Introduction People who experience homelessness face disproportionately poor reproductive health and adverse pregnancy outcomes, including but not limited to unintended pregnancy, abortion, low birth weight and preterm birth, as well as a higher risk of sexually transmitted infections (STIs). Precarious living conditions are known to contribute to poor uptake and engagement with sexual and reproductive healthcare (SRH) for this population. Aim To identify and understand the perceived barriers and facilitators for accessing and utilising SRH for people who experience homelessness from their perspective, and the perspective of support staff/volunteers and healthcare professionals. Methods Electronic databases and online sources were searched. Two reviewers independently carried out the screening, data extraction, critical appraisal, data synthesis and thematic analysis of findings. Results Following deduplication and screening, 23 papers/reports were considered eligible for the review. Barriers for people experiencing homelessness to accessing and utilising SRH were identified within the themes of complexity, feelings and knowledge (ie, individual-level factors), as well as patient/provider interaction and healthcare system (ie, organisational factors). Facilitators were identified within all of the above themes except for complexity. Conclusions Both population characteristics and attributes of the healthcare system influence access and utilisation of SRH by people experiencing homelessness. Given the complexity of living conditions associated with homelessness, greater efforts to improve access should be placed on healthcare systems and aspects of care delivery. This systematic review highlights current gaps in the literature and provides recommendations for enhancing future research and practice to meet the needs of this vulnerable group more effectively.

中文翻译：

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无家可归者获得和利用性保健和生殖保健的感知障碍和促进因素：系统评价

简介 经历过无家可归的人面临着不成比例的生殖健康和不良妊娠结局，包括但不限于意外怀孕、流产、低出生体重和早产，以及更高的性传播感染 (STI) 风险。众所周知，不稳定的生活条件会导致该人群对性与生殖保健 (SRH) 的接受和参与不佳。目标 从无家可归者的角度，以及支持人员/志愿者和医疗保健专业人员的角度，确定并理解在获取和利用 SRH 方面存在的障碍和促进因素。方法检索电子数据库和在线资源。两名审稿人独立进行筛选、数据提取、批判性评价、数据综合和调查结果的专题分析。结果 在重复数据删除和筛选之后，23 篇论文/报告被认为符合审查条件。在复杂性、感受和知识（即个人层面因素）以及患者/提供者互动和医疗保健系统（即组织因素）等主题中确定了无家可归者获取和利用 SRH 的障碍。除了复杂性之外，在上述所有主题中都确定了协调人。结论 医疗保健系统的人口特征和属性都会影响无家可归者对 SRH 的获取和利用。鉴于与无家可归相关的生活条件的复杂性，应在医疗保健系统和护理提供方面做出更大的努力来改善可及性。