are indeed aware of the perceived barriers to care of homeless women. We examined link data obtained from the 1997 UCLA Homeless Women's Health Study and 1998 Los Angeles County Provider Survey, which consisted of 390 homeless women who were linked to one of the primary care clinics in the Provider Survey. Women and medical directors of the clinic the women identified were asked to report whether each of 16 barriers to care were a “big problem” (vs. “small problem” or “not a problem at all”) for homeless women to access medical care. Bivariate analyses were performed to determine the level of concordance between the barriers identified by homeless women and the medical director of their identified clinic. Factor analysis revealed that 16 barriers clustered into 5 barrier domains: access, systemic, competing needs, fear, and general. Overall, clinic directors were more likely than women to rate potential barriers as a “big problem” for homeless women in accessing medical care. Clinic directors overestimated barriers to care for 11 out of 16 items, ranging from 3%-64%. Healthcare clinic directors who have similar perceptions of barriers that affect homeless women's access to healthcare services could potentially design and modify services aimed specifically to meet the clinic level barriers to care that homeless women face.