title: Perceived barriers to healthcare for persons living in poverty in Quebec, Canada: the EQUIhealThY project.
abstract: BACKGROUND
  Ensuring access to timely and appropriate primary healthcare for deprived patients is an issue facing all countries, even those with universal healthcare systems. There is a paucity of information on how patients living in a context of material and social deprivation perceive barriers in the healthcare system. This study combines the perspectives of persons living in poverty and of healthcare providers to explore barriers to responsive care for underserved persons with a view to developing equity-focused primary care.
  
  
  METHODS
  In this participatory action research we used photovoice, together with a method known as 'merging of knowledge and practice' developed by ATD Fourth World, an international community organization working to eradicate poverty. The study was conducted in two teaching primary care practices in the Canadian province of Quebec. Participants consisted of 15 health professionals and six members of ATD Fourth World; approximately 60 group meetings were held. Data were analyzed through thematic analysis, in part with the involvement of persons living in poverty.
  
  
  RESULTS
  Three main barriers to responsive care in a context of poverty were highlighted by all participants: the difficult living conditions of people living in poverty, the poor quality of interactions between providers and underserved patients, and the complexity of healthcare system organization and functioning.
  
  
  CONCLUSIONS
  Our research revealed that unhealthy living conditions prevent persons living in poverty from accessing quality healthcare and maintaining good health. Also, the complexity of the healthcare system's organization and functioning has a negative impact on the interactions with healthcare providers. Changes in policy and practice are needed to address those barriers and to achieve greater equity and provide more responsive care for persons living in poverty.
authors.affiliation: Department of Family Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, Quebec, Canada. christine.loignon@usherbrooke.ca.
authors.forename: Christine
authors.initials: C
authors.lastname: Loignon
authors.forename: Catherine
authors.initials: C
authors.lastname: Hudon
authors.forename: Émilie
authors.initials: É
authors.lastname: Goulet
authors.forename: Sophie
authors.initials: S
authors.lastname: Boyer
authors.forename: Marianne
authors.initials: M
authors.lastname: De Laat
authors.forename: Nathalie
authors.initials: N
authors.lastname: Fournier
authors.forename: Cristina
authors.initials: C
authors.lastname: Grabovschi
authors.forename: Paula
authors.initials: P
authors.lastname: Bush
mesh_terms: D001291:Attitude of Health Personnel; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D010342:Patient Acceptance of Health Care; D011203:Poverty; D011320:Primary Health Care / Q000706:statistics & numerical data*; D036301:Qualitative Research; D011792:Quebec