Relational trust in outreach with women experiencing street-involvement in British Columbia, Canada: a qualitative study
Bibliographic record
Abstract
BACKGROUND: Women who experience street-involvement are severely underserved in health care. Outreach can address this service gap, but little is known about what constitutes gender-appropriate and effective outreach worker-client relationships in this context. METHODS: To explore the relational attributes of outreach, qualitative interviews were conducted with women (n = 19) enrolled in a pilot study (2017–2020) aimed at designing a gender-specific outreach program in British Columbia and with outreach staff (n = 8). Data analysis focused on women’s experiences, supplemented by outreach staffs’ perspectives. Reflexive thematic analysis informed by central tenets of feminist relational theory and harm reduction was used. RESULTS: Trust was the overarching theme, conceptualized as a relational, dynamic, and iterative process co-constructed over time. Eight interrelated domains of trust were identified: commitment; consistency; professional boundaries; privacy and confidentiality; empathy; non-judgement; expert knowledge; and “doing with not for”. Relational trust integrated understandings of the impact of gender-based violence, poverty, and drug-related criminalization. When enacted, trust facilitated participants’ engagement with outreach workers, improved care access, and advanced women’s capacities to navigate their general and substance use health care more independently. CONCLUSIONS: Trust is a critical element of health and social service delivery and distrust remains a major barrier. These findings advance new conceptualizations of trust that consider the interplay between interpersonal and structural features of care delivery such as stigma, discrimination, colonization, ableism, and classism. Outreach programs emphasizing trust-building as a dynamic and socio-structurally embedded process hold significant potential for improving care engagement among women who are chronically underserved. TRIAL REGISTRATION: Retrospectively registered on February 25, 2025 (NCT06854770) with ClinicalTrials.gov.
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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 | 0.005 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.031 | 0.010 |
| Scholarly communication | 0.006 | 0.002 |
| Open science | 0.003 | 0.005 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 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".