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No Digital Divide? Technology Use among Homeless Adults
Abstract
Homeless adults experience increased risk of negative health outcomes, and technology-based interventions may provide an opportunity for improving health in this population. However, little is known about homeless adults’ technology access and use. Utilizing data from a study of 421 homeless adults moving into PSH, this paper presents descriptive technology findings, and compares results to age-matched general population data. The vast majority (94%) currently owned a cell phone, although there was considerable past 3-month turnover in phones (56%) and phone numbers (55%). More than half currently owned a smartphone, and 86% of those used Android operating systems. Most (85%) used a cell phone daily, 76% used text messaging, and 51% accessed the Internet on their cell phone. One-third reported no past 3-month Internet use. These findings suggest that digital technology may be a feasible means of disseminating health and wellness programs to this at-risk population, though important caveats are discussed.
... A mobile phone was seen as a valued asset, enabling homeless neighbors to keep in touch with family and friends, contact emergency and supporting services, and call for medical assistance. Similar research was conducted by Rhoades et al. (2017) in the Los Angeles and Long Beach areas in the U. S. from August 2014 to October 2015. Of the interviewed 421 homeless adults, 94% owned mobile phones at the time of the interview, while 56% owned a smartphone. ...
... Overall, daily internet use was reported by 39% of the study participants. Precisely because a large percentage of homeless neighbors have access to mobile phones, smartphones, and other digital devices (Humphry, 2014;Rhoades et al., 2017), DSIs supporting their requirements are needed (Rhoades et al., 2017). One example of a DSI is the information app Ask Izzy, which enables users to easily find important information about existing homeless aid support services (Burrows et al., 2019). ...
... Overall, daily internet use was reported by 39% of the study participants. Precisely because a large percentage of homeless neighbors have access to mobile phones, smartphones, and other digital devices (Humphry, 2014;Rhoades et al., 2017), DSIs supporting their requirements are needed (Rhoades et al., 2017). One example of a DSI is the information app Ask Izzy, which enables users to easily find important information about existing homeless aid support services (Burrows et al., 2019). ...
Homelessness is a major global challenge. It can have a negative impact on people’s social, physical, and psychological well-being, which makes those experiencing homelessness a particularly vulnerable group in society. Digital social innovations (DSIs) try to address social issues such as homelessness with the help of digital solutions. Since homeless neighbors are vulnerable, DSIs need to be designed and developed to fit their values and needs. Prior research has contributed design principles (DPs) to be acted upon for the creation of value-sensitive DSIs. However, these DPs have only been abstracted based on one action design research project, implicating a low projectability level. By analyzing these DPs’ fitness within currently available DSI applications to support homeless neighbors, we further codify, generalize, and refine them, inducing higher projectability. Researchers and practitioners can draw on our refined DPs to better understand value-sensitive DSI projects and simultaneously use this knowledge for instantiations.
... This ranged from 53% [39] to 100% [23]. The largest study (n = 421) identified that 94% of participants owned a mobile phone [36] and across the 17 studies included in the review (n = 1507), 80% (n = 1205) owned a mobile phone. Male and female phone ownership was very similar across all studies. ...
... Raven et al. [34] found similar differences with 72.3% of participants with a mobile phone; only half (32.1%) of those who owned phones had smartphone functionality. Lastly, Jennings et al. [31] found a drop off between basic phone and smartphone from 93 to 84%, respectively, whilst Rhoades et al. [36] identified, overall, 94% (mobile ownership) but with only 51% owning a smartphone. Although some studies simply reported ownership of a phone without identifying phone functionality, the majority seemed to concur that a high percentage of the homeless population owned a phone and about a half to three quarters of these had smart functions. ...
... Although some studies simply reported ownership of a phone without identifying phone functionality, the majority seemed to concur that a high percentage of the homeless population owned a phone and about a half to three quarters of these had smart functions. However, the way homeless participants used their phones varied [31,33,34,36]. Unsurprisingly, the main usage of mobile phones was to make calls (100%) and send texts (ranging between 72-93%) and general internet access (ranging from 22-84%). ...
Background:
People who are homeless experience poorer health outcomes and challenges accessing healthcare contribute to the experienced health inequality. There has been an expansion in using technology to promote health and wellbeing and technology has the potential to enable people who are socially excluded, including those who are homeless, to be able to access health services. However, little research has been undertaken to explore how technology is used to promote health and wellbeing for those who are homeless. This review aims to address the questions: 'what mobile health (mHealth) related technology is used by homeless populations' and 'what is the health impact of mobile technology for homeless populations'?
Methods:
An integrative review methodology was employed. A systematic search of electronic databases was carried out between 4 January 2021 and 30 April 2021, searching for papers published between 2015 and 2021, which yielded 2113 hits, relevant papers were selected using specified inclusion and exclusion criteria reported using the Preferred Reporting Items for Systematic reviews and Meta-Analysis. The quality assessment of each paper included in the review was undertaken using the Mixed Methods Appraisal Tool.
Results:
Seventeen papers were selected for review and thematic analysis identified four themes: technology ownership, barriers to use, connectivity and health benefits.
Conclusion:
It is evident that technology has the potential to support the health and wellbeing of individuals who are homeless; however, there are challenges regarding connectivity to the internet, as well as issues of trust in who has access to personal data and how they are used. Further research is needed to explore the use of health technology with people who are homeless to address these challenges.
... In 2013, McInnes et al [28], in a systematic review, found that mobile phone ownership ranged from 44% to 62%, computer ownership from 24% to 40%, computer access and use from 47% to 55%, and internet use from 19% to 84% in this population. In 2017, Rhoades et al [29] found that the vast majority of homeless individuals (94%) owned a cell phone, more than half owned a smartphone, and 51% accessed the internet on their cell phones. One-third of the participants reported no internet use in the past 3 months [29]. ...
... In 2017, Rhoades et al [29] found that the vast majority of homeless individuals (94%) owned a cell phone, more than half owned a smartphone, and 51% accessed the internet on their cell phones. One-third of the participants reported no internet use in the past 3 months [29]. In 2021, Thurman et al [30] analyzed feasibility studies related to mHealth interventions among people experiencing homelessness and found that 52% of the participants (n=31) reported having a personal cell phone, and of those with phones at baseline, the majority (87%) reported that their phones were capable of SMS text messaging, picture messaging, and mobile app use. ...
Background
In recent years, there has been an increase in the use of digital technology for personal health and well-being. Previous research has revealed that these technologies might provide vulnerable populations, including those who are homeless, better access to health services and thus a greater chance of more personalized care.
Objective
However, little is known about the relationship between technology and health among people experiencing homelessness in Central and Eastern Europe. This study is part of a series of studies by the Digital Health Research Group at Semmelweis University (Budapest, Hungary) in cooperation with the Hungarian Charity Service of the Order of Malta; it aims to assess the existing technological resources available for the homeless population and their health-related internet use characteristics to set the ground for potential health policy interventions, enabling better access to health services by strengthening the digital components of the existing health care system.
Methods
Between April 19, 2021, and August 11, 2021, a total of 662 people from 28 institutions providing social services for people experiencing homelessness in Budapest, Hungary, were surveyed about their access to digital tools and internet use patterns. For selected questions, the responses of a representative sample of the Hungarian population were used for comparison as the reference group. Chi-square tests and logistic regression analyses were performed to identify variables affecting internet use for health-related reasons.
Results
The results demonstrated a considerable level of internet use in the homeless population; 52.9% (350/662) of the respondents used the internet frequently compared with 81.3% (1220/1500) of the respondents in the reference group. Among the homeless group, 69.6% (461/662) of the respondents reported mobile phone ownership, and 39.9% (264/662) of the respondents added that it had a smartphone function. Moreover, 11.2% (70/662) of the respondents had already used a health mobile app, and 34.6% (229/662) of the respondents had used the internet for medical purposes. On the basis of these characteristics, we were able to identify a broadly defined, digitally engaged group among people experiencing homelessness (129/662, 19.5%). This subpopulation was inclined to benefit from digitalization related to their personal health. Multivariate analysis demonstrated that internet use for health reasons was more significant for younger respondents, women, those with higher levels of education, and those with no chronic conditions.
Conclusions
Although compared with the general population, health-related internet use statistics are lower, our results show that the idea of involving homeless populations in the digital health ecosystem is viable, especially if barriers to access are systematically reduced. The results show that digital health services have great promise as another tool in the hands of community shelters for keeping homeless populations well ingrained in the social infrastructure as well as for disease prevention purposes.
... Researchers have found that citizens use mobile devices, mobile apps, and mobile digital health devices to support their healthcare and have created their own digital health ecosystems. [6][7][8][9][10][11] Despite the potential positive and transformative impact of digital health, the systematic integration of these citizen purchased and personally controlled devices remains to be explored within the greater healthcare system. To date, the link between the formal healthcare technology infrastructure and the informal citizen controlled personal health technology ecosystems has remained to be fully explored and continues to remain siloed. ...
... Eighty six percent of the homeless owned a cell or mobile phone with an Android operating system, and 85% used their mobile phone daily for text messaging and Internet access. [7][8][9] The research suggests a significant potential for tapping the digital ecosystems of the homeless population for accessing healthcare services and addressing equity and accessibility issues. Moreover, citizens from around the world are increasingly becoming accustomed to working with technologies and adopting consumer technologies that make their lives easier such as robotic vacuum cleaners and automated voice assistants. ...
The pandemic has accelerated the move to virtual care. This has included remote monitoring and implementation of technologies that allow for patient care at home and assisted living for ageing in place. Technologies are available to help consumers to maintain their health and wellness. However, challenges associated with implementing virtual care remain. In this article, we describe some of these challenges, along with the need to develop new models for promoting effective and sustainable virtual care. This includes the need for integration of institutional efforts (eg, government and hospital) with emerging access to commercially available home technologies supplied to patients and citizens. The authors argue that consideration of a personal digital ecosystem and its relation to institutional digital health ecosystems is critical. The authors suggest virtual care be considered in the combined context of the person and healthcare system. Implications for future research directions for virtual care are discussed.
... 64 % (Smartphone) angegeben (Humphry 2014b). Zu einem ähnlichen Ergebnis kamen Rhoades et al. (2017) bei einer Befragung von über 400 wohnungslosen Erwachsenen über 39 Jahren in Los Angeles und Long Beach. Auch hier besaßen 94 % der Befragten zum Erhebungszeitpunkt ein Mobiltelefon, mehr als die Hälfte davon ein Smartphone. ...
... Über beide Voraussetzungen verfügen Wohnungslose meist nicht (Studeny 2020). So schließen sie nur sehr selten feste Telefonverträge ab und wechseln häufig ihre Geräte sowie Telefonnummern (Rhoades et al. 2017). Andere Faktoren führen ebenso zu Diskontinuitäten im Zugang zu digitalen Technologien für Wohnungslose und gefährden deren dauerhafte Erreichbarkeit über Mobiltelefone. ...
Der Band skizziert und diskutiert den digitalen Wandel in der Sozialwirtschaft. Internationale Beiträge aus der Praxis und Wissenschaft Sozialer Arbeit sowie dem Gesundheits- und Pflegebereich beschreiben, wie digitale Technologien den Alltag von Beschäftigten und deren Klient*innen prägen (werden). Enorme Chancen und gleichzeitig erhebliche Risiken dieses Wandels werden dabei debattiert, etwa mit Blick auf die Arbeitswelten, Professionen, soziale Teilhabe und daraus abzuleitende ethische Implikationen.
Den Leser*innen bieten sich Praxiseinblicke, wissenschaftliche Analysen, Handlungsempfehlungen und Reflexionspotentiale, um soziale Dienstleistungsarbeit im Heute und Morgen (mit) zu gestalten.
... Healthy ageing and longevity are related to how individuals and groups choose, adapt and co-/selfmanage in the face of social, physical and emotional challenges (Huber et al., 2011). The combination of longevity and digitization of health services have raised concerns about evolving digital divides (World Health Organization, 2016;Friemel, 2016;Hall et al., 2015;Rhoades et al., 2017) and digital exclusion in later life (Matthews, Nazroo and Marshall, 2018;Tennant et al., 2015;Silver, 2015;Kickbusch, 2001). Digital proficiency in online health information activities demands a minimum of socio-material resources (e.g. ...
... The combination of longevity and digitisation of health services has raised concerns about evolving digital divides (World Health Organization, 2017a;Friemel, 2016;Hall et al., 2015;Rhoades et al., 2017) and digital exclusion in later life (MatthewsNazroo and Marshall, 2019;Tennant et al., 2015;Kickbusch, 2001;Silver, 2015). Responding to this concern can be challenging: "Despite the significance of this phenomenon, the information systems (IS) literature lacks a comprehensive consideration and explanation of technology acceptance in general www.ejkm.com ...
ORCID Tobba Therkildsen Sudmann https://orcid.org/0000-0002-7482-9984 ORCID Eva Haukeland Fredriksen https://orcid.org/0000-0001-5609-8308 ORCID Ingebjørg Traeland Børsheim https://orcid.org/0000-0003-4706-7790 ORCID Ilona Heldal https://orcid.org/ Abstract: In today's society, all citizens who need digital information to manage their everyday life must be able to access it and trust it. They should have enough knowledge to use information and communication technologies (ICTs) and online health information (OHI) in an intended and purposeful way. The broader aim of this paper is to present and discuss health knowledge management (KM) from senior users of the online health information point of view. The theoretical point of departure is based on an understanding of health, knowledge and the Internet as social practices. This paper investigates e-Health literacy (eHL) and KM in health amongst seniors aged 65-90. It presents a case study on how they access, apprais, share and apply OHI in comparison to the way they use face-to-face health-encounters. Data comes from 17 open-ended interviews. E-HL and KM concepts are used to analyse and describe online behaviour and knowledge management in health as an interplay between individual and social factors. The results show how participants engage in self-and co-management of their own or others' health and illustrate how they get or receive help to understand OHI. By examining how they use ICT and do (not) trust OHI regarding "serious cases," this paper provides critical insight into ways seniors acquire information and how they appraise, understand or trust in it. Their information-seeking activities are performed mainly in private settings, seldom with professionals. They have lower levels of trust in their own, individual appraisal skills, compared to collective searches and discussions. Norwegian seniors are cool and pragmatic, and emphatic on the "when needs must, see your GP!". By examining differences in ICT use, knowledge acquisition and support given or received, the results pinpoint how providers must affirm seniors' ICT use and individual and collective online health behaviour as assets for healthy ageing. A potential barrier for citizens' use of OHI and health technology is the built-in understanding of health as an individual capacity and ICT use as an individual activity, compared to a contemporary understanding of health and the Internet as social practices and collective resources. Designers of health technologies and OHI should critically consider built-in understandings of content and users to enhance accessibility and value for citizens of all ages.
... Although estimates vary between studies, 11 new research suggests that the digital divide between people who are homeless and the general population is narrowing. 12 Further, technology access is consistent across the lifespan, with similar rates being found among homeless youth, adults, and older adults. [12][13][14][15][16] Persons experiencing homelessness use technology and the internet to stay connected with family and friends, search for housing and employment, and contact employers and case workers. ...
... 12 Further, technology access is consistent across the lifespan, with similar rates being found among homeless youth, adults, and older adults. [12][13][14][15][16] Persons experiencing homelessness use technology and the internet to stay connected with family and friends, search for housing and employment, and contact employers and case workers. 11,[17][18][19] Further, persons experiencing homelessness are open and willing to use technology for health-related purposes. ...
Objective
eHealth interventions are being developed to meet the needs of diverse populations. Despite these advancements, little is known about how these interventions are used to improve the health of persons experiencing homelessness. The aim of this systematic review was to examine the feasibility, effectiveness, and experience of eHealth interventions for the homeless population.
Methods
Following PRISMA guidelines, a systematic search of PsycINFO, PubMed, Web of Science, and Google Scholar was conducted along with forward and backward citation searching to identify relevant articles.
Results
Eight articles met eligibility criteria. All articles were pilot or feasibility studies that used modalities, including short message service, mobile apps, computers, email, and websites, to deliver the interventions. The accessibility, flexibility, and convenience of the interventions were valued by participants. However, phone retention, limited adaptability, a high level of human involvement, and preference for in-person communication may pose future implementation challenges.
Conclusions
eHealth interventions are promising digital tools that have the potential to improve access to care and service delivery. eHealth interventions are feasible and usable for persons experiencing homelessness. These interventions may have health benefits by augmenting existing services and if implementation challenges are addressed. Further evaluation of the effectiveness of eHealth interventions is needed before widespread implementation. Those with lived experience should also be engaged in developing and evaluating these interventions.
... On this note, it is worth mentioning that among our participants, 68.3% of homeless participants still owned a mobile phone. These results are in line with a range of studies on rates of mobile phone use among people in different forms of precarious housing: one US study found that 94% of the respondents in permanent supportive housing possessed a phone, 25 whereas studies among non-sheltered people reported that between 44% and 62% possessed a mobile phone. 26 27 So far, studies with digital interventions among homeless people in general only exist with small sample sizes and in the form of pilot studies, and not specifically for homeless people with mental illness, although prevalence among homeless people is high. ...
Few studies and almost exclusively from the USA have recently investigated mobile phone and computer use among users of psychiatric services, which is of high relevance regarding the increasing development of digital health applications and services.
Objective, design and setting
In a cross-sectional patient survey, we examined (a) rates and purposes of mobile phone, computer, internet and social media use, and (b) the role of social and clinical predictors on rates of utilisation among psychiatric inpatients in Berlin, Germany.
Participants and results
Descriptive analyses showed that among 496 participants, 84.9% owned a mobile phone and 59.3% a smartphone. Among 493 participants, 68.4% used a computer regularly. Multivariate logistic regression models revealed being homeless, diagnosis of a psychotic illness, being of older age and a lower level of education to be significant predictors for not owning a mobile phone, not using a computer regularly or having a social media account, respectively.
Conclusions
Users of psychiatric services may have access to mobile phones and computers, although rates are lower than in the general population. However, key barriers that need to be addressed regarding the development of and engagement with digital health interventions are factors of social exclusion like marginalised housing as well as clinical aspects like psychotic illness.
... In the U.S., 96% of adults own a cellphone, 25 and 81% of them commonly use text messages to communicate. 26 Text-based chatbots could serve as an inexpensive and scalable mechanism to reach a broad populationacross the age spectrum, among racial and ethnic minorities, rural populations, 27 people who are unhoused, 28 people with low socioeconomic status as well as people with limited English proficiency. 29 The chatbot system is also easy to be implemented on diverse online platforms, including social media, mobile phone apps, and websites, with the potential to be available in multiple languages. ...
Objective:
Our goal is to establish the feasibility of using an artificially intelligent chatbot in diverse healthcare settings to promote COVID-19 vaccination.
Methods:
We designed an artificially intelligent chatbot deployed via short message services and web-based platforms. Guided by communication theories, we developed persuasive messages to respond to users' COVID-19-related questions and encourage vaccination. We implemented the system in healthcare settings in the U.S. between April 2021 and March 2022 and logged the number of users, topics discussed, and information on system accuracy in matching responses to user intents. We regularly reviewed queries and reclassified responses to better match responses to query intents as COVID-19 events evolved.
Results:
A total of 2479 users engaged with the system, exchanging 3994 COVID-19 relevant messages. The most popular queries to the system were about boosters and where to get a vaccine. The system's accuracy rate in matching responses to user queries ranged from 54% to 91.1%. Accuracy lagged when new information related to COVID emerged, such as that related to the Delta variant. Accuracy increased when we added new content to the system.
Conclusions:
It is feasible and potentially valuable to create chatbot systems using AI to facilitate access to current, accurate, complete, and persuasive information on infectious diseases. Such a system can be adapted to use with patients and populations needing detailed information and motivation to act in support of their health.
... and internet use (23.8-51.1%) (Raven et al., 2018;Rhoades et al., 2017). For instance, our team's previous work identified that 71.9% of adults experiencing homelessness own either a cell phone or smartphone (Businelle et al., 2015;Reitzel et al., 2017). ...
Mobile technologies can deliver physical and mental health services for recently incarcerated homeless adults (RIHAs). The purpose of this study was to examine the prevalence and perceived utility of mobile technology to support health behavior change among RIHAs. Participants (n = 324) from an ongoing clinical trial at a homeless shelter in Texas were included in the current descriptive cross-sectional analyses. Over one fourth (28.4%) of participants had an active cell phone. Nearly 90 percent (88.6%) of participants reported at least weekly use of the internet, 77 percent used email (77.2%), and more than half used Facebook (55.2%). Although most participants (82.8%) believed that smartphone applications (apps) could help change their behavior, only a quarter (25.1%) had used an app for this purpose. These findings highlight the potential for smartphone-based intervention technologies, and future studies should examine whether smartphone apps that address mental health and health behaviors are feasible among RIHAs.
... It is common that many people experiencing homelessness do not have smartphones. 29,30 For the native mobile applications, the patients are provided with the option to login using their phone's native biometric authentication (fingerprints for Android devices and TouchID/FaceID for iOS devices). ...
... Our experiences highlight broader recommendations for social scientists recruiting hard-to-reach and vulnerable populations (e.g., lower-income older adults, persons experiencing homelessness, formerly incarcerated individuals, and youth aging out of the foster care system) in the context of socially disruptive events like pandemics or natural or manmade disasters, which lead to breakdowns of infrastructure and social systems. Common characteristics such as the digital divide (Blomberg et al., 2021;Rhoades et al., 2017), limited mobility (Fields et al., 2019;Hustlage et al., 2022), and fewer social networks (Watson et al., 2016), as well as a desire to eschew traditional social service systems (Cronley, 2020), have always posed challenges to participant recruitment and engagement with vulnerable populations, but COVID-19 exacerbated the challenges. Vulnerable populations were less accessible via electronic communications, while also experiencing disparately poor health outcomes due to COVID-19 (Connolly et al., 2022). ...
PurposeIn this brief report, we highlight the challenges that we experienced while attempting to conduct primary data collection with intimate partner violence (IPV) survivors living in an IPV emergency shelter throughout the prolonged COVID-19 pandemic and our strategies to overcome them.Method
In the summer of 2021, we began collecting data on a study investigating maternal-child bonding while living in IPV emergency shelters. We proposed a 14-day electronic daily diary methodology with follow-up semi-structured interview. The purpose of the study was to understand what factors affect maternal-child bonding to support survivors’ relationships with their children while living in an emergency shelter.ResultsWe encountered two global obstacles to study implementation: the Institutional Review Board (IRB) pausing in-person data collection and low IPV shelter utilization. In what we term methodological resilience, we engaged in innovative and flexible team work to overcome these barriers. Specific strategies centered on creating an entirely remote data collection process and expanding our geographic area and participant eligibility criteria.Conclusions
Implications for researchers include greater communication with IRB offices, planning for multi-state recruitment, triangulated recruitment methods, reminder texts for participants and incremental incentives to ensure continued engagement with the study.
... Social health inequalities may contribute to a digital gap, as next to older age and being male, lower level of education and lower annual income are associated with a lower likelihood of owning a smartphone [27]. By contrast, Rhoades et al [28] showed that more than half of the homeless population owns smartphones and uses the internet daily. Moreover, Reinwand et al [29] reported that unemployed persons in a randomized controlled study used the intervention more frequently than employed persons, probably because it was time consuming and they had more time to use it. ...
Background
Long-term unemployed have poor nutritional and physical activity statuses, and, therefore, special health promotion needs. Particularly in rural areas, however, they often do not have access to health promotion service. Thus, new promising strategies to improve the health of long-term unemployed are needed. Hence, a digital health intervention to promote nutritional and physical health behaviors was conceived, and the effectiveness of the intervention in combination with face-to-face sessions will be evaluated in a randomized controlled trial.
Objective
The aim of this study is to elucidate the effectiveness of a mobile digital health intervention to promote the nutritional and physical activity behaviors of long-term unemployed in the rural areas of Germany.
Methods
The 9-week intervention aims to promote nutritional or physical activity behavior by improving drinking habits, increasing the consumption of fruits, vegetables, and whole grains, increasing daily step count, strengthening muscles, and improving endurance. The intervention design is based on the transtheoretical model and is implemented in a mobile app using the MobileCoach open-source platform. The effectiveness of the intervention will be elucidated by a 9-week, 2-armed, parallel-designed trial. Therefore, long-term unemployed will be recruited by employees of the German social sector institutions and randomized either to receive information brochures; the digital intervention in the form of a mobile app; and 3 face-to-face sessions regarding technical support, healthy eating, and physical activity (n=100) or to receive a control treatment consisting of solely the hand over of information brochures (n=100). The effectiveness of the intervention will be assessed using questionnaires at baseline, after 9 weeks in face-to-face appointments, and after a 3-month follow-up period by postal contact. The use of the mobile app will be monitored, and qualitative interviews or focus groups with the participants will be conducted. Incentives of €50 (US $49.7) will be paid to the participants and are tied to the completion of the questionnaires and not to the use of the mobile app or progress in the intervention.
Results
The effectiveness of the intervention in promoting the nutritional and physical activity behaviors of long-term unemployed participants will be elucidated. The adherence of the participants to and the acceptance and usability of the mobile device app will be evaluated. Recruitment started in March 2022, and the final publication of the results is expected in the first half of 2023.
Conclusions
Positive health-related changes made by the intervention would display the potency of digital health interventions to promote nutritional and physical activity behaviors among long-term unemployed in the rural areas of Germany, which would also contribute to an improved health status of the German population in general.
Trial Registration
German Clinical Trials Register DRKS00024805; https://www.drks.de/DRKS00024805
International Registered Report Identifier (IRRID)
PRR1-10.2196/40321
... Multiple problems faced by PEH result from their precarious socioeconomic situation which also affects the ability to maintain a digital device and to have access to internetbased services (13). Digital inequalities result in further social exclusion as it limits career opportunities, represents a barrier to maintaining social and service-related contacts, causes financial hardship and are a determinant of health (14)(15)(16). At the same time, digitalization can be an opportunity for better social inclusion (14,17). ...
Introduction
People experiencing homelessness (PEH) are disproportionally affected by the COVID-19 pandemic. The realities of their daily lives have been given little consideration in the pandemic response. They are not represented in existing health information campaigns, and many are structurally excluded from digital information. The project aimed to develop inclusive COVID-19-information material to strengthen infection prevention and control of PEH.
Material and methods
In a participatory process, PEH were involved in the planning, production, and evaluation of poster and video information material on COVID-19. Various stakeholders were consulted for external supervision. Service providers all over Germany were informed about the material that could be ordered free of charge. For the evaluation, semi-structured interviews with homeless service providers and PEH were conducted, and the online views of the videos were measured.
Results
Sixteen PEH participated actively in the project. Two COVID-19-information videos were launched in 5 languages in February 2021. Posters promoting vaccination against COVID-19 were produced in 9 languages. As of May 2022, the videos have been viewed more than 2,000 times. A total of 163 service providers for PEH and public institutions received the posters, thereof 72 upon request. Twelve service providers and 8 PEH participated in the evaluation. They pointed out the lack of targeted information material for PEH. The consideration of the concerns and the diverse representation of PEH was perceived as particularly important. Most of the service providers were unable to show the videos due to technical and spatial limitations. Digital challenges for PEH, like the lack of and maintenance of a smart phone, became apparent.
Conclusion
The cooperation of research, practice and the community were key factors for the realization of this project. Strong links to the community and the involvement of relevant stakeholders are indispensable when working with PEH. Exclusion from digital information is an increasingly important component of the structural marginalization of PEH. Digital inclusion for PEH and service providers can help to counteract social and health inequalities. The lessons learned through this project can contribute to strengthen participation of PEH and to consider their perspectives in future health communication strategies.
... However, a recent national survey found that more than 90% of US adults own a smartphone, with the numbers increasing among all demographic groups. Black, Hispanic, and less educated adults have only a few percentage points lower smartphone adoption than average (28,29). ...
Objective:
Many patients with rheumatoid arthritis (RA) have difficulty finding clinicians to treat them because of workforce shortages. We developed an app to address this problem by improving care efficiency. The app collects patient-reported outcomes (PROs) and can be used to inform visit timing, potentially reducing the volume of low-value visits. We describe the development process, intervention design, and planned study for testing the app.
Methods:
We employed user-centered design, interviewing patients and clinicians, to develop the app. To improve visit efficiency, symptom tracking logic alerts clinicians to PRO trends: worsening PROs generate alerts suggesting an earlier visit, and stable or improving PROs generate notifications that scheduled visits could be delayed. An interrupted time-series analysis with a nonrandomized control population will allow assessment of the impact of the app on visit frequency.
Results:
Patient interviews identified several of the following needs for effective app and intervention design: the importance of a simple user interface facilitating rapid answering of PROs, the availability of condensed summary information with links to more in-depth answers to common questions regarding RA, and the need for clinicians to discuss the PRO data during visits with patients. Clinician interviews identified the following user needs: PRO data must be easy to view and use during the clinical workflow, and there should be reduced interval visits when PROs are trending worse. Some clinicians believed visits could be delayed for patients with stable PROs, whereas others raised concerns.
Conclusion:
PRO apps may improve care efficiency in rheumatology. Formal evaluation of an integrated PRO RA app is forthcoming.
... Furthermore, given that the women were able to access cellphones during this study and one participant described the potential for text message reminders, mobile phone reminders for women who are unstably housed (e.g., for appointments, medication pick-ups, and adherence) may be a potential method of intervention. Other studies have shown that homeless populations have cellphone use that matches the general population, suggesting this as a potential platform for SMS or other mobile interventions that are tailored for the population [27]. ...
Despite advances in biomedical treatments, women living with HIV (WLH) who experience homelessness and housing instability suffer suboptimal HIV outcomes, even when linked to treatment. The purpose of this study was to explore experiences of housing instability among WLH and to understand its role in their ability to adhere to antiretroviral medication and remain retained in care. Sixteen women who were linked to Ryan White Program HIV care in South Florida participated in in-depth interviews. The findings focus around four larger themes: difficulty storing medication, privacy- and stigma-related issues, inconsistent access to medication and health care disruptions, and competing and unmet physical and mental health needs. Findings underscore the importance of strategies that are responsive to the disruption of routines and are sensitive to privacy issues in shared dwelling spaces; the proactive inquiry of behavioral and environmental considerations when prescribing antiretroviral medication; and the identification and treatment of comorbid conditions. This study provides evidence for strategies to facilitate self-management and improve modifiable system realities to augment larger-level policy and funding shifts that are critically needed to end the epidemic among vulnerable populations living with HIV.
... Historically, Veterans in HUD-VASH or experiencing homelessness encountered barriers to engaging in virtual care which included limited access to a phone, computer, or stable internet. Cell phone ownership is common among homeless Americans, but smartphone ownership, which can facilitate video encounters, is less common 21,22 . ...
The US Department of Housing and Urban Development-Department of Veterans Affairs (VA) Supportive Housing (HUD-VASH) program provides Veterans with a subsidy for rent and case management. In response to the Coronavirus 2019 pandemic, many states enacted stay-at-home orders that may have limited access to case managers. Therefore, we examined the association between statewide stay-at-home orders and utilization of HUD-VASH case management. We linked data on whether a state implemented a statewide stay-at-home order between March 1, 2020 and April 30, 2020 with VA medical records. Analysis time was centered on the date of a state’s stay-at-home order (exposed states). For Veterans in states without a stay-at home-order (unexposed states), we used the average date exposed states implemented an order (March 27, 2020). We used a difference-in-difference design and adjusted linear regression models to compare total, in-person, telephone, and video case management encounters per Veteran in the 60 days after a stay-at-home order relative to the prior year. There was no significant difference in utilization of case management between Veterans who lived in states that did and did not issue a stay-at-home order. Across all states and in the 60 days after the index date relative to the prior year, Veterans had more total, telephone and video, and fewer in-person encounters. Statewide stay-at-home orders did not differentially affect utilization of case management. Virtual case management in HUD-VASH can increase program reach; however, the effect of virtual case management on outcomes such as quality of life and Veteran satisfaction is unknown.
... However, technology enabled studies conducted with individuals experiencing homelessness are few, in part because of concerns about their feasibility. Recent research has shown that mobile phones are commonly used by people experiencing homelessness (35,36) and that these devices are used for a broad range of purposes (35,(37)(38)(39)(40)(41). This has led to increasing interest in studies that explore how to deliver services via smartphones and meet the differing needs of this population (18). ...
Objective:
While Veteran homelessness has steadily declined over the last decade, those who continue to be unhoused have complex health and social concerns. Housing instability interferes with access to healthcare, social services, and treatment adherence. Preventing unwanted housing transitions is a public health priority. This study is the first phase of a larger research agenda that aims to test the acceptability and feasibility of smartphone-enabled data collection with veterans experiencing homelessness. In preparation for the development of the smartphone data collection application, we utilized ethnographic methods guided by user-centered design principles to inform survey content, approach to recruitment and enrollment, and design decisions.
Methods:
We used a case study design, selecting a small sample (n = 10) of veterans representing a range of homelessness experiences based on risk and length of time. Participants were interviewed up to 14 times over a 4-week period, using a combination of qualitative methods. Additionally, 2 focus group discussions were conducted. Interviews were audio-recorded and transcribed. Data were synthesized and triangulated through use of rapid analysis techniques.
Results:
All participants had experience using smartphones and all but one owned one at the time of enrollment. Participants described their smartphones as "lifelines" to social network members, healthcare, and social service providers. Social relationships, physical and mental health, substance use, income, and housing environment were identified as being directly and indirectly related to transitions in housing. Over the course of ~30 days of engagement with participants, the research team observed dynamic fluctuations in emotional states, relationships, and utilization of services. These fluctuations could set off a chain of events that were observed to both help participants transition into more stable housing or lead to setbacks and further increase vulnerability and instability. In addition to informing the content of survey questions that will be programmed into the smartphone app, participants also provided a broad range of recommendations for how to approach recruitment and enrollment in the future study and design features that are important to consider for veterans with a range of physical abilities, concerns with trust and privacy, and vulnerability to loss or damage of smartphones.
Conclusion:
The ethnographic approach guided by a user-centered design framework provided valuable data to inform our future smartphone data collection effort. Data were critical to understanding aspects of day-to-day life that important to content development, app design, and approach to data collection.
... The qualitative feedback in this study also encourages service providers to develop skills training and communication tools (e.g., easy-to-use Web designs, centralized resource guide, personalized mobile apps) that will improve clients' service navigation processes and outcomes. To achieve impactful client empowerment, social workers will need up-to-date information on the changing capacities and needs of clients (Halvorsen & Yulikova, 2020;Rhoades et al., 2017) as well as policy advocacy and funding to allocate resources for technological development at an organizational level. ...
Social workers’ critical role as service navigators on behalf of their clients is expanding in the online space at a faster pace than ever before. This study examined the process and outcome of online information navigation through the lens of service providers and service users based on observational and interactive surveys. T tests and correlation results showed that human services providers demonstrated a higher capacity to visit more websites and yield more accurate search outcomes in a similar duration of time compared with general service users. Results suggest that digital literacy for navigating information online can be improved through educational opportunities. At the same time, both groups shared some common feedback on desired features for future service navigation online, including but not limited to an open search bar, search filters, instruction videos, live chat, and discussion forums for seeking mutual help and networking. The findings bear implications for formulating the roles, responsibilities, and desired competencies of social workers for online service navigation in the digital and postpandemic future.
... Overall, the results of this study suggest that smartphone-based JITAIs may be feasible and potentially efficacious in this population that has substantial barriers to entering and completing traditional AUD treatments. A majority of people experiencing homelessness already have and use cell phones, a number that will undoubtedly increase in the coming years (Rhoades et al., 2017). Indeed, a number of ongoing and recently completed studies are exploring the utility of mobile health interventions for this population (Gonzalez et al., 2018;Sheoran et al., 2016;Thompson Jr et al., 2020). ...
Background:
Adults experiencing homelessness have much higher rates of alcohol misuse than housed individuals. This study describes the development and preliminary effectiveness of a smartphone-based, just-in-time adaptive intervention (JITAI) to reduce alcohol use among adults experiencing homelessness.
Methods:
We conducted a pilot trial (N = 41; mean age [SD] = 45.2 [11.5]; 19.5% women) of the Smart-T Alcohol JITAI where participants completed brief ecological momentary assessments (EMAs) each day, received personalized treatment messages following each EMA, and accessed on-demand intervention content for 4 weeks. The prediction algorithm and treatment messages were developed based on an independent but similar sample as part of the trial. We examined three drinking outcomes: daily drinking (yes/no), drinks per day, and heavy episodic drinking, controlling for scores on the Alcohol Use Disorders Identification Test (AUDIT) at baseline, age, and sex using quadratic growth curve models.
Results:
Over the 4-week period, participants showed a decline in all alcohol use outcomes. Participants also reported high levels of satisfaction with the JITAI.
Conclusions:
Use of the Smart-T Alcohol JITAI was well received and provided encouraging evidence that it may reduce any drinking, drinks per day, and heavy episodic drinking among adults experiencing homelessness.
... While phone access is widespread (Rhoades et al. 2017;McInnes et al. 2014), only 50% of the devices could support video calls. Furthermore, maintaining telephone connectivity is often challenging due to financial constraints. ...
People experiencing homelessness in the UK were unconditionally offered housing (and support) from the beginning of the first lockdown in March 2020. For many, that meant ‘(re)entering’ the support system and having a chance to ‘move on’ to longer-term housing. This beneficial effect of some of the policy reactions to the pandemic on people experiencing homelessness was unexpected. On the flip side, however, particularly for people struggling with drug use and mental health issues, adequate support was not available for long periods of time; support was either suspended temporarily or people were excluded from institutional support for not adhering to, for instance, lockdown rules. Similarly, digital support alternatives—modelled on increasingly widespread telemedicine—did often not work specifically for people struggling with complex needs or women experiencing homelessness. This research paper reports detailed evidence of what we observed as continued and catalysed exclusions based on interviews and ethnographic observations with both people experiencing homelessness and service providers from the beginning of the COVID-19 pandemic. Referring to our insights and learnings from three locally and temporally overlapping research projects between May 2020 and April 2021, we also propose changes to redesign future (health)care provision to prevent such impasses—which extend beyond lockdown situations to general conditional housing and support.
... The challenges presented by the pandemic are that whilst TAMs were historically held in-person, they are now almost all exclusively conducted online via Microsoft Teams or Zoom. Digital exclusion, which is a common barrier to engagement for homeless adults (Rhoades et al., 2017) can inhibit client involvement in the meetings. Few FLIC clients have phones, or any devices that allow them access to the internet; some clients find using technology daunting and do not feel comfortable engaging with online meetings. ...
Purpose
This study aims to present a case study about the Team Around Me (TAM) model of case coordination which was developed by Fulfilling Lives Islington and Camden (FLIC) as an action experiment. The model is a standardised tool for running case conferences for clients experiencing multiple disadvantage (MD).
Design/methodology/approach
Deploying a case study approach, this study explores why a TAM-coordinated approach is beneficial for people experiencing MD.
Findings
The authors explore why the need for effective case coordination is integral for clients experiencing MD, and how current structures fail to facilitate effective case management. The authors put forward an argument for the four core principles underpinning the TAM model: strengths-based, action-focussed, systems thinking and client involvement. The barriers to embedding and upscaling this approach are discussed, alongside the obstacles presented by the wider system that prevent wider implementation.
Originality/value
The TAM model is a new approach to case conferences, designed and upscaled by FLIC, and has since been adopted across two London boroughs, and training has reached services across the UK. This paper highlights the need for innovative approaches to case coordination that centre client involvement, promote a strengths-based approach and recognise system blockages as a key barrier to client progress.
... In fact, 58% of homeless adults in the MediLinker own a smartphone, thus providing a mechanism for them to access MediLinker in their devices. 40 Nonetheless, considering that MediLinker can also be accessed as a web application, those without smartphones can access it through internet-connected computers in public libraries. 41 On the security perspective, creating an optimized mobile application for MediLinker would enable us to incorporate robust security (e.g., twofactor authentication and biometrics log-in) and input features (e.g., image recognition for credit cards and predictive text) that are being deployed in contemporary mobile applications. ...
Objective In this study, we obtained participants' views on using MediLinker—a blockchain-based identity verification and personal health information management application. We also gathered their views about the use of blockchain technology for controlling and managing personal health information, especially in the context of a global health crisis such as a pandemic.
Methods Online semistructured interviews were conducted with 29 simulated patients (i.e., avatars) who used MediLinker between February and May 2020. Interview data were analyzed qualitatively using a phenomenological approach to thematic analysis.
Results Most of the participants noted that they do not know what blockchain is nor understand how it works. Nonetheless, in the context of the study, they trust blockchain as a technology that can enhance data protection and privacy of their personal health information. Participants noted that MediLinker is a useful application that allows patients to easily input, share, and revoke personal health information. As a proof-of-concept application, participants also noted several issues and recommendations that can serve as points of improvement when developing subsequent versions of MediLinker. In the context of using MediLinker as part of a telemedicine system during a pandemic, participants noted that it facilitates social distancing, makes clinical transactions efficient and convenient, and enhances identity verification.
Conclusion In general, the findings lay the foundation for a user-centered approach in developing future iterations of MediLinker and other patient-facing blockchain-based health information technologies. Also, the findings provide important insights into how people perceive blockchain-based health information technologies, especially during a pandemic.
... In general, technology can provide several benefits for individuals experiencing homelessness. For example, cell phones provide a way for these individuals to call for help in the case of an emergency; find work; stay in contact with service providers and close others; and access information, supportive services, and housing opportunities (Eyrich-Garg, 2010;Goodwin-Smith & Myatt, 2014;Rhoades et al., 2017). Unfortunately, youth experiencing homelessness often have unreliable access to technology (Bender et al., 2014), which may make it difficult for them to communicate with their case manager, healthcare providers, and close others. ...
Youth homelessness is a growing crisis in the United States that is associated with a range of adverse outcomes. A variety of social service programs exist to address youth homelessness and its consequences, such as street outreach and diversion services, emergency shelters, transitional housing programs, and rapid rehousing services, among others. The coronavirus disease 2019 (COVID-19) pandemic reached the United States in early 2020, altering nearly every facet of daily life, including the way social service organizations structure and deliver their programming. To understand the implications of the pandemic on housing and homelessness services for youth, the current study examines data from interviews conducted with staff from a large non-profit in Austin, Texas, serving vulnerable transition-age youth. Through these interviews, programmatic changes that occurred as a result of COVID-19—as well as challenges and facilitators to service delivery—were identified. This article provides an overview of these key learnings, as well as recommendations derived from these key learnings, for other organizations adapting their housing and homelessness services in response to the COVID-19 pandemic.
... It is common that many people experiencing homelessness do not have smartphones. 29,30 For the native mobile applications, the patients are provided with the option to login using their phone's native biometric authentication (fingerprints for Android devices and TouchID/FaceID for iOS devices). ...
Objective:
Clinical data in the United States are highly fragmented, stored in numerous different databases, and are defined by service providers or clinical specialties rather than by individuals or their families. As a result, linking or aggregating a complete record for a patient is a major technological, legal, and operational challenge. One of the factors that has made clinical data integration so difficult to achieve is the lack of a universal ID for everyone. This leads to other related problems of having to prove identity at each interaction with the health system and repeatedly providing basic information on demographics, insurance, payment, and medical conditions. Traditional solutions that require complex governance, expensive technology, and risks to privacy and security of the data have failed adequately to solve this interoperability problem. We describe the technical design decisions of a patient-centric decentralized health identity management system using the blockchain technology, called MediLinker, to address some of these challenges.
Design:
Our multidisciplinary research group developed and implemented an identity wallet, which uses the blockchain technology to manage verifiable credentials issued by healthcare clinics, banks, and insurance companies. To manage patient's self-sovereign identity, we leveraged the Hyperledger Indy blockchain framework to store patient's decentralized identifiers (DIDs) and the schemas or format for each credential type. In contrast, the credentials containing patient data are stored 'off-ledger' in each person's wallet and accessible via a computer or smartphone. We used Hyperledger Aries as a middleware layer (API: Application Programming Interface) to connect Hyperledger Indy with the front-end, which was developed using a JavaScript framework, ReactJS (Web Application) and React Native (iOS Application).
Results:
MediLinker allows users to store their personal data on digital wallets, which they control. It uses a decentralized trusted identity using Hyperledger Indy and Hyperledger Aries. Patients use MediLinker to register and share their information securely and in a trusted system with healthcare and other service providers. Each MediLinker wallet can have six credential types: health ID with patient demographics, insurance, medication list including COVID-19 vaccination status, credit card, medical power of attorney (MPOA) for guardians of pediatric or geriatric patients, and research consent. The system allows for in-person and remote granting and revoking of such permissions for care, research, or other purposes without repeatedly requiring physical identity documents or enrollment information.
Conclusion:
We successfully developed and tested a blockchain-based technical architecture, described in this article, as an identity management system that may be operationalized and scaled for future implementation to improve patient experience and control over their personal information.
... In 2020, roughly 86% of the total US population had access to the internet [34]. A US study in greater Los Angeles that examined digital technology use in homeless populations discovered that 94% owned a cell phone [35]. Currently where digital technology is a requirement for survival, internet data can be used to track populations from all over the world over any period. ...
Background:
The epidemiology of mental health disorders has important theoretical and practical implications for health care service and planning. The recent increase in big data storage and subsequent development of analytical tools suggest that mining search databases may yield important trends on mental health, which can be used to support existing population health studies.
Objective:
This study aimed to map depression search intent in the United States based on internet-based mental health queries.
Methods:
Weekly data on mental health searches were extracted from Google Trends for an 11-year period (2010-2021) and separated by US state for the following terms: "feeling sad," "depressed," "depression," "empty," "insomnia," "fatigue," "guilty," "feeling guilty," and "suicide." Multivariable regression models were created based on geographic and environmental factors and normalized to the following control terms: "sports," "news," "google," "youtube," "facebook," and "netflix." Heat maps of population depression were generated based on search intent.
Results:
Depression search intent grew 67% from January 2010 to March 2021. Depression search intent showed significant seasonal patterns with peak intensity during winter (adjusted P<.001) and early spring months (adjusted P<.001), relative to summer months. Geographic location correlated with depression search intent with states in the Northeast (adjusted P=.01) having higher search intent than states in the South.
Conclusions:
The trends extrapolated from Google Trends successfully correlate with known risk factors for depression, such as seasonality and increasing latitude. These findings suggest that Google Trends may be a valid novel epidemiological tool to map depression prevalence in the United States.
... The social instability faced by this population can also hinder engagement in research, as was demonstrated by frequent changes in residence and telephone numbers during the study period-this, too, had previously been described in the literature. 47 As indicated in reflections from several of our group members, additional support resources and specific training in trauma-based care would have been helpful. Many group members had previous experience participating in community-based group programming and seemed to bring expectations from those experiences to the CDAC. ...
Introduction Participatory research is a study method that engages patients in research programs, ideally from study design through to dissemination. It is not commonly used in diabetes health services research. Our objectives were to describe the process and challenges of conducting a participatory research project and to highlight the experiences of both patient co-researchers and academic researchers.
Research design and methods We recruited people with lived experience of homelessness (PWLEH) and diabetes in Toronto, Canada to become patient co-researchers. They were asked to commit to attending biweekly meetings. We undertook two major research projects: concept mapping to choose a research focus; and photovoice to explore accessing healthy food while homeless. We used
a convergent mixed-methods design to evaluate their experience.
Results A diverse group of eight PWLEH had an average attendance of 82% over 21 meetings—despite this success, we encountered a number of challenges of conducting this research: funding, ethics approval and recruitment were particularly difficult. Group members reported that participation improved their ability to self-advocate in their diabetes care and provided them with tangible skills and social benefits. Group members
stated that they valued being involved in all aspects of the research, in particular knowledge translation activities, including advocating for nutritious food at shelters; presenting to stakeholders; and meeting with policymakers.
Conclusions The use of participatory research methods enables academic researchers to support community members in pursuing research that is pertinent to them and which has a positive impact. In our study, coresearchers contributed in meaningful ways and also valued the experience.
... Moreover, text messages have the opportunity to reach those with no fixed addresses. For example, a recent systematic review on technology use among homeless adults showed that a majority (94%) owned a cell phone [68]. Overall, Tamuzi et al [18] found that call reminders were the only intervention to show a statistically significant pooled effect estimate. ...
Background:
Cancer is a leading cause of death, and although screening can reduce cancer morbidity and mortality, participation in screening remains suboptimal.
Objective:
This systematic review and meta-analysis aims to evaluate the effectiveness of social media and mobile health (mHealth) interventions for cancer screening.
Methods:
We searched for randomized controlled trials and quasi-experimental studies of social media and mHealth interventions promoting cancer screening (breast, cervical, colorectal, lung, and prostate cancers) in adults in MEDLINE, Embase, PsycINFO, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, and Communication & Mass Media Complete from January 1, 2000, to July 17, 2020. Two independent reviewers screened the titles, abstracts, and full-text articles and completed the risk of bias assessments. We pooled odds ratios for screening participation using the Mantel-Haenszel method in a random-effects model.
Results:
We screened 18,008 records identifying 39 studies (35 mHealth and 4 social media). The types of interventions included peer support (n=1), education or awareness (n=6), reminders (n=13), or mixed (n=19). The overall pooled odds ratio was 1.49 (95% CI 1.31-1.70), with similar effect sizes across cancer types.
Conclusions:
Screening programs should consider mHealth interventions because of their promising role in promoting cancer screening participation. Given the limited number of studies identified, further research is needed for social media interventions.
Trial registration:
PROSPERO International Prospective Register of Systematic Reviews CRD42019139615; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=139615.
International registered report identifier (irrid):
RR2-10.1136/bmjopen-2019-035411.
... 121 A recent study on shelters in New York City indicated that residents used the internet to seek permanent housing, medical care, jobs, for transportation, and public assistance. 122 They also used it for email and social networking that help retain social connections, social capital and personal relationships. 123 On one hand access to technology seems similar to families who are in homes. ...
... For instance, Rice and Barman-Adhikari (2014) found that homeless youth frequently used technology to make contact with social service workers, and more frequent use of technology was correlated with positive outcomes such as job and family connections. For example, in a study of 400 homeless adults, 97% owned smartphones and used them to connect to basic needs (Rhoades et al., 2017). ...
Although pedagogical fundamentals of teaching with technology appear in the literature, the use of podcasting in the classroom is primarily documented outside of social work education. This study explored outcomes of an assignment in which students create podcasts meant for consumption by people besides the instructor. The authors theorized that this would allow social work students to build skills with engagement, self-awareness and communication while also developing skills with technology. Results suggest that podcasting as an assignment is replicable across levels and types of social work courses, and is potentially a good way to introduce students to the new technologies.
... As would be expected based on other research showing widespread cell phone ownership among individuals experiencing homelessness [28][29][30], we found that we had to exclude only a small percentage of young people experiencing homelessness from participating due to not having a phone that could receive text messages; indeed, most participants had smartphones, unlimited text and call plans, and a significant portion even had unlimited data plans. Taken together, these results suggest that phone and even smartphone-based interventions are feasible for this highly mobile population. ...
Background
Smoking rates are significantly higher among young people experiencing homelessness than in the general population. Despite a willingness to quit, homeless youth have little success in doing so on their own, and existing cessation resources tailored to this population are lacking. Homeless youth generally enjoy the camaraderie and peer support that group-based programs offer, but continuous in-person support during a quit attempt can be prohibitively expensive.
Objective
This study aimed to assess the feasibility and acceptability of an automated text messaging intervention (TMI) as an adjunct to group-based cessation counseling and provision of nicotine patches to help homeless youth quit smoking. This paper outlines the lessons learned from the implementation of the TMI intervention.
Methods
Homeless youth smokers aged 18 to 25 years who were interested in quitting (n=77) were recruited from drop-in centers serving homeless youth in the Los Angeles area. In this pilot randomized controlled trial, all participants received a group-based cessation counseling session and nicotine patches, with 52% (40/77) randomly assigned to receive 6 weeks of text messages to provide additional support for their quit attempt. Participants received text messages on their own phone rather than receiving a study-issued phone for the TMI. We analyzed baseline and follow-up survey data as well as back-end data from the messaging platform to gauge the acceptability and feasibility of the TMI among the 40 participants who received it.
ResultsParticipants had widespread (smart)phone ownership—16.4% (36/219) were ineligible for study participation because they did not have a phone that could receive text messages. Participants experienced interruptions in their phone use (eg, 44% [16/36] changed phone numbers during the follow-up period) but reported being able to receive the majority of messages. These survey results were corroborated by back-end data (from the program used to administer the TMI) showing a message delivery rate of about 95%. Participant feedback points to the importance of carefully crafting text messages, which led to high (typically above 70%) approval of most text messaging components of the intervention. Qualitative feedback indicated that participants enjoyed the group counseling session that preceded the TMI and suggested including more such group elements into the intervention.
Conclusions
The TMI was well accepted and feasible to support smoking cessation among homeless youth. Given high rates of smartphone ownership, the next generation of phone-based smoking cessation interventions for this population should consider using approaches beyond text messages and focus on finding ways to develop effective approaches to include group interaction using remote implementation. Given overall resource constraints and in particular the exigencies of the currently ongoing COVID-19 epidemic, phone-based interventions are a promising approach to support homeless youth, a population urgently in need of effective smoking cessation interventions.
Trial RegistrationClinicalTrials.gov NCT03874585; https://clinicaltrials.gov/ct2/show/NCT03874585
International Registered Report Identifier (IRRID)RR2-10.1186/s13722-020-00187-6
... Second, mobile phone ownership has increased among low-income individuals. A recent study reported that 94% of homeless adults had access to a mobile phone, suggesting new opportunities to increase access to care in underserved populations [6]. Third, provider interest and the adoption of patient-centered technologies have strengthened [7]. ...
Background:
COVID-19 social distancing guidelines caused a rapid transition to telephone and video technologies for the delivery of substance use disorder (SUD) treatment. The study examined: a) adoption of these technologies across the SUD service continuum; b) acceptance of these technologies by service providers; and c) intention of providers to use these technologies following the pandemic. An additional analysis used the validated Technology Acceptance Model (TAM) to test the rigor of the intent to use the technology post-pandemic.
Objective:
1) Assess use of telehealth, via phone and video, for different substance use disorder services (SUDS) during May-June of COVID-19; 2) Measure intent to use telehealth beyond COVID-19 for SUD services; 3) Evaluate the perceived ease of use and value of telehealth for delivering SUD services; and 4) Assess organizational readiness for sustained use of telehealth services.
Methods:
An online survey distributed between May and August 2020 measured current use of telephone and video services, assessed perceived organizational readiness to use these services, and gauged intent to use telephone and video applications post-COVID-19. Eight of the 10 Regional Addiction Technology Transfer Centers (ATTCs), representing 43 states, distributed the survey. The unit of analysis was the organization.
Results:
Four hundred and fifty-seven organizations responded. Overall, there was widespread use of technology; greater than 70% (n = > 335) of organizations reported using telephone or video for most services. For all but two services (residential and buprenorphine services by telephone), organizations reported significantly greater odds (mean OR = 3.79; range from 1.87 to 6.98) of intending to use technology to deliver services post COVID-19. Clinical users regarded video more favorably than telephone for virtually all services. Readiness for telephone and video use was high across numerous factors, though telephone services were viewed as being more accessible. Consistent with the TAM, perceived usefulness and ease of use influenced intention to use both telephone and video technologies.
Conclusions:
The overall perceived ease of use and usefulness of telephone and video-based services provide a promising outlook for these services post the COVID-19 pandemic. Survey participants consistently preferred video-based services over telephone-based services. However, having telephonic services available for those lacking easy access to video technology appears to be an important system characteristic. Future studies should continue to review the acceptance of telehealth services and their comparative impact on SUD care outcomes. Key Words: Telehealth, COVID-19, Substance Use Disorders, Technology Acceptance Model.
Background: Permanent supportive housing (PSH) is an evidence-based practice to address homelessness. This paper describes the protocols for a mixed-methods comparative effectiveness study of two distinct approaches to implementing PSH and patient-centered quality of life, health care utilization, and health behaviors that reduce COVID-19 risk.
Methods: People experiencing homelessness who are placed in either (a) single-site (place-based) PSH or (b) scatter-site PSH completed 6 monthly surveys after move-in using smartphones provided by the study team. A subsample of participants completed three qualitative interviews at baseline, 3 months, and 6 months. Two stakeholder advisory groups, including one featuring people with lived experience of homelessness, helped guide study decisions and interpretations of findings.
Discussion: Recruitment during the pandemic was challenging given that in-person contact was not permitted at times either by the recruitment sites or research institutions during COVID-19 surges and high community transmission, which particularly affected homelessness programs. To overcome these challenges, flexible strategies were employed that included extending the recruitment period and distribution of cell phones with paid data plans.
Trial registration: NCT04769349
Introduction:
Patients with orthopaedic trauma are frequently lost to follow-up. Personal mobile devices have been used to ascertain clinical research outcomes. The prevalence of mobile device ownership, use patterns, and attitudes about research among patients with orthopaedic trauma would inform clinical research strategies in this population.
Methods:
A total of 1,434 consecutive unique adults scheduled for an orthopaedic trauma outpatient clinic from December 2019 through February 2020 at a metropolitan level 1 trauma center were identified. Associations of demographic data with clinic attendance and mobile phone registration were explored by logistic regression. One hundred one patients attending clinic were then prospectively surveyed from June 2021 through August 2021 about housing stability, personal mobile device ownership, capabilities, use patterns, and openness to communicating via the device with for orthopaedic care and research.
Results:
The prevalence of personal mobile device ownership was 91% by registration data and 90% by a survey. Ninety-nine percent of survey respondents with mobile devices reported cell service always or most of the time. Ninety-three percent kept their devices charged always or most of the time. Ninety-two percent reported e-mail access. Eighty-three percent reported video capability. Ninety-one percent would communicate with their orthopaedic trauma care team by text message. Eighty-seven percent would answer research questions by phone call, 79% by text, and 61% by video. Eighty-five percent reported stable housing, which was not associated with mobile device ownership or use, but was associated with clinic nonattendance (29% vs. 66%, P < 0.01) and changing phone number at least once in the previous year (28% vs. 58%, P = 0.04).
Discussion:
Personal mobile devices represent a feasible platform for screening and collecting outcomes from patients with orthopaedic trauma. Nine in 10 patients own personal mobile devices, keep them charged, have text and e-mail service, and would use the device to participate in research. Housing instability was not associated with mobile device ownership or use patterns.
Background
In recent years, cities across the world have seen widespread growth in unsheltered homelessness, in which a person sleeps “in a place not meant for human habitation” such as cars, parks, sidewalks, and abandoned buildings. It is widely understood that people experiencing homelessness (PEH) have poorer health outcomes than the general population. Less is known about the health of people who are unsheltered, yet they may be exposed to greater health risks than their sheltered counterparts. The purpose of this literature review is to evaluate and summarize the evidence on unsheltered homelessness and health.
Methods
A literature search was conducted using PubMed to identify publications on unsheltered homelessness and health. A total of 42 studies were included for review.
Results
Unsheltered populations experience higher rates of chronic disease, serious mental illness, and substance abuse compared to sheltered populations. Unsheltered homelessness is strongly associated with chronic homelessness that exacerbates serious mental illness and substance use, which is often co-occurring. Despite having large unmet health needs, unsheltered populations have lower health care utilization and often lack health insurance.
Interpretation
Evaluating the impact of shelter status on health outcomes has important implications for the allocation of housing and health services. Longitudinal studies are needed to examine the relationship between duration of sheltered and unsheltered homelessness and health outcomes and explore mediating mechanisms that lead to poor health among unsheltered populations. In spite of these limitations, our results also suggest an urgent need to address the unique and severe challenges facing unsheltered populations and the need for intervention approaches that are sensitive to these unique disease burdens.
The role of digital media in contemporary understandings and experiences of homelessness is not well understood or researched. This introductory chapter sets out the book’s aim to address a gap in research on the digital experiences of people who are homeless in developed Western countries where mobiles are mundane and taken for granted. It explains the data sources used, the research carried out, the mixed methods methodology and the analytical framework developed. The chapter engages with definitions and trends relating to homelessness and argues for the need to interrogate the underpinning structures and dynamics that shape the digital experiences of a range of social groups when homeless. To support this analysis, I advance the concept of ‘precarious connectivity’, referring to features of communication access that create or exacerbate structural inequalities, making it insecure, expensive, and poor in quality for some segments of the population. The chapter explains the book’s contribution to mobile communication and digital inequalities scholarship and explains the organisation of the book’s chapters.KeywordsHomelessnessMobile communicationMediationDigital inequalitiesDigitisationPrecarityMobilities
The chapter focuses on the impact of the digitisation of services in government, health, and welfare in the context of changing practices and norms of device and data use. People experiencing homelessness and other marginalised and low-income groups are increasingly required to access a wide range of services and conduct everyday activities in an online environment, heightening the need for a smartphone and reliable access to mobile data. The chapter highlights the communication costs of these digital service reforms and the new risks and harms associated with data-driven systems, arguing that the burden of change is borne by those who are the most precariously connected.KeywordsDigitisationDigital transformationData-drivenDigital welfareData useCost of connectivity
Introduction. The article describes the impact of the global trend of digitalization on the most vulnerable category of the population. The study of the digital divide is a fairly new area of research in the social sciences. Modern technologies are a part of our lives that influence social processes – in particular, it can increase or reduce social inequality. Modern researchers are finding more and more evidence of the growth of relative inequalities in Internet skills and Internet use. In case if the typical user’s “set” is a smartphone, the Internet and a laptop (or computer), the homeless person’s “set of technologies” may be different or not at all. Studies of the digital divide have already been conducted in large cities of socially and economically developed countries.
Methodology and sources. The object of the study is a group with a low socio-economic status, homeless people, including those who have returned from prison. The study involved 15 respondents from 24 living in the social center at the time of the interview.
Results and discussion. As a result of the analysis of the collected data, some features of the perception of digital technologies and practices of their use were identified. The peculiarities of perception are combined into a group of discursive patterns, the practice of using digital technologies – into a group of behavioral patterns. A good result of sociological research is the refutation of stereotypes that have developed in society. So, it seems possible to identify two main stereotypes. It is believed that mostly the homeless do not have cell phones, but if they do, it is likely a status thing for them. The second stereotype is associated with the repertoire of digital technologies: homeless people likely use non-personalized technologies due to their marginal position. Both stereotypes have been refuted. The unexpected result of the study indicates its absolute relevance and the prospect of further study, including vulnerable groups of the population.
Conclusion. The prospect of future research is the continuation of the study on the example of other organizations and the study of other categories of homeless people (applying for overnight accommodation for one night or not visiting social organizations). It also should be noted, that the possibility of developing new social work practices taking into account the results of the study.
To assess the relationship between LGBTQ status and (1) current, recent, and lifetime experiences of housing instability, (2) risk of housing instability due to fears of interpersonal violence, and (3) perceived housing challenges, this study examined online survey data from individuals with a household income <$35,000 (N = 1,270). Analyses compared LGBTQ and cisgender heterosexual respondents using chi-square tests and logistic regression. Over their lifetime, LGBTQ respondents had increased odds of sleeping outdoors (adjusted odds ratios [AOR] = 1.580) or in a car (AOR = 1.465) because they had nowhere else to stay. They also had increased odds of reporting housing challenges related to violence from family/friends (AOR = 3.278), substance abuse (AOR = 3.063), and mental health (AOR = 2.048). Interventions serving LGBTQ adults should prioritize safety concerns and consider providing services to both individuals and families. In addition, providers should increase sensitivity toward issues of sexual orientation and gender identity and the unique needs of LGBTQ adults.
Background/setting:
In San Francisco, HIV viral suppression is 71% among housed individuals, but only 20% among unhoused individuals. We conducted a discrete choice experiment (DCE) at a San Francisco public HIV clinic to evaluate care preferences among people living with HIV (PLH) experiencing homelessness/unstable housing during the COVID-19 pandemic.
Methods:
From July-November 2020, we conducted a DCE among PLH experiencing homelessness/unstable housing who accessed care through a) an incentivized, drop-in program ("POP-UP") or b) traditional primary care. We investigated five program features: single provider vs team of providers; visit incentives ($0, $10, $20); location (current site vs current+additional site); drop-in vs scheduled visits; in-person only vs optional telehealth visits; and navigator assistance. We estimated relative preferences using mixed-effects logistic regression and conducted latent class analysis to evaluate preference heterogeneity.
Results:
We enrolled 115 PLH experiencing homelessness/unstable housing, 40% of whom lived outdoors. The strongest preferences were for the same provider (β=0.94, 95%CI 0.48-1.41), visit incentives (β=0.56 per $5; 95%CI 0.47-0.66), and drop-in visits (β=0.47, 95%CI 0.12-0.82). Telehealth was not preferred. Latent class analysis revealed two distinct groups: 78 (68%) preferred a flexible care model; while 37 (32%) preferred a single provider.
Conclusion:
We identified heterogeneous care preferences among PLH experiencing homelessness/unstable housing during the COVID pandemic, with two-thirds preferring greater flexibility and one-third preferring provider continuity. Telehealth was not preferred, even with navigator facilitation. Including patient choice in service delivery design can improve care engagement, particularly for marginalized populations, and is an essential tool for ending the HIV epidemic.
Surveys of underserved patient populations are needed to guide quality improvement efforts but are challenging to implement. The goal of this study was to describe recruitment and response to a national survey of Veterans with homeless experience (VHE). We randomly selected 14,340 potential participants from 26 U. S. Department of Veterans Affairs (VA) facilities. A survey contract organization verified/updated addresses from VA administrative data with a commercial address database, then attempted to recruit VHE through 4 mailings, telephone follow-up, and a $10 incentive. We used mixed-effects logistic regressions to test for differences in survey response by patient characteristics. The response rate was 40.2% (n = 5766). Addresses from VA data elicited a higher response rate than addresses from commercial sources (46.9% vs 31.2%, p < .001). Residential addresses elicited a higher response rate than business addresses (43.8% vs 26.2%, p < .001). Compared to non-respondents, respondents were older, less likely to have mental health, drug, or alcohol conditions, and had fewer VA housing and emergency service visits. Collectively, our results indicated a national mailed survey approach is feasible and successful for reaching VA patients who have recently experienced homelessness. These findings offer insight into how health systems can obtain perspectives of socially disadvantaged groups.
Abbreviations: H-PACTS: Homeless-Patient Aligned Care Teams; SHEP: Survey of Healthcare Experiences of Patients; SRG: Strategic Research Group; USPS: United States Postal Service; VA: U.S. Department of Veterans Affairs; VHE: veterans with homeless experience
There is currently a little observational work exploring homeless peoples’ digital networking behaviors, with previous research relying on limited self-report data. This study fills this gap through a qualitative thematic analysis of the public subreddit r/homeless. We analyzed the 30 most commented posts on the subreddit from each month of 2019, examining a total of 360 posts. We find that r/homeless contributions primarily center around (a) commentary on social issues, (b) communication of needs and concerns, (c) offering of care and support, and (d) online community management and engagement, suggesting that homeless individuals not only leverage the r/homeless subreddit to gain support and information, but to generate discourse around larger societal issues. Evidence of both bridging and bonding ties was present on the subreddit, with bonding ties being especially valued and sought after by homeless users, contributing to the growing literature on the relationship between social capital, social media, and homelessness.
Governments and NGOs are switching to phone- and Internet-based communication technologies to reduce costs and broaden access to public services. However, these technological shifts can backfire if they exacerbate administrative burden in high-need communities. We conducted a randomized controlled trial in Greece evaluating which communication mode best allows disadvantaged groups to solicit information about free services. Subjects were 18 times more likely to use a prepaid postcard and 8 times more likely to use a postcard requiring postage than a hotline or email to seek information about free dental care. Focus groups indicate that low self-efficacy greatly limits disadvantaged groups’ willingness to use newer technologies for bureaucratic inquiries. We demonstrate that the administrative burden associated with technological shifts is larger than previously believed and that widespread psychological barriers include not only the stigma of welfare receipt, but also the stigma of mishandling a conversation with a bureaucrat.
This article is protected by copyright. All rights reserved.
M-PESA is the world’s leading mobile money system which supports the person-to-person transfer of money. While the institutional meaning of M-PESA concerning financial inclusion and market access is well documented, the meaning attached to M-PESA by users, particularly in rural communities, has received less attention. This study examines the meaning of M-PESA to the rural poor in villages in Busia County, Western Kenya using the approach of poetic inquiry in which the expressions of local people are rendered as poetry in order to draw out affective and lived experience. A reading of the poems of seven participants reveals the perception of M-PESA as a means of empowerment for women, alignment with their social identity and access to education. This contrasts sharply with the meaning of M-PESA as seen by commercial and non-commercial institutions which focuses on connecting the unbanked to formal banking systems and the exploitation of M-PESA as a primary revenue stream. The paper concludes by highlighting the need for regulation which is delicately balanced between independence from institutional control and the exposure of the rural poor to exploitation.
Background
Few obesity interventions have been developed for American Indian (AI) families despite the disproportionate risk for obesity experienced within AI communities. The emergence of mobile technologies to enhance intervention delivery may particularly benefit AI communities, many of which are hard-to-reach and underserved.
Objective
This study aimed to assess the use and perceptions of text messaging and Facebook to support delivery of the Healthy Children, Strong Families 2 (HCSF2) mailed healthy lifestyle/obesity prevention intervention and discuss lessons learned regarding intervention support via these platforms among AI participants.
Methods
From among AI families with young children (2–5 years old), 450 adult/child dyads were recruited from five rural and urban communities for a year-long intervention. Intervention content was delivered by mail and supported by text messaging and optional Facebook groups. Participants provided feedback on text message and Facebook components post-intervention, and Facebook analytic data were tracked.
Results
Self-report feedback indicated high satisfaction with both text messaging and Facebook, with tangible content (e.g., recipes, physical activity ideas) cited as most useful. Overall, participants reported higher satisfaction with and perceived efficacy of Facebook content compared to text messaging. Analytic data indicate the optional HCSF2 Facebook groups were joined by 67.8% of adult participants. Among those who joined, 78.4% viewed, 50.8% “liked”, and 22.6% commented on one or more post. Engagement levels differed by urban-rural status, with more urban participants “liking” (P = 0.01) and commenting on posts (P = 0.01). Of note, nearly 1/3 of participants reported changing phone nubsmbers during the intervention.
Conclusions
This paper demonstrates high satisfaction regarding mobile delivery of HCSF2 intervention support components. Best practices and challenges in utilizing different mobile technologies to promote wellness among AI families are discussed, with particular focus on urban-rural differences. Future mobile-based interventions should consider the context of unstable technology maintenance, especially in low-resource communities.
Clinicaltrials.gov ID: NCT01776255
Für den deutschsprachigen Raum ist bisher unbeantwortet, inwiefern wohnungs- und obdachlose Menschen Zugang zu digitalen Informations- und Kommunikationstechnologien erhalten und wie ihnen diese nutzen. Anders als der Diskurs um die digitale Spaltung nahelegt, zeigt sich in der Verfügbarkeit sowie im Nutzungsverhalten zwischen Menschen mit und ohne Wohnung keine digitale Kluft: wohnungslose Menschen besitzen häufig ein Smartphone und nutzen es in ihrem Alltag. Dennoch ist die tatsächliche, kontinuierliche Verfügbarkeit digitaler Technologien sozial ungleich verteilt (1). Dabei können digitale Technologien die Teilhabe von Menschen ohne eigene Wohnung verbessern (2).
Objectives
Office-based opioid treatment (OBOT) with buprenorphine is increasingly integrated in primary care to treat opioid use disorder (OUD). Online portals seek to engage patients in care of their chronic medical conditions, yet we know little about how patients with OUD experience these portals. Our study explores how patients with OUD perceive the impact of portal use on addiction treatment and clinical care.
Materials and methods
We purposively sampled patients with an active portal account enrolled in an OBOT program embedded within primary care, stratifying by recent or distant portal use. The study conducted individual semistructured interviews to understand how patients perceived and interfaced with the portal until the study reached saturation of themes. The research team analyzed the data via thematic analysis and three investigators independently coded the data to identify themes, which all authors then refined.
Results
Among 17 participants, 9 were recent users and 8 were distant. Though we stratified analyses by level of portal use, the study observed no differences in resultant themes, thus the study combined themes, which we present here. Portal use was felt to (1) facilitate and reinforce OUD and other substance use treatment goals, (2) improve health care participation, (3) enable monitoring and addressing broader health concerns beyond SUD treatment, and (4) have mixed impacts on patient-provider trust.
Discussion
Our findings suggest that patients with OUD identify aspects of the patient portal contributing to their engagement and retention in substance use treatment. Lingering concerns remain about the potential of portal use to negatively impact the patient-provider relationship.
Introduction:
Smoking rates are alarmingly high among young people experiencing homelessness (YEH), yet there are no evidence-based cessation programs for this population. This paper presents results from a pilot evaluation of a text messaging-based smoking cessation treatment, as an adjunct to brief group cessation counseling, to improve abstinence rates among 18-25 year old smokers experiencing homelessness. The goal of this study was to estimate effect sizes for a larger trial and it was not powered to detect group differences.
Methods:
YEH smokers who had a working cell phone with them at recruitment were randomized to receive a group counseling session, nicotine patches, and written material on quitting (n=37) or a similar program that also included a 6-week automated text messaging intervention (TMI) to provide ongoing support for quitting (n=40). Smoking outcomes were evaluated through a 90-day follow-up.
Results:
7-day point prevalence abstinence at 90-day follow-up was higher in the TMI condition than standard condition (17.50% vs. 8.11%, respectively; Cohen's h=.37); however, the 90-day continuous abstinence rate was not statistically different from zero in either condition. Reductions in the number of days smoked in the past 30 days from baseline to follow-up were greater in the TMI condition than the standard condition (-14.24 vs. -8.62, respectively; Cohen's d=.49).
Conclusions:
Adding a 6-week TMI support to a brief group counseling and pharmacotherapy protocol holds promise for smoking reduction and abstinence among YEH smokers. Results indicate that further development and evaluation of the TMI in this population is warranted.
Implications:
This is the first study to evaluate the feasibility of using a text messaging-based intervention (TMI) for behavior change with 18-25 year olds experiencing homelessness, and more specifically, the first to test a TMI to provide ongoing support for smoking cessation. Small to medium effect sizes for the TMI are promising in terms of implementing a TMI using participants' own cell phones, as well as the efficacy of this approach as an adjunct to standard care (brief group counseling and pharmacotherapy) for smoking cessation among young people experiencing homelessness.
The Building Early Emotional Skills (BEES) parenting program is designed to promote parent-child relationships and more optimal social-emotional development by addressing four sequentially built skills in parenting infants/toddlers: (1) building parental awareness of emotions in self and child; (2) listening and interacting sensitively; (3) identifying and labeling emotions; and (4) intentionally supporting early self-regulation skills. BEES used an 8-session format delivered in online or face-to-face platforms (N = 264 female caregivers; n = 214 online, n = 50 face-to-face). Linear mixed modeling for pre-to-post changes showed significant increases in knowledge, emotion coaching beliefs, acceptance of negative emotions, and self-reported emotionally supportive responses to emotions; and, significant decreases in rejection of emotions, emotionally unsupportive responses, and parenting distress. Results suggested no differences in rate of change by program delivery type. Caregivers with more depressive symptoms showed greater improvement in their parenting distress. The BEES program may be a tool to support early positive parenting.
Advancements in information technology (IT) and its increasingly ubiquitous nature expand the ability to engage patients in the health care process and motivate health behavior change.
Objective: Our aim was to systematically review the (1) impact of IT platforms used to promote patients’ engagement and to effect change in health behaviors and health outcomes, (2) behavior theories or models applied as bases for developing these interventions and their impact on health outcomes, (3) different ways of measuring health outcomes, (4) usability, feasibility, and acceptability of these technologies among patients, and (5) challenges and research directions for implementing IT platforms to meaningfully impact patient engagement and health outcomes.
Methods: PubMed, Web of Science, PsycINFO, and Google Scholar were searched for studies published from 2000 to December 2014. Two reviewers assessed the quality of the included papers, and potentially relevant studies were retrieved and assessed for eligibility based on predetermined inclusion criteria.
Results: A total of 170 articles met the inclusion criteria and were reviewed in detail. Overall, 88.8% (151/170) of studies showed positive impact on patient behavior and 82.9% (141/170) reported high levels of improvement in patient engagement. Only 47.1% (80/170) referenced specific behavior theories and only 33.5% (57/170) assessed the usability of IT platforms. The majority of studies used indirect ways to measure health outcomes (65.9%, 112/170).
Conclusions: In general, the review has shown that IT platforms can enhance patient engagement and improve health outcomes. Few studies addressed usability of these interventions, and the reason for not using specific behavior theories remains unclear. Further research is needed to clarify these important questions. In addition, an assessment of these types of interventions should be conducted based on a common framework using a large variety of measurements; these measurements should include those related to motivation for health behavior change, long-standing adherence, expenditure, satisfaction, and health outcomes.
Background
Adults who experience prolonged homelessness have mortality rates 3 to 4 times that of the general population. Housing First (HF) is an evidence-based practice that effectively ends chronic homelessness, yet there has been virtually no research on premature mortality among HF enrollees. In the United States, this gap in the literature exists despite research that has suggested chronically homeless adults constitute an aging cohort, with nearly half aged 50 years old or older.
Methods
This observational study examined mortality among formerly homeless adults in an HF program. We examined death rates and causes of death among HF participants and assessed the timing and predictors of death among HF participants following entry into housing. We also compared mortality rates between HF participants and (a) members of the general population and (b) individuals experiencing homelessness. We supplemented these analyses with a comparison of the causes of death and characteristics of decedents in the HF program with a sample of adults identified as homeless in the same city at the time of death through a formal review process.
Results
The majority of decedents in both groups were between the ages of 45 and 64 at their time of death; the average age at death for HF participants was 57, compared to 53 for individuals in the homeless sample. Among those in the HF group, 72 % died from natural causes, compared to 49 % from the homeless group. This included 21 % of HF participants and 7 % from the homeless group who died from cancer. Among homeless adults, 40 % died from an accident, which was significantly more than the 14 % of HF participants who died from an accident. HIV or other infectious diseases contributed to 13 % of homeless deaths compared to only 2 % of HF participants. Hypothermia contributed to 6 % of homeless deaths, which was not a cause of death for HF participants.
Conclusions
Results suggest HF participants face excess mortality in comparison to members of the general population and that mortality rates among HF participants are higher than among those reported among members of the general homeless population in prior studies. However, findings also suggest that causes of death may differ between HF participants and their homeless counterparts. Specifically, chronic diseases appear to be more prominent causes of death among HF participants, indicating the potential need for integrating medical support and end-of-life care in HF.
Health telematics is a growing up issue that is becoming a major improvement on patient lives, especially in elderly, disabled, and chronically ill. In recent years, information an d communication technologies improvements, along with mobile Internet, offering anywhere and anytime connectivity, play a key role on modern healthcare solutions. In this context, mobile health (m-Health) delivers healthcare services,overcoming geographical, temporal, and even organizational barriers. M-Health solutions address emerging problems on health services, including, the increasing number of chronic diseases related to lifestyle, high costs of existing national health services, the need to empower patients and families to self-care and handle their own healthcare, and the need to provide direct access to health services, regardless of time and place. Then, this paper presents a comprehensive review of the state of the art on m-Health services and applications. It surveys the most significant research work and presents a deep analysis of the top and novel m-Health services and applications proposed by industry. A discussion considering the European Union and United States approaches addressing the m-Health paradigm and directives already published is also considered. Open and challenging issues on emerging m-Health solutions are proposed for further works.
Copyright © 2015. Published by Elsevier Inc.
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.
Background:
Addressing the health needs of homeless veterans is a priority in the United States, and, although information technologies can potentially improve access to and engagement in care, little is known about this population's use of information technologies or their willingness to use technologies to communicate with healthcare providers and systems.
Materials and methods:
This study fills this gap through a survey of homeless veterans' use of information technologies and their attitudes about using these technologies to assist with accessing needed healthcare services.
Results:
Among the 106 homeless veterans surveyed, 89% had a mobile phone (one-third were smartphones), and 76% used the Internet. Among those with a mobile phone, 71% used text messaging. Nearly all respondents (93%) were interested in receiving mobile phone reminders (text message or phone call) about upcoming medical appointments, and a similar proportion (88%) wanted mobile phone outreach asking if they would like to schedule an appointment if they had not been seen by a health provider in over a year. In addition, respondents already used these technologies for information and communication related to health, housing, and jobs.
Conclusions:
These findings suggest new avenues for communication and health interventions for hard-to-reach homeless veterans.
The overweight and obesity trends have risen over the past few decades, placing significant burdens on health care in terms of increased morbidity and cost. Behavioral change therapy is an effective treatment strategy and includes goal setting, self-monitoring, problem solving, and reinforcement tactics. Traditionally, behavior change therapy has been delivered using face-to-face counseling along with paper and pen recording of dietary intake and physical activity. The current advances in technology provide opportunities to deliver interventions using cellphones, internet, and active video games. These new methods to deliver behavior change for the management and prevention of obesity are being developed in order to increase access, improve convenience, decrease cost, and increase participant engagement. In this review, we present new approaches to promote behavior changes in the management of obesity. Currently available data show promising results. However, future research is needed to address study limitations and implementation challenges of these innovative interventions.
Cell phone use has become nearly ubiquitous among adolescents in the United States. Despite the potential for cell phones to facilitate intervention, research, and care for homeless youth, no data exists to date on cell phone use among this population. In 2009, a survey of cell phone use was conducted among a non-probability sample of 169 homeless youth in Los Angeles, CA. Levels of ownership and use, instrumental uses (connecting to case workers, employers) and patterns of connecting to various network types were assessed (family, home-based peers, street-based peers). Differences in socio-demographic characteristics and cell phone ownership were assessed via t test and chi-square statistics. Sixty-two percent of homeless youth own a cell phone; 40% have a working phone. Seventeen percent used their phone to call a case manager, 36% to call either a potential or current employer. Fifty-one percent of youth connected with home-based peers on the phone and 41% connected to parents. Cell phones present new opportunities for intervention research, connecting homeless youth to family and home-based peers who can be sources of social support in times of need. Moreover, cell phones provide researchers and providers with new avenues to maintain connections with these highly transient youth.
Individuals experiencing homelessness have disproportionately high rates of health problems. Those who perceive themselves as having greater access to their social support networks have better physical and mental health outcomes as well as lower rates of victimization. Mobile phones offer a connection to others without the physical constraints of landlines and, therefore, may make communication (e.g., access to one's social support networks) more feasible for homeless individuals. This, in turn, could lead toward better health outcomes. This exploratory study examined mobile phone possession and use among a sample of 100 homeless men and women who do not use the shelter system in Philadelphia, PA. Interviews were comprised of the Homeless Supplement to the Diagnostic Interview Schedule, a technology module created for this investigation, and the substance use and psychiatric sections of the Addiction Severity Index. Almost half (44%) of the sample had a mobile phone. In the past 30 days, 100% of those with mobile phones placed or received a call, over half (61%) sent or received a text message, and one fifth (20%) accessed the Internet via their mobile phone. Participants possessed and used mobile phones to increase their sense of safety, responsibility (employment, stable housing, personal business, and sobriety or "clean time"), and social connectedness. Mobile phones could potentially be used by public health/health care providers to disseminate information to the street homeless, to enhance communication between the street homeless and providers, and to increase access for the street homeless to prevention, intervention, and aftercare services. Finally, this technology could also be used by researchers to collect data with this transient population.
Reliable and valid longitudinal residential histories are needed to assess interventions to reduce homelessness and increase community tenure. This study examined the test-retest reliability, sensitivity to change, and concurrent validity of the Residential Time-Line Follow-Back (TLFB) Inventory, a method used to record residential histories in the Collaborative Program to Prevent Homelessness (n 1,381). The Residential TLFB Inventory yielded temporally stable aggregate measures of duration in residential categories, and it revealed significant differences in change over time when contrasting study groups. A comparison of agency and participant data at one site
Purpose of the study:
Older homeless adults living in shelters have high rates of geriatric conditions, which may increase their risk for acute care use and nursing home placement. However, a minority of homeless adults stay in shelters and the prevalence of geriatric conditions among homeless adults living in other environments is unknown. We determined the prevalence of common geriatric conditions in a cohort of older homeless adults, and whether the prevalence of these conditions differs across living environments.
Design and methods:
We interviewed 350 homeless adults, aged 50 and older, recruited via population-based sampling in Oakland, CA. We evaluated participants for common geriatric conditions. We assessed living environment using a 6-month follow-back residential calendar, and used cluster analysis to identify participants' primary living environment over the prior 6 months.
Results:
Participants stayed in 4 primary environments: unsheltered locations (n = 162), multiple locations including shelters and hotels (n = 88), intermittently with family/friends (n = 57), and, in a recently homeless group, rental housing (n = 43). Overall, 38.9% of participants reported difficulty performing 1 or more activities of daily living, 33.7% reported any falls in the past 6 months, 25.8% had cognitive impairment, 45.1% had vision impairment, and 48.0% screened positive for urinary incontinence. The prevalence of geriatric conditions did not differ significantly across living environments.
Implications:
Geriatric conditions were common among older homeless adults living in diverse environments, and the prevalence of these conditions was higher than that seen in housed adults 20 years older. Services that address geriatric conditions are needed for older homeless adults living across varied environments.
In the European Union, more than 400,000 individuals are homeless on any one night and more than 600,000 are homeless in the USA. The causes of homelessness are an interaction between individual and structural factors. Individual factors include poverty, family problems, and mental health and substance misuse problems. The availability of low-cost housing is thought to be the most important structural determinant for homelessness. Homeless people have higher rates of premature mortality than the rest of the population, especially from suicide and unintentional injuries, and an increased prevalence of a range of infectious diseases, mental disorders, and substance misuse. High rates of non-communicable diseases have also been described with evidence of accelerated ageing. Although engagement with health services and adherence to treatments is often compromised, homeless people typically attend the emergency department more often than non-homeless people. We discuss several recommendations to improve the surveillance of morbidity and mortality in homeless people. Programmes focused on high-risk groups, such as individuals leaving prisons, psychiatric hospitals, and the child welfare system, and the introduction of national and state-wide plans that target homeless people are likely to improve outcomes.
Homelessness has serious implications for the health of individuals and populations. Primary health-care programmes specifi cally tailored to homeless individuals might be more eff ective than standard primary health care. Standard case management, assertive community treatment, and critical time intervention are eff ective models of mental health-care delivery. Housing First, with immediate provision of housing in independent units with support, improves outcomes for individuals with serious mental illnesses. Many diff erent types of interventions, including case management, are eff ective in the reduction of substance misuse. Interventions that provide case management and supportive housing have the greatest eff ect when they target individuals who are the most intensive users of services. Medical respite programmes are an eff ective intervention for homeless patients leaving the hospital. Although the scientifi c literature provides guidance on interventions to improve the health of homeless individuals, health-care providers should also seek to address social policies and structural factors that result in homelessness.
We systematically reviewed the health and social science literature on access to and use of information technologies by homeless persons by searching 5 bibliographic databases. Articles were included if they were in English, represented original research, appeared in peer-reviewed publications, and addressed our research questions.
Sixteen articles met our inclusion criteria. We found that mobile phone ownership ranged from 44% to 62%; computer ownership, from 24% to 40%; computer access and use, from 47% to 55%; and Internet use, from 19% to 84%. Homeless persons used technologies for a range of purposes, some of which were health related.
Many homeless persons had access to information technologies, suggesting possible health benefits to developing programs that link homeless persons to health care through mobile phones and the Internet.
Purpose: We examined the feasibility of using cell phones to monitor medication adherence among homeless participants and collected data for research purposes.
Data sources: Ten homeless individuals with a co-occurring substance use and psychiatric disorders who were receiving psychopharmacologic treatment participated in the study. All psychopharmacologic treatment was provided by a psychiatric mental health nurse practitioner. Cell phones were provided to participants with unlimited phone service for 45 days. An automated telephone system was programmed to call participants daily for 30 days. All participant responses were reported to a computer and reviewed by study staff on a daily basis.
Conclusions: The automated calls reached study participants 93% of days and, when reached, participants reported 100% adherence with the prescribed medication regimen. Exit interviews indicated strong support for the usefulness of the phone and the value of the call and survey as reminders to take their medication. No patients dropped out of this study.
Implications for practice: This pilot study establishes the feasibility of using cell phones to monitor and manage medication regimens for hard-to-reach populations, such as the homeless with co-occurring disorders. It also establishes that this technology would work for research data collection.
Disclaimer The views expressed in this article do not represent the views of the Veterans Administration or the United States Government.
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