title: Perceived unmet need and barriers to care amongst street-involved people who use illicit drugs.
abstract: Research on perceived unmet need for care for mental health and substance use problems focuses on general populations to the detriment of hidden populations. This study describes prevalence and correlates of perceived unmet need for care in a community-based sample of street-involved people who use illicit drugs and identifies barriers to care.
  
  
  
  A sample of 320 street-involved people who use drugs participated in a structured, interviewer-assisted survey in Edmonton, Canada. The survey included the Perceived Need for Care Questionnaire, which assessed unmet need for care for mental health and substance use problems across seven service types. Logistic regression examined the associations between perceived unmet need, extent of socioeconomic marginalisation and problem severity. Barriers underlying unmet service needs were also examined.
  
  
  
  Most (82%) participants reported unmet need for one or more services during the past year. Odds of reporting one or more unmet needs were elevated amongst participants reporting substantial housing instability (adjusted odds ratio = 2.37; 95% confidence interval 1.19-4.28) and amongst participants meeting criteria for drug dependence (adjusted odds ratio = 1.22; 95% confidence interval 1.03-1.50), even after adjustment for sociodemographic covariates. Structural, rather than motivational barriers were the most commonly reported reasons underlying unmet service needs.
  
  
  
  Street-involved people who use drugs experience very high rates of perceived unmet need for care for mental health and substance use problems. General population studies on perceived unmet need are insufficient for understanding needs and barriers to care in hidden populations.[Hyshka E, Anderson JT, Wild TC. Perceived unmet need and barriers to care amongst street-involved people who use illicit drugs. Drug Alcohol Rev 2017;36:295-304].
authors.affiliation: School of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, Edmonton, Canada.|Inner City Health and Wellness Program, 606-1 Community Services Centre, Royal Alexandra Hospital, Edmonton, Canada.
authors.forename: Elaine
authors.identifier: 0000-0001-5785-8890
authors.initials: E
authors.lastname: Hyshka
authors.affiliation: School of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, Edmonton, Canada.|Human Geography Program, Department of Earth and Atmospheric Sciences, 1-26 Earth Sciences Building, University of Alberta, Edmonton, Canada.
authors.forename: Jalene Tayler
authors.initials: JT
authors.lastname: Anderson
authors.affiliation: School of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, Edmonton, Canada.
authors.forename: T Cameron
authors.initials: TC
authors.lastname: Wild
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010465:Perception; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D011795:Surveys and Questionnaires
chemical_list: D013287:Illicit Drugs
keywords: drug users; health services; needs assessment; social marginalization; substance-related disorders