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Can I risk using public services? Perceived consequences of seeking help and health care among households living in poverty: qualitative study

¹ Division of Public Health, University of Liverpool, Whelan Building, Quadrangle, Brownlow Hill, Liverpool L69 3GB, UK
² Department of Sociology and Social Policy, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool L69 7ZA, UK
³ Department of Public Health Sciences, Karolinska Institutet, Norrbacka, SE-171 76 Stockholm, Sweden

Correspondence to:
M Whitehead, Division of Public Health, University of Liverpool, Whelan Building, Quadrangle, Brownlow Hill, Liverpool L69 3GB, UK; mmw{at}liverpool.ac.uk

Objectives: To improve understanding of how families living in adverse conditions perceive their encounters with public services and how past experiences influence current and future attempts to seek help.

Design: Qualitative interviews with adult members of households living in poverty in deprived areas, plus observations conducted in the surrounding neighbourhoods and service settings.

Participants: Purposive sample of 25 adults living in a deprived area, on welfare benefits.

Setting: Eight sites in disadvantaged areas in Merseyside, North Wales, London and Greater Manchester in 2004/05.

Results: Participants generally perceived public services as a source of distrust and a potential risk to well-being. Encounters with a range of services were perceived as risky in terms of losing resources, being misunderstood or harshly judged, and carrying the ultimate threat of losing custody of their children. Participants perceived that they were subjected to increasing levels of surveillance, with fear of "being told on" by neighbours, in addition to service providers, adding to anxiety. Adverse consequences included avoiding child health and social services, anxiety and self-imposed isolation.

Conclusions: Approaching services was perceived as akin to taking a gamble that might or might not result in their needs being met. Faced with this "choice", participants employed strategies to minimise the risks that on the surface may appear risky to health. If public services are to succeed in providing support to disadvantaged families, greater efforts are needed to build trust and demonstrate understanding for the strategies these families use to maintain their well-being against formidable odds.

Keywords: perception of public services; poverty; public health; qualitative research; strategies for health

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