Multiple Paths to Just Ends: Using Narrative Interviews and Timelines to Explore Health Equity and Homelessness

Abstract

Underlying the daily lives of people with experiences of homelessness and mental illness is a complex interplay of individual and structural factors that perpetuate cycles of inequity. The introduction of novel methodological combinations within qualitative research has the potential to advance knowledge regarding the experience of health equity by such individuals and to clarify the relationship between these experiences and broader structural inequities. To explore the lived experience of inequity, we present a thematic analysis of narrative interviews in conjunction with timelines from 31 adults experiencing homelessness and mental illness. Use of these methods together enabled a novel and expanded appreciation for the varied ways in which differential access to the social determinants of health influences the trajectories and experiences of inequity for people who are homeless and mentally ill. The further utility of these methods for better understanding the experience of inequity is explored and implications for research, policy, and practice are discussed.

Timeline Mapping in Qualitative Interviews: A Study of Resilience with Marginalized Groups

“…Others have recognized the timeline as a tool to organize and accumulate data, helping to place the research construct in the context of a participant's life events (Berends, 2011). Complementary aspects of timelines for enhancement of verbal interviewing are also confirmed by other research utilizing visual methods (Bagnoli, 2009;Patterson, et al, 2012;Sheridan et al, 2012).…”

“…The chronological sequencing of events in timelines allows for comparison within the participant's life story to confirm or complete their description of their story (Patterson, et al, 2012). The findings of the current study show that the use of researcher reflection notes acted as another component of data triangulation through sharing the reflexive process of evaluating the implementation of timelines and analytical consideration of how timelines and verbal interviews inform one another, as well as by making visible the research process through the eyes of interviewers themselves.…”

Trajectories of recovery among homeless adults with mental illness who participated in a randomised controlled trial of Housing First: a longitudinal, narrative analysis

“…Negative, neutral and mixed trajectories were typically characterised by increasing or continued hardship and instability across multiple domains, resulting in feelings of social devaluation, feeling trapped and a profound lack of autonomy (as described in the previous analysis of our baseline narratives) 32. In addition, the emotional tone of negative and neutral trajectories was often flat with little elaboration or detail provided around experiences.…”

“…These struggles resulted in a pervasive sense of social devaluation and helplessness, as described in a previous analysis of the baseline interviews 32. Trauma theory and research may provide a useful lens through which to view and understand the experience of and attempts to exit homelessness in at least three respects35: first, becoming homeless (and repeatedly thereafter) may itself produce symptoms of trauma.…”

Visualizing participant experiences in maternal and child nutrition studies using timeline mapping

“…Timelines are usually constructed from a participant's life events, in some sort of chronological order, with visual notations of highlighted events [12][13][14][15] . Timelines have been previously used to study several topics including substance use and treatment 12 , health equity and homelessness 13 and resilience among marginalized groups 14 , but they are still underutilized in maternal and child health and nutrition. Timelines are a useful tool to explore pregnant women's antenatal experiences, since pregnancy naturally lends itself to thinking of antenatal experiences in a chronological manner.…”