title: Exploring levers and barriers to accessing primary care for marginalised groups and identifying their priorities for primary care provision: a participatory learning and action research study.
abstract: The involvement of patients and the public in healthcare has grown significantly in recent decades and is documented in health policy documents internationally. Many benefits of involving these groups in primary care planning have been reported. However, these benefits are rarely felt by those considered marginalised in society and they are often excluded from participating in the process of planning primary care. It has been recommended to employ suitable approaches, such as co-operative and participatory initiatives, to enable marginalised groups to highlight their priorities for care.
  
  
  
  This Participatory Learning and Action (PLA) research study involved 21 members of various marginalised groups who contributed their views about access to primary care. Using a series of PLA techniques for data generation and co-analysis, we explored barriers and facilitators to primary healthcare access from the perspective of migrants, Irish Travellers, homeless people, drug users, sex workers and people living in deprivation, and identified their priorities for action with regard to primary care provision.
  
  
  
  Four overarching themes were identified: the home environment, the effects of the 'two-tier' healthcare system on engagement, healthcare encounters, and the complex health needs of many in those groups. The study demonstrates that there are many complicated personal and structural barriers to accessing primary healthcare for marginalised groups. There were shared and differential experiences across the groups. Participants also expressed shared priorities for action in the planning and running of primary care services.
  
  
  
  Members of marginalised groups have shared priorities for action to improve their access to primary care. If steps are taken to address these, there is scope to impact on more than one marginalised group and to address the existing health inequities.
authors.affiliation: Graduate Entry Medical School, University of Limerick, Limerick, Ireland. patrick.e.odonnell@ul.ie.
authors.forename: Patrick
authors.identifier: 0000-0001-7710-7832
authors.initials: P
authors.lastname: O'Donnell
authors.affiliation: Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: Edel
authors.initials: E
authors.lastname: Tierney
authors.affiliation: North Dublin City General Practice Training Scheme, Catherine McAuley Centre, Nelson Street, Dublin 7, Ireland.
authors.forename: Austin
authors.initials: A
authors.lastname: O'Carroll
authors.affiliation: National Social Inclusion Office, Primary Care Division, Health Service Executive, Mill Lane, Palmerstown, Dublin 20, Ireland.
authors.forename: Diane
authors.initials: D
authors.lastname: Nurse
authors.affiliation: Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: Anne
authors.initials: A
authors.lastname: MacFarlane
mesh_terms: D055030:Drug Users; D005260:Female; D006285:Health Planning; D006291:Health Policy; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006703:Ill-Housed Persons; D006801:Humans; D008297:Male; D011203:Poverty; D011320:Primary Health Care; D036301:Qualitative Research; D060386:Sex Workers; D062487:Social Marginalization; D014171:Transients and Migrants
keywords: Access; Equity; Hard to reach; Marginalised groups; Participatory research; Patient and public involvement (PPI); Primary healthcare; Vulnerable groups