Barriers, facilitators and solutions to the care of people experiencing homelessness with traumatic brain injury in Quebec, Canada: clinicians' and concerned parties' perspectives.

Abstract

People experiencing homelessness have disproportionately high rates of traumatic brain injury (TBI), yet services remain inaccessible or poorly adapted to their needs. Limited research has explored the barriers, facilitators and potential solutions to improve healthcare for this population. The objectives were to identify the individual- and environment-level barriers to healthcare for people experiencing homelessness who have sustained a TBI, identify the environment-level facilitators to care for this population, and identify potential solutions to improve care. A qualitative descriptive study was conducted and four focus groups were held (<i>n</i> = 20), consisting of healthcare professionals (<i>n</i> = 10), community workers (<i>n</i> = 6), and managers from both sectors (<i>n</i> = 4). Data were analyzed using Braun and Clarke's thematic analysis approach. Participants reported: (1) healthcare structures misaligned with the realities of people experiencing homelessness; (2) reduced trust in health services by people experiencing homelessness; (3) reliance on overburdened community organizations lacking TBI expertise; and (4) transforming care requires cross-sector collaborations and rethinking current healthcare delivery to provide more flexible TBI services. Healthcare for this population is not optimal and fails to meet their needs. Implementing low-threshold service models, fostering collaboration, and providing targeted training could significantly improve TBI care for this population.