Combining Self-Determination Theory and Photo-Elicitation to Understand the Experiences of Homeless Women

Collaborative Interpretation of Researcher-Generated Photo-Elicitation Findings: Insights From Women With Lived Experience of Homelessness

Interviews with individuals experiencing homelessness can be challenging for various reasons, including mental and physical health issues, substance use, and negative experiences with authority figures. Researchers have used photos to facilitate communication and empower participants during data collection. We analyzed data from a previous study to explore the use of researcher-generated photos during interviews about health with 13 women experiencing homelessness. Conversation analysis revealed clear patterns regarding the use of the photos during the interviews. The photos were referred to 118 times over the total interview length, 6 hours and 23 minutes, with the interviewer making 62% of the referrals and the women accounting for 38%. Fifty-nine percent of the referrals occurred within the first 5 minutes of the interviews. The women used the photos to trigger associations and emotions, to describe photo content, or in a minor role during the interview. Interpretations from an advisory board of six women with lived experiences of homelessness suggested that the photos did not engage participants as intended, highlighting the importance of considering participants' perspectives when designing photo-elicitation methods. The feedback also provided valuable insights into interview locations and incentives in research that may have influenced the women's willingness to use the photos. This study emphasizes the importance of understanding the complexity of choosing researcher-generated photos in interviews with underserved, hard-to-reach populations.

Using Photovoice to Explore Determinants of Health among Homeless and Unstably Housed Women

The lived experiences of homeless and unstably housed women, including their health-related priorities, are understudied in smaller metropolitan and rural communities. In this study, we partnered with a day center for women who experience homelessness in Spokane, Washington. We used Photovoice, a community-based participatory action research method, to explore the health-related concerns, needs, and behavior of women who are homeless or unstably housed. Participant-generated photographs and group interview data were analyzed using thematic analysis. Three themes were generated: "These are my supports", "I'm trying to make my health better", and "[My] choices are very limited". The themes illustrated individual, interpersonal, community, and societal strengths and vulnerabilities aligned with the social ecological model. Participants demonstrated resourcefulness, creativity, and hope as they strived toward health improvement. Trauma-informed, strengths-based approaches that respect the autonomy of homeless and unstably housed women and that amplify their voices are needed to minimize power imbalances in research, policy, and practice. This includes an imperative for healthcare and social work programs to ready graduates to deliver effective, empathic services by increasing their knowledge of social determinants of health and of the stigma faced by marginalized communities. Moreover, collaborating with these communities when designing, implementing, and evaluating services is critical.

Reflections on health among women in homelessness: A qualitative study

WHAT IS KNOWN ON THE SUBJECT?: Previous research reports that people in homelessness have poor physical and mental health and are excluded from society with risk for loneliness and social exclusion. Women in homelessness face particularly vulnerable circumstances with significant risks of harm. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Feelings of having a home is a basis for meeting physical, psychosocial, and existential needs related to health. Being involved in authentic relationships and caring for others gives women in homelessness a sense of worth. To be accepted by others and feeling like an equal was important for experiences of preserved dignity. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses need to recognize and support women in homelessness for their capacity to heal and to experience health. To regard women in homelessness as active health-seekers, instead of passive victims, can improve women's experiences of care provided by mental health professionals. Nurses can promote health by regarding women as resourceful and active, despite the fact that they live in homelessness.

ABSTRACT

INTRODUCTION: Mental health issues are common among women in homelessness, alongside undertreated chronic physical conditions leading to serious and unnecessary complications. Even though homelessness and risks of impaired health have been researched, broader perspectives of health are absent.

AIM

To describe reflections on health among women with experiences of homelessness.

METHOD

We conducted 13 interviews with women in homelessness using researcher-driven photograph elicitation. Together with an advisory board of women with lived experience of homelessness, researchers were guided by the DEPICT model for collaborative data analysis and performed a thematic analysis.

FINDINGS

Women with experiences of homelessness emphasized three main resources for achieving health and well-being: feelings of having a home, being involved in authentic relationships and experiences of preserved dignity.

IMPLICATION FOR PRACTICE

Healthcare needs to integrate the perceived resources for health and well-being when caring for women in homelessness. It is imperative since women will return to the healthcare setting only if they feel safe and secure, and only if dignity is preserved or restored. The results promote utilization of an integrative nursing approach; understanding that the health of women in homelessness is inseparable from their environment and social determinants for health, such as housing and social integration.

Between the sea and the sky: A social practice investigation into health behaviours during cruise travel

ISSUE ADDRESSED

The COVID-19 pandemic has highlighted organised cruise holidays as perfect incubators for microbiological infections due to the constant socialising within closed spaces. Little is known about people's health behaviours and perceptions during cruise holidays.

METHODS

Narrative group interviews and respondent photo diary exercises were conducted with families (n = 25) residing in different areas across metropolitan NSW, Australia. Guided by a social practice theoretical approach we undertook a thematic analysis that identifies reasons for choosing a cruise, health considerations and behaviours in relation to cruise travel and awareness of official cruise health information.

RESULTS

Cruise travel included a licence to abandon cautious behaviours, reinforced by confidence in the cruise organiser's risk management ability. Health concerns were not a high priority for participants and were mainly understood in terms of eating healthy, modest exercise, managing seasickness and having adequate supplies of medications. Awareness of official cruise health and risk information was largely non-existent.

CONCLUSION

Understanding how travel health practices emerge and are likely to be modifiable produces health-promoting awareness and intervention efforts that recognise and link with people's ideas about cruise holidays as times of fun, leisure, relaxation, without interfering with or imposing on them. SO WHAT?: This study highlights the importance of developing health communication and promotion strategies that are responsive to the interconnected meanings, competencies and materials that have a bearing on how cruise travellers understand and enact health-related behaviours in preparation for and during a cruise holiday.

A photoelicitation exploration on formally homeless people experience with Universal Credit: System error and 'the government don't care'

This article explores the impact of Universal Credit (UC) on a group of formerly homeless people who were forcibly made to experience a system of full of errors and government that, in their view, did not care. The experience of a marginalised and vulnerable group with complex needs allows one to consider the impacts of welfare reforms on vulnerable people. The research was conducted with formerly homeless contacted via organisations that support people who experienced homelessness in Brighton, Southeast of the UK. Five people (32 years and older) participated. Qualitative data were obtained in photo-elicitation interviews and were thematically analysed. Findings were that they faced a system of error as well as experiencing a sense the government did not care about their situation. The participants expressed their views on how the UC process made them 'struggle' and caused them to have to 'use food banks', and argued that the staff did not know the policy. The system is singled out as the cause of UC claimants' destitution. For the participants, policymakers' negligence, contempt, and detachment were not hard to understand. The article provides implications for practice and research.

More than a house: Women's recovery from homelessness in Australia

Recovery from homelessness for women is often a long, complex and highly individualised journey. This study investigated women's experiences of exiting homelessness and examined the factors that influenced recovery. The qualitative interpretive study involved auto-driven photo elicitation and in-depth interviews with 11 women who had previously been homeless. It took place in Australia between August 2018 and August 2019. Women took photographs that represented their experiences of exiting homelessness to guide discussion during interviews. Data were analysed using thematic analysis. Findings indicate that recovery from homelessness involves more than becoming housed. Recovery from homelessness is the overarching theme being presented, described using five subthemes: Finding the right house, Making a house a home, Connection, Building confidence and Helping others. Housing was only the starting point for recovery from homelessness for women. The women drew on their own self determination to create factors necessary for recovery from the experience of homelessness. We conclude that ongoing support is necessary to empower and assist women recovering from the traumatic experiences of homelessness. Trauma-informed care offers service providers a framework for supporting women who have lived through homelessness. Services can draw on this framework to provide support beyond the point of securing a house and assist women to create a home environment, build confidence in themselves and form connections to their community as they transition out of homelessness.

A qualitative exploration of women's resilience in the face of homelessness

The aim of this study was to examine the experiential perspectives of women becoming and experiencing homelessness. Situated in the qualitative interpretative tradition, data were collected using auto-driven photo-elicitation and in-depth face-to-face interviews. Eleven Australian women used photographs that represented their experiences of being homeless to guide their interview discussion. The findings revealed that homelessness for women is a period often preceded by a series of adverse incidents in their lives, characterised by progressive resilience building in the face of trauma, finding hope and building strength to work towards exiting homelessness. After becoming homeless, five stages of resilience transition emerged: The trauma of homelessness, Finding hope and surviving, Finding help, Finding connection and Taking control. Women experiencing homelessness are resilient and capable of enacting competence and autonomy in seeking help to exit homelessness. Changes to service delivery are recommended to improve trauma-informed, person-centred housing and social services that are integrated and easy to navigate.