https://doi.org/10.1177/1049732319829434 Qualitative Health Research 1–11 © The Author(s) 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1049732319829434 journals.sagepub.com/home/qhr Research Article Introduction Our global and local communities are increasingly affected by homelessness, a complex issue with signifi- cant health implications. Homelessness is strongly associ- ated with morbidity from both chronic health conditions, such as cardiovascular and respiratory conditions, as well as mental health disorders, such as schizophrenia (Aldridge et al., 2018). Individuals experiencing home- lessness report lower health-related quality of life and increased hospital readmissions compared with the gen- eral population (Saab, Nisenbaum, Dhalla, & Hwang, 2016; Sun, Irestig, Burström, Beijer, & Burström, 2012). These inequalities further increase when considering overlapping marginalization and multimorbidity; morbid- ity and mortality appear to increase proportionally with social exclusion (Aldridge et al., 2018). At the extremes, the life expectancy of those living in poverty in a Canadian municipality was found to be 21 years less than that of the wealthiest residents (DeLuca, Buist, & Johnston, 2012). In 2014, the Living in Niagara Report identified homelessness as a primary area of concern for the Regional Municipality of Niagara (“Niagara region”) in Ontario, Canada (Niagara Connects, 2014b). The Niagara region is located in southern Ontario and is home to nearly 450,000 people from diverse social, economic, and cultural backgrounds (“About Niagara Region,” 2018). The percentage of people living below the low income measure in Niagara was 17.6% in 2012 (Niagara Connects, 2014a), a rate of poverty higher than that of Ontario and the rest of Canada (“Income Research Paper Series: Low Income Measure,” 2018). The waitlist for 829434QHR XX X 10.1177/1049732319829434Qualitative Health ResearchRamsay et al. research-article 2019 1 McMaster University, Michael G. DeGroote School of Medicine, Niagara Regional Campus, St. Catharines, Ontario, Canada Corresponding Author: Rahat Hossain, Michael G. DeGroote School of Medicine, McMaster University, Niagara Regional Campus, 1812 Sir Isaac Brock Way, St. Catharines, Ontario, Canada L2S 3A1. Email: rahat.hossain@medportal.ca Health Care While Homeless: Barriers, Facilitators, and the Lived Experiences of Homeless Individuals Accessing Health Care in a Canadian Regional Municipality Natalie Ramsay 1 , Rahat Hossain 1 , Mo Moore 1 , Michael Milo 1 , and Allison Brown 1 Abstract Persons struggling with housing remain significantly disadvantaged when considering access to health care. Effective advocacy for their needs will require understanding the factors which impact their health care, and which of those most concern patients themselves. A qualitative descriptive study through the lens of a transformative framework was used to identify barriers and facilitators to accessing health care as perceived by people experiencing homelessness in the regional municipality of Niagara, Canada. In-person, semi-structured interviews with 16 participants were completed, and inductive thematic analysis identified nine barriers and eight facilitators. Barriers included affordability, challenges finding primary care, inadequacy of the psychiatric model, inappropriate management, lack of trust in health care providers, poor therapeutic relationships, systemic issues, and transportation and accessibility. Facilitators included accessibility of services, community health care outreach, positive relationships, and shelters coordinating health care. Knowledge of the direct experiences of marginalized individuals can help create new health policies and enhance the provision of clinical care. Keywords health-seeking behavior; transformative framework; qualitative descriptive; thematic analysis; barriers; facilitators; qualitative’ semi-structured interviews; Canada