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Jiménez-Lérida C, Herrera-Espiñeira C, Granados R, Martín-Salvador A. Attending to the Mental Health of People Who Are Homeless by Mobile Telephone Follow-Up: A Systematic Review. Healthcare (Basel) 2023; 11:1666. [PMID: 37372784 DOI: 10.3390/healthcare11121666] [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: 04/18/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND More than 20% of the world's population has no decent or suitable home. People who are homeless have more health problems than the rest of the population, especially mental health-type problems. The main objective of this study was to identify follow-up interventions by using mobile telephones to improve the mental health of people who are homeless and to analyze their efficiency. METHODS To do so, a systematic review was carried out in the Web of Science, PubMed, Scopus, Ebscohost, and PsyInfo databases. RESULTS Studies conclude that mobile phone use is a suitable means to improve adherence to medication and the mental health of the homeless. However, significant attempts to demonstrate health benefits by means of reliable and valid instruments that supplement qualitative satisfaction and feedback instruments appear to be lacking. CONCLUSIONS The literature about mental health benefits through technology for people who are homeless is scarce and shows methodological limitations that can lead to failure when setting up methodologies in clinical practice.
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Affiliation(s)
| | - Carmen Herrera-Espiñeira
- PhD Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (Ibs. Granada), 18012 Granada, Spain
| | - Reina Granados
- PhD Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
| | - Adelina Martín-Salvador
- PhD Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
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Lyles CR, Nguyen OK, Khoong EC, Aguilera A, Sarkar U. Multilevel Determinants of Digital Health Equity: A Literature Synthesis to Advance the Field. Annu Rev Public Health 2023; 44:383-405. [PMID: 36525960 PMCID: PMC10329412 DOI: 10.1146/annurev-publhealth-071521-023913] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Current digital health approaches have not engaged diverse end users or reduced health or health care inequities, despite their promise to deliver more tailored and personalized support to individuals at the right time and the right place. To achieve digital health equity, we must refocus our attention on the current state of digital health uptake and use across the policy, system, community, individual, and intervention levels. We focus here on (a) outlining a multilevel framework underlying digital health equity; (b) summarizingfive types of interventions/programs (with example studies) that hold promise for advancing digital health equity; and (c) recommending future steps for improving policy, practice, and research in this space.
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Affiliation(s)
- Courtney R Lyles
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA;
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, USA
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
- School of Public Health, University of California-Berkeley, Berkeley, California, USA
| | - Oanh Kieu Nguyen
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
- Department of Medicine, Division of Hospital Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Elaine C Khoong
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA;
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
| | - Adrian Aguilera
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
- School of Social Welfare, University of California-Berkeley, Berkeley, California, USA
- Department of Psychiatry, University of California-San Francisco, San Francisco, California, USA
| | - Urmimala Sarkar
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA;
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
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Mizumoto J, Mitsuyama T, Kondo S, Izumiya M, Horita S, Eto M. Assessing Social Circumstances in Primary Care: Expert Consensus via Delphi Technique. PRIMER (LEAWOOD, KAN.) 2023; 7:765336. [PMID: 36845843 PMCID: PMC9957451 DOI: 10.22454/primer.2023.765336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background and Objective In the Japanese primary care setting, a set of questions to screen patients' social circumstances has never been developed in a scientific manner. This project aimed to reach a consensus among diverse experts to develop a set of such questions, to meet the need for assessing patients' health-related social circumstances. Methods We used a Delphi technique to generate expert consensus. The expert panel was composed of various clinical professionals, medical trainees, researchers, support members for marginalized people, and patients. We conducted multiple rounds of communication online. In round 1, the participants provided their opinions about what health care professionals should ask to assess patients' social circumstances in primary care settings. These data were analyzed into several themes. In round 2, all themes were confirmed by consensus. Results Sixty-one people participated in the panel. All participants completed the rounds. Six themes were generated and confirmed: economic condition and employment, access to health care and other services, living in everyday life and leisure time, total physiological needs, tools and technology, and history of the patient's life. In addition, the panelists emphasized the importance of respecting the patient's preferences and values. Conclusion A questionnaire, abbreviated by the acronym of HEALTH+P, was developed. Further research about its clinical feasibility and impact on patient outcomes is warranted.
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Affiliation(s)
- Junki Mizumoto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Toshichika Mitsuyama
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Satoshi Kondo
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Masashi Izumiya
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Shoko Horita
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Masato Eto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
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Montgomery A, Neil JM, Cannell MB, Gonzalez J, Cole A, Ra CK, Kezbers K, Robison J, Kendzor DE, Businelle MS. The Prevalence and Perceived Utility of Mobile Health Technology Among Recently Incarcerated Homeless Adults. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2023; 8:158-166. [PMID: 36844754 PMCID: PMC9939856 DOI: 10.1007/s41347-023-00308-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/15/2022] [Accepted: 02/01/2023] [Indexed: 05/21/2023]
Abstract
Mobile technologies can deliver physical and mental health services for recently incarcerated homeless adults (RIHAs). The purpose of this study was to examine the prevalence and perceived utility of mobile technology to support health behavior change among RIHAs. Participants (n = 324) from an ongoing clinical trial at a homeless shelter in Texas were included in the current descriptive cross-sectional analyses. Over one fourth (28.4%) of participants had an active cell phone. Nearly 90 percent (88.6%) of participants reported at least weekly use of the internet, 77 percent used email (77.2%), and more than half used Facebook (55.2%). Although most participants (82.8%) believed that smartphone applications (apps) could help change their behavior, only a quarter (25.1%) had used an app for this purpose. These findings highlight the potential for smartphone-based intervention technologies, and future studies should examine whether smartphone apps that address mental health and health behaviors are feasible among RIHAs.
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Affiliation(s)
- Audrey Montgomery
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Oklahoma City, OK 73104 USA
| | - Jordan M. Neil
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Oklahoma City, OK 73104 USA
| | - Michael B. Cannell
- School of Public Health, University of Texas Health Sciences Center, Dallas, TX USA
| | | | - Ashley Cole
- Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, OK 74078 USA
| | - Chaelin K. Ra
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Oklahoma City, OK 73104 USA
| | - Krista Kezbers
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Oklahoma City, OK 73104 USA
| | - Jillian Robison
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Oklahoma City, OK 73104 USA
| | - Darla E. Kendzor
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Oklahoma City, OK 73104 USA
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Michael S. Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Oklahoma City, OK 73104 USA
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
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Leung T, Elias S, Sieu V, Peredo R. The Use of Technology to Provide Mental Health Services to Youth Experiencing Homelessness: Scoping Review. J Med Internet Res 2023; 25:e41939. [PMID: 36645703 PMCID: PMC9887515 DOI: 10.2196/41939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND There is growing interest in using information and communication technologies (ICTs) to improve access to mental health services for youth experiencing homelessness (YEH); however, limited efforts have been made to synthesize this literature. OBJECTIVE This study aimed to review the research on the use of ICTs to provide mental health services and interventions for YEH. METHODS We used a scoping review methodology following the Arksey and O'Malley framework and guidelines from the Joanna Briggs Institute Manual for Evidence Synthesis. The results are reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A systematic search was conducted from 2005 to 2021 in MEDLINE, Embase, CINAHL, PsycInfo, Cochrane, Web of Science, and Maestro and in ProQuest Thesis and Dissertations, Papyrus, Homeless Hub, and Google Scholar for gray literature. Studies were included if participants' mean age was between 13 and 29 years, youth with mental health issues were experiencing homelessness or living in a shelter, ICTs were used as a means of intervention, and the study provided a description of the technology. The exclusion criteria were technology that did not allow for interaction (eg, television) and languages other than French or English. The data were analyzed using descriptive statistics and qualitative approaches. Two reviewers were involved in the screening and data extraction process in consultation with a third reviewer. The data were summarized in tables and by narrative synthesis. RESULTS From the 2153 abstracts and titles screened, 12 were included in the analysis. The most common types of ICTs used were communication technologies (eg, phone, video, and SMS text messages) and mobile apps. The intervention goals varied widely across studies; the most common goal was reducing risky behaviors, followed by addressing cognitive functioning, providing emotional support, providing vital resources, and reducing anxiety. Most studies (9/11, 82%) focused on the feasibility of interventions. Almost all studies reported high levels of acceptability (8/9, 89%) and moderate to high frequency of use (5/6, 83%). The principal challenges were related to technical problems such as the need to replace phones, issues with data services, and phone charging. CONCLUSIONS Our results indicate the emerging role of ICTs in the delivery of mental health services to YEH and that there is a high level of acceptability based on early feasibility studies. However, our results should be interpreted cautiously, considering the limited number of studies included in the analysis and the elevated levels of dropout. There is a need to advance efficacy and effectiveness research in this area with larger and longer studies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2022-061313.
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Affiliation(s)
| | - Sarah Elias
- School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, QC, Canada.,Youth Mental Health and Technology Lab, Health Innovation and Evaluation Hub, University of Montréal Hospital Research Centre, Montréal, QC, Canada
| | - Vida Sieu
- School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, QC, Canada.,Youth Mental Health and Technology Lab, Health Innovation and Evaluation Hub, University of Montréal Hospital Research Centre, Montréal, QC, Canada
| | - Rossana Peredo
- School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, QC, Canada.,Youth Mental Health and Technology Lab, Health Innovation and Evaluation Hub, University of Montréal Hospital Research Centre, Montréal, QC, Canada
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Mattsson E, Lindblad M, Kneck Å, Salzmann-Eriksson M, Klarare A. Voices of women in homelessness during the outbreak of the COVID-19 pandemic: a co-created qualitative study. BMC Womens Health 2023; 23:11. [PMID: 36627642 PMCID: PMC9830620 DOI: 10.1186/s12905-023-02157-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Women in homelessness face extreme health- and social inequities. It could be postulated that during societal crises, they become even more vulnerable. Thus, the aim was to explore experiences related to the COVID-19 pandemic among women in homelessness. METHODS Ten interviews were conducted with women in homelessness, in Stockholm, Sweden, using researcher-driven photo elicitation. The data analysis was guided by the DEPICT model for collaborative data analysis and a qualitative content analysis was performed. A collaborative reference group of women with lived experience of homelessness contributed to the research process through designing the data collection, performing the data analysis, and providing feedback during report writing. RESULTS For women in homelessness, the COVID-19 pandemic was adding insult to injury, as it significantly affected everyday life and permeated most aspects of existence, leading to diminished interactions with others and reduced societal support. Thus, in an already dire situation, the virus amplified health- and social issues to another level. The women strived to find their balance on the shifting sands of guidelines and restrictions due to the pandemic. Adhering to the new social distancing rules and guidelines in line with the rest of society, was simply impossible when experiencing homelessness. However, for some women the pandemic was nothing but a storm in a teacup. The harsh reality continued irrespectively, living one day at a time and prioritizing provision for basic human needs. CONCLUSIONS The COVID-19 pandemic and homelessness can be viewed as two intersecting crises. However, the women's aggregated experiences were greater than the sum of experiencing homelessness and meeting the threat of the virus. Gender, exposure to violence, poverty, social isolation, and substance use were additional factors that further marginalized the women during the pandemic. To rebuild a better and more sustainable post-pandemic future for all, global commitment to ending homelessness is crucial. In addition, addressing social determinants of health must be the number one health intervention.
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Affiliation(s)
- Elisabet Mattsson
- grid.8993.b0000 0004 1936 9457Department of Women’s and Children’s Health, Healthcare Sciences and e-Health, Uppsala University, 751 85 Uppsala, Sweden ,grid.412175.40000 0000 9487 9343Department of Health Care Sciences, Marie Cederschiöld University, Stigbergsgatan 30, Box 11189, 100 61 Stockholm, Sweden
| | - Marléne Lindblad
- Department of Health Sciences, Swedish Red Cross University, Box 1059, 141 21 Huddinge, Sweden
| | - Åsa Kneck
- grid.412175.40000 0000 9487 9343Department of Health Care Sciences, Marie Cederschiöld University, Stigbergsgatan 30, Box 11189, 100 61 Stockholm, Sweden
| | - Martin Salzmann-Eriksson
- grid.69292.360000 0001 1017 0589Department of Caring Sciences, Faculty of Health an Occupational Studies, University of Gävle, 801 76 Gävle, Sweden
| | - Anna Klarare
- grid.8993.b0000 0004 1936 9457Department of Women’s and Children’s Health, Healthcare Sciences and e-Health, Uppsala University, 751 85 Uppsala, Sweden ,grid.412175.40000 0000 9487 9343Department of Health Care Sciences, Marie Cederschiöld University, Stigbergsgatan 30, Box 11189, 100 61 Stockholm, Sweden
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DeLaCruz-Jiron EJ, Hahn LM, Donahue AL, Shore JH. Telemental Health for the Homeless Population: Lessons Learned when Leveraging Care. Curr Psychiatry Rep 2023; 25:1-6. [PMID: 36480149 PMCID: PMC9734763 DOI: 10.1007/s11920-022-01400-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW The purpose of this paper is to review key lessons when using telehealth within the context of mental health and homelessness. We examine technological and bandwidth issues the homeless population might face when getting telehealth services, discuss clinical process adaption needed for working remotely, and highlight the lessons learned when leveraging mental health services to homeless patients across telehealth platforms. RECENT FINDINGS Homelessness is associated with chronic, mental health disparities and access to mental health services is often less accessible among communities with unstable housing. Telehealth provides "OnDemand" treatment options while removing specific barriers found with in-person health care such as transportation, overwhelmed mental health facilities, i.e., appointment availability, and office hour limitations while reducing costs for both providers and patients. We provide two case examples to demonstrate successful delivery of telemental health services to homeless patients and review lessons learned when leveraging care.
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Affiliation(s)
| | - Lauren M. Hahn
- Access Management Services LLC, 11100 East Bethany Drive, Aurora, CO 80014 USA
| | - Amy L. Donahue
- Access Management Services LLC, 11100 East Bethany Drive, Aurora, CO 80014 USA
| | - Jay H. Shore
- Access Management Services LLC, 11100 East Bethany Drive, Aurora, CO 80014 USA ,Department of Psychiatry and Family Medicine, School of Medicine and Centers for American Indian and Alaska Native Health Colorado School of Public Health, Anschutz Medical Campus, Aurora, USA
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Radó N, Girasek E, Békási S, Győrffy Z. Digital Technology Access and Health-Related Internet Use Among People Experiencing Homelessness in Hungary: Quantitative Survey. J Med Internet Res 2022; 24:e38729. [PMID: 36260379 PMCID: PMC9631172 DOI: 10.2196/38729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background In recent years, there has been an increase in the use of digital technology for personal health and well-being. Previous research has revealed that these technologies might provide vulnerable populations, including those who are homeless, better access to health services and thus a greater chance of more personalized care. Objective However, little is known about the relationship between technology and health among people experiencing homelessness in Central and Eastern Europe. This study is part of a series of studies by the Digital Health Research Group at Semmelweis University (Budapest, Hungary) in cooperation with the Hungarian Charity Service of the Order of Malta; it aims to assess the existing technological resources available for the homeless population and their health-related internet use characteristics to set the ground for potential health policy interventions, enabling better access to health services by strengthening the digital components of the existing health care system. Methods Between April 19, 2021, and August 11, 2021, a total of 662 people from 28 institutions providing social services for people experiencing homelessness in Budapest, Hungary, were surveyed about their access to digital tools and internet use patterns. For selected questions, the responses of a representative sample of the Hungarian population were used for comparison as the reference group. Chi-square tests and logistic regression analyses were performed to identify variables affecting internet use for health-related reasons. Results The results demonstrated a considerable level of internet use in the homeless population; 52.9% (350/662) of the respondents used the internet frequently compared with 81.3% (1220/1500) of the respondents in the reference group. Among the homeless group, 69.6% (461/662) of the respondents reported mobile phone ownership, and 39.9% (264/662) of the respondents added that it had a smartphone function. Moreover, 11.2% (70/662) of the respondents had already used a health mobile app, and 34.6% (229/662) of the respondents had used the internet for medical purposes. On the basis of these characteristics, we were able to identify a broadly defined, digitally engaged group among people experiencing homelessness (129/662, 19.5%). This subpopulation was inclined to benefit from digitalization related to their personal health. Multivariate analysis demonstrated that internet use for health reasons was more significant for younger respondents, women, those with higher levels of education, and those with no chronic conditions. Conclusions Although compared with the general population, health-related internet use statistics are lower, our results show that the idea of involving homeless populations in the digital health ecosystem is viable, especially if barriers to access are systematically reduced. The results show that digital health services have great promise as another tool in the hands of community shelters for keeping homeless populations well ingrained in the social infrastructure as well as for disease prevention purposes.
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Affiliation(s)
- Nóra Radó
- Institute of Behavioural Sciences, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Edmond Girasek
- Institute of Behavioural Sciences, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Sándor Békási
- Health Centre, Hungarian Charity Service of the Order of Malta, Budapest, Hungary.,Telemedicine Workgroup, FitPuli Kft., Győr, Hungary
| | - Zsuzsa Győrffy
- Institute of Behavioural Sciences, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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Thurman W, Moczygemba LR, Baffoe JO. "Without my medication, I'm a wreck": Photo-elicitation to explore medication use among people experiencing homelessness. Res Social Adm Pharm 2021; 18:3149-3157. [PMID: 34479800 DOI: 10.1016/j.sapharm.2021.08.015] [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: 03/02/2021] [Revised: 08/29/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND People experiencing homelessness (PEH) live with a high burden of chronic illness, functional and cognitive impairments, and serious mental illness. Many PEH are prescribed complex medication regimens to manage symptoms and improve health and functioning. However, medication use within the context of homelessness is complicated, and adherence is often suboptimal. OBJECTIVE To document medication use within the context of homelessness and explore experiences of medication use among people experiencing homelessness (PEH). METHODS This study used mixed methods including photo-elicitation interviews. Participants were given a digital camera and asked to take pictures of people, places, things, and situations that represented every day medication use. Participants were also asked to write down reasons for taking the pictures. After two weeks, participants returned the camera and notes. At a subsequent interview, the photographs and notes were reviewed and discussed. Demographic and health-related information was also collected for each participant. An interpretive description approach was used for qualitative data analysis. Quantitative data were analyzed using descriptive statistics in order to describe the sample. RESULTS Seven PEH completed this study. Mean age was 45 years (SD = 11.3) and length of homelessness was 6.1 years (SD = 11.3). All reported multiple chronic conditions (≥2) and reported taking 6.6 (SD = 2.6) medications. Participants reported medication adherence barriers with mean score of 37 (SD = 5.5) on the ASK-12, a 12-item scale with a range of 12-60 (higher scores indicate more barriers). Qualitative analysis identified four categories: medication-related burdens, medication-related beliefs, connectedness, and stigmatizing encounters. CONCLUSIONS Medication use among PEH is complex and cannot be considered separately from daily life or from struggles to meet basic needs. Multi-level interventions are needed to optimize medication use among PEH, and healthcare professionals including community pharmacists should reinforce beliefs that medication-related benefits outweigh the burdens and then tailor services to the context of homelessness.
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Affiliation(s)
- Whitney Thurman
- College of Pharmacy, Health Outcomes Division, The University of Texas at Austin, 2900 University Ave. Austin, TX, 78712, USA; School of Nursing, The University of Texas at Austin, 1710 Red River St. Austin, TX, 78701, USA.
| | - Leticia R Moczygemba
- College of Pharmacy, Health Outcomes Division, The University of Texas at Austin, 2900 University Ave. Austin, TX, 78712, USA
| | - James O Baffoe
- College of Pharmacy, Health Outcomes Division, The University of Texas at Austin, 2900 University Ave. Austin, TX, 78712, USA
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