Abstract
BackgroundPeople who are houseless (also referred to as homeless) perceive high stigma in healthcare settings, and face disproportionate disparities in morbidity and mortality versus people who are housed. Medical students and the training institutions they are a part of play important roles in advocating for the needs of this community. The objective of this study was to understand perceptions of how medical students and institutions can meet needs of the self-identified needs of the houseless community.MethodsBetween February and May 2018, medical students conducted mixed-methods surveys with semi-structured qualitative interview guides at two community-based organizations that serve people who are houseless in Portland, Oregon. Medical students approach guests at both locations to ascertain interest in participating in the study. Qualitative data were analyzed using thematic analysis rooted in an inductive process.ResultsWe enrolled 38 participants in this study. Most participants were male (73.7%), white (78.9%), and had been houseless for over a year at the time of interview (65.8%). Qualitative themes describe care experiences among people with mental health and substance use disorders, and roles for medical students and health-care institutions. Specifically, people who are houseless want medical students to 1) listen to and believe them, 2) work to destigmatize houselessness, 3) engage in diverse clinical experiences, and 4) advocate for change at the institutional level. Participants asked healthcare institutions to use their power to change laws that criminalize substance use and houselessness, and build healthcare systems that take better care of people with addiction and mental health conditions.ConclusionsMedical students, and the institutions they are a part of, should seek to reduce stigma against people who are houseless in medical systems. Additionally, institutions should change their approaches to healthcare delivery and advocacy to better support the health of people who are houseless.
Highlights
People who are houseless perceive high stigma in healthcare settings, and face disproportionate disparities in morbidity and mortality versus people who are housed
We explored ideas related to the experience of participants engaging with healthcare systems before, during and after clinic or hospital visits, which we believed may shape the asks of healthcare providers and systems
We identified two qualitative themes in this work: 1) Care experiences among people with mental health and substance use disorders, and 2) Roles for medical students and health-care institutions
Summary
People who are houseless ( referred to as homeless) perceive high stigma in healthcare settings, and face disproportionate disparities in morbidity and mortality versus people who are housed. People who are houseless are three to four times more likely to die than the average population, and the average life expectancy for a person who is houseless in the United States is between 42 and 52 years, whereas average life expectancy is nearly 35 years longer for the general population [2]. To address these disparities, much research has supported “housing as health”, citing emerging areas of research that have identified links between housing and health outcomes, including decreasing health utilization and improving self-reported mental and physical health [3, 4]. Stigmatizing care can actively harm patients who critically need access to equitable healthcare [14, 15]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
