title: Soup kitchen consumer perspectives on the quality and frequency of health service interactions.
abstract: OBJECTIVE
  Whilst previous research has repeatedly documented premature mortality and high morbidity among seriously disadvantaged and homeless populations, far less is known of the extent and nature of their interactions with health services.
  
  
  METHODS
  This cross-sectional case study describes health service utilization patterns and explores participant-reported difficulties in accessing health care, adhering to prescribed treatment and maintaining continuity of care amongst 100 users of a charity-run soup kitchen in urban Sydney. Participants and results. The study describes a largely welfare-dependent population sample with poor health who are frequent users of the health system (85% had seen a general practitioner in the preceding 6 months). The homeless were more likely to report difficulties accessing health care when needed [odds-ratio 3.15; 95% confidence interval (CI) 1.04-9.62]. One in three respondents reported difficulty adhering to prescribed treatment following their last health care visit. Affordability (P < 0.0001), not understanding instructions (P = 0.007), and not agreeing with advice (P < 0.0001) were the main factors associated with adherence difficulties. One in four failed to return for follow-up visits as advised, largely associated with attitudinal barriers such as a history of not believing problems would be addressed (P = 0.05), not trusting health professionals (P = 0.04), and not knowing where to get help in the past (P = 0.05).
  
  
  CONCLUSIONS
  These results reinforce the important role of free primary care in reducing access barriers for the disadvantaged, but also highlight possible reasons for service interactions being ineffective in a substantial proportion of cases.
authors.affiliation: School of Public Health, The University of Sydney, NSW, Australia. lyndalt@health.usyd.edu
authors.forename: L J
authors.initials: LJ
authors.lastname: Trevena
authors.forename: J M
authors.initials: JM
authors.lastname: Simpson
authors.forename: D
authors.initials: D
authors.lastname: Nutbeam
mesh_terms: D000293:Adolescent; D000328:Adult; D003153:Community Health Services / Q000592:standards* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005522:Food Services / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics / Q000592:standards; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D009517:New South Wales; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics / Q000592:standards; D011787:Quality of Health Care; D013997:Time Factors; D014505:Urban Population; D035862:Vulnerable Populations / Q000523:psychology