Working-Age Caregivers of Stroke Survivors: Needs, Concerns, and Quality of Life.

PURPOSE: The purpose of this study was to characterize the unmet needs and concerns of working-age caregivers of stroke survivors and to explore the relationships between these unmet needs and concerns and factors such as stroke survivor functional independence, caregiver strain, caregiver self-efficacy, caregiver perceived social support, and caregiver quality of life (QoL). DESIGN: Cross-sectional descriptive design was used in this study. METHODS: Participants ( N = 103) completed an online survey. Descriptive statistics, bivariate Pearson correlation, and linear regression analysis was performed. RESULTS: Negative correlations were found between caregiver needs and concerns and both stroke survivor functional independence and caregiver self-efficacy. Positive correlations were identified between caregiver needs and concerns and caregiver strain. In multiple regression models, stroke survivor functional independence, caregiver self-efficacy, race, and gender were statistically significantly associated with caregiver QoL. CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING: Results of this study can inform nurses as they collaborate with informal caregivers and researchers in optimizing the rehabilitation and discharge process and aiding in the support of caregiver QoL. CONCLUSION: Working-age caregivers of stroke survivors expressed many needs and concerns. These needs, along with other factors, can affect outcomes including QoL in caregivers and stroke survivors.

Survey of South Carolina Public School Personnel Perspectives on Barriers and Facilitators to Regular Physical Activity and Healthy Eating Behaviors in Schools.

BACKGROUND: In South Carolina (SC), 42% of youth are overweight or obese. Two sets of modifiable behaviors contributing to obesity are physical activity (PA) and dietary habits. School-based interventions have successfully improved these behaviors. The purpose of this study was to identify SC public school personnel perspectives on the most common barriers and facilitators to regular PA and healthy eating behaviors in schools. METHODS: A needs assessment survey was conducted with school personnel statewide. There were 17 questions on the survey that addressed: (1) demographic information about participants' educational backgrounds, (2) barriers to regular PA and healthy eating behaviors in schools, and (3) facilitators to regular PA and healthy eating behaviors in schools. Univariate and bivariate descriptive statistical analyses were performed using IBM SPSS Statistics 27. RESULTS: Participants (N = 1311) indicated insufficient time for regular PA (n = 514, 39.2%) and limited access to healthy foods for healthy eating (n = 271, 20.7%) as main barriers. The primary facilitators were support from administrators for regular PA (n = 264, 20.1%) and support from cafeteria staff for healthy eating (n = 234, 17.8%). Further analyses explored how factors compared based on roles in schools, academic levels, and school district classifications. CONCLUSIONS: Results suggest that overarching barriers and facilitators to school-based interventions addressing childhood obesity exist, so common strategies to mitigate challenges and maximize supports can be used in schools. Future studies are needed to examine how decreasing barriers and enhancing facilitators affect the implementation and outcomes of these school-based interventions.

Describing South Carolina Public School Administrators' Perceptions and Experiences Related to School-Based Interventions and Strategies to Promote Healthy Physical Activity and Eating Behaviors: A Qualitative Study.

BACKGROUND: School-based interventions and strategies targeting physical activity (PA) and eating patterns have successfully addressed unhealthy behaviors contributing to excess weight in school-age children. The purpose of this study was to investigate South Carolina (SC) public school administrators' perceptions of and experiences with weight-related issues in schools and associated barriers and facilitators to awareness, selection, and implementation of school-based healthy PA and eating interventions and strategies. METHODS: This qualitative descriptive study, guided by the Social Ecological Model and the Steps in Quality Intervention Development Model, involved semistructured interviews with SC public school administrators from all academic levels (N = 28). Data were analyzed using thematic analysis. RESULTS: Four themes were identified from interviews (N = 28): weight-related terminology or stigma, experiences with school-based healthy PA and eating interventions and strategies, barriers to school-based healthy PA and eating interventions and strategies, and facilitators to school-based healthy PA and eating interventions and strategies. CONCLUSIONS: Schools are well-positioned to provide interventions and strategies to improve PA and dietary habits leading to childhood obesity. School administrators, while knowledgeable and experienced with weight-related issues and school-based interventions and strategies, encounter barriers and facilitators that impact offerings and delivery. Understanding these challenges and supports is important in the development, adaptation, and implementation of school-based interventions and strategies focused on healthy PA and eating behaviors.

Barriers and Facilitators to Supportive Care Implementation in Advanced Disease Prostate Cancer Survivors: A Theory-Informed Scoping Review.

BACKGROUND: Individualized supportive care is recommended to manage the debilitating effects of advanced prostate cancer and its treatments. Yet, the implementation of supportive care in practice remains inconsistent. OBJECTIVE: The aim of this study was to synthesize the barriers and facilitators to implementing supportive care interventions after identifying supportive care interventions for advanced prostate cancer survivors. METHODS: PubMed, SCOPUS, CINAHL Complete, ProQuest, and PsycINFO were searched for relevant studies published between 2011 and 2020. Studies were included if they reported on a supportive care intervention and included a description of implementation barriers and/or facilitators. The Theoretical Domains Framework was used to characterize implementation barriers and facilitators. RESULTS: Of the 620 articles identified, 13 met all prespecified inclusion criteria. Primary barriers were related to the domains of environmental context and resources (eg, limited resources), knowledge (eg, insufficient knowledge on efficacy of supportive care), and beliefs about capabilities (eg, lack of confidence in materials). Facilitators fell under environmental context and resources (partnerships with local services), reinforcement (eg, partners inclusion), and skills (eg, delivery by professionals). CONCLUSIONS: This scoping review highlights barriers and facilitators that affect supportive care implementation. Future research that focuses on overcoming barriers and maximizing facilitators is needed to improve, modify, or supplement existing supportive care implementation practices. IMPLICATIONS FOR PRACTICE: As the number of advanced prostate cancer survivors continues to increase, supportive care must become the standard of care. Future interventions must incorporate increased knowledge and funding, alternative delivery models, and consistent use of specialty nurses.

Supportive care interventions and quality of life in advanced disease prostate cancer survivors: An integrative review of the literature.

BACKGROUND: Supportive care interventions can improve quality of life and health outcomes of advanced prostate cancer survivors. Despite the high prevalence of unmet needs, supportive care for this population is sparse. METHODS: The databases PubMed, SCOPUS, CINAHL, and ProQuest were searched for relevant articles. Data were extracted, organized by thematic matrix, and categorized according to the seven domains of the Supportive Care Framework for Cancer Care. RESULTS: The search yielded 1678 articles, of which 18 were included in the review and critically appraised. Most studies were cross-sectional with small, non-diverse samples. Supportive care interventions reported for advanced prostate cancer survivors are limited with some positive trends. Most outcomes were symptom-focused and patient self-reported (e.g., anxiety, pain, self-efficacy) evaluated by questionnaires or interview. Interventions delivered in group format reported improvements in more outcomes. CONCLUSIONS: Additional supportive care intervention are needed for men with advanced prostate cancer. Because of their crucial position in caring for cancer patients, nurse scientists and clinicians must partner to research and develop patient-centered, culturally relevant supportive care interventions that improve this population's quality of life and health outcomes. Efforts must concentrate on sampling, domains of needs, theoretical framework, guidelines, and measurement instruments.

"We've Had to Build the Plane as We Flew It.": Impacts of the COVID-19 Pandemic on School-Based Weight Management Interventions.

Background: In response to the coronavirus disease 2019 (COVID-19) pandemic, elementary and secondary schools in the United States transitioned to remote learning to slow viral spread and protect students and school officials. This move interrupted academic education and school-based health interventions focused on physical activity (PA) and healthy eating behaviors to help combat childhood obesity. Little is known on how these interventions were affected by COVID-19. Methods: This concurrent multimethodological study incorporated two independent components: qualitative descriptive semistructured interviews with public school administrators and quantitative descriptive cross-sectional needs assessment survey of public school personnel. Results: Three themes were identified from interviews with school administrators (N = 28): changes in school-based interventions addressing PA and healthy eating behaviors, changes in academic delivery affecting PA and healthy eating behaviors, and needs of school administrators. From the survey (N = 1311), 635 (48.4%) participants indicated that schools' abilities to address PA and healthy eating behaviors were negatively impacted by COVID-19. The majority (n = 876, 66.8%) of participants strongly agreed or agreed that the pandemic would affect future school-based interventions related to PA and healthy eating behaviors. Conclusions: While schools are prime locations for delivering school-based weight management interventions related to childhood obesity, participants reported the pandemic had overall negative impacts on interventions addressing PA and healthy eating behaviors. Understanding these impacts is essential to adapting school-based interventions to changes from COVID-19 so students may receive health information and access health promotion interventions in remote learning environments and during social distancing.

Self-efficacy measurement instrument for neonatal resuscitation training: An integrative review.

Neonatal resuscitation is recognized by the World Health Organization as one of the priority interventions to reduce neonatal mortality rate. Measuring self-efficacy regarding neonatal resuscitation is one important criterion for evaluating the effectiveness of related training programs. This integrative review aims to critique evidence from high and low-to-middle-income countries. Additionally, guides appraisals of the instruments that measure self-efficacy in resuscitation training programs and adapt for low-to-middle-income countries. The databases searched for studies from 1980 to 2017 include: PubMed, CINAHL, SCOPUS, PyschINFO, and ERIC. and revealed 212 publications. Data extracted from eight instruments included theoretical framework, study location, instrument description and scoring, reliability and validity, and self-efficacy measurement outcomes. Six of eight self-efficacy instruments reported utilizing Bandura's Social Cognitive Theory while two of the eight instruments implied the use of self-efficacy. Most of the instruments reported acceptable internal consistency as Cronbach's alpha values ranged from 0.74 to 0.98 for reliability. Five of eight instruments were used in low-to-middle-income countries. A valid and reliable self-efficacy instrument is a necessary antecedent to evaluating the effectiveness of a neonatal resuscitation training program. Future studies may consider self-efficacy instruments with Visual Analog Scales in low-to-middle-income countries due to the ease of implementing the simple visual instrument.

Deaf: A Concept Analysis From a Cultural Perspective Using the Wilson Method of Concept Analysis Development.

The purpose of this article is to provide an analysis of the concept Deaf to increase health care provider (HCP) understanding from a cultural perspective. Deaf signers, people with hearing loss who communicate primarily in American Sign Language (ASL), generally define the term Deaf as a cultural heritage. In the health care setting, the term deaf is most often defined as a pathological condition requiring medical intervention. When HCPs are unaware that there are both cultural and pathological views of hearing loss, significant barriers may exist between the HCP and the Deaf individual. The concept of Deaf is analyzed using the Wilsonian method. Essential elements of the concept "Deaf" from a cultural perspective include a personal choice to communicate primarily in ASL and identify with the Deaf community. Resources for HCPs are needed to quickly identify Deaf signers and provide appropriate communication.

Review of educational interventions to increase traditional birth attendants' neonatal resuscitation self-efficacy.

BACKGROUND: Annually, up to 2.7 million neonatal deaths occur worldwide, and 25% of these deaths are caused by birth asphyxia. Infants born in rural areas of low-and-middle-income countries are often delivered by traditional birth attendants and have a greater risk of birth asphyxia-related mortality. AIM: This review will evaluate the effectiveness of neonatal resuscitation educational interventions in improving traditional birth attendants' knowledge, perceived self-efficacy, and infant mortality outcomes in low-and-middle-income countries. METHODS: An integrative review was conducted to identify studies pertaining to neonatal resuscitation training of traditional birth attendants and midwives for home-based births in low-and-middle-income countries. Ten studies met inclusion criteria. FINDINGS: Most interventions were based on the American Association of Pediatrics Neonatal Resuscitation Program, World Health Organization Safe Motherhood Guidelines and American College of Nurse-Midwives Life Saving Skills protocols. Three studies exclusively for traditional birth attendants reported decreases in neonatal mortality rates ranging from 22% to 65%. These studies utilized pictorial and oral forms of teaching, consistent in addressing the social cognitive theory. Studies employing skill demonstration, role-play, and pictorial charts showed increased pre- to post-knowledge scores and high self-efficacy scores. In two studies, a team approach, where traditional birth attendants were assisted, was reported to decrease neonatal mortality rate from 49-43/1000 births to 10.5-3.7/1000 births. CONCLUSION: Culturally appropriate methods, such as role-play, demonstration, and pictorial charts, can contribute to increased knowledge and self-efficacy related to neonatal resuscitation. A team approach to training traditional birth attendants, assisted by village health workers during home-based childbirths may reduce neonatal mortality rates.

Translating a spinal cord injury self-management intervention for online and telehealth delivery: A community-engaged research approach.

Objective: To develop educational content and pilot test the use of tablet computers (iPads), online content management platform (iTunes U) and video conferencing (FaceTime) for delivery of a peer supported, spinal cord injury self-management intervention, using a community-engaged research approach. Design: Cross-sectional convenience sampled pilot study; evaluation using a combination of observation and questionnaires. Setting: Community-based. Participants: Individuals with SCI (n = 10) recruited from the community. Interventions: Participants engaged in a hands-on evaluation of the educational content and technology. Outcome Measures: Usability and acceptability of educational content and technology. Results: Participants were receptive and satisfied with the iPad and iTunes U platform and the video chat experience. Statements by our participants demonstrated a clear preference for interactive and multimedia platforms to promote engagement with educational materials. The use of FaceTime to facilitate contact between the participant and PN demonstrated satisfactory usability and acceptability. The hands-on evaluation process highlighted the need for consideration of connectivity for rural participants and assistive technology needs. Conclusion: Our community-engaged research approach and evaluation processes provided direct user feedback on the online and telehealth implementation of PHOENIX that will guide development of the remaining educational content, and testing of the intervention in a future feasibility trial.

Factors Influencing Southeastern U.S. Mothers' Participation in Baby-Friendly Practices: A Mixed-Methods Study.

BACKGROUND: Mothers in the southeastern United States, including rural-dwelling and African American mothers, have historically had low rates of breastfeeding; however, no studies have investigated these mothers' experiences of breastfeeding support processes associated with the Baby-Friendly Hospital Initiative. Research aim: This study aimed to determine factors influencing southeastern U.S. mothers' participation in Baby-Friendly practices and breastfeeding decisions. METHODS: Using a convergent parallel mixed-methods design, medical record review of mother-infant dyads ( n = 234) provided data to determine if those who participated in more than half of the Ten Steps to Successful Breastfeeding had improved breastfeeding outcomes. Logistic regression was conducted to determine whether maternal demographic/clinical characteristics were predictive of Baby-Friendly practice participation. Qualitative methods included in-depth interviews ( n = 16). Directed content analysis was conducted to identify themes. Results of the analysis of the two data sets were triangulated to enhance understanding of mothers' barriers to and facilitators of participation in Baby-Friendly practices. RESULTS: Rural-dwelling and African American mothers had greater odds of nonparticipation in Baby-Friendly practices relative to other groups (odds ratios = 5 and 10, respectively; p ≤ .01). Mothers who received lactation consultation and had moderate (15-44 min) or completed (≥ 45 min) skin-to-skin contact had greater odds of participation in Baby-Friendly practices (both odds ratios ≥ 17.5; p < .05). Directed content analysis revealed six themes: maternal desire to breastfeed, infant state, maternal state, milk supply concerns, provider support, and access to breastfeeding equipment and support services. CONCLUSION: Rural-dwelling African American mothers had limited knowledge of Baby-Friendly practices; however, culturally tailored services could improve Baby-Friendly practice participation and breastfeeding success.

Nurse practitioner perceptions of barriers and facilitators in providing health care for deaf American Sign Language users: A qualitative socio-ecological approach.

BACKGROUND AND PURPOSE: Nurse practitioners (NPs), as well as all healthcare clinicians, have a legal and ethical responsibility to provide health care for deaf American Sign Language (ASL) users equal to that of other patients, including effective communication, autonomy, and confidentiality. However, very little is known about the feasibility to provide equitable health care. The purpose of this study was to examine NP perceptions of barriers and facilitators in providing health care for deaf ASL users. DATA SOURCES: Semistructured interviews in a qualitative design using a socio-ecological model (SEM). CONCLUSIONS: Barriers were identified at all levels of the SEM. NPs preferred interpreters to facilitate the visit, but were unaware of their role in assuring effective communication is achieved. A professional sign language interpreter was considered a last resort when all other means of communication failed. Gesturing, note-writing, lip-reading, and use of a familial interpreter were all considered facilitators. IMPLICATIONS FOR PRACTICE: Interventions are needed at all levels of the SEM. Resources are needed to provide awareness of deaf communication issues and legal requirements for caring for deaf signers for practicing and student NPs. Protocols need to be developed and present in all healthcare facilities for hiring interpreters as well as quick access to contact information for these interpreters.

Social isolation after spinal cord injury: Indicators from the Longitudinal Aging Study.

OBJECTIVE: The purpose of this study was to develop and test a conceptual model of social isolation, incorporating social disconnectedness (objective measures) and perceived isolation (subjective appraisals) in an aging sample of participants with spinal cord injury (SCI). METHOD: The study used cross-sectional data from 768 participants from the most recent administration of the SCI Longitudinal Aging Study, which was initiated in 1973. Measures included the revised version of the Life Situation Questionnaire, items from the Craig Handicap Assessment Reporting Technique, and the Patient Reported Outcomes Measurement Information System. Indicators of social isolation were combined into scales assessing social disconnectedness and perceived isolation. We tested the hypothesized model of social isolation, including both social disconnectedness and perceived isolation, after SCI using structural equation modeling. RESULTS: Results of structural equation modeling indicated good fit between the hypothesized model and data (root-mean-square error of approximation = 0.073, 90% confidence interval [0.070, 0.075]; comparative fit index = 0.949; Tucker Lewis Index = 0.946). Perceived isolation was significantly related with social disconnectedness (standardized coefficient [r] = .610). Several exogenous factors were significantly related to social disconnectedness and perceived isolation. Older participants were more likely to report lower levels of perceived isolation. Time since injury demonstrated an inverse relationship with both social disconnectedness and perceived isolation. Higher level and severity of injury were associated with higher levels of social disconnectedness. CONCLUSION: Our study establishes a stable model of social isolation to guide future research exploring the effect of social isolation on health after SCI. (PsycINFO Database Record

Effect of a smoking cessation intervention for women in subsidized neighborhoods: A randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of a community based participatory research (CBPR) developed, multi-level smoking cessation intervention among women in subsidized housing neighborhoods in the Southeastern US. METHODS: A total of n=409 women in 14 subsidized housing neighborhoods in Georgia and South Carolina participated in this group randomized controlled trial conducted from 2009 to 2013. Intervention neighborhoods received a 24-week intervention with 1:1 community health worker contact, behavioral peer group sessions, and nicotine replacement. Control neighborhoods received written cessation materials at weeks 1, 6, 12, 18. Random coefficient models were used to compare smoking abstinence outcomes at 6 and 12months. Significance was set a p<0.05. RESULTS: The majority of participants (91.2%) were retained during the 12-month intervention period. Smoking abstinence rates at 12months for intervention vs. control were 9% vs. 4.3%, p=0.05. Additional analyses accounting for passive smoke exposure in these multi-unit housing settings demonstrated 12month abstinence rates of 12% vs. 5.3%, p=0.016. However, in the multivariate regression analyses, there was no significant effect of the intervention on the odds of being a non-smoker (OR=0.44, 95% CI: 0.18-1.07). Intervention participants who kept coach visits, attended group sessions, and used patches were more likely to remain abstinent. CONCLUSIONS: This CBPR developed intervention showed potential to engage smokers and reduce smoking among women in these high-poverty neighborhoods. Effectiveness in promoting cessation in communities burdened with fiscal, environmental and social inequities remains a public health priority.

Baccalaureate Minority Nursing Students Perceived Barriers and Facilitators to Clinical Education Practices: An Integrative Review.

AIM: This integrative review synthesized baccalaureate minority nursing students' perceptions of their clinical experiences. BACKGROUND: The diversity of the nursing workforce does not mirror the United States population. Attrition rates of minority nursing students remain higher than rates for White students. Literature examining facilitators and barriers to minority student success predominantly focuses on academic factors, excluding those relevant to clinical education. METHOD: An integrative review using literature from nursing and education. FINDINGS: Three common perceived barriers were identified: discrimination from faculty, peers, nursing staff, and patients; bias in faculty grading practices; and isolation. CONCLUSION: Although little is known about the relationship between clinical failures and overall attrition, this review provides evidence that minority students encounter significant barriers in clinical education. To increase the diversity of the nursing workforce, faculty must address these issues and make modifications to ensure an equal opportunity at a quality education for all students.

The Impact in the United States of the Baby-Friendly Hospital Initiative on Early Infant Health and Breastfeeding Outcomes.

UNLABELLED: Studies were examined to evaluate the impact of the Baby-Friendly Hospital Initiative (BFHI) on breastfeeding and early infant health outcomes in U.S. POPULATIONS: Using the Social Ecological Model as a guiding theoretical framework, results were categorized into four interrelated multilevel factors: (1) maternal/infant dyad factors, (2) provider factors, (3) hospital organizational factors, and (4) policy/systems factors. Results from the review support the BFHI's success in facilitating successful breastfeeding initiation and exclusivity. Breastfeeding duration also appears to increase when mothers have increased exposure to Baby-Friendly practices, but deficiencies in breastfeeding tracking mechanisms have limited reliable breastfeeding duration data. Of the 10 steps of the BFHI, step 3, prenatal education and step 10, postnatal breastfeeding support are the most difficult steps to implement; however, those steps have the potential to significantly impact maternal breastfeeding decisions. The underlying mechanisms by which Baby-Friendly practices contribute to maternal breastfeeding decisions remain unclear; thus, studies are needed to examine mothers' experiences and perceptions of Baby-Friendly practices. Additionally, studies are needed to investigate the impact of the BFHI for women living in rural areas and in southeastern regions of the United States. Finally, studies are needed to examine early infant health outcomes related to the BFHI, especially for late premature infants (34-36 weeks) who are most vulnerable to poor outcomes and are in need of specialized breastfeeding support. Results from future qualitative and quantitative explorations could clarify how the delivery of Baby-Friendly practices leads to successful breastfeeding and infant health outcomes.

Factors Influencing Patient Safety During Postoperative Handover.

Patient safety continues to be a major concern for healthcare providers and organizations. Handovers, also called handoffs, serve as the transfer of postoperative care from the anesthesia provider to the postanesthesia care unit (PACU) provider. Ineffective handovers result in gaps in care and potential harm to the patient. We conducted a scoping review to identify key factors affecting patient safety during the process of postoperative handovers. We searched empirical literature examining factors associated with patient safety and postoperative handovers in the context of anesthesia, in the Cumulative Index to Nursing & Allied Health Literature, Ovid, Google Scholar, and The Joint Commission websites between January 2004 and March 2014. We excluded obstetric and cardiac anesthesia-related studies. A total of 31 articles met criteria for inclusion in the review. Factors at multiple levels of the Social Ecological Model affecting patient safety and handovers were identified. Intrapersonal factors included individual communication styles; interpersonal factors were related to anesthesia and to PACU provider team dynamics; organizational environmental factors described the dynamic PACU environment; and organizational policy-level factors included emphasizing a culture of patient safety. This scoping review demonstrates a multilevel analysis of factors affecting handovers and patient safety.

Alcohol Misuse Among Nursing Students.

BACKGROUND: The self-reported prevalence of alcohol use among U.S. college students decreased from 90.5% in 1980 to 79.2% in 2012. National efforts exist to reduce alcohol misuse among college students in the United States, yet little research addresses substance abuse among nursing students and even less addresses alcohol misuse. Alcohol misuse in nursing students may result in patient harm. PURPOSE: This scoping study describes the state of the science of alcohol misuse among nursing students, guided by the research question: "What is the current state of alcohol misuse among U.S. nursing students?" METHODS: Evidence was drawn from several scholarly sources. Articles were included if they addressed U.S. nursing students; alcohol misuse; substance abuse or chemical impairment; prevalence rates; and/or characteristics including nursing student behaviors, attitudes, and beliefs. Using thematic analysis, common themes were extracted, followed by hand coding those themes and using NVivo qualitative software. RESULTS: Six studies met inclusion criteria. Three themes, eight subthemes, and several gaps in knowledge were identified. The themes include "high prevalence exists," "necessity of supportive environments," and "hopelessness without policies." Subthemes include "root cause," "vulnerable population," "scholarship and substance use," "education," "identification of risk factors," "prevention and deterrents," "safety," "ethical and legal issues," and "consequences." CONCLUSIONS: On the basis of this analysis, several research questions were developed to explore alcohol misuse in this population. Alcohol was the most often used substance. Nursing students were unaware of a safe level of consumption and the potential negative health-related and professional effects associated with alcohol misuse.

Access to primary care services among the homeless: a synthesis of the literature using the equity of access to medical care framework.

OBJECTIVE: To identify barriers and facilitators to primary care access among the homeless using the Equity of Access to Medical Care Framework and to provide recommendations for medical and public health practitioners to improve health among this underserved population. METHODS: A quasi-systematic review of the literature was conducted using the PubMed, CINAHL, and PsycINFO databases. Study elements from articles in the final analysis were extracted and categorized into dimensions of access from the Framework. RESULTS: The review identified multiple barriers to primary care access for the homeless. This included lack of insurance coverage and competing priorities. Facilitators to access included tailored health care delivery systems and having a regular source of care. CONCLUSION: This review provides evidence that health policy initiatives, patient-centered care, and targeted interventions can assist with improving primary care access among the homeless.