Relationships in healthcare and homelessness: Exploring solidarity

Abstract Background: People experiencing homelessness have some of the highest morbidity rates and lowest age of mortality in Canada yet face many barriers to care, in particular the attitudes of healthcare providers. Objectives: In this critical ethnographic study, power within client–provider relationships in health care with people experiencing homelessness is explored. Methods: Multiple qualitative methods of document analysis, participant observation, interviews, and focus groups were used with both clients and providers in a community clinic for people experiencing homelessness. Data analysis involved individual and team thematic analysis, guided by Lather's (2007, Getting lost: Feminist efforts towards a double(d) science. Albany, NY: SUNY Press) criteria for validity. Results: Caregiving relationships involve a negotiation of power based on the many differences of social location between clients and providers. Both clinic policies and personal practices influence the ways power is asserted, taken, or shared. Conclusions: In discussing the implications for addressing power relations in caregiving relationships, it is highlighted that most work in this area has focused on educating health professionals to assist them to relate in more appropriate ways. More needs to be done to actively address the power differentials inherent in caregiving with people experiencing homelessness, for which the concept of ‘solidarity’ is presented as offering some promise.