G61(P) Improving the sexual health of homelessyoung people

Abstract

AimsThe study examined knowledge and attitudes around Sexual Health (SH) and contraceptive use among Young People (YP) who are homelessness and resident in hostels in a large urban area and their key workers. The aim was to improve SH outcomes through building a model of SH care appropriate to the needs of YP. Less is known about SH in homeless young males’ than females’, thus the study aimed to ensure inclusion of male views.MethodsA constructivist theoretical framework was used to underpin this qualitative ethnographic case study. The case under study being homeless YP, girls, boys or transgender, aged 16–21 years resident in homeless hostel accommodation. Participants were selected by purposive sampling in order to ensure maximum variety within the case. Twenty-nine homeless YP, and five key workers were recruited from homeless hostels and a homeless day-centre in a large urban area. One to one semi-structured interviews were carried out examining knowledge and attitudes concerning SH and contraceptive use. Insider observations of resident’s meetings and the hostel and centre settings were undertaken. A reflexive approach was used in interviewing. Demographic data was collected from YP participants. Nvivo 10 QSR computer assisted software was used to analyse the data thematically, and demographic data used to stratify and identify trends between males, females and age groups.ResultsFour overarching themes were identified: Meaning of sexual health:○ Tended to differ between males and females○ Females made associations with emotions, relationships and safety○ Males with using protection○ Life experiences have overriding effect on:○ Attitudes○ Sexual well-being.○ Being homeless poses risks and influences priority of SH:○ Hygiene○ Dangers○ Survival○ Use of SH services:○ Barriers○ Stigma and embarrassment○ Staff attitudesFacilitators Using non SH services e.g. GPs ConclusionHomeless YP resident in hostel accommodation require specialised delivery of SH care which is holistic and supports their needs. This could be provided within the familiar hostel or day-centre environment. It should be managed in a way that ensures facilitation of quality therapeutic relationships, with highly skilled workers, and sensitive dissemination of targeted information.

Scoping review: Scope of practice of nurse‐led services and access to care for people experiencing homelessness

“…Comorbidity was common, with 87.5% of participants in one study reporting more than one health issue (Roche et al, 2018), and in another, the average number of clinical conditions per client was 10.5 (Dorney‐Smith, 2011). Smoking was the most commonly reported health risk behaviour, with rates between 70% (Muirhead et al, 2011) and 90% (McGregor et al, 2018; Nyamathi, Branson, et al, 2012; Roche et al, 2018; Savage et al, 2008). Daily illicit drug use ranged from 26% (Nyamathi et al, 2006) to 54% (Roche et al, 2018), and daily use of alcohol from 14% (Nyamathi, Marlow, et al, 2012) to 20% (Roche et al, 2018).…”

“… Note : References: 1 Dorney‐Smith (2011); 2 Hooke et al (2001); 3 Muirhead et al (2011); 4 Murphy et al (2015); 5 Nyamathi, Branson, et al (2012); 6 Nyamathi et al (2009); 7 Nyamathi, Marlow, et al (2012); 8 Nyamathi et al (2006); 9 Nyamathi et al (2008); 10 Savage et al (2008); 11 Paradis‐Gagné and Pariseau‐Legault (2020); 12 Paradis‐Gagné et al (2020); 13 Poulton et al (2006); 14 Seiler and Moss (2012); 15 Goeman et al (2019); 16 McGregor et al (2018); 17 Roche et al (2018); 18 Segan et al (2015); 19 Dorney‐Smith (2007). …”

“…Barriers relating to the healthcare system included: a complex, fragmented system which is difficult to navigate (Goeman et al, 2019; Paradis‐Gagné et al, 2020), rigid appointment or access times (McGregor et al, 2018; Paradis‐Gagné et al, 2020) and administration barriers ( availability ), such as needing a healthcare card ( affordability ) or a fixed address (Paradis‐Gagné et al, 2020; Paradis‐Gagné & Pariseau‐Legault, 2020). It was reported that limitations on the scope can be experienced by services when funding is tied to specific activities (Goeman et al, 2019), and by nurses when practising under restrictive protocols (Poulton et al, 2006), resulting in service gaps ( availability ).…”

“…A lack of awareness about homelessness amongst healthcare professionals acted as a barrier to the appropriateness of service provision (Goeman et al, 2019; Paradis‐Gagné et al, 2020; Paradis‐Gagné & Pariseau‐Legault, 2020; Poulton et al, 2006). Stigmatizing and prejudiced attitudes amongst healthcare professionals ( approachability ) were reported to be a further barrier (McGregor et al, 2018; Paradis‐Gagné & Pariseau‐Legault, 2020; Poulton et al, 2006), one which can ultimately result in exclusion from care (Paradis‐Gagné et al, 2020). Wariness and distrust ( approachability , acceptability , appropriateness ) of mainstream services can discourage clients from seeking care (Dorney‐Smith, 2011; Goeman et al, 2019; McGregor et al, 2018; Poulton et al, 2006), with three studies reporting that this stemmed from negative previous experiences (Paradis‐Gagné et al, 2020; Paradis‐Gagné & Pariseau‐Legault, 2020; Seiler & Moss, 2012).…”

“…Of the mixed methods studies, it was difficult to judge whether the quantitative sample was representative (Goeman et al, 2019). McGregor et al (2018) reported a low response rate.…”