Client-provider relationships in a community health clinic for people who are experiencing homelessness.

MEDICAL personnel; ATTITUDE (Psychology); COMMUNITY health services; CONCEPTUAL structures; FOCUS groups; HEALTH facility design & construction; HOMELESS persons; INTERVIEWING; PATIENT-professional relations; HEALTH policy; PARTICIPANT observation; MEDICAL care of poor people; POVERTY; POWER (Social sciences); RESEARCH funding; STATISTICAL sampling; ETHNOLOGY research; PATIENTS' attitudes

Recognizing the importance of health-promoting relationships in engaging people who are experiencing homelessness in care, most research on health clinics for homeless persons has involved some recognition of client-provider relationships. However, what has been lacking is the inclusion of a critical analysis of the policy context in which relationships are enacted. In this paper, we question how client-provider relationships are enacted within the culture of community care with people who are experiencing homelessness and how clinic-level and broader social and health policies shape relationships in this context. We explore these questions within a critical theoretical perspective utilizing a critical ethnographic methodology. Data were collected using multiple methods of document review, participant observation, in-depth interviews and focus groups. The participants include both clients at a community health clinic, and all clinic service providers. We explore how clients and providers characterized each other as 'good' or 'bad'. For providers, this served as a means by which they policed behaviours and enforced social norms. The means by which both providers' and clients' negotiated relationships are explored, but this is couched within both local and system-level policies. This study highlights the importance of healthcare providers and clients being involved in broader policy and systemic change. [ABSTRACT FROM AUTHOR]