Abstract
Background. Homeless veterans have complex healthcare needs, but experience many barriers to treatment engagement. While information technologies (IT), especially mobile phones, are used to engage patients in care, little is known about homeless veterans’ IT use. This study examines homeless veterans’ access to and use of IT, attitudes toward health-related IT use, and barriers to IT in the context of homelessness.Methods. Qualitative interviews were conducted with 30 homeless veterans in different housing programs in Boston, MA, ranging from emergency shelters to supportive transitional housing that allow stays of up to 2 years. Interviews were conducted in person, audio recorded and then transcribed. Three researchers coded transcripts. Inductive thematic analysis was used.Results. Most participants (90%) had a mobile phone and were receptive to IT use for health-related communications. A common difficulty communicating with providers was the lack of a stable mailing address. Some participants were using mobile phones to stay in touch with providers. Participants felt mobile-phone calls or text messages could be used to remind patients of appointments, prescription refills, medication taking, and returning for laboratory results. Mobile phone text messaging was seen as convenient, and helped participants stay organized because necessary information was saved in text messages. Some reported concerns about the costs associated with mobile phone use (calls and texting), the potential to be annoyed by too many text messages, and not knowing how to use text messaging.Conclusion. Homeless veterans use IT and welcome its use for health-related purposes. Technology-assisted outreach among this population may lead to improved engagement in care.
Highlights
The health of homeless veterans is among the worst of any vulnerable group, which is concerning given that there are approximately 49,900 homeless veterans on the street (US Department of Housing and Urban Development, 2014) and homeless veterans comprise 11% of the US homeless population (Perl, 2011)
While we sought information on a wide range of technologies, special attention was given to the topic of mobile phones, for two reasons: first, the growing literature indicating that persons who are homeless have access to that technology more than others (McInnes, Li & Hogan, 2013; Eyrich-Garg, 2010; Eyrich-Garg, 2011), and second, the Veterans Affairs (VA)’s development of a patient-provider text messaging system for chronic disease management (McInnes et al, 2014)
Veterans are an important group to study because of the multiple opportunities to engage them in their health care through existing and developing information technologies, such as the My HealtheVet personal health record system used by 1.8 million veterans (Nazi et al, 2013), and the coming national patient-provider text messaging system (McInnes et al, 2014)
Summary
While we sought information on a wide range of technologies (e.g., computer, mobile phone, internet), special attention was given to the topic of mobile phones, for two reasons: first, the growing literature indicating that persons who are homeless have access to that technology more than others (McInnes, Li & Hogan, 2013; Eyrich-Garg, 2010; Eyrich-Garg, 2011), and second, the VA’s development of a patient-provider text messaging system for chronic disease management (McInnes et al, 2014) This system could be a promising means of improving patient-provider communication and addressing chronic health conditions in homeless veterans. Technology-assisted outreach among this population may lead to improved engagement in care
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