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Macklin J, Samson B, Zsager A, Ross H, Pinto A, Gibson JL. Cardiovascular disease management and healthcare delivery for people experiencing homelessness: a scoping review. BMC Health Serv Res 2024; 24:1080. [PMID: 39289676 PMCID: PMC11406789 DOI: 10.1186/s12913-024-11503-0] [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: 06/15/2024] [Accepted: 08/28/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND People experiencing homelessness have increased prevalence, morbidity, and mortality of cardiovascular disease (CVD), attributable to several traditional and non-traditional risk factors. While this burden is well-known, mainstream CVD management plans and healthcare delivery have not been developed with people experiencing homelessness in mind nor tailored to their unique context. The overall objective of this work was to explore and synthesize what is known about CVD management experiences, programs, interventions, and/or recommendations specifically for people experiencing homelessness. METHODS We conducted a scoping review to combine qualitative and quantitative studies in a single review using the Arksey and O'Malley framework and lived experience participation. We performed a comprehensive search of OVID Medline, Embase, PsychINFO, CINAHL, Web of Science, Social Sciences Index, Cochrane, and the grey literature with key search terms for homelessness, cardiovascular disease, and programs. All dates, geographic locations, and study designs were included. Articles were analyzed using conventional content analysis. RESULTS We included 37 articles in this review. Most of the work was done in the USA. We synthesized articles' findings into 1) barriers/challenges faced by people experiencing homelessness and their providers with CVD management and care delivery (competing priorities, lifestyle challenges, medication adherence, access to care, and discrimination), 2) seven international programs/interventions that have been developed for people experiencing homelessness and CVD management with learnings, and 3) practical recommendations and possible solutions at the patient encounter level (relationships, appointment priorities, lifestyle, medication), clinic organization level (scheduling, location, equipment, and multi-disciplinary partnership), and systems level (root cause of homelessness, and cultural safety). CONCLUSIONS There is no 'one-size-fits all' approach to CVD management for people experiencing homelessness, and it is met with complexity, diversity, and intersectionality based on various contexts. It is clear, however, we need to move to more practically-implemented, community-driven solutions with lived experience and community partnership at the core. Future work includes tackling the root cause of homelessness with affordable housing, exploring ways to bring cardiac specialist care to the community, and investigating the role of digital technology as an avenue for CVD management in the homeless community. We hope this review is valuable in providing knowledge gaps and future direction for health care providers, health services research teams, and community organizations.
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Affiliation(s)
- Jillian Macklin
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, Toronto, ON, Canada.
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Bethel Samson
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alex Zsager
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | - Heather Ross
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Andrew Pinto
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Division of Clinical Public Health, Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Jennifer L Gibson
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, Toronto, ON, Canada
- Division of Clinical Public Health, Dalla Lana School of Public Health, Toronto, ON, Canada
- Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada
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Hickey MD, Sergi F, Zhang K, Spinelli MA, Black D, Sola C, Blaz V, Nguyen JQ, Oskarsson J, Gandhi M, Havlir DV. Pragmatic randomized trial of a pre-visit intervention to improve the quality of telemedicine visits for vulnerable patients living with HIV. J Telemed Telecare 2023; 29:187-195. [PMID: 33342328 PMCID: PMC8214632 DOI: 10.1177/1357633x20976036] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has required a shift of many routine primary care visits to telemedicine, potentially widening disparities in care access among vulnerable populations. In a publicly-funded HIV clinic, we aimed to evaluate a pre-visit phone-based planning intervention to address anticipated barriers to telemedicine. METHODS We conducted a pragmatic randomized controlled trial of patients scheduled for a phone-based HIV primary care visit at the Ward 86 HIV clinic in San Francisco from 15 April to 15 May 2020. Once reached by phone, patients were randomized to either have a structured pre-visit planning intervention to address barriers to an upcoming telemedicine visit versus a standard reminder call. The primary outcome was telemedicine visit attendance. RESULTS Of 476 scheduled telemedicine visits, 280 patients were reached by a pre-visit call to offer enrollment. Patients were less likely to be reached if virally unsuppressed (odds ratio (OR) 0.11, 95% confidence intervals (CI) 0.03-0.48), CD4 < 200 (OR 0.24, 95% CI 0.07-0.85), or were homeless (OR 0.24, 95% CI 0.07-0.87). There was no difference between intervention and control in scheduled visit attendance (83% v. 78%, OR 1.38, 95% CI 0.67-2.81). CONCLUSIONS A structured phone-based planning call to address barriers to telemedicine in a public HIV clinic was less likely to reach patients with poorly-controlled HIV and patients experiencing homelessness, suggesting additional interventions may be needed in this population to ensure access to telemedicine-based care. Among patients reachable by phone, telemedicine visit attendance was high and not improved with a structured pre-visit intervention, suggesting that standard reminders may be adequate in this population.
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Affiliation(s)
- Matthew D Hickey
- Division of HIV, ID and Global Medicine, University of California, USA
| | | | - Kevin Zhang
- Feinberg School of Medicine, Northwestern University, USA
| | | | - Douglas Black
- Division of HIV, ID and Global Medicine, University of California, USA
| | - Cyril Sola
- Division of HIV, ID and Global Medicine, University of California, USA
| | - Vanessa Blaz
- Division of HIV, ID and Global Medicine, University of California, USA
| | - Janet Q Nguyen
- Division of HIV, ID and Global Medicine, University of California, USA
| | - Jon Oskarsson
- Division of HIV, ID and Global Medicine, University of California, USA
| | - Monica Gandhi
- Division of HIV, ID and Global Medicine, University of California, USA
| | - Diane V Havlir
- Division of HIV, ID and Global Medicine, University of California, USA
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deRussy AJ, Jones AL, Austin EL, Gordon AJ, Gelberg L, Gabrielian SE, Riggs KR, Blosnich JR, Montgomery AE, Holmes SK, Varley AL, Hoge AE, Kertesz SG. Insights for Conducting Large-Scale Surveys with Veterans Who Have Experienced Homelessness. JOURNAL OF SOCIAL DISTRESS AND THE HOMELESS 2021; 32:123-134. [PMID: 37234355 PMCID: PMC10208227 DOI: 10.1080/10530789.2021.2013013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/15/2021] [Accepted: 11/27/2021] [Indexed: 05/27/2023]
Abstract
Surveys of underserved patient populations are needed to guide quality improvement efforts but are challenging to implement. The goal of this study was to describe recruitment and response to a national survey of Veterans with homeless experience (VHE). We randomly selected 14,340 potential participants from 26 U.S. Department of Veterans Affairs (VA) facilities. A survey contract organization verified/updated addresses from VA administrative data with a commercial address database, then attempted to recruit VHE through 4 mailings, telephone follow-up, and a $10 incentive. We used mixed-effects logistic regressions to test for differences in survey response by patient characteristics. The response rate was 40.2% (n=5,766). Addresses from VA data elicited a higher response rate than addresses from commercial sources (46.9% vs 31.2%, p<.001). Residential addresses elicited a higher response rate than business addresses (43.8% vs 26.2%, p<.001). Compared to non-respondents, respondents were older, less likely to have mental health, drug, or alcohol conditions, and had fewer VA housing and emergency service visits. Collectively, our results indicated a national mailed survey approach is feasible and successful for reaching VA patients who have recently experienced homelessness. These findings offer insight into how health systems can obtain perspectives of socially disadvantaged groups.
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Affiliation(s)
| | - Audrey L Jones
- VA Salt Lake City Health Care System
- University of Utah School of Medicine
| | - Erika L Austin
- Birmingham Veterans Affairs Medical Center
- University of Alabama at Birmingham School of Public Health
| | - Adam J Gordon
- VA Salt Lake City Health Care System
- University of Utah School of Medicine
| | - Lillian Gelberg
- VA Greater Los Angeles Healthcare System
- University of California Los Angeles
| | - Sonya E Gabrielian
- VA Greater Los Angeles Healthcare System
- University of California Los Angeles
| | - Kevin R Riggs
- Birmingham Veterans Affairs Medical Center
- University of Alabama at Birmingham School of Medicine
| | - John R Blosnich
- VA Pittsburgh Healthcare System
- Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Ann Elizabeth Montgomery
- Birmingham Veterans Affairs Medical Center
- University of Alabama at Birmingham School of Public Health
| | | | - Allyson L Varley
- Birmingham Veterans Affairs Medical Center
- University of Alabama at Birmingham School of Medicine
| | | | - Stefan G Kertesz
- Birmingham Veterans Affairs Medical Center
- University of Alabama at Birmingham School of Public Health
- University of Alabama at Birmingham School of Medicine
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Adams CS, Player MS, Berini CR, Perkins S, Fay J, Walker L, Buffalo E, Roach C, Diaz VA. A Telehealth Initiative to Overcome Health Care Barriers for People Experiencing Homelessness. Telemed J E Health 2021; 27:851-858. [PMID: 34297907 DOI: 10.1089/tmj.2021.0127] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
People experiencing homelessness (PEH) encounter barriers to health care, increasing their vulnerability to illness, hospitalization, and death. Telehealth can improve access to health care, but its use in PEH has been insufficiently evaluated. Needs assessment surveys completed by clients at an urban drop-in center for PEH (n = 63) showed mental (58.7%) and physical (52.4%) health challenges were common, as was emergency department (ED) use (75.9%, n = 54). Surveys collected after in-person and telehealth clinical visits showed patient satisfaction was >90% for both visit types (n = 125, 44.0% telehealth and 56.0% in person). Without access to telehealth visits, 29.1% of patients would have gone to the ED and 38.2% would not have gotten care. Providers (n = 93, 69.6% telehealth and 30.4% in person) were more likely to agree/strongly agree they made a positive impact on patients' health through telehealth (92.2%) than in person (71.4%) (p = 0.019). Telehealth is a feasible and potentially cost-effective method to increase access to health care and reduce health outcome disparities in PEH.
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Affiliation(s)
- Cristin S Adams
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Marty S Player
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Carole R Berini
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Suzanne Perkins
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jerome Fay
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Layne Walker
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Echo Buffalo
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chelsea Roach
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Vanessa A Diaz
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Heaslip V, Richer S, Simkhada B, Dogan H, Green S. Use of Technology to Promote Health and Wellbeing of People Who Are Homeless: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6845. [PMID: 34202242 PMCID: PMC8296891 DOI: 10.3390/ijerph18136845] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND People who are homeless experience poorer health outcomes and challenges accessing healthcare contribute to the experienced health inequality. There has been an expansion in using technology to promote health and wellbeing and technology has the potential to enable people who are socially excluded, including those who are homeless, to be able to access health services. However, little research has been undertaken to explore how technology is used to promote health and wellbeing for those who are homeless. This review aims to address the questions: 'what mobile health (mHealth) related technology is used by homeless populations' and 'what is the health impact of mobile technology for homeless populations'? METHODS An integrative review methodology was employed. A systematic search of electronic databases was carried out between 4 January 2021 and 30 April 2021, searching for papers published between 2015 and 2021, which yielded 2113 hits, relevant papers were selected using specified inclusion and exclusion criteria reported using the Preferred Reporting Items for Systematic reviews and Meta-Analysis. The quality assessment of each paper included in the review was undertaken using the Mixed Methods Appraisal Tool. RESULTS Seventeen papers were selected for review and thematic analysis identified four themes: technology ownership, barriers to use, connectivity and health benefits. CONCLUSION It is evident that technology has the potential to support the health and wellbeing of individuals who are homeless; however, there are challenges regarding connectivity to the internet, as well as issues of trust in who has access to personal data and how they are used. Further research is needed to explore the use of health technology with people who are homeless to address these challenges.
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Affiliation(s)
- Vanessa Heaslip
- Department of Nursing Science, Faculty of Health and Social Sciences, Bournemouth University, Poole BH12 5BB, UK; (V.H.); (S.G.)
- Department of Social Work, Stavanger University, 4021 Stavanger, Norway
| | - Stephen Richer
- Department of Nursing Science, Faculty of Health and Social Sciences, Bournemouth University, Poole BH12 5BB, UK; (V.H.); (S.G.)
| | - Bibha Simkhada
- Department of Nursing and Midwifery, University of Huddersfield, Huddersfield HD1 3DH, UK;
| | - Huseyin Dogan
- Department of Computing and Informatics, Faculty of Science and Technology, Bournemouth University, Poole BH12 5BB, UK;
| | - Sue Green
- Department of Nursing Science, Faculty of Health and Social Sciences, Bournemouth University, Poole BH12 5BB, UK; (V.H.); (S.G.)
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Polillo A, Gran-Ruaz S, Sylvestre J, Kerman N. The use of eHealth interventions among persons experiencing homelessness: A systematic review. Digit Health 2021; 7:2055207620987066. [PMID: 33598308 PMCID: PMC7863153 DOI: 10.1177/2055207620987066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022] Open
Abstract
Objective eHealth interventions are being developed to meet the needs of diverse populations. Despite these advancements, little is known about how these interventions are used to improve the health of persons experiencing homelessness. The aim of this systematic review was to examine the feasibility, effectiveness, and experience of eHealth interventions for the homeless population. Methods Following PRISMA guidelines, a systematic search of PsycINFO, PubMed, Web of Science, and Google Scholar was conducted along with forward and backward citation searching to identify relevant articles. Results Eight articles met eligibility criteria. All articles were pilot or feasibility studies that used modalities, including short message service, mobile apps, computers, email, and websites, to deliver the interventions. The accessibility, flexibility, and convenience of the interventions were valued by participants. However, phone retention, limited adaptability, a high level of human involvement, and preference for in-person communication may pose future implementation challenges. Conclusions eHealth interventions are promising digital tools that have the potential to improve access to care and service delivery. eHealth interventions are feasible and usable for persons experiencing homelessness. These interventions may have health benefits by augmenting existing services and if implementation challenges are addressed. Further evaluation of the effectiveness of eHealth interventions is needed before widespread implementation. Those with lived experience should also be engaged in developing and evaluating these interventions.
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Affiliation(s)
- Alexia Polillo
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | | | - John Sylvestre
- Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, Canada
| | - Nick Kerman
- School of Psychology, University of Ottawa, Ottawa, Canada
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Watson T, Schindel TJ, Simpson SH, Hughes CA. Medication adherence in patients with mental illness and recent homelessness: contributing factors and perceptions on mobile technology use. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2020; 28:362-369. [PMID: 32100398 DOI: 10.1111/ijpp.12608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 01/15/2020] [Accepted: 01/28/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The primary objective was to determine medication-taking behaviours and factors influencing adherence in patients with mental illness and recent homelessness. Secondary objectives were to explore patients' perceptions on mobile technology use to support adherence. METHODS A constructivist approach and qualitative description method was used. The sample population consisted of patients with recent homelessness and mental illness affiliated with a community-based outreach programme in Canada. Participants were purposefully selected; semi-structured interviews were conducted to elicit information on medication-taking strategies and mobile technology to support adherence. A standardized questionnaire collected demographic and medical information; the Medication Adherence Rating Scale (MARS) was used to evaluate self-reported adherence. Questionnaire data were analysed using summary descriptive statistics. Interview data were subject to qualitative content analysis. KEY FINDINGS Fifteen participants with a mean age of 44 years were included. The mean MARS score ± standard deviation was 7.3 ± 1.5. Themes arising from the data included patient factors (i.e. insight, attitudes towards medications, coping strategies) and external factors (i.e. therapeutic alliance, family support that impacted adherence) and technology use and health. Eight participants (53%) had access to a mobile phone. There was a moderate interest in the use of mobile technology to support adherence, with cost and technology literacy identified as barriers. CONCLUSION External supports and individual medication management strategies were important in supporting medication adherence in this patient group. Perceived need for mobile technology, in addition to existing supports for adherence, was not high. Challenges accessing and maintaining consistent mobile technology and individual preferences should be considered when developing mobile technology-based interventions.
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Affiliation(s)
- Tyler Watson
- Alberta College of Pharmacy, Edmonton, AB, Canada.,Faculty of Pharmacy & Pharmaceutical Sciences, 3-171 Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada
| | - Theresa J Schindel
- Faculty of Pharmacy & Pharmaceutical Sciences, 3-171 Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada
| | - Scot H Simpson
- Faculty of Pharmacy & Pharmaceutical Sciences, 3-171 Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada
| | - Christine A Hughes
- Faculty of Pharmacy & Pharmaceutical Sciences, 3-171 Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada
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Calvo F, Carbonell X, Johnsen S. Information and communication technologies, e-Health and homelessness: A bibliometric review. COGENT PSYCHOLOGY 2019. [DOI: 10.1080/23311908.2019.1631583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Fran Calvo
- FPE, Universitat de Girona, Girona, Spain
- FPCEE Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | | | - Sarah Johnsen
- Institute for Social Policy, Housing, Equalities Research, Heriot-Watt University, Edinburgh, Scotland
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Raven MC, Kaplan LM, Rosenberg M, Tieu L, Guzman D, Kushel M. Mobile Phone, Computer, and Internet Use Among Older Homeless Adults: Results from the HOPE HOME Cohort Study. JMIR Mhealth Uhealth 2018; 6:e10049. [PMID: 30530464 PMCID: PMC6305882 DOI: 10.2196/10049] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 09/20/2018] [Accepted: 09/25/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The median age of single homeless adults is approximately 50 years. Older homeless adults have poor social support and experience a high prevalence of chronic disease, depression, and substance use disorders. Access to mobile phones and the internet could help lower the barriers to social support, social services, and medical care; however, little is known about access to and use of these by older homeless adults. OBJECTIVE This study aimed to describe the access to and use of mobile phones, computers, and internet among a cohort of 350 homeless adults over the age of 50 years. METHODS We recruited 350 participants who were homeless and older than 50 years in Oakland, California. We interviewed participants at 6-month intervals about their health status, residential history, social support, substance use, depressive symptomology, and activities of daily living (ADLs) using validated tools. We performed clinical assessments of cognitive function. During the 6-month follow-up interview, study staff administered questions about internet and mobile technology use. We assessed participants' comfort with and use of multiple functions associated with these technologies. RESULTS Of the 343 participants alive at the 6-month follow-up, 87.5% (300/343) completed the mobile phone and internet questionnaire. The median age of participants was 57.5 years (interquartile range 54-61). Of these, 74.7% (224/300) were male, and 81.0% (243/300) were black. Approximately one-fourth (24.3%, 73/300) of the participants had cognitive impairment and slightly over one-third (33.6%, 100/300) had impairments in executive function. Most (72.3%, 217/300) participants currently owned or had access to a mobile phone. Of those, most had feature phones, rather than smartphones (89, 32.1%), and did not hold annual contracts (261, 94.2%). Just over half (164, 55%) had ever accessed the internet. Participants used phones and internet to communicate with medical personnel (179, 64.6%), search for housing and employment (85, 30.7%), and to contact their families (228, 82.3%). Those who regained housing were significantly more likely to have mobile phone access (adjusted odds ratio [AOR] 3.81, 95% CI 1.77-8.21). Those with ADL (AOR 0.53, 95% CI 0.31-0.92) and executive function impairment (AOR 0.49; 95% CI 0.28-0.86) were significantly less likely to have mobile phones. Moderate to high risk amphetamine use was associated with reduced access to mobile phones (AOR 0.27, 95% CI 0.10-0.72). CONCLUSIONS Older homeless adults could benefit from portable internet and phone access. However, participants had a lower prevalence of smartphone and internet access than adults aged over 65 years in the general public or low-income adults. Participants faced barriers to mobile phone and internet use, including financial barriers and functional and cognitive impairments. Expanding access to these basic technologies could result in improved outcomes.
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Affiliation(s)
- Maria C Raven
- Department of Emergency Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States
| | - Lauren M Kaplan
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, United States
- Division of General Internal Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, United States
| | - Marina Rosenberg
- School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Lina Tieu
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, United States
- Division of General Internal Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, United States
| | - David Guzman
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, United States
- Division of General Internal Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, United States
| | - Margot Kushel
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, United States
- Division of General Internal Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, United States
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Harris T, Winetrobe H, Rhoades H, Castro CA, Wenzel S. Moving Beyond Housing: Service Implications for Veterans Entering Permanent Supportive Housing. CLINICAL SOCIAL WORK JOURNAL 2018; 46:130-144. [PMID: 30416223 PMCID: PMC6219637 DOI: 10.1007/s10615-018-0648-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
As a result of efforts to end homelessness among U.S. veterans, more former service members are entering permanent supportive housing (PSH). While PSH has been successfully used to house homeless veterans, more research is needed about services beyond housing placement and retention. This study uses the Gelberg-Andersen behavioral model for vulnerable populations to determine associations between predisposing, enabling, and need characteristics and recent service use (i.e., services to satisfy basic needs, occupational development, financial, healthcare, mental health) among unaccompanied homeless veterans (N=126) entering PSH in Los Angeles. Among the significant findings, as indicated using univariable logistic regression models, were veterans who had incarceration histories were more likely to utilize basic needs services, compared to those without incarceration histories. Veterans who received an honorable discharge were more likely to utilize occupational development services, compared to veterans with other discharge statuses. Veterans who had a case manager were more likely to utilize mental health services than those without a case manager, while those who received social security were less likely to utilize mental health services compared to veterans who did not receive social security. Veterans who met criteria for a psychological disability and veterans who met criteria for probable PTSD were more likely to use basic needs services and mental health services than veterans who fell below these thresholds. Clinical implications for social workers including "equal access to services," "enhancing economic stability," "providing safe and affordable housing with trauma-informed services," and "training service social workers to deliver well-informed linkages and services" are discussed.
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Affiliation(s)
- Taylor Harris
- School of Social Work, University of Southern California, 1149 S. Hill St. Suite 360, Los Angeles, CA 90015
| | - Hailey Winetrobe
- School of Social Work, University of Southern California, 1149 S. Hill St. Suite 360, Los Angeles, CA 90015
| | - Harmony Rhoades
- School of Social Work, University of Southern California, 1149 S. Hill St. Suite 360, Los Angeles, CA 90015
| | - Carl Andrew Castro
- School of Social Work, University of Southern California, 1149 S. Hill St. Suite 360, Los Angeles, CA 90015
| | - Suzanne Wenzel
- School of Social Work, University of Southern California, 1149 S. Hill St. Suite 360, Los Angeles, CA 90015
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Eyrich-Garg KM, Moss SL. How Feasible is Multiple Time Point Web-Based Data Collection with Individuals Experiencing Street Homelessness? J Urban Health 2017; 94:64-74. [PMID: 28105585 PMCID: PMC5359169 DOI: 10.1007/s11524-016-0109-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Three barriers investigators often encounter when conducting longitudinal work with homeless or other marginalized populations are difficulty tracking participants, high rates of no-shows for follow-up interviews, and high rates of loss to follow-up. Recent research has shown that homeless populations have substantial access to information technologies, including mobile devices and computers. These technologies have the potential both to make longitudinal data collection with homeless populations easier and to minimize some of these methodological challenges. This pilot study's purpose was to test whether individuals who were homeless and sleeping on the streets-the "street homeless"-would answer questions remotely through a web-based data collection system at regular "follow-up" intervals. We attempted to simulate longitudinal data collection in a condensed time period. Participants (N = 21) completed an in-person baseline interview. Each participant was given a remotely reloadable gift card. Subsequently, weekly for 8 weeks, participants were sent an email with a link to a SurveyMonkey questionnaire. Participants were given 48 h to complete each questionnaire. Data were collected about life on the streets, service use, community inclusion, substance use, and high-risk sexual behaviors. Ten dollars was remotely loaded onto each participant's gift card when they completed the questionnaire within the completion window. A substantial number of participants (67% of the total sample and 86% of the adjusted sample) completed at least seven out of the eight follow-up questionnaires. Most questionnaires were completed at public libraries, but several were completed at other types of locations (social service agencies, places of employment, relative/friend/acquaintance's domiciles, or via mobile phone). Although some of the questions were quite sensitive, very few participants skipped any questions. The only variables associated with questionnaire completion were frequency of computer use and education-both positive associations. This pilot study suggests that collecting longitudinal data online may be feasible with a subpopulation of persons experiencing homelessness. We suspect that participant follow-up rates using web-based data collection methods have the potential to exceed follow-up rates using traditional in-person interviews. If this population of persons experiencing street homelessness can be successful with this method of data collection, perhaps other disenfranchised, difficult-to-track, or difficult-to-reach populations could be followed using web-based data collection methods. Local governments are striving to decrease the "digital divide," providing free or greatly discounted wi-fi connectivity as well as mobile computer lab access to low-income geographic areas. These actions, in combination with increased smart phone ownership, may permit vulnerable populations to connect and communicate with investigators.
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Affiliation(s)
- Karin M Eyrich-Garg
- College of Public Health, School of Social Work, Temple University, Philadelphia, PA, USA.
| | - Shadiya L Moss
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Rhoades H, Wenzel S, Rice E, Winetrobe H, Henwood B. No Digital Divide? Technology Use among Homeless Adults. JOURNAL OF SOCIAL DISTRESS AND THE HOMELESS 2017; 26:73-77. [PMID: 31097900 PMCID: PMC6516785 DOI: 10.1080/10530789.2017.1305140] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Homeless adults experience increased risk of negative health outcomes, and technology-based interventions may provide an opportunity for improving health in this population. However, little is known about homeless adults' technology access and use. Utilizing data from a study of 421 homeless adults moving into PSH, this paper presents descriptive technology findings, and compares results to age-matched general population data. The vast majority (94%) currently owned a cell phone, although there was considerable past 3-month turnover in phones (56%) and phone numbers (55%). More than half currently owned a smartphone, and 86% of those used Android operating systems. Most (85%) used a cell phone daily, 76% used text messaging, and 51% accessed the Internet on their cell phone. One-third reported no past 3-month Internet use. These findings suggest that digital technology may be a feasible means of disseminating health and wellness programs to this at-risk population, though important caveats are discussed.
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Affiliation(s)
- Harmony Rhoades
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 1149 S. Hill St., Suite 360, Los Angeles, CA, 90015. . 213.821.3645
| | - Suzanne Wenzel
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Montgomery Ross Fisher Building, Los Angeles, CA, 90089. . 213.740.0819
| | - Eric Rice
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 1149 S. Hill St., Suite 1400, Los Angeles, CA, 90015. . 213.821.4292
| | - Hailey Winetrobe
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 1149 S. Hill St., Suite 360, Los Angeles, CA, 90015. . 213.821.4030
| | - Benjamin Henwood
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 1149 S. Hill St., Suite 1400, Los Angeles, CA, 90015. . 213.821.6449
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Moczygemba LR, Cox LS, Marks SA, Robinson MA, Goode JVR, Jafari N. Homeless patients' perceptions about using cell phones to manage medications and attend appointments. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2016; 25:220-230. [PMID: 27896909 DOI: 10.1111/ijpp.12321] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 09/23/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objectives of this study were to (1) describe homeless persons' access and use of cell phones and their perceptions about using cell phone alerts to help manage medications and attend health care appointments and (2) identify demographic characteristics, medication use and appointment history and perceptions associated with interest in receiving cell phone alerts to manage medications and appointments. METHODS A cross-sectional survey was conducted in 2013 at a homeless clinic in Virginia. The questionnaire comprised items about cell phone usage, ownership and functions such as text messaging. Participants reported medication use and appointment history, perceptions about cell phone alerts and interest in receiving alerts to manage medications and appointments. Descriptive statistics for all variables are reported. Logistic regression was used to examine predictors of interest in using a cell phone to manage medications and appointments. KEY FINDINGS A total of 290 participants completed the survey; 89% had a cell phone. Seventy-seven percent were interested in appointment reminders, whereas 66%, 60% and 54% were interested in refill reminders, medication taking reminders and medication information messages respectively. Those who believed reminders were helpful were more likely to be interested in medication taking, refill and appointment reminder messages compared to those who did not believe reminders were helpful. A history of running out of medicine and forgetting appointments were predictors of interest in refill and appointment reminders. CONCLUSIONS Mobile technology is a feasible method for communicating medication and appointment information to those experiencing or at risk for homelessness.
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Affiliation(s)
- Leticia R Moczygemba
- Health Outcomes and Pharmacy Practice Division, The University of Texas College of Pharmacy, Austin, TX, USA
| | - Lauren S Cox
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA
| | - Samantha A Marks
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA
| | - Margaret A Robinson
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA
| | - Jean-Venable R Goode
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA
| | - Nellie Jafari
- Allegheny General Hospital, Health-System Pharmacy Administration Resident, Pittsburgh, PA, USA
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Fix GM, Hogan TP, Amante DJ, McInnes DK, Nazi KM, Simon SR. Encouraging Patient Portal Use in the Patient-Centered Medical Home: Three Stakeholder Perspectives. J Med Internet Res 2016; 18:e308. [PMID: 27876686 PMCID: PMC5141333 DOI: 10.2196/jmir.6488] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/23/2016] [Accepted: 10/29/2016] [Indexed: 11/30/2022] Open
Abstract
Background Health care organizations are increasingly offering patients access to their electronic medical record and the ability to communicate with their providers through Web-based patient portals, thus playing a prominent role within the patient-centered medical home (PCMH). However, despite enthusiasm, adoption remains low. Objective We examined factors in the PCMH context that may affect efforts to improve enrollment in a patient portal. Methods Using a sociotechnical approach, we conducted qualitative, semistructured interviews with patients and providers from 3 primary care clinics and with national leaders from across a large integrated health care system. Results We gathered perspectives and analyzed data from 4 patient focus groups and one-on-one interviews with 1 provider from each of 3 primary care clinics and 10 program leaders. We found that leaders were focused on marketing in primary care, whereas patients and providers were often already aware of the portal. In contrast, both patients and providers cited administrative and logistical barriers impeding enrollment. Further, although leadership saw the PCMH as the logical place to focus enrollment efforts, providers and patients were more circumspect and expressed concern about how the patient portal would affect their practice and experience of care. Further, some providers expressed ambivalence about patients using the portal. Despite absence of consensus on how and where to encourage portal adoption, there was wide agreement that promoting enrollment was a worthwhile goal. Conclusions Patients, clinicians, and national leaders agreed that efforts were needed to increase enrollment in the patient portal. Opinions diverged regarding the suitability of the PCMH and, specifically, the primary care clinic for promoting patient portal enrollment. Policymakers should consider diverse stakeholder perspectives in advance of interventions to increase technology adoption.
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Affiliation(s)
- Gemmae M Fix
- Center for Healthcare Organization and Implementation Research, Bedford, MA, United States.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, Bedford, MA, United States.,Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Daniel J Amante
- Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - D Keith McInnes
- Center for Healthcare Organization and Implementation Research, Bedford, MA, United States.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Kim M Nazi
- Veterans Health Administration, Veterans and Consumers Health Informatics Office, Office of Connected Care, US Department of Veterans Affairs, Washington, DC, United States
| | - Steven R Simon
- Center for Healthcare Organization and Implementation Research, Bedford, MA, United States.,Section of General Internal Medicine, VA Boston Healthcare System, Boston, MA, United States
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