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Armoon B, Mohammadi R, Griffiths MD. The Global Prevalence of Non-suicidal Self-injury, Suicide Behaviors, and Associated Risk Factors Among Runaway and Homeless Youth: A Meta-analysis. Community Ment Health J 2024; 60:919-944. [PMID: 38451378 DOI: 10.1007/s10597-024-01245-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/29/2024] [Indexed: 03/08/2024]
Abstract
A meta-analysis was performed to determine pooled prevalence of non-suicidal self-injury (NSSI), suicide behaviors (including ideation, attempts), and associated risk factors among runaway and homeless youth (RHY). The databases PubMed, Scopus, Web of Science, and Cochrane Library were searched for relevant studies published from January 1995 to May 2023. Initially, 8465 papers were screened, resulting in 69 included studies. The results showed that among RHY, lifetime prevalence rates were 42% for NSSI, 38% for suicidal ideation, and 27% for suicide attempts. Lifetime prevalence of NSSI and suicide behaviors was higher among adolescent minors (aged 12-17 years) compared to young adults (aged 18-24 years). Also, NSSI and suicide behaviors were associated with having a childhood history of physical and sexual abuse. Developing an impactful community-based suicide prevention campaign tailored for RHY appears warranted. Peer groups and mentorship programs would provide invaluable support for young individuals, as supportive friendships protect against NSSI.
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Affiliation(s)
- Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran.
| | - Rasool Mohammadi
- Social Determinants of Health Research Center, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
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Llobet-Estany M, Serrano-Miguel M, Muñoz A, Boixadós-Porquet A, Campomar B. [Stigma in homelessness and health care: reflections from a Housing First program in Barcelona, Spain]. Salud Colect 2024; 20:e4826. [PMID: 38967971 DOI: 10.18294/sc.2024.4826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/14/2024] [Indexed: 07/07/2024] Open
Abstract
The experience of homelessness is associated with strong stigmatization processes, which are often reflected in the treatment received from professionals and the healthcare system itself. This article aims to analyze the experiences of participants in a program for homeless individuals in Barcelona called Primer la Llar within the healthcare system, and how the stigma they suffer affects the care processes. This program follows the Housing First model, a social intervention that proposes providing housing without preconditions to individuals with long histories of street living, who suffer from severe mental disorders and/or addictions. Based on individual interviews with 20 participants conducted between 2016 and 2020, it is observed that in certain cases, entering the program, having housing availability, support from professionals, and the development of their own strategies had positive effects on improving their health, although they continue to perceive discriminatory attitudes in some medical settings. It is suggested that the transformation regarding stigmatization be understood broadly, affecting individuals, institutions, and society as a whole.
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Affiliation(s)
- Marta Llobet-Estany
- Doctora en Sociología. Docente e investigadora, Unitat de Formació i Recerca - Escola de Treball Social, Universitat de Barcelona, España
| | - Mercedes Serrano-Miguel
- Doctora en Antropología Social. Docente e investigadora, Unitat de Formació i Recerca - Escola de Treball Social, Universitat de Barcelona, España
| | - Araceli Muñoz
- Doctora en Antropología Social. Docente e investigadora, Unitat de Formació i Recerca -Escola de Treball Social, Universitat de Barcelona, España
| | - Adela Boixadós-Porquet
- Licenciada en Sociología, diplomada en Trabajo Social. Docente e investigadora, Unitat de Formació i Recerca - Escola de Treball Social, Universitat de Barcelona, España
| | - Belén Campomar
- Licenciada en Relaciones Internacionales, Especialista en Política, Evaluación y Gerencia Social. Investigadora, Universitat de Barcelona, España
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Sánchez Hidalgo M, Andrés MS, Canadell Rusiñol J, Fürstenheim Milerud LP, Gómez Palomar E, Moya Tena M. [Barriers and facilitators in accessing and using primary health care centers for people experiencing homelessness]. Aten Primaria 2024; 56:102949. [PMID: 38678854 PMCID: PMC11066605 DOI: 10.1016/j.aprim.2024.102949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVE To identify barriers and facilitators for the access and use of primary care centers for people experiencing homelessness. DESIGN Qualitative study, phenomenological theoretical-methodological approach. Between May 19 and July 27, 2023. LOCATION Besòs Primary Health Care Center and Gregal social dining (Besòs and Maresme neighborhood, Barcelona). PARTICIPANTS People experiencing homelessness attending the Gregal social dining and professionals from the Besòs Primary Health Care Center. METHOD Theoretical purposive sampling. Individual and group interviews and open non-participant observation. Thematic content analysis, triangulation by independent analysis of three members of the research team and triangulation of methods. Discourse saturation was achieved through variability of discourse and techniques. RESULTS Eleven individual interviews, three group interviews and two observations. Different barriers and facilitators were identified. These were classified into five categories: (1)concept and identification of people experiencing homelessness; (2)personal factors of people experiencing homelessness; (3)behaviors and attitudes of professionals; (4)structural factors related to health system regulation, anf (5)internal organizational factors of primary health care centers. CONCLUSIONS People experiencing homelessness face multiple barriers to access primary health care, although there are also facilitators such as trusting relationships and multidisciplinary and intersectoral work that can be enhanced from primary health care centers to contribute to health equity.
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Clark SM, Reeb RN, Born CC, Hurley KE. Benefits of a health advocacy intervention intended to improve self-efficacy for self-care in residents of a homeless shelter. J Prev Interv Community 2024; 52:198-217. [PMID: 38178550 DOI: 10.1080/10852352.2023.2299895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Despite a great need for healthcare, unhoused individuals encounter significant barriers to utilizing public healthcare systems. Given the inequities in access to healthcare, accompanied by disabilities and health risks associated with homelessness, self-efficacy for self-care is particularly critical. As a primary purpose of this article, we describe a self-care intervention (Health Advocacy Behavioral Activation), which was implemented within a long-standing participatory community action research project for homeless shelters, and report evidence of the intervention's effectiveness in enhancing self-efficacy for self-care. Participants included 62 residents of the St. Vincent de Paul Gateway Shelter for Men (Dayton, Ohio). Shelter residents with disabilities and those without disability benefited approximately equally from the intervention and both showed statistically significant pre- to post-intervention improvements in self-efficacy for self-care. Recommendations for future research examining the effectiveness of the intervention are provided. As a secondary (supplementary) purpose, we report preliminary evidence of psychometric validation for a new instrument (Scale of Self-Efficacy for Self-Care), which was developed in service of our primary purpose (i.e., to examine the effects of intervention on self-efficacy for self-care) because a literature search did not identify an appropriate measure. Because this new instrument fills a void in the literature, we anticipate that it will be useful in practice and research, and so we delineate research recommendations for additional psychometric validation of this measure. Because of the barriers that unhoused people encounter with regard to access to healthcare in the community, self-care interventions provided (and evaluated) on-site (e.g., in homeless shelters) are necessary.
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Affiliation(s)
- Sarah M Clark
- Department of Psychology, University of Dayton, Dayton, Ohio, USA
| | - Roger N Reeb
- Department of Psychology, University of Dayton, Dayton, Ohio, USA
| | - Caroline C Born
- Department of Psychology, University of Dayton, Dayton, Ohio, USA
| | - Kathryn E Hurley
- Department of Psychology, University of Dayton, Dayton, Ohio, USA
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Carmichael C, Schiffler T, Smith L, Moudatsou M, Tabaki I, Doñate-Martínez A, Alhambra-Borrás T, Kouvari M, Karnaki P, Gil-Salmeron A, Grabovac I. Barriers and facilitators to health care access for people experiencing homelessness in four European countries: an exploratory qualitative study. Int J Equity Health 2023; 22:206. [PMID: 37803317 PMCID: PMC10559410 DOI: 10.1186/s12939-023-02011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 09/12/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND People experiencing homelessness (PEH) are known to be at higher risk of adverse health outcomes and premature mortality when compared to the housed population and often face significant barriers when attempting to access health services. This study aimed to better understand the specific health care needs of PEH and the barriers and facilitators associated with their timely and equitable access to health services in the European context. METHODS We conducted an exploratory cross-national qualitative study involving people with lived experience of homelessness and health and social care professionals in Austria, Greece, Spain, and the UK. A total of 69 semi-structured interviews comprising 15 social care professionals, 19 health care professionals, and 35 PEH were completed, transcribed, and analysed thematically. RESULTS Findings were organised into three overarching themes relating to the research question: (a) Health care needs of PEH, (b) Barriers to health care access, and (c) Facilitators to health care access. Overall, the general health of PEH was depicted as extremely poor, and mainstream health services were portrayed as ill-equipped to respond to the needs of this population. Adopting tailored approaches to care, especially involving trusted professionals in the delivery of care, was identified as a key strategy for overcoming existing barriers. CONCLUSIONS The results of this study indicate there to be a high degree of consistency in the health care needs of PEH and the barriers and facilitators associated with their access to health care across the various European settings. Homelessness in itself is recognized to represent an essential social determinant of health, with PEH at risk of unequal access to health services. Changes are thus required to facilitate PEH's access to mainstream primary care. This can also be further complemented by investment in 'in-reach' services and other tailored and person-centred forms of health care. TRIAL REGISTRATION This study was registered retrospectively on June 6, 2022, in the registry of ClinicalTrials.gov under the number NCT05406687.
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Affiliation(s)
- Christina Carmichael
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, East Rd, Cambridge, CB1 1PT, UK
- School of Psychology, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - Tobias Schiffler
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, Vienna, 1090, Austria.
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, East Rd, Cambridge, CB1 1PT, UK
| | - Maria Moudatsou
- PRAKSIS - Programs of Development, Social Support and Medical Cooperation, Stournari 57, Athens, 104 32, Greece
| | - Ioanna Tabaki
- PRAKSIS - Programs of Development, Social Support and Medical Cooperation, Stournari 57, Athens, 104 32, Greece
| | - Ascensión Doñate-Martínez
- Polibienestar Research Institute, University of Valencia, Carrer del Serpis, 29, Valencia, 46022, Spain
| | - Tamara Alhambra-Borrás
- Polibienestar Research Institute, University of Valencia, Carrer del Serpis, 29, Valencia, 46022, Spain
| | - Matina Kouvari
- Environmental and Occupational Health, PROLEPSIS - Institute of Preventive Medicine, Fragoklisias street 7, Athens, 151 25, Greece
| | - Pania Karnaki
- Environmental and Occupational Health, PROLEPSIS - Institute of Preventive Medicine, Fragoklisias street 7, Athens, 151 25, Greece
| | - Alejandro Gil-Salmeron
- International Foundation for Integrated Care, Linton Road, Oxford, OX2 6UD, UK
- International University of Valencia, Calle del Pintor Sorolla, 21, Valencia, 46002, Spain
| | - Igor Grabovac
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, Vienna, 1090, Austria
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van Everdingen C, Peerenboom PB, van der Velden K, Delespaul P. Vital Needs of Dutch Homeless Service Users: Responsiveness of Local Services in the Light of Health Equity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2546. [PMID: 36767905 PMCID: PMC9915996 DOI: 10.3390/ijerph20032546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/18/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Healthcare and social services aim to ensure health equity for all users. Despite ongoing efforts, marginalized populations remain underserved. The Dutch HOP-TR study intends to expand knowledge on how to enable the recovery of homeless service users. METHODS A naturalistic meta-snowball sampling resulted in a representative sample of homeless services (N = 16) and users (N = 436). Interviews collected health and needs from user and professional perspectives in a comprehensive, rights-based ecosystem strategy. We calculated the responsiveness to needs in four domains (mental health, physical health, paid work, and administration). RESULTS Most service users were males (81%) with a migration background (52%). In addition to physical (78%) and mental health needs (95%), the low education level (89%) and functional illiteracy (57%) resulted in needs related to paid work and administration support. Most had vital needs in three or four domains (77%). The availability of matching care was extremely low. For users with needs in two domains, met needs ranged from 0.6-13.1%. Combined needs (>2 domains) were hardly met. CONCLUSIONS Previous research demonstrated the interdependent character of health needs. This paper uncovers some causes of health inequity. The systematic failure of local services to meet integrating care needs demonstrates the urgency to expand recovery-oriented implementation strategies with health equity in mind.
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Affiliation(s)
- Coline van Everdingen
- Department of Psychiatry and Neuropsychology, Maastricht University, 6200 MD Maastricht, The Netherlands
- Van Everdingen Health Care Consultancy, 6132 TP Sittard, The Netherlands
| | | | - Koos van der Velden
- Department of Primary and Community Care, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, Maastricht University, 6200 MD Maastricht, The Netherlands
- Mondriaan Mental Health Trust, 6401 CX Heerlen, The Netherlands
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Grune J, Savelsberg D, Kobus M, Lindner AK, Herrmann WJ, Schuster A. Determinants of COVID-19 vaccine acceptance and access among people experiencing homelessness in Germany: A qualitative interview study. Front Public Health 2023; 11:1148029. [PMID: 37033048 PMCID: PMC10081579 DOI: 10.3389/fpubh.2023.1148029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/28/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction People experiencing homelessness face lower life expectancy, higher prevalence of somatic and mental diseases and a more difficult access to healthcare compared to people in secure living. During the COVID-19 pandemic transmission rates were higher among people experiencing homelessness and preventive public health measures were not properly adapted to the specific needs of people experiencing homelessness. Thus, goal of our study was understanding the determinants of acceptability and access of the COVID-19 vaccine. Materials and methods We conducted a qualitative interview study with twenty guideline interviews with adult people currently experiencing homelessness in Berlin, Germany (August 2021 - April 2022). Participants were approached in a purposive sampling strategy. The interviews were analyzed with qualitative content analysis according to Mayring. Results Acceptance and attitude toward the COVID-19 vaccine is influenced by confidence in the vaccine as well as in the political and healthcare system, the individual COVID-19 risk perception and sense of collective responsibility. Overall, the acceptance of the vaccine was high among our participants. Facilities offering low threshold COVID-19 vaccines for people experiencing homelessness were perceived as helpful. Language barriers and the need for identity documents were major barriers to access the COVID 19 vaccine. Discussion People experiencing homelessness are a marginalized and vulnerable group often underrepresented in the public and scientific discourse. During the COVID-19 pandemic, preventive public health measures, including the COVID-19 vaccine, failed to consider specific needs of people experiencing homelessness. Multidimensional strategy to enhance inclusive healthcare are needed to improve access and to reduce discrimination and stigmatization.
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Affiliation(s)
- Julianna Grune
- Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- *Correspondence: Julianna Grune,
| | - Darius Savelsberg
- Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Marta Kobus
- Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Andreas K. Lindner
- Institute of International Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Wolfram J. Herrmann
- Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Angela Schuster
- Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Reid N, Buchman D, Brown R, Pedersen C, Kozloff N, Stergiopoulos V. The acceptability of financial incentives to support service engagement of adults experiencing homelessness and mental illness: a qualitative study of key stakeholder perspectives Authorship. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:1060-1071. [PMID: 36071341 DOI: 10.1007/s10488-022-01217-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 08/11/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Evidence suggests financial incentives may effectively support service engagement among people experiencing homelessness, but literature related to their acceptability in this population is limited. This study used qualitative methods to explore stakeholder perspectives on the acceptability of using financial incentives to promote service engagement among homeless adults with mental illness. METHODS As part of a larger mixed-methods pragmatic trial of a community-based brief case management program in Toronto, Canada, twenty-two trial participants were purposefully recruited to participate in semi-structured qualitative interviews, and five service providers and seven key informants were purposefully recruited to participate in a focus group and interviews, respectively. Topics included perspectives of acceptability and lived experiences of using financial incentives to support engagement, health and well-being. Data collection occurred between April 2019 and December 2020. Data was audio-recorded and transcribed. Coding and interpretation of data was informed by grounded theory and inductive thematic analysis. RESULTS Stakeholders held diverse views on the acceptability of financial incentives to promote service engagement in this population. Main themes across groups included moralizing recipient motivation; tensions in how best to define and respect autonomy; and consideration of potential unintended consequences for both individuals and the service system. Significant group differences within some themes emerged. CONCLUSION Results highlight ongoing debates over using financial incentives to facilitate service engagement among adults experiencing homelessness and mental illness. Differences in stakeholder perspectives suggest the need for person-centredness in health and research settings, and balancing theoretical risks and long-term goals with likely potential for immediate benefits.
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Affiliation(s)
- Nadine Reid
- Centre for Addiction and Mental Health, 1000 Queen St. W, M6H 1H4, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, M5T 3M6, Toronto, ON, Canada
| | - Daniel Buchman
- Centre for Addiction and Mental Health, 1000 Queen St. W, M6H 1H4, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, M5T 3M7, Toronto, ON, Canada
- Joint Centre for Bioethics, University of Toronto, 155 College St, M5T 1P8, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, 60 Leonard Ave, M5T 0S8, Toronto, ON, Canada
| | - Rebecca Brown
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond St, M5B 1W8, Toronto, ON, Canada
| | - Cheryl Pedersen
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond St, M5B 1W8, Toronto, ON, Canada
| | - Nicole Kozloff
- Centre for Addiction and Mental Health, 1000 Queen St. W, M6H 1H4, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, M5T 3M6, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, 250 College St, M5T 1R8, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, 1000 Queen St. W, M6H 1H4, Toronto, ON, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, M5T 3M6, Toronto, ON, Canada.
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond St, M5B 1W8, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, 250 College St, M5T 1R8, Toronto, ON, Canada.
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Etty MC, Michaelsen S, Yelle B, Beaulieu K, Jacques P, Ettaleb S, Samaha D, Tousignant B, Druetz T. The sociodemographic characteristics and social determinants of visual impairment in a homeless population in the Montreal area. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 114:113-124. [PMID: 35969355 PMCID: PMC9377295 DOI: 10.17269/s41997-022-00676-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/11/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Homelessness is a serious social and public health concern in Canada. Individuals experiencing homelessness face numerous health problems and barriers in accessing health services. Visual impairment can exacerbate the lower quality of life experienced by people who are homeless, but its incidence among this population has been poorly documented in the literature. Our study aimed to describe health and sociodemographic characteristics and determine their association with visual impairment, ocular pathology and uncorrected refractive errors in a homeless population in Montreal, Canada. METHODS This cross-sectional study was conducted between May 2019 and September 2020 in eight homeless shelters selected using a stratified random sampling approach on the island of Montreal. An eye examination was performed on all participants, who were also administered a survey on social determinants of health. Descriptive analysis was used to analyze survey data, and logistic regression was used for each of the three study outcomes. RESULTS A total of 124 individuals experiencing homelessness (93 men, 31 women) were recruited. Participants were mostly Caucasian (> 70%) with an average age of 48 years (standard deviation = 13 years). Our sample reported a high level of education (68% had a high school diploma or higher), a high level of health insurance coverage (77%), social assistance benefits (71%), and social support (over 50%). There was a high prevalence of chronic conditions including diabetes (14%), hypertension (25%), and HIV/AIDS (3%). Results from eye examinations showed a high prevalence of visual impairment (22%), ocular pathology (23%), and uncorrected refractive error (75%). Age was statistically significantly associated with each outcome variable. CONCLUSION Despite a high level of social and health support, individuals experiencing homelessness in Montreal, Canada, experience high levels of chronic conditions and visual impairment. Our study highlights the unmet need for eye healthcare among homeless populations, and that eye health can be a unique entry point for intervening with homeless populations.
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Affiliation(s)
- Marie-Christine Etty
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9 Canada
| | - Sonia Michaelsen
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9 Canada
| | - Brittany Yelle
- School of Optometry, University of Montreal, 3744 Rue Jean Bureau 110, Montreal, QC H3T 1P1 Canada
| | - Kimberlie Beaulieu
- School of Optometry, University of Montreal, 3744 Rue Jean Bureau 110, Montreal, QC H3T 1P1 Canada
| | - Patricia Jacques
- School of Optometry, University of Montreal, 3744 Rue Jean Bureau 110, Montreal, QC H3T 1P1 Canada
| | - Sarah Ettaleb
- School of Optometry, University of Montreal, 3744 Rue Jean Bureau 110, Montreal, QC H3T 1P1 Canada
| | - Dan Samaha
- School of Optometry, University of Montreal, 3744 Rue Jean Bureau 110, Montreal, QC H3T 1P1 Canada
| | - Benoit Tousignant
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9 Canada ,School of Optometry, University of Montreal, 3744 Rue Jean Bureau 110, Montreal, QC H3T 1P1 Canada ,Public Health Research Centre (CReSP), University of Montreal, C.P. 6128 Succursale Centre-Ville, Montreal, QC H3C 3J7 Canada
| | - Thomas Druetz
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC, H3N 1X9, Canada. .,Public Health Research Centre (CReSP), University of Montreal, C.P. 6128 Succursale Centre-Ville, Montreal, QC, H3C 3J7, Canada. .,Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA, 70112, USA.
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Fu L, Fang Y, Dong Y. The healthcare inequality among middle-aged and older adults in China: a comparative analysis between the full samples and the homogeneous population. HEALTH ECONOMICS REVIEW 2022; 12:34. [PMID: 35761111 PMCID: PMC9238267 DOI: 10.1186/s13561-022-00383-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In the Chinese population, the middle-aged and older adults are the two main segments that utilize a large portion of healthcare. With the fast growth of the two segments, the demands of healthcare services increases significantly. The issue related to inequality in utilization of healthcare emerges with the growth and it deserves more attention. Most existing studies discuss overall inequality. Less attention is paid to inequality among subdivisions, that is, relative inequality. This study focuses on the inequality of healthcare utilization among the homogeneous population and the inequality of the full samples in China. METHODS Data were obtained from four waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013, 2015 and 2018. First, the Concentration Index (CI) was used to measure the inequality of outpatient, inpatient and preventive care for the samples, and regression analysis was applied to decompose the contributing factors of inequality. Then SOM is introduced to identify homogeneous population through clustering and measure the inequality in three types of healthcare utilization among homogeneous population. Based on this, the difference between absolute inequalities and relative inequalities was discussed. RESULTS The preventive care is shown to have the highest degree of inequality inclined to the rich and has the largest increase (CI: 0.048 in 2011 ~ 0.086 in 2018); The inequality degree in outpatient care appears to be the smallest (CI: -0.028 in 2011 ~ 0.014 in 2018). The decomposition results show that age, education, income, chronic disease and self-reported health issues help explain a large portion of inequality in outpatient and inpatient care. And the contribution of socioeconomic factors and education to the inequality of preventive care is the largest. In regards to three types of healthcare among the homogeneous population, the degree of inequality seems to be higher among group with high socioeconomic status than those with lower socioeconomic status. In particular, for the people who are in the high socioeconomic group, the degree of inequality in preventive care is consistently higher than in outpatient and inpatient care. The inequality degree of preventive care in the low socioeconomic status group varies significantly with the flexibility of their response to policies. CONCLUSIONS Key policy recommendations include establishing a health examination card and continuously improving the fit of free preventive care with the needs of the middle-aged and older adults; developing CCB activities to avoid people's excessive utilization in the high socioeconomic status group or insufficient utilization in the low socioeconomic status group; reasonable control of reimbursement and out-of-pocket payments.
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Affiliation(s)
- Liping Fu
- College of Management and Economics, Tianjin University; Center for Social Science Survey and Data, Tianjin University, Tianjin, 300072, China
- College of Politics and Public Administration, Qinghai Minzu University, Qinghai, 810007, China
| | - Ya'nan Fang
- College of Management and Economics, Tianjin University; Center for Social Science Survey and Data, Tianjin University, Tianjin, 300072, China.
| | - Yongqing Dong
- College of Management and Economics, Tianjin University; Center for Social Science Survey and Data, Tianjin University, Tianjin, 300072, China
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Reid N, Brown R, Pedersen C, Kozloff N, Sosnowski A, Stergiopoulos V. Using financial incentives to support service engagement of adults experiencing homelessness and mental illness: A qualitative analysis of key stakeholder perspectives. Health Expect 2022; 25:984-993. [PMID: 35104030 PMCID: PMC9122468 DOI: 10.1111/hex.13442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/07/2021] [Accepted: 01/12/2022] [Indexed: 12/17/2022] Open
Abstract
Introduction Homelessness and mental illness are associated with poor service engagement, health and health service use outcomes. Existing literature suggests that financial incentives may effectively support service engagement of this population, but studies investigating key stakeholder perspectives are lacking. This study aimed to elicit, using qualitative methods, nuanced service user and provider experiences by using financial incentives to support service engagement among adults experiencing homelessness and mental illness. Methods This qualitative study is part of a larger mixed‐methods pragmatic trial of financial incentives (Coordinated Access to Care for the Homeless—Financial Incentives [CATCH‐FI]) within a community‐based brief case management programme (CATCH) in Toronto, Ontario. Twenty‐two CATCH‐FI participants were purposefully recruited to participate in in‐depth, semi‐structured interviews; five CATCH service providers participated in a focus group and seven key informants in individual interviews. Data collection occurred between April 2019 and December 2020. All interviews and the focus group were audio‐recorded and transcribed. Topic guides prompted participant perspectives on and experiences of using financial incentives to support engagement, health and well‐being. Grounded theory and inductive thematic analysis guided coding and interpretation of transcripts. Triangulation and member‐checking enhanced the analytical rigour and validity of findings. Results CATCH service providers, key informants and subgroup of CATCH‐FI participants perceived financial incentives to directly facilitate service engagement. The majority of CATCH‐FI participants however highlighted that intrinsic motivation and service quality may be relatively more important facilitators of engagement. Most study participants across stakeholder groups perceived that financial incentives have direct positive influences on health and well‐being in enabling access to basic needs and simple pleasures. Conclusions Our data suggest that for some adults experiencing homelessness and mental illness, financial incentives can directly support service engagement. In addition, financial incentives may positively impact health and well‐being by easing financial stress and enabling deeper attention to individual health needs. Further research on the effectiveness and acceptability of financial incentives is needed to improve understanding and uptake of a promising intervention to support health and health service use outcomes in an underserved population. Patient or Public Contribution Study participants provided input into the study research questions, study design, interview guides and interpretation of findings.
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Affiliation(s)
- Nadine Reid
- General and Health Systems Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Health Services Research Program, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Brown
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Cheryl Pedersen
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Nicole Kozloff
- General and Health Systems Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Health Services Research Program, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Child, Youth and Emerging Adult Program, Centre of Addiction and Mental Health, Toronto, Ontario, Canada
| | - Alexandra Sosnowski
- Health Services Research Program, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- General and Health Systems Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Health Services Research Program, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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