Barriers and facilitators to accessing community-based health and social services among mothers experiencing social and structural disadvantage: a mixed-methods study

Background Mothers experiencing social and structural disadvantage—such as limited income and unstable housing—often encounter barriers to accessing services intended to meet their needs. To inform responsive and equitable health service delivery, research should examine service access from the perspectives of mothers with lived experience. This study examined the characteristics and experiences of mothers of young children who had recently accessed services (e.g. emergency shelters, substance use treatment) through a community-based, non-profit organization in Greater Vancouver, British Columbia, focusing on facilitators and barriers to service access and use. Methods We used a community-partnered, mixed-methods design. From April to November 2022, data were collected via surveys ( N = 38), followed by in-depth, semi-structured interviews ( n = 20). Surveys were analyzed using descriptive statistics and interviews using reflexive thematic analysis. Results Participants reported adverse social and structural conditions, including unstable housing, mental health challenges, and experiences of maltreatment. Three themes were identified: (1) understanding and addressing access limitations; (2) providing saf(er) services; and (3) orienting services towards whole health. Participants reported intersecting systemic, structural, and interpersonal barriers to service access, and identified supports and system-level solutions. System-level gaps were evident in access, coordination, and continuity across community-based services, including limited connections to formal health and social systems. Conclusions These findings have implications for similar community-based organizations and for broader efforts to improve health service delivery for mothers and children facing intersecting disadvantages.