Making Sense of Street Chaos
: An Ethnographic Exploration of the Health Service Usage of Homeless People in Dublin

  • Austin O'Carroll

Student thesis: Doctoral ThesisDoctor of Health (DHealth)


The aim of this study was to explore the Health Service Utilization (HSU) of homeless people in Dublin. In particular, it sought to identify a critical realist explanatory model for why the HSU of homeless people differs from that of the general population. Critical realist (CR) ethnography was used as the research methodology and was supplemented with forty-seven semi-structured interviews and two focus groups. The HSU of homeless participants in Dublin is described. When compared to the domiciled population, homeless people were found to have a tendency to present late on in their illness, to have higher utilization of primary care services and lower utilization of secondary care services and to avoid psychiatric services. The factors that influenced participants HSU tendency are identified as external or internal influences on HSU. External factors are described as physical, administrative or attitudinal barriers or deterrents; or external promoters of health service usage. Internalised inhibitors and promoters are illustrated as either cognitions or emotions that are developed in reaction to external circumstances and which either negatively or positively impact on health service usage. Interactions between health professionals and participants that resulted in exclusion (by the health professional or self-exclusion) are described as Conversations of Exclusion. A critical realist model was outlined that offers an explanation for why homeless people’s HSU differs from that of the general population in Dublin. This model included a description of the generative mechanisms identified as producing the HSU tendencies in the study population. The implications of this new model are discussed in the light of the literature and previous models that seek to explain the HSU of homeless people.
Date of Award7 Dec 2015
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorDavid Wainwright (Supervisor) & Derval Howley (Supervisor)


  • Homeless Persons
  • Health Care Utilization
  • Ethnography
  • Health Disparities
  • Accessibility of Health Service
  • Ireland, Republic of

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