Academic journal article Australian Health Review

Complex Health Service Needs for People Who Are Homeless

Academic journal article Australian Health Review

Complex Health Service Needs for People Who Are Homeless

Article excerpt

Background

Homeless people experience difficulties in accessing and utilising health services based in the hospital and community.1 Providers of these services often lack the resources and flexibility to promote a timely response to manage the complex care needs. Trying to understand the health service needs of homeless people poses special challenges to service providers and researchers.2 It is often difficult to identify and engage with people who are homeless, to manage the complex psychosocial health issues and to offer appropriate housing, points of reference and establish social supports.

Homeless people are high users of emergency departments (EDs) and during a 2-year period, over10%ofEDpresentations to a single Australian public hospital were found to be homeless.3 There is an increasing need to understand the complexity of the health service needs for people who are homeless and how the service providers address those multiple care needs. It has also been identified that treating people who are homeless with respect and within a supportive environment is essential for successful engagement and continued access to health services.1,4

Methods

Participants and data collection

Participants comprised 27 service providers and 20 homeless people. The service providers were purposively sampled due to their involvement in the care of homeless people who accessed a public, teaching hospital in Melbourne, Australia. Service providers were selected from key service access points including an inpatient unit specifically for homeless people. Potential homeless participants were identified when they presented to the ED by their accommodation status, as performed by the clerical admission staff. People were identified as homeless if they lived: on the streets, in crisis accommodation, in boarding houses or hostel and unstable private rental accommodation.

A purposive sampling approach was used with participants in an effort to obtain a broad cross-section of people with different demographic profiles.Twomatrices were drawn up that identified each service provider's occupation and length of service as well as each homeless person's age and type of medical condition experienced. These matrices provided information about the characteristics of participants, and which person to target for future interviews. In this way, the types of participants recruited involved a balanced combination of demographic profiles. Interviews were audio recorded and transcribed verbatim by the first author.

The final number of interviews was completed when key themes were saturated. Thus, themes were analysed at the same time as interviews were being conducted. Ethics approval for the conduct of the study was obtained from the institutional review board of the participating hospital, the participating communitybased organisation that deals with the needs of homeless people, and the university.

Two separate interview schedules were developed: one for homeless people and the other for service providers, based on a literature search and work experience of the research team. Two pilot interviews were conducted to ensure interview questions were appropriate and relevant for the purpose of the study.

Coding and analysis

Codes were applied to participants to maintain confidentiality. Service providers were coded as SP1 to SP27 and homeless people were coded as HP1 to HP20. To protect anonymity fictitious names are used throughout the paper when referring to the interviewees.

The five-step thematic framework method, as described by Ritchie and Spencer5 provided a systematic approach to the analysis of qualitative data regarding the interviewees' perceptions and experiences of the healthcare system, and barriers and facilitators encountered.5 The framework method comprises five key steps: familiarisation, identification of a thematic framework, indexing, charting and finally, mapping and interpretation. …

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