Self-management of health care: multimethod study of using integrated health care and supportive housing to address systematic barriers for people experiencing homelessness

Abstract

Objectives The aims of the present study were to examine tenants' experiences of a model of integrated health care and supportive housing and to identify whether integrated health care and supportive housing improved self-reported health and healthcare access. Methods The present study used a mixed-method survey design (n=75) and qualitative interviews (n=20) performed between September 2015 and August 2016. Participants were tenants of permanent supportive housing in Brisbane (Qld, Australia). Qualitative data were analysed thematically. Results Integrated health care and supportive housing were resources for tenants to overcome systematic barriers to accessing mainstream health care experienced when homeless. When homeless, people did not have access to resources required to maintain their health. Homelessness meant not having a voice to influence the health care people received; healthcare practitioners treated symptoms of poverty rather than considering how homelessness makes people sick. Integrated healthcare and supportive housing enabled tenants to receive treatment for health problems that were compounded by the barriers to accessing mainstream healthcare that homelessness represented. Conclusions Extending the evidence about housing as a social determinant of health, the present study shows that integrated health care and supportive housing enabled tenants to take control to self-manage their health care. In addition to homelessness directly contributing to ill health, the present study provides evidence of how the experience of homelessness contributes to exclusions from mainstream healthcare. What is known about the topic? People who are homeless experience poor physical and mental health, have unmet health care needs and use disproportionate rates of emergency health services. What does the paper add? The experience of homelessness creates barriers to accessing adequate health care. The provision of onsite multidisciplinary integrated health care in permanent supportive housing enabled illness self-management and greater control over lifestyle, and was associated with self-reported improved health and life satisfaction in formerly homeless tenants. What are the implications for practitioners? Integrated health care and supportive housing for the formerly homeless can improve self-reported health outcomes, enable healthier lifestyle choices and facilitate pathways into more appropriate and effective health care.

Experience of healthcare among the homeless and vulnerably housed a qualitative study: opportunities for equity-oriented health care

“…Finally, EOHC requires that an approach to and delivery of care be developed with input from all stakeholders, including people with lived experience, but also all members of the healthcare team from physicians and nurses to janitors and receptionists. A recent study has found that cross sector collaboration that provides integrated health care improved barriers to access and also enabled self-managed care [30]. These changes require leaders to engage not only with providers who are already advocates for equity-seeking populations, but also with those who are not.…”

Evidence for an integrated healthcare and psychosocial multidisciplinary model to address rough sleeping

“…Chronic poor health can further contribute to the economically deprived social conditions that make people sick; the causes of the causes of poor health (Marmot, ). The interaction of chronic poor health and deep and persistent social disadvantage act as barriers for people using and benefiting from mainstream health and social care even when those resources do exists (Parsell et al, ). The high rates of poverty and racism experienced by Australia's Indigenous people constitute an additional barrier to access mainstream health and social care (Davy et al, ).…”

“…The Multidisciplinary Model is nested within three bodies of knowledge in the health and social science literature that highlights the structural mechanisms that contribute to exclusion and deprivation among sections of society. These are as follows: the social determinants of health framework that shows how social disadvantage drives poor health among excluded groups and health inequities in society (Marmot, ); literature highlighting the link between chronic poor health and socioeconomic disadvantage (Blyth et al, ); and research illustrating how the cumulative effect of persistent disadvantage and chronic poor health represent structural barriers that limit people's capacity to engage with and benefit from mainstream health and social care systems (Parsell, Have, Denton, & Walter, ).…”

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“…The health impacts of homelessness are exacerbated because people experiencing homelessness are often excluded from proper health care. Research shows that the state of homelessness represents a barrier to accessing essential health care (Baggett et al, 2010) and it likewise subverts homeless people's capacity to control their health care (Parsell et al, 2018). The result of all this is that homelessness drastically reduces people's life expectancy: the OECD (2020, p. 3) estimates that people experiencing homelessness die "up to 30 years earlier than the general population on average.…”