1
|
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.
Collapse
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
| |
Collapse
|
2
|
Jafry MZ, Martinez J, Chen TA, Businelle MS, Kendzor DE, Reitzel LR. Perceived Social Support Attenuates the Association between Stress and Health-Related Quality of Life among Adults Experiencing Homelessness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010713. [PMID: 34682458 PMCID: PMC8536194 DOI: 10.3390/ijerph182010713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/02/2021] [Accepted: 10/09/2021] [Indexed: 11/16/2022]
Abstract
Health-related quality of life (HRQoL) is defined as a multidimensional subjective assessment of one’s physical and mental health. Homelessness is associated with numerous stressors that can reduce HRQoL. Social support is defined as the availability of individuals, or resources provided by individuals, to cope with stress. Interpersonal social support may be important in buffering HRQoL from the negative implications of stress. Here, we examine this association in a marginalized group known for high rates of physical and mental health comorbidities: adults experiencing homelessness. Participants (N = 581; 63.7% men; Mage = 43.6 ± 12.2) were recruited from homeless-serving agencies in Oklahoma City. Social support was measured with the 12-item Interpersonal Support Evaluation List (ISEL). HRQoL was measured by the Behavioral Risk Factor Surveillance System (BRFSS) survey using self-rated health, the number of poor mental and poor physical health days over the preceding 30 days, as well as the number of limited activity days as the result of poor mental and/or physical health. Perceived stress was assessed using the 4-item Perceived Stress Scale (PSS). The potential moderation effect of social support was examined by assessing the interaction term of social support and stress in a series of linear regression analyses, controlling for sex, age, months homeless, race, education, health insurance status, serious mental illness diagnosis, and recruitment agency/site. There was a significant interaction effect of social support and stress on the prediction of days of poor physical health, days of poor mental health, and days of limited activity (p in all cases ≤ 0.05). Results add to a growing literature on the potentially protective benefits of social support for HRQoL, extend them to a large sample of adults experiencing homelessness in the South, and demonstrate the significance of this moderating effect of social support over and above the influence of several prominent sociodemographic and diagnostic variables. Future work should determine if interventions designed to enhance social support can buffer HRQoL from the deleterious effects of stress among this vulnerable population.
Collapse
Affiliation(s)
- Midhat Z. Jafry
- Department of Biology and Biochemistry, College of Natural Sciences & Mathematics, University of Houston, Science & Research Building 2, 3455 Cullen Blvd Room 342, Houston, TX 77204, USA;
- Department of Psychological, Health, and Learning Services, College of Education, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (J.M.); (T.A.C.)
| | - Jayda Martinez
- Department of Psychological, Health, and Learning Services, College of Education, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (J.M.); (T.A.C.)
| | - Tzuan A. Chen
- Department of Psychological, Health, and Learning Services, College of Education, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (J.M.); (T.A.C.)
- HEALTH Research Institute, University of Houston, 1100 Health 2, 4849 Calhoun Rd., Houston, TX 77204, USA;
| | - Michael S. Businelle
- HEALTH Research Institute, University of Houston, 1100 Health 2, 4849 Calhoun Rd., Houston, TX 77204, USA;
- TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, University of Oklahoma, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA;
| | - Darla E. Kendzor
- TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, University of Oklahoma, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA;
| | - Lorraine R. Reitzel
- Department of Psychological, Health, and Learning Services, College of Education, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (J.M.); (T.A.C.)
- HEALTH Research Institute, University of Houston, 1100 Health 2, 4849 Calhoun Rd., Houston, TX 77204, USA;
- Correspondence: ; Tel.: +1-713-743-6679
| |
Collapse
|