Barriers and Facilitators to Eye Care Among Homeless Adults in Montreal, Canada
Bibliographic record
Abstract
Purpose People experiencing homelessness have higher prevalence of health and eye problems than the general population and are less likely to access healthcare services, despite universal healthcarecoverage in Canada. This study aims to describe the competing priorities to healthcare and thebarriers and facilitators to eye care for homeless adults in Montreal (Canada), exploring potential differences between genders. Methods Cross-sectional study conducted in homeless shelters in Montreal, following stratified randomization. A questionnaire was adapted from existing validated items on competing priorities as well as on barriers and facilitators. Items explored included costs, accessibility and transportation, trust and previous experiences and health literacy. Comparisons were made usingchi-squared and Mann-Whitney U tests. Results Six shelters for the homeless were approached and accepted to serve as data collection sites. Sixty-two participants completed the questionnaire and 51.6% (n = 32) identified as women. In all, 69.4% (n = 43) of participants had valid eye care coverage. Half of participants (n = 31) hadnot consulted an optometrist or ophthalmologist in ≥ 3 years. Nearly a quarter (24.2%, n = 15) of participants reported having at least one strongly competing priority. Prohibitive costs were the most strongly identified barrier, with a group median score of 4.0 (IQR 2.0-5.0). Complexity of coverage procedures seemed to be a barrier mostly for men (median score 4.0 [IQR 3.0-5.0] on a 5-point Likert scale). Strong facilitators included trust in optometrists (median 1.0 [IQR 1.0-2.0])and having more than one health and social services in the same location (median 1.0 [IQR 1.0-2.0] on a 5-point Likert scale). No statistical differences were found between men and women. Conclusion For adults experiencing homelessness in Montreal, despite large coverage for eye care services, competing priorities and prohibitive costs are strong barriers to seeking care. Trust in optometrists and the grouping of health services are notable facilitators. These data may help develop more inclusive strategies for delivering eye care to this underserved population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.005 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".