UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

Individual agency under systemic constraints : dynamics of health and social service access among people who use drugs receiving income assistance Jamula, Ryan


Prior research shows that people who use drugs and receive income assistance experience unique difficulties accessing and engaging with health and social services, contributing to unmet population health needs. While these findings are important, a deeper understanding of the factors shaping barriers is necessary so that effective strategies to facilitate access can be implemented. Drawing on 121 interviews conducted in a Canadian inner-city, this study analyzes the health and social service experiences of people who use drugs and receive income assistance during the ongoing opioid overdose crisis. Through an application of Coleman’s framework for linking macro social outcomes and micro-level behaviour, this research examines the institutional, operational and interactional dynamics impacting client experiences with service access. The findings show that institutional frameworks influence the decisions and actions of individuals when engaging with providers by structuring and constraining their available choices. Operational challenges and stigmatization during encounters with providers leads to disengagement, which limits the utilization and positive effects of services. Despite these obstacles, individuals exercise agency in navigating, adapting to and pushing back against these constraints in order to meet their service needs. Efforts to reform social policies and service delivery must be informed by a patient-focused perspective that considers the inter-related institutional, operational and interactional dimensions of this complex service landscape.

Item Media

Item Citations and Data


Attribution-NonCommercial-NoDerivatives 4.0 International