UBC Theses and Dissertations

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UBC Theses and Dissertations

The intersection of stigma and inequity : the impact of structural violence on people with lived and living experience of substance use and homelessness in the emergency department Wright, Patrice


People with lived and living experience of substance use and homelessness (PWLESH) often face barriers when accessing care including stigma and discrimination, transportation costs, limited services hours and the need to present identification. Such barriers may lead people to leave prior to the completion of treatment, delay seeking care or avoid care altogether. Although PWLESH visit the emergency department at a rate seven times the general population, I could find no published research has explored access to healthcare specifically within the emergency department among adults. The purpose of this thesis was to understand: (a) the emergency department health care experiences, specifically in terms of access, of PWLESH; (b) how the culture within the emergency department and larger health care organization shapes these experiences; and (c) the factors that will positively contribute to providing more equitable health care. A critical ethnographic approach was used for data collection and analysis. Twelve in-depth interviews with PWLESH and thirty hours of observations were conducted in two emergency departments, and seven hospital documents were reviewed. Drawing on central tenets of intersectionality and stigma theories, thematic coding techniques detailed by Thorne (2008) were used during data analysis. This analysis revealed three themes including: (a) experiences of stigma, (b) effects of stigma, and (c) recommendations for equitable healthcare. Several implications for practice and policy and future research are made.

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