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"Understanding the context in which we live" : an interpretive description of the structural and relational factors that influence the care-seeking efforts of persons living in poverty Da Silva, Beatrice (Betty) Hanna


In Canada, poverty rates, the gap between the rich and poor, and the health inequalities that follow continue to rise in disturbing proportions. There is therefore a compelling imperative for nurses to broaden their understanding of poverty and health inequalities and to reconstruct the model of health to include sociopolitical factors that reflect society's values and conflicts. The traditional health care response has been an emphasis on primarily increasing the availability and accessibility of health care to address the health needs of persons and communities living with poverty. Despite the enhancement of health care services, a lack of understanding the care-seeking efforts related to the attainment of health needs of persons living in poverty existed in the literature. The purpose of this qualitative research was to explore the structural and relational factors that influenced the effectiveness of the care-seeking efforts of urban persons living in poverty from the perspective of these economically disadvantaged persons. An interpretive description method that allowed the participants to identify and describe their care-seeking experiences was used for this study. Ten men and women with varied background who lived in one of the four low income neighbourhoods of Community Health Area #2 in Vancouver participated in the study. Thirteen audio-taped and transcribed interviews were accomplished and analyzed for emerging patterns and themes. The findings of this study focused on the participants' descriptions of living in poverty, receiving and providing lay help, and seeking necessary health or social care and supports. The study concludes that living in poverty influenced the participants' efforts in seeking help or care for the attainment of their health and basic needs. The participants' care-seeking behaviours and processes were influenced by the structural and relational factors related to the everyday constraints of living in poverty, their experiences of helpful and unhelpful health care, and the infrastructure barriers and gaps within the health and social care systems. An extensive range and types of helpful lay care from the participants' social and community support networks were also described. These findings have implications for nursing practice, nursing education, health care and public policy, and research.

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