Abstract
BackgroundRecent literature has called for humanistic care of patients and for medical schools to begin incorporating humanism into medical education. To assess the attitudes of health-care professionals toward homeless patients and to demonstrate how those attitudes might impact optimal care, we developed and validated a new survey instrument, the Health Professional Attitudes Toward the Homeless Inventory (HPATHI). An instrument that measures providers' attitudes toward the homeless could offer meaningful information for the design and implementation of educational activities that foster more compassionate homeless health care. Our intention was to describe the process of designing and validating the new instrument and to discuss the usefulness of the instrument for assessing the impact of educational experiences that involve working directly with the homeless on the attitudes, interest, and confidence of medical students and other health-care professionals.MethodsThe study consisted of three phases: identifying items for the instrument; pilot testing the initial instrument with a group of 72 third-year medical students; and modifying and administering the instrument in its revised form to 160 health-care professionals and third-year medical students. The instrument was analyzed for reliability and validity throughout the process.ResultsA 19-item version of the HPATHI had good internal consistency with a Cronbach's alpha of 0.88 and a test-retest reliability coefficient of 0.69. The HPATHI showed good concurrent validity, and respondents with more than one year of experience with homeless patients scored significantly higher than did those with less experience. Factor analysis yielded three subscales: Personal Advocacy, Social Advocacy, and Cynicism.ConclusionsThe HPATHI demonstrated strong reliability for the total scale and satisfactory test-retest reliability. Extreme group comparisons suggested that experience with the homeless rather than medical training itself could affect health-care professionals' attitudes toward the homeless. This could have implications for the evaluation of medical school curricula.
Highlights
Recent literature has called for humanistic care of patients and for medical schools to begin incorporating humanism into medical education
The remaining 35 items constituted the first draft of the instrument we named the Healthcare Professionals' Attitude Toward the Homeless Inventory (HPATHI)
The development of the Health Professional Attitudes Toward the Homeless Inventory (HPATHI) has many implications for and applications to future research on homeless health care, its most valuable use may be to assess the attitudes toward homeless persons of medical students, Despite the limited sampling, the research process has demonstrated that the HPATHI is a reliable and valid instrument that has the ability to assess the attitudes of health-care professionals toward the homeless population
Summary
Recent literature has called for humanistic care of patients and for medical schools to begin incorporating humanism into medical education. According to Gelberg and Arangua [2], such estimates provide only a partial picture of the problem: among the U.S population, 14% (26 million people) have been homeless at some time in their lives and 5% (8.5 million people) have been homeless within the past five years. As members of the larger society, these professionals often harbor the same preconceived ideas and biases toward the homeless that the rest of society does Such judgmental attitudes can, and often do, emerge during the provider-patient encounter, limiting the effectiveness of medical treatment of the homeless [9]
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