Maintaining one's health while homeless

Background and Significance: The interdependence of housing and health is substantial. A lack of housing is an independent risk factor for indiscriminate use of acute health services by homeless adults that is not offset by coverage with health insurance. Crisis driven service access leads to poor health outcomes with higher morbidity and mortality. Current recommendations, policies, and processes to address these issues are largely based upon the perceived needs of homeless adults from the viewpoint of service providers and are compounded by stereotype bias. Less known are the practical strategies homeless persons use to maintain their health and how they prioritize their health needs. This topic exposes an important informational gap. The purposes of this project were to a) uncover health related experiences of homeless adults, b) identify resource assets and deficits as perceived by homeless adults, and c) determine best practices for assisting a person who is homeless to meet their health care needs. The conceptual framework for this project was participatory action research. Methods: A mixed methods approach was used that combined Photovoice with a pre/post assessment of health self-efficacy. Evaluation: Pre and post scores on the Health Self-Efficacy scale were compared for any change in perception related to study participation. In depth interviews with participants were facilitated by critical discussion of the photographs they took. The interviews were recorded, transcribed verbatim, and then thematic analysis applied. Clinical Implications and Summary: The findings offer insight into best practices for improving health outcomes and informing policy and advocacy initiatives. Keywords: Photovoice, participatory action research, homeless, health, housing, policy, health disparities, self-efficacy, stereotype bias