Experiencing the COVID-19 pandemic as a homeless person in Chennai, India: An interpretative phenomenological analysis.

Abstract

Persons experiencing homelessness (PEHs) have a higher risk of morbidity and mortality compared to the general population and are highly vulnerable during the coronavirus disease (COVID-19) pandemic. Understanding their experience of the pandemic is important for mitigating the effects of the pandemic. Accordingly, we conducted a qualitative study on their lived experiences during the COVID-19 pandemic. Semi-structured interviews were conducted in nine PEHs from Chennai, India, recruited at food stalls between September 14-25, 2020. Data were analyzed using interpretive phenomenological analysis. The participants shared their experiences of the COVID-19 pandemic, its impact on them, and their coping strategies. All the participants were migrant workers living alone, and were the sole breadwinners of their families. Five group experiential themes emerged relating to the experiences of the participants during the COVID-19 pandemic. Most participants reported significant psychosocial stress, but low suicide risk and robust coping mechanisms. They delayed seeking healthcare for non-COVID-19-related problems. Public hospitals were preferred over private hospitals due to cost constraints and prior experience of discrimination. Upward classism was observed as participants blamed the rich for the spread of COVID-19. Initial assumption that COVID-19 would only affect the rich was also reported. Free government testing and quarantine facilities assuaged their medico-psychosocial needs. Engaging in collective activities was a key stress mitigator. We highlight several important policy implications. Firstly, we underscore the importance of involving social workers to facilitate communication between healthcare providers and patients from vulnerable communities. This engagement can help minimize discrimination and promote equitable access to healthcare. Secondly, we emphasize the need for effective public health communication. Specifically, there is a need to address and alleviate concerns about the transmission of COVID-19 within hospital premises. Lastly, the research suggests that government initiatives aimed at fostering community participation should persist both during and after the pandemic.