Experience of health care among marginalized populations: Women on the edge

Significance: Vulnerable populations are highly affected by social ills resulting from structural inequalities. The interaction of these structural factors and their consequences on minority communities may affect health care utilization patterns of marginalized populations and ultimately, their health. Objective: This work examined the way marginalized women defined and experienced health and health care needs in the context of these inequalities. Methods: Five focus groups were conducted with thirteen women whose narratives were used to illuminate health care experiences for a group of Black, female, drug using sex workers. Results: Any consistent link or resource for accessing health care facilitated current and future utilization behaviors. Women communicated their experiences with health care in the context of their links to care, and those without these links had negative experiences, as discrimination based on lack of insurance became the primary perception and barrier of accessing health care. Through these experiences, women constructed expectations and beliefs about health care, and negative experiences reinforced their constantly developing perceptions of discrimination. While experiences were influenced by their vulnerable status, their definitions of health were consistent with typical goals and focused on diet, exercise, being free of pain, and feeling mentally clear. Discussion: A model was constructed linking health definitions and experiences of seeking care at one level, all of these to structural violence at a more abstract level and the reinforced ideology that maintains a repressive system. Utilization behaviors are affected by structural issues, upheld by individualistic ideologies and internalized through interactions with health care providers.