Health status and resources of rural homeless women and children. Iowa Homeless Research Team

Physical illnesses associated with childhood homelessness: a literature review

BACKGROUND

Childhood homelessness is a growing concern in Ireland [1] creating a paediatric subpopulation at increased risk of physical illnesses, many with life-long consequences [2].

AIM

Our aim was to identify and categorize the physical morbidities prevalent in homeless children.

METHODS

A review of the English-language literature on physical morbidities affecting homeless children (defined as ≤ 18 years of age) published from 1999 to 2019 was conducted.

RESULTS

Respiratory issues were the most commonly cited illnesses affecting homeless children, including asthma, upper respiratory tract infections, and chronic cough [3]. Homeless children were described as being at increased risk for contracting infectious diseases, with many studies placing emphasis on the risks of sexually transmitted infections (STIs) and HIV/AIDS transmission [4, 5]. Dermatologic concerns for this population comprised of scabies and head lice infestation, dermatitis, and abrasions [3, 6]. Malnutrition manifested as a range of physical morbidities, including childhood obesity [7], iron deficiency anemia [4], and stunted growth [8]. Studies demonstrated a higher prevalence of poor dental [7] and ocular health [9] in this population as well. Many articles also commented on the risk factors predisposing homeless children to these physical health concerns, which can broadly be categorized as limited access to health care, poor living conditions, and lack of education [3, 10].

CONCLUSION

This literature review summarized the physical illnesses prevalent among homeless children and the contributing factors leading to them. Gaps in the literature were also identified and included a dearth of studies focusing on younger children compared with adolescents. Further research into prevention and intervention programs for this vulnerable population is urgently needed.

Health assessments and screening tools for adults experiencing homelessness: a systematic review

Background

Homelessness is increasing globally. It results in poorer physical and mental health than age matched people living in permanent housing. Better information on the health needs of people experiencing homelessness is needed to inform effective resourcing, planning and service delivery by government and care organisations.

The aim of this review was to identify assessment tools that are valid, reliable and appropriate to measure the health status of people who are homeless.

Methods

Data sources: A systematic literature search was conducted in PubMed (and Medline), PsychInfo, Scopus, CINAHL and ERIC from database inception until September 2018. Key words used were homeless, homelessness, homeless persons, vagrancy, health status, health, health issues, health assessment and health screening. The protocol was registered with PROSPERO. The National Health and Medical Research Council of Australia (NHMRC) hierarchy of evidence was applied; methodological quality of included articles was assessed using the McMaster critical appraisal tools and psychometric properties of the tools were appraised using the International Centre for Allied Health Evidence Ready Reckoner.

Results

Diverse tools and measures (N = 71) were administered within, and across the reviewed studies (N = 37), with the main focus being on general health, oral health and nutrition. Eleven assessment tools in 13 studies had evidence of appropriate psychometric testing for the target population in domains of quality of life and health status, injury, substance use, mental health, psychological and cognitive function. Methodological quality of articles and tools were assessed as moderate to good. No validated tools were identified to assess oral health, chronic conditions, anthropometry, demography, nutrition, continence, functional decline and frailty, or vision and hearing. However, assessments of physical constructs (such as oral health, anthropometry, vision and hearing) could be applied to homeless people on a presumption of validity, because the constructs would be measured with clinical indicators in the same manner as people living in permanent dwellings.

Conclusions

This review highlighted the need to develop consistent and comprehensive health assessment tools validated with, and tailored for, adults experiencing homelessness.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7234-y) contains supplementary material, which is available to authorized users.

Shelter Environment and Placement in Community Affects Lifestyle Factors among Homeless Families in Minnesota

Purpose

To investigate the impact of the shelter environment and surrounding community on lifestyle factors influencing the health of homeless families.

Design and Setting

Seven focus groups were conducted at two homeless shelters serving families in Minneapolis, Minnesota. Food resources and food prices at convenience stores were recorded within a five-block radius of shelters.

Subjects

Low-income parents of children aged 3–12 years (n = 53).

Measures

Focus groups were transcribed verbatim, evaluated for common themes, coded, and reevaluated for consistency. Food resources were mapped via GIS software, and recorded food prices were compared to available TFP market basket prices.

Analysis Results

The shelter environment and surrounding community influenced lifestyle factors related to health, including food access and availability, exercise behaviors, job access, and day care issues. Participants commented that location of grocery stores, inflated prices, and poor food quality and variety limited their families’ food choice and access. Walking was the main form of exercise and served as a means of transportation. Finding employment, housing, and affordable day care caused high levels of stress because of inadequate social support and government subsidies.

Conclusions

Several strategies should be considered to modify environments affecting lifestyle factors among homeless families, including greater affordability and access of food, reevaluation of food stamp allotments, alterations in urban planning designs, and increased access to affordable day care.

Diabetes and hypertension prevalence in homeless adults in the United States: a systematic review and meta-analysis

We estimated hypertension and diabetes prevalence among US homeless adults compared with the general population, and investigated prevalence trends. We systematically searched 5 databases for published studies (1980-2014) that included hypertension or diabetes prevalence for US homeless adults, pooled disease prevalence, and explored heterogeneity sources. We used the National Health Interview Survey for comparison. We included data from 97366 homeless adults. The pooled prevalence of self-reported hypertension was 27.0% (95% confidence interval=23.8%, 29.9%; n=43 studies) and of diabetes was 8.0% (95% confidence interval=6.8%, 9.2%; n=39 studies). We found no difference in hypertension or diabetes prevalence between the homeless and general population. Additional health care and housing resources are needed to meet the significant, growing burden of chronic disease in the homeless population.

Fear and loathing in New England: examining the health-care perspectives of homeless people in rural areas

Little anthropological research has been conducted on the health care perspectives of homeless people in rural areas. The aim of the present study is to elicit health-care beliefs, and examine overall health experience among a sample of current or recently homeless people in rural New Hampshire. Thirteen qualitative interviews were conducted, 11 with single men. Interviews were audio-recorded and transcribed, and analyzed using thematic analysis. Despite a massive burden of disease and illness, almost all participants reported an abiding aversion to doctors, hospitals and professional health care. Participants reported numerous negative encounters with doctors and health care professionals, often of a demeaning and disparaging nature. Participants noted that these encounters resulted in frequent cases of misdiagnosis and iatrogenesis. In contrast, participants spoke more fondly of other social and voluntary services, for example homeless organizations. Like other rural New Englanders, participants made their own individual efforts to maintain and promote health, for example by pursuing hobbies or prayer. The findings are contextualized within literature suggesting that these perspectives are generally shared by other poor rural people. Consistent with this literature, the findings suggest that homelessness in rural areas is often temporary and episodic. As such, this paper brings into question the distinctiveness and overall utility of the concept: 'the rural homeless'. The key determinant of negative attitudes to health care may not be recent homelessness. It may be entrenched socio-economic marginalization, and the resultant social stigma, that are shared amongst the rural poor, regardless of their current housing status.

Mothers with mental illness experiencing homelessness: a critical analysis

The experiences of homeless mothers with mental illness were examined from the critical perspective of feminist intersectionality. The purpose of this study was to unveil experiences of oppression and resistance in the lives of homeless mothers with mental illness, while learning from them what is conducive to their health. A qualitative secondary analysis was done using focus group transcripts from a study examining issues related to diversity and homelessness for psychiatric survivors and a study on mental health and housing. A purposive sample of 7 focus groups comprised of 67 participants was used for this study. Findings revealed three overarching themes: (1) discrimination based on intersecting social identities; (2) being stuck: the cycle of oppression; and (3) we're not giving up: resistance through perseverance. The contextual influences of mothering while homeless with a mental illness were emphasized in the results. The findings illuminate the need for increased on ongoing advocacy at individual and structural levels.

Drug and HIV-related risk behaviors after geographic migration among a cohort of injection drug users

To determine whether migration impacted on drug use and HIV-related risk behaviors among injection drug users (IDU), we identified participants in a prospective cohort of IDU (Vancouver Injection Drug User Study) who had reported migrating out of Greater Vancouver between May 1996 and November 2005. We compared risk behaviors before and after a move for individuals who migrated (movers) and for a similar period for non-movers using linear growth curve analyses. In total, 1,122 individuals were included, including 430 (38.3%) women and 331 (29.5%) Aboriginal participants. Among these, 192 (17.1%) individuals reported migrating out of Greater Vancouver between 1996 and 2005 while 930 (82.9%) did not. Movers were significantly younger than non-movers: 32.0 (Interquartile Range [IQR]: 24.3-39.2) and 34.6 (IQR: 26.9-40.8) respectively. A significant decrease in those reporting unstable housing, frequent heroin and cocaine injection occurred only in movers. Our findings suggest that, in this setting, risk-taking among IDU declines following periods of migration out of Greater Vancouver.

The perceptions of homeless people in Stockholm concerning oral health and consequences of dental treatment: a qualitative study

This study investigated the perceptions of Swedish homeless people concerning their oral health and perceived consequences of dental treatment. Candid, tape-recorded interviews were conducted in a conversational style. A phenomenological-hermeneutical method was used to analyze the subjects' stories. New participants were recruited into the study, until the interviews provided no additional new information, which occurred after eight interviews. All narratives revealed expressions of loss as well as recovery in the informants' life. Both aspects highlighted the fact that homelessness equated to "loss" not only of a permanent residence but also of many values. Similarly, oral health was described and interpreted in terms of loss and recovery. During periods of drug abuse, study participants ranked oral health as a low priority and generally received only emergency dental attention. In more rehabilitative phases of life, however, they perceived oral health and dental treatment as a function to restore their human dignity and as a key to their holistic recovery of total body health.

Health-promoting behaviors of sheltered homeless women

To expand the body of knowledge and provide further insight into the complex area of homelessness and health, health practices of sheltered homeless women were investigated using a cross-sectional, descriptive, and non-experimental design using Pender's Health Promotion Model as the theoretical framework. The sample (n=137) was well educated, mostly unemployed, primarily single, and homeless due to relationship problems/conflict per self-report. Homeless women were noted to practice health-promoting behaviors in all areas but scored the lowest on physical activity and nutrition. Significant findings reflected women's personal strengths and resources in the areas of spiritual growth and interpersonal relations.

A theory of taking care of oneself grounded in experiences of homeless youth

BACKGROUND

Homeless adolescents are vulnerable to poor health outcomes owing to the dangerous and stressful environments in which they live. Despite their vulnerability, many of them are motivated to engage in self-care behaviors.

OBJECTIVE

The specific aim of this study was to explore self-care attitudes and behaviors of homeless adolescents.

METHOD

Individual interviews were conducted with 15 homeless adolescents. Interviews were audiotaped, transcribed verbatim, and analyzed using the constant comparative method of grounded theory.

RESULTS

Findings revealed a basic social process of taking care of oneself in a high-risk environment. This basic social process was supported by three categories: Becoming Aware of Oneself, Staying Alive With Limited Resources, and Handling One's Own Health, each including two processes.

DISCUSSION

Findings support Orem's conceptualizations of self-care and self-care agency and suggest the need for programs to support further healthy growth and development among homeless adolescents.