The perceptions of homeless people regarding their healthcare needs and experiences of receiving health care

Rae, Bernadette; Rees, Sharon

doi:10.1111/jan.12675

Cited by 112 publications

(132 citation statements)

References 37 publications

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“…The predominance of recently diagnosed participants may also limit the transferability of themes to those no longer in care. Furthermore, the participants' reports of encountering few barriers to accessing care is in stark contrast to the findings of multiple previous studies evaluating the health care-seeking behaviors of homeless persons, 13,14,21,22 further limiting the transferability of the findings. We postulate that this largely reflects the unique health care service environment (described above) created by GMH.…”

Section: Limitationscontrasting

confidence: 77%

“…7 Similar themes of health de-prioritization and symptom normalization relating to delayed presentation for care were identified in two qualitative studies involving homeless persons in the UK. 13,14 Our findings add to this work by highlighting the influence of the social environment of the homeless shelter on these suboptimal health care-seeking behaviors.…”

Section: Discussionsupporting

confidence: 52%

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Homeless shelter context and tuberculosis illness experiences during a large outbreak in Atlanta, Georgia

Connors

Hussen

Holland

et al. 2017

public health action

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A mong US-born tuberculosis (TB) cases, homelessness represents a major risk factor. 1 Compared with housed individuals, persons experiencing homelessness (PEH) have a 10-fold increased risk of TB disease, 2 are more often hospitalized, and experience worse disease outcomes. 3 Furthermore, TB outbreaks among PEH are associated with increased TB transmission, resulting in larger outbreak clusters. 4 Despite this, an important perspective is underrepresented in both guidelines and research in the field: that of the affected PEH themselves. Understanding this internal, or 'emic' perspective of illness can allow for more defensible public health decision making, and is essential to the implementation of appropriate control measures and effective risk communication. 5,6 A large outbreak of drug-resistant TB involving overnight homeless shelters began in Atlanta, Georgia, USA, in 2008, resulting in over 100 cases of active TB disease and involving nine additional states. 7 The resultant multifaceted response involved public health collaboration with shelters to develop and implement prevention and control measures. 8 It remains unclear, however, how these interventions were experienced by PEH with TB. Utilizing the unique opportunity to interview PEH with active TB disease in the setting of an ongoing outbreak and evolving public health response, this study aimed to explore how individuals experience illness and shelter-based interventions. The goals of this research were to inform ongoing TB control efforts and contribute hypothesis-generating data for further research on TB elimination in this setting. METHODS ContextThis study was conducted in Atlanta, GA, during an ongoing outbreak of drug-resistant TB among PEH that began in 2008. 7 Atlanta has a population of about 5.7 million, with a homeless population estimated at 4317 in 2015. 9,10 The metropolitan area is primarily located in Fulton County, where there was an average of 55 cases of TB per year from 2008 to 2015, and 36% of TB cases occurred among PEH. 7 The county's public health response to the outbreak included shelter-based prevention and control interventions implemented across all homeless facilities, including TB screening requirements for admission to shelters (TB card program), active TB case finding measures (e.g., intake symptom screening, cough logs), increased availability of voluntary latent tuberculous infection (LTBI) screening, TB education activities (e.g., shelter staff/ resident teaching, educational posters), and environmental control measures. 8,11 DesignIn-depth interviews were conducted with a purposive sample of 10 PEH with active TB disease. Study eligibility criteria were age 18 years, clinical diagnosis of active TB disease, homelessness during the year preceding TB diagnosis, and prior contact with Atlanta city shelters. Homelessness was defined as living in an emergency shelter, a transitional housing program, a place not meant for human habitation, or on the streets. The purpose of these criteria was to ensure inclusion of par...

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Section: Limitationscontrasting

confidence: 77%

Section: Discussionsupporting

confidence: 52%

Homeless shelter context and tuberculosis illness experiences during a large outbreak in Atlanta, Georgia

Connors

Hussen

Holland

et al. 2017

public health action

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“…Another critical factor that affects homeless persons’ primary care service use is negative perceptions of how homeless persons were treated by healthcare providers and their perceptions of the healthcare environment (Mason, Jensen, & Boland, 1992; O’Toole, Johnson, Redihan, Borgia, & Rose, 2015; Steward et al, 2016; Wen, Hudak, & Hwang, 2007). For example, homeless persons participating in qualitative interviews have reported feeling unwelcome (Wen et al, 2007) and being treated with prejudice in health care settings (Rae & Rees, 2015). In one survey of homeless persons with MHSUDs participating in a Housing First intervention in Toronto, 30% of homeless persons reported experiences of healthcare discrimination due to homelessness or poverty (Skosireva et al, 2014).…”

mentioning

confidence: 99%

A national evaluation of homeless and nonhomeless veterans’ experiences with primary care.

Jones¹,

Hausmann²,

Haas³

et al. 2017

Psychological Services

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Persons who are homeless, particularly those with mental health and/or substance use disorders (MHSUDs), often do not receive continuous primary care services. In addition, negative experiences with primary care might contribute to homeless persons’ avoidance and early termination of MHSUD treatment. The patient-centered medical home (PCMH) model aims to address care fragmentation and improve patient experiences. How homeless persons with MHSUDs experience care within PCMHs is unknown. This study compared the primary care experiences of homeless and non-homeless Veterans with MHSUDs receiving care in the Veterans Health Administration’s medical home environment, called Patient Aligned Care Teams. The sample included VHA outpatients who responded to the national 2013 PCMH-Survey of Healthcare Experiences of Patients (PCMH-SHEP) and had a past-year MSHUD diagnosis. Veterans with evidence of homelessness (henceforth “homeless”) were identified through VHA administrative records. PCMH-SHEP survey respondents included 67,666 Veterans with MHSUDs (9.2% homeless). Compared to their non-homeless counterparts, homeless Veterans were younger, more likely to be non-Hispanic Black and non-married; had less education; and were more likely to live in urban areas. Homeless Veterans had elevated rates of most MHSUDs assessed, indicating significant co-occurrence. After controlling for these differences, homeless Veterans reported more negative and fewer positive experiences with communication; more negative provider ratings; and more negative experiences with comprehensiveness, care coordination, medication decision-making, and self-management support than non-homeless Veterans. Homeless persons with MHSUDs may need specific services that mitigate negative care experiences and encourage their continuation in longitudinal primary care services.

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“…Challenges to homeless people’s access to general health care are varied and multifaceted. They include mistrust of health care professionals [6, 7], perceived stigma and discrimination [8], competing priorities [7], difficulties registering with GPs (due to a lack of fixed address or photo ID) [4] and making [9] and keeping appointments [8]. …”

Section: Introductionmentioning

confidence: 99%

Challenges to access and provision of palliative care for people who are homeless: a systematic review of qualitative research

Hudson

Flemming

Shulman³

et al. 2016

BMC Palliat Care

103

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BackgroundPeople who are homeless or vulnerably housed are a marginalized group who often experience high rates of morbidity and die young as a result of complex problems. Access to health care and support can be challenging, with access to palliative care even more so. This review presents a synthesis of published qualitative research exploring from the perspective of homeless people and those working to support them, current challenges to palliative care access and provision, in addition to suggestions for what may improve palliative care for this population.MethodsSystematic review of qualitative research analysed using thematic synthesis. PsycINFO, Medline, Sociological Abstracts, Social Services Abstracts, Science citations index and CINAHL were searched up to September 2016. Thematic synthesis involved a three-step inductive process to develop a deeper understanding of the challenges to and suggestions for the access and provision of palliative care for homeless people.ResultsThirteen qualitative articles, reporting nine studies were identified. The challenges to access and provision to palliative care were drawn from the data covering three broad areas, namely “the chaotic lifestyles sometimes associated with being homeless”, “the delivery of palliative care within a hostel for homeless people” and provision within “mainstream health care systems”. Obstacles were related to homeless persons competing day-to-day priorities, their experience of stigma in mainstream settings, the high burden on hostel staff in supporting residents at the end of life and inflexibility in mainstream health care systems. Suggestions for improving access to palliative care include building trust between homeless persons and health professionals, increasing collaboration between and flexibility within services, and providing more training and support for all professionals.ConclusionsThe provision of palliative care can be complicated for all populations, however delivering palliative care for people who are homeless is influenced by a potentially greater and more varied range of factors, on both individual and systemic levels, than providing palliative care for the housed population. Careful consideration and potentially great changes will be needed within health care systems to ensure homeless populations have equitable access to palliative care.

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The perceptions of homeless people regarding their healthcare needs and experiences of receiving health care

Abstract: Address apparent inconsistency of care; promote greater interdisciplinary communication and referrals to homeless services from prisons and hospitals; increase the availability of intermediate services; reduce obligation of homeless to move area; research experiences of homeless families.

Cited by 112 publications

References 37 publications

Homeless shelter context and tuberculosis illness experiences during a large outbreak in Atlanta, Georgia

Homeless shelter context and tuberculosis illness experiences during a large outbreak in Atlanta, Georgia

A national evaluation of homeless and nonhomeless veterans’ experiences with primary care.

Challenges to access and provision of palliative care for people who are homeless: a systematic review of qualitative research

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