Health experiences of homeless women in LA County: Looking beyond individual-level factors

This dissertation provides a better understanding of how contextual factors at the clinic-level influence the health experiences of homeless women. It focuses on the organizational factors that impact their health experiences. It examines the impact of patient-administrator racial concordance and special homeless services on these women's agreement with administrators about perceived barriers to care, perceived unmet need, and patient satisfaction. Little is known about the variation in the health experiences of homeless women. It is important to explore the impact of the clinic administrator due to their decision-making power in the clinics where homeless women receive healthcare. Clinic managers may indirectly impact the health experiences of this vulnerable population through the services and programs delivered in the health care setting that they supervise.;This dissertation utilized data obtained from the UCLA Homeless Women's Health and Administrator Surveys. Descriptive and bivariate analyses were acquired to determine the relationship between clinic and patient-level factors. Random-effects regression models were used to determine the between and within group effects at the clinic and patient level for each dependent variable.;The majority of the women in this study were African-American and received their healthcare from community clinics. The findings from this dissertation suggest that structural processes and factors related to the clinic administrator explain some of the racial/ethnic differences in the access, use of services, and level of patient satisfaction among homeless women. Clinic administrators tend to overestimate the barriers to care perceived by these women. Women who identified similar barriers to care as administrators were more satisfied. Also, women facing competing needs reported more unmet need.;The results suggest that competing factors are more important to these women than seeking healthcare. Effective public policies that address the competing needs of homeless women are needed in order to reduce the level of unmet need and improve the overall health of this vulnerable population in Los Angeles County and throughout America. This could impact racial/ethnic healthcare disparities across populations, and may be accomplished by altering some organizational factors.