Documenting attitude changes towards homeless people: comparing two standardised surveys

Abstract

Curricula about the care of homeless patients have been developed to improve stigmatising attitudes towards patients living in poverty. The Attitudes Toward Homelessness Inventory (ATHI) and the Attitudes Towards the Homeless Questionnaire (ATHQ) are both validated instruments developed to assess attitudes towards homeless patients. Although these surveys have similar goals, it is not clear which is superior for documenting attitude changes among doctors in training. Seven cohorts of Year 2 and 3 primary care internal medicine residents at an urban public hospital in the USA completed the ATHI and ATHQ in a confidential manner before and after a 2-week rotation on health care for homeless patients (n = 25). Both the ATHI (P < 0.001) and the ATHQ (P = 0.050) documented changes in residents' attitudes. The magnitude of the pre/post change was 0.63 per item for the ATHI and 0.13 per item for the ATHQ. When the ATHI per-item change was standardised to reflect the change that would be expected if there were 5 response choices instead of 6, the per-item change for the ATHI was 4.1-fold greater than for the ATHQ (P = 0.001). Residents improved their responses to 1 of every 8 statements on the ATHQ and 1 of every 2 statements on the ATHI after the course. Both the ATHI and the ATHQ documented improvement in residents' attitudes after a 2-week homeless medicine curriculum. However, the ATHI was 4 times more responsive to change. These findings suggest that the ATHI is superior for detecting changes in attitudes after an educational intervention.