‘If I die, I die, I don’t care about my health’: Perspectives on self‐care of people experiencing homelessness

Abstract

Self‐care, which refers to what people do to prevent disease and maintain good health, can alleviate negative health consequences of people experiencing homelessness. The aim of the study was to apply a theoretically informed approach in exploring engagement of people experiencing homelessness in self‐care and to identify factors that can be targeted in future health and social care interventions. Qualitative semi‐structured interviews were conducted with 28 participants opportunistically recruited from a specialist homelessness healthcare centre of North East Scotland, the United Kingdom (UK). An interview schedule was developed based on the theoretical domains framework (TDF). Interviews were audio‐recorded and transcribed verbatim. Six aspects of self‐care were explored, including (a) self‐awareness of physical and mental health, (b) health literacy, including health seeking behaviour, (c) healthy eating, (d) risk avoidance or mitigation, (v) physical activity and sleep and (e) maintaining personal hygiene. Thematic analysis was conducted by two independent researchers following the Framework Approach. Participants described low engagement in self‐care. Most of the barriers to engagement in self‐care by participants were related to 'environmental context and resources' domain of TDF. Participants often resorted to stealing or begging for food. Many perceived having low health literacy to interpret health‐related information. Visits to churches and charities to get a shower or to obtain free meals were commonplace. Participants expressed pessimism that there was ‘nothing’ they could do to improve their health and described perceived barriers often too big for them to overcome. Alienation, lack of social support and the perception that they had done irreversible damage to their health prevented their involvement in self‐care. The theme of ‘social circle’ held examples of both enabler and barriers in participants’ uptake of risky behaviours. Health and social services should work with persons experiencing homelessness in designing and delivering targeted interventions that address contextual barriers, multi‐morbidity, health literacy and self‐efficacy.

Research priorities in healthcare of persons experiencing homelessness: outcomes of a national multi-disciplinary stakeholder discussion in the United Kingdom

“…Link workers were deemed to connect people to community groups and statutory services for practical and emotional support. There was recognition of the need to include wider services including community pharmacy in social prescribing activities and promotion of self-care in this population [21]. Participants discussed that services are often fragmented for patients with multi-morbidity.…”

‘Genuine doctor care’: Perspectives on general practice and community‐based care of Australian men experiencing homelessness

“…Episodic crises with life‐threatening illness or injury may lend themselves more readily to such accounts than subacute or chronic problems presenting to general practice, and to some extent the apparently dismissive attitudes of hospital‐based practitioners to both general practice and clients may perpetuate this bind. Limited environmental resources and competing priorities are also likely to limit client dispositions to self‐care and preventive interventions (Paudyal et al, ). Much of a general practitioner's advocacy and coordination on behalf of patients may also be undertaken outside face‐to‐face consultations, out of sight of participants, so not readily detected by them.…”

Clinical Pharmacy Intervention for Persons Experiencing Homelessness: Evaluation of Patient Perspectives in Service Design and Development

“…Both focus group and semi-structured interviews were conducted using a topic guide (Box 1) developed amongst the research team, based on the objective of the study and researchers' previous experience around healthcare of homeless populations [8,9,17]. Data were analysed using thematic coding of the focus group transcript and notes taken during one to one engagement.…”

“…Despite their poor health, people experiencing homelessness use health services differently to the general population [8]. Barriers include difficulty registering at a general practice due to lack of proof of address, inadequate signposting from healthcare staff, and perceived stigma and discrimination in healthcare settings [8,9]. They often lack the knowledge, and the physical and mental capacity to navigate services [8].…”

“…Homeless populations also experience reduced prescribing of medicines, and face barriers to accessing and managing their medicines. Cardiovascular diseases, mental health and substance misuse issues are often undiagnosed and under-treated [9][10][11]. Therefore, they have an increased rate of use of unscheduled care, with high resource and cost implications to healthcare services.…”