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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.
... No obstante, en los últimos años existen otras evidencias teóricas. La investigación de Rhoades et al. (2017), en el contexto de los Estados Unidos, destaca que un sorprendente 94% de las personas sin hogar encuestadas (n=421) poseían un teléfono móvil, y más de la mitad (58%) disponían de dispositivos inteligentes. Así mismo, el reciente estudio Marler et al. (2024) concluye que los y las jóvenes en situación de calle dependen, e incluso prefieren, la comunicación exclusivamente digital para acceder a recursos. ...
... Estos datos coinciden con investigaciones recientes, como la realizada en los Estados Unidos (Rhoades et al., 2017), que han revelado que, en sociedades tecnológicamente avanzadas, como España, el acceso a Internet y la posesión de un teléfono móvil son fundamentales tanto para las personas con vivienda como para las personas sin hogar, ya que facilitan la conexión con la sociedad y mejoran la seguridad de aquellos que viven en la calle. En este estudio se ha comprobado que el uso de dispositivos móviles y acceso a Internet son comunes para escuchar música, usar WhatsApp, consultar YouTube, redes sociales, noticias, búsqueda de empleo y temas de vivienda, recursos sociales y salud, entre otras. ...
... Estos objetivos son una respuesta directa a las necesidades identificadas durante el diagnóstico participativo, que reveló la carencia de un canal centralizado de información actualizada para las personas sin hogar en Córdoba. Además, los datos obtenidos indican que las personas sin hogar entrevistadas tienen un alto grado de participación en la era digital, tal y como afirmaba el trabajo de Rhoades et al. (2017). Por lo tanto, la acción que proponemos contribuye a mantenerlos "conectados" (Fernández et al., 2006) al proporcionar información fácilmente accesible sobre los recursos disponibles (Reina et al., 2022). ...
El aumento de personas sin hogar ha generado una creciente preocupación por mejorar su atención. Cualquier iniciativa debe construirse desde un diagnóstico participativo, en colaboración con redes ya existentes con experiencia en la atención al sinhogarismo y basarse en sus necesidades reales, informadas por las personas sin hogar y el personal técnico que trabaja con ellas. Desde este enfoque, el proyecto "cordobasinhogar" pretende transformar el acceso a la información sobre recursos para personas sin hogar en un entorno digital, con especial atención al sinhogarismo femenino. Surge de una Investigación-Acción Participativa y se desarrolló tras explorar cómo las personas sin hogar en Córdoba, España, valoran y utilizan los recursos disponibles y cómo es su acceso a la ciudadanía digital. Cordobasinhogar.es ofrece un sitio web con información geolocalizada sobre las necesidades de las personas en situación de sinhogarismo. En colaboración con el Ayuntamiento de Córdoba, se realizaron entrevistas estructuradas a 215 personas adultas (23,3% mujeres). Los datos rompen con el estereotipo más común asociado a las personas sin hogar, que carecen de acceso a las TIC y revelan el uso de los recursos sociales más utilizados con diferencias según el género y la tipología ETHOS. El uso de dispositivos móviles y acceso a Internet son comunes para escuchar música, usar WhatsApp, consultar YouTube, redes sociales, noticias, búsqueda de empleo y temas de vivienda, recursos sociales y salud, entre otras.
Este estudio destaca la importancia de involucrar a la comunidad en la mejora de la atención a personas sin hogar y muestra cómo la tecnología digital puede contribuir a estar "conectados", proporcionando información de fácil acceso sobre los recursos disponibles.
... Likewise, the review of scientific literature on this matter (Eyrich-Garg, 2010;Eyrich-Garg & Rice, 2012;Redpath et al., 2006) shows that one of the most common stereotypes associated with homeless people is lack of access to information technology. However, this belief is challenged with works such as that of Rhoades et al. (2017) in the United States, in which it is shown that 94% of the homeless people contacted (n = 421) own a mobile phone, while more than half (58%) own smart devices. ...
... About 78.6% (n = 169) have their own mobile phones (77.6% of men, n = 128; 82% of women, n = 41) and 4.2% (n = 9) have access to someone else's mobile phone (4.2% of men, n = 7; 4% of women, n = 2). The figure found by Rhoades et al. (2017) shows that 94% of homeless people in Los Angeles, California (n = 421) own a mobile (13) Total responses 100% (255) 100% (135) 100% (578) Note: Answers are multiple choice. ...
... phone. These data highlight that the use of the mobile phone has become a daily necessity in the lives of these people and is one of the major Internet access channels for this group (Rhoades et al., 2017). ...
Homelessness represents the most extreme social exclusion and vulnerability conditions. It is urgent to perform a social diagnosis that explores the sociodemographic and descriptive characteristics of homeless people who make a living in Spain in order to identify their specific needs, particularities of the situation of women and strategies to improve their quality of life. Through a sample of 215 homeless people (Córdoba city, Spain) a structured interview using a guided questionnaire was conducted. A descriptive statistics analysis was performed. The results show that although there are similar characteristics in terms of mean age and level of education, there are also striking differences between men and women. More women report to be mothers, have a partner in an attempt, among other things, to seek protection in such extreme conditions, and a lower presence of women on public roads is the result of their avoiding sleeping in the open or in places where they may be exposed to violent situations. The knowledge of the different trajectories and characteristics of homeless people and, more specifically, the group of women, may be considered when designing public policies and allocating social resources.
... Common barriers in accessing technology included low battery life, broken devices, and difficulty charging the device (Adkins et al., 2017). However, Rhoades et al. (2017) suggests that the homeless population could benefit from technology-based interventions. ...
... The technology theme within this study is notable because of the research indicating a sizable percentage of IEH have access to technology (Culhane et al., 2020), and that this population could greatly benefit from interventions that leverage technology (Rhoades et al., 2017). Study participants indicated specific challenges with technology that mirror findings in the literature, such as access to devices and device charging (Adkins et al., 2017). ...
... Others mentioned they enjoyed the flexibility that telehealth provided. This mirrors some of the literature (Adkins et al., 2017;Culhane et al., 2020;Rhoades et al., 2017) and presents an opportunity for more exploration and understanding among IEH and service providers. ...
Many individuals experiencing homelessness have frequent interactions with mental and/or substance use providers and services. The purpose of this qualitative study was to gain a better understanding of the views of mental health and substance use treatment services in San Diego County by individuals experiencing homelessness (N = 25). This study queried what aspects of various services were helpful or not helpful to individuals to maintain stable housing and/or continue in mental health and substance use treatment services. Qualitative interviews were audio recorded, transcribed , and then analyzed utilizing thematic analysis. Findings include six key themes: perception of providers, provision of services, stability, the impact of COVID-19, technology, and trauma and loss. Based on these findings, we provide suggestions for service providers and policies to positively impact individuals experiencing homelessness. ARTICLE HISTORY
... Digital divide scholarship has therefore largely pivoted to address differences in skills and motivations surrounding mobile phone use. A more nuanced literature, however, points to the unique challenges of access faced by unhoused populations (Gonzales, 2016;Heaslip et al., 2021;Humphry, 2021Humphry, , 2022aMarler, 2019;Reitzes et al., 2016;Rhoades et al., 2017;Thurman et al., 2021). Conceptualizing technology access as varying shades of opportunity that range far beyond device ownership or service connection at a single point in time, these studies focus on the capricious circumstances among the unstably housed by highlighting the interdependence between digital inequalities, housing, employment, and other resources. ...
... General findings nod to the struggles vehicle residents experience in maintaining mobile devices and connections, echoing similar results of challenges to access faced by unstably housed populations (Gonzales, 2016;Heaslip et al., 2021;Humphry, 2021Humphry, , 2022aMarler, 2019;Reitzes et al., 2016;Rhoades et al., 2017;Thurman et al., 2021). However, previous results placed an emphasis on the quality and the availability of the devices themselves, whereas, in contrast, vehicle residents maintained smartphones and unlimited data plans as a result of sustaining employment to varying degrees. ...
This high-exposure study explores information-seeking via mobile phone usage among a specific unstably housed population. There exists a population referred to as “vehicle residents” who are people earning wages, who have chosen to move into their vehicles as a survival strategy during a time when housing expenses account for more than half of lower-income Americans’ monthly income, and whose situation varies from traditional homelessness in that they sustain some stability in maintaining ownership of the vehicle in which they are residing. Building on previous studies of homeless people and their mobile phone usage, while using mobilism as the frame, this study investigates the ways that access instability, an underexamined facet of digital inequality, impacts vehicle residents’ ability to search for information via their mobile phones to support their daily lives. This study is based on two rounds of semi-structured interviews with the same participants, complemented by a virtual guided tour of participant's vehicles. Among the key findings is that mobility creates and resolves access instability for vehicle residents, introducing the concept of mobile access instability. Overall, understanding the unique features and information needs of this particular group results in a more thorough comprehension of the contemporary housing crisis, which is necessary to improve policy by developing mitigation strategies and resolutions.
... We conducted a scoping review of the literature to identify the sociodemographic factors that could put an individual at risk of digital exclusion. Based on the findings published in peer-reviewed articles 24,47-60 , systematic reviews 61-64 , government reports 8,65 , and regulatory organisation documents 66 , we identified a number of sociodemographic factors that we complied into six groups, relating to Culture (ethnicity, language, and religion) 8,[47][48][49][50][51][52][53]62 , Limiting conditions (visual and hearing impairments) 6,54,66 , Education (at or below United Kingdom (UK) government mandated level or equivalent) 52,55,56,66 , Age (over 65 years) 51,[54][55][56]62,66 , Residence (rural or deprived areas [based on consensus data within a country], or homeless) 8,24,51,60 , and Socioeconomic status (low income [earns less than 60% of the median household annual income within a country] and unemployed individuals) 8,52,55,56,62,65,66 abbreviated to CLEARS (Fig. 4). These factors often intersect (i.e. ...
Digital Health Technologies (DHTs) are revolutionizing healthcare. However, there is a lack of demonstrable health benefits across all populations. To advance digital health equity, we explored the perspectives of underserved groups on strategies to support digital inclusivity. Participants belonged to two or more CLEARS (Culture (ethnicity, language, religion), Limiting conditions (visual or hearing), low Educational attainment, older Age, Residence (rural, deprived or no fixed address), low Socioeconomic status) groups. This framework encompassed sociodemographic factors associated with digital exclusion and recognizes the role of intersectionality.(1) Twenty-nine individuals participated in focus groups (n = 4) or interviews (n = 11) and shared their perspectives on the barriers to DHTs, innovative ideas to improve inclusivity, and perceived feasibility of implementing changes. An inductive reflective thematic analysis was used to analyze the transcripts, assisted by N-Vivo. Participants experienced fragmented communication with healthcare providers when using DHTs, explaining how they received a no-reply SMS message asking them to confirm an appointment via a link but were unable to access the link. Current solutions to overcoming such barriers included using non-digital routes (e.g., visiting a pharmacy) or calling non-emergency healthcare services. Many participants expressed the need for DHT support services to be implemented to provide educational support and access to devices. However, some participants raised concerns about the financial strain this might place on healthcare systems. Future research should evaluate the feasibility of implementing different DHTs support services across different settings to advance digital health equity.
(1)Wilson et al. (2023). Strategies to develop, design, implement and support digital health equity in key underserved groups: protocol for a systematic review. Alzheimer’s & Dementia.
Key messages
• Strategies to mitigating digital exclusion within healthcare should be designed with underserved groups.
• Future research should evaluate the feasibility of implementing different DHTs support services across different settings to advance digital health equity.
... Die breite Angebotspallette soll die Basis für eine innovative digitale Unterstützungsstrategie zur Stärkung der Teilhabe wohnungsloser Menschen dienen. Auch wenn der Gebrauch von mobilen Endgeräten und Computern innerhalb der heterogenen Gruppe der Menschen ohne Wohnung unterschiedlich ist (Hauprich 2020), zeigen Studien, dass diese Smartphones und Computer zahlreich nutzen (z.B. Rhoades et al. 2017;Harris 2017). Vor diesem Hintergrund können Barrieren des Hilfesystems unter Zuhilfenahme digitaler Instrumente abgebaut werden (Sowa et al. 2020). ...
Wie können Menschen zu Hause bleiben, die kein Zuhause haben? Obdach- und wohnungslose Menschen waren mit am stärksten von der COVID-19-Pandemie betroffen, wurden aber lange von der Politik übersehen. Apelle wie unter dem Hashtag StayAtHome wirkten ihnen gegenüber geradezu zynisch. Auch in der Forschungslandschaft fand die Situation dieser Menschen bisher wenig Berücksichtigung. Die Beiträger*innen nehmen sich dieser Lücke an und bündeln den derzeitigen Forschungsstand zum sozialen Phänomen der Obdach- und Wohnungslosigkeit sowie daran angrenzende Themengebiete in pandemischen Zeiten. Ein Blick zurück lohnt sich, um aus dieser Zeit zu lernen und für künftige Pandemien besser gewappnet zu sein.
... We conducted a scoping review of the literature to identify the sociodemographic factors that could put an individual at risk of digital exclusion. Based on the findings published in peer-reviewed articles 24,47-60 , systematic reviews 61-64 , government reports 8,65 , and regulatory organisation documents 66 , we identified a number of sociodemographic factors that we complied into six groups, relating to Culture (ethnicity, language, and religion) 8,[47][48][49][50][51][52][53]62 , Limiting conditions (visual and hearing impairments) 6,54,66 , Education (at or below United Kingdom (UK) government mandated level or equivalent) 52,55,56,66 , Age (over 65 years) 51,[54][55][56]62,66 , Residence (rural or deprived areas [based on consensus data within a country], or homeless) 8,24,51,60 , and Socioeconomic status (low income [earns less than 60% of the median household annual income within a country] and unemployed individuals) 8,52,55,56,62,65,66 abbreviated to CLEARS (Fig. 4). These factors often intersect (i.e. ...
The World Health Organisation advocates Digital Health Technologies (DHTs) for advancing population health, yet concerns about inequitable outcomes persist. Differences in access and use of DHTs across different demographic groups can contribute to inequities. Academics and policy makers have acknowledged this issue and called for inclusive digital health strategies. This systematic review synthesizes literature on these strategies and assesses facilitators and barriers to their implementation. We searched four large databases for qualitative studies using terms relevant to digital technology, health inequities, and socio-demographic factors associated with digital exclusion summarised by the CLEARS framework (Culture, Limiting conditions, Education, Age, Residence, Socioeconomic status). Following the PRISMA guidelines, 10,401 articles were screened independently by two reviewers, with ten articles meeting our inclusion criteria. Strategies were grouped into either outreach programmes or co-design approaches. Narrative synthesis of these strategies highlighted three key themes: firstly, using user-friendly designs, which included software and website interfaces that were easy to navigate and compatible with existing devices, culturally appropriate content, and engaging features. Secondly, providing supportive infrastructure to users, which included devices, free connectivity, and non-digital options to help access healthcare. Thirdly, providing educational support from family, friends, or professionals to help individuals develop their digital literacy skills to support the use of DHTs. Recommendations for advancing digital health equity include adopting a collaborative working approach to meet users’ needs, and using effective advertising to raise awareness of the available support. Further research is needed to assess the feasibility and impact of these recommendations in practice.
... Lastly, if the discharged patient has access to a mobile device, the information from the digital solutions mentioned above could potentially be used to inform the discharged patient on resources for PEH, shelter bed availability, and healthcare follow-up reminders. A 2017 study of PEH in Los Angeles and Long Beach, California found that the majority of respondents owned a cell phone currently (94%) or in the past 3 months (97%) [34]. ...
People experiencing homelessness are more likely to utilize emergency departments than their non-homeless counterparts. However, obtaining a bed in a homeless shelter for patients can be complex. To better understand the challenges of finding a safe discharge plan for homeless patients in the emergency department, our team conducted interviews with emergency department social workers and homeless shelter case managers in the Boston area. We identified and mapped the stages in the processes performed by both parties, identifying challenges with successful placement into a shelter. Furthermore, we assembled a data dictionary of key factors considered when assessing a patient’s fit for a homeless shelter. By identifying bottlenecks and areas of opportunity, this study serves as a first step in enabling homeless individuals to receive the post-discharge assistance they require.
... 53 All recruitment occurred through telephone or email, potentially excluding people without access to these technologies; however, recent research in the United States indicates that the vast majority of unhoused people have access to mobile phones, computers, and the internet. 54 We recruited participants through homeless assistance providers, whose services included access to mobile phones and computers, or referral to internet access locations. The purposive sampling strategy may have introduced some selection bias, as participants were identified through homelessness services agencies and not randomly. ...
Background: Homelessness during pregnancy contributes to adverse pregnancy and infant outcomes from birth through early childhood. Washington, DC, a microcosm of structural inequities in the United States, has persistent racial disparities in perinatal outcomes and housing insecurity.
Methods: Grounded in a reproductive justice framework, we explored the lived experience of navigating homelessness assistance while pregnant to inform recommendations for a collaborative policy and practice change effort. We conducted 20 individual interviews with DC residents who experienced homelessness during pregnancy. We analyzed the data using thematic analysis and an action-oriented approach.
Results: Our analysis resulted in three main recommendation areas for policy and practice change: (1) timely and meaningful access to safe and stable housing in pregnancy; (2) care coordination for services and referrals that support physical, mental, and social well-being; and (3) access to a living wage and affordable housing.
Discussion: Access to stable housing is critical to ensure that pregnant and parenting people can have and raise children in a safe and sustainable environment—key tenets of reproductive justice. Housing support must be meaningfully accessible, including service delivery that accommodates the complex social histories and competing demands that accompany housing insecurity.
Health Equity Implications: This study informed the development of strategic recommendations, catalyzed a new model for multisector collaboration, and influenced a system-wide practice change to expand access to robust housing supports for pregnant people. Policy and practice change require sustained leveraging of political will to promote economic justice and ensure that residents can achieve safe, sustainable, and affordable housing.
... The study also will not follow people after the basic income funding has ended. It should also be noted that this intervention primarily focused on individuals who had a cell phone, which research suggests is much of the homeless population [57]. ...
Background
This paper describes the protocols for a randomized controlled trial using a parallel-group trial design that includes an intervention designed to address social isolation and loneliness among people experiencing homelessness known as Miracle Friends and an intervention that combines Miracles Friends with an economic poverty-reduction intervention known as Miracle Money. Miracle Friends pairs an unhoused person with a volunteer “phone buddy.” Miracle Money provides guaranteed basic income of $750 per month for 1 year to Miracle Friends participants. The study will examine whether either intervention reduces social isolation or homelessness compared to a waitlist control group.
Methods
Unhoused individuals who expressed interest in the Miracle Friends program were randomized to either receive the intervention or be placed on a waitlist for Miracle Friends. Among those randomized to receive the Miracle Friends intervention, randomization also determined whether they would be offered Miracle Money. The possibility of receiving basic income was only disclosed to study participants if they were randomly selected and participated in the Miracle Friends program. All study participants, regardless of assignment, were surveyed every 3 months for 15 months.
Results
Of 760 unhoused individuals enrolled in the study, 256 were randomized to receive Miracle Friends, 267 were randomized to receive Miracle Money, and 237 were randomized to the waitlist control group. In the two intervention groups, 360 of 523 unhoused individuals were initially matched to a phone buddy. Of the 191 study participants in the Miracle Money group who had been initially matched to a volunteer phone buddy, 103 were deemed to be participating in the program and began receiving monthly income.
Discussion
This randomized controlled trial will determine whether innovative interventions involving volunteer phone support and basic income reduce social isolation and improve housing outcomes for people experiencing homelessness. Although we enrolled unhoused individuals who initially expressed interest in the Miracle Friends program, the study team could not reach approximately 30% of individuals referred to the study. This may reflect the general lack of stability in the lives of people who are unhoused or limitations in the appeal of such a program to some portion of the unhoused population.
Trial registration
ClinicalTrials.gov NCT05408884 (first submitted on May 26, 2022).
... An overlap exists among populations experiencing homelessness and those with SUD. In addition, 94% of those experiencing homelessness own a mobile phone (15), suggesting opportunities to increase audio-only telemedicine for SUD care in underserved populations. ...
The future of telemedicine for substance use treatment hangs by a thread, as the United States awaits approval of proposed regulations and laws to increase care access in light of the 2022 Centers for Medicare and Medicaid Services revisions allowing for audio-only care. Telemedicine improves patient care access and outcomes. Audio-only telemedicine can be an effective and viable modality for individuals without technology resources (devices, internet services, and literacy), those with reduced telehealth service utilization (Black individuals or those with unstable housing, who are older, with low income, or with low education), and those living in rural locations. Studies suggest that telephone visits for buprenorphine treatment are well-accepted by patients and providers, making telephone visits essential in care access to reduce disparities. Telephone counseling for patients in substance use treatment is convenient, flexible, and empowering and can augment therapeutic alliances and treatment goals. Both providers and patients advocate for patient-centered hybrid care to include telephone-only treatment, which enhances service productivity and care access; reduces no-show rates, costs, and stigma; and is sustainable. Numerous solutions can expand technology access, proficiency, assimilation, and trust. Despite being “old” technology, the telephone remains an essential resource for substance use treatment.
... Yet few studies have used smartphone apps to gather detailed, contextual knowledge on housing transitions among VEH. Notably, smartphone ownership among persons experiencing homelessness is growing and almost equivalent to that of the general population [21,22]. ...
Background
US military veterans who have experienced homelessness often have high rates of housing transition. Disruptions caused by these transitions likely exacerbate this population’s health problems and interfere with access to care and treatment engagement. Individuals experiencing homelessness increasingly use smartphones, contributing to improved access to medical and social services. Few studies have used smartphones as a data collection tool to systematically collect information about the daily life events that precede and contribute to housing transitions, in-the-moment emotions, behaviors, geographic movements, and perceived social support.
Objective
The study aims to develop and test a smartphone app to collect longitudinal data from veterans experiencing homelessness (VEH) and to evaluate the feasibility and acceptability of using the app in a population that is unstably housed or homeless.
Methods
This study’s design had 3 phases. Phase 1 used ethnographic methods to capture detailed data on day-to-day lived experiences of up to 30 VEH on topics such as housing stability, health, and health behaviors. Phase 2 involved focus groups and usability testing to develop and refine mobile phone data collection methods. Phase 3 piloted the smartphone mobile data collection with 30 VEH. We included mobile ethnography, real-time surveys through an app, and the collection of GPS data in phase 3.
Results
The project was launched in June 2020, and at this point, some data collection and analysis for phases 1 and 2 are complete. This project is currently in progress.
Conclusions
This multiphase study will provide rich data on the context and immediate events leading to housing transitions among VEH. This study will ensure the development of a smartphone app that will match the actual needs of VEH by involving them in the design process from the beginning. Finally, this study will offer important insights into how best to develop a smartphone app that can help intervene among VEH to reduce housing transitions.
International Registered Report Identifier (IRRID)
DERR1-10.2196/53022
... In a case report conducted in Los Angeles, USA, 85% of homeless people used a cell phone and used text messaging daily, and 51% accessed the Internet on their cell phone. 34 A number of other studies have postulated a convergence on the similar findings. [35][36][37] The current cell phone using status support the possibility of Webbased intervention use in the homelessness context. ...
Objectives
Homelessness among families with children under 5 residing in temporary accommodation is a growing global concern, especially in high-income countries (HICs). Despite significant impacts on health and development, these ‘invisible’ children often fall through the gaps in policy and services. The study’s primary objective is to map the content and delivery methods of culturally sensitive interventions for children under 5 experiencing homelessness in HICs.
Design
A scoping review guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist.
Data sources
Databases include PubMed, Medline, SCOPUS, The Cochrane Library and Google Scholar were searched up to 24 March 2022.
Eligibility criteria
This scoping review includes studies that describe, measure or evaluate intervention strategies aimed at improving child health programmes, specifically those yielding positive outcomes in key areas like feeding, nutrition, care practices and parenting.
Data extraction and synthesis
Articles were selected and evaluated by two independent reviewers, with a dispute resolution system involving a third reviewer for contested selections. The methodological quality of the studies was assessed using various tools including the Risk of Bias (RoB) tool, Cochrane RoB V.2.0, the Risk of Bias Assessment Tool for Non-randomized Studies (RoBANS) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), each selected according to the type of article.
Results
The database search yielded 951 results. After deduplication, abstract screening and full review, 13 articles met the inclusion criteria. Two predominant categories of intervention delivery methods were identified in this research: group-based interventions (educational sessions) and individual-based interventions (home visits).
Conclusion
This review highlights effective interventions for promoting the health and well-being of children under 5 experiencing homelessness, including educational sessions and home visits. Research has supported the importance of home visiting to be instrumental in breaking down language, cultural and health literacy barriers.
... People with severe mental illness, especially those who are experiencing homelessness or housing instability related to their mental illness, may face additional barriers to tele-health services. There is some evidence that the gap in access to technology, or the "digital divide" is narrowing for this group, with one study finding near universal cell phone ownership among homeless adult participants (Rhoades et al., 2017); however, other study results show much lower rates of technology use (Polillo et al., 2021;Tobitt & Percival, 2019). ...
Covid-19 has presented challenges to community mental health organizations that have historically almost exclusively delivered in-person services. This study uses qualitative methods to examine the launch of tele-mental health case management delivery in response to the Covid-19 pandemic in a community mental health organization, from the perspectives of case managers and clients. Tele-mental health challenges included access to and use of technology, and limitations of technology. Our findings suggest that tele-mental health case management delivered via the phone and videoconferencing is viewed, for the most part, positively by both clients and case managers, although it cannot fully replicate in-person services.
... Current research on homelessness and mobile communications shows that digital technologies, especially in the form of smartphones, are as common among a wide age range of people experiencing homelessness as the general population (Humphry, 2014;Rhoades et al., 2017). Using digital media allows them to secure basic needs, ensures their survival, establishes a sense of security, promotes social inclusion, supports the construction of the self, and can strengthen their mental well-being (Eyrich-Garg, 2010;Hauprich, 2021;Humphry, 2014;Roberson & Nardi, 2010). ...
This contribution sheds light on how people experiencing homelessness in Germany make sense of an app designed with them in mind and whether using it would be of benefit to them. However, it must be acknowledged that the app has yet to be developed. “Urban figurations of social control,” a term we use to refer to the social conditions of homelessness in Germany, give rise to a significant loss of trust as well as a state of vulnerability, feelings of loneliness, and limited agency for people experiencing homelessness. Drawing on a group discussion with 12 people experiencing homelessness that took place in Germany in 2019, our findings demonstrate that the respondents project particular fears and desires onto the use of the potential app. Whenever they fear surveillance and institutional control, they wish to be invisible to the app. On the other hand, their desire to access resources and information (food, places to sleep, housing) and to meet with peers in order to create meaningful social relationships requires their visibility. Thus, navigating between visibility and invisibility by way of a smartphone involves situationally and strategically constructing a safe environment for their digital participation, helping them to reduce their vulnerability and loneliness and restore their agency. Moreover, in that the app is used as a means of rendering assistance to homeless people (and highlighting the grievances associated with this) that is visible to others, the respondents challenge the current framing of homelessness. The supposed system of help is revealed to be the social problem itself.
... Existing research on mobile technologies to support people experiencing homelessness has focused primarily on issues related to mobile technology access, adoption, and use. For example, several studies have focused on the extent to which homeless populations use mobile phones in their everyday lives (Eyrich-Garg, 2010;Reitzes et al., 2017;Rhoades et al., 2017), whereas other studies have centered on mobile device use among specific demographic groups, such as homeless young people (Jennings et al., 2016;Rice et al., 2011;Rice et al., 2012;Winetrobe et al., 2017). Other scholars have investigated how people experiencing homelessness use social media (Calvo & Carbonell, 2019;Marler, 2021;Rice & Barman-Adhikari, 2014), while others have looked at the barriers to healthcare access for rural homeless populations (Easterday et al., 2019). ...
Previous studies have examined the benefits and challenges of using mobile phones to support people experiencing homelessness. However, few studies have considered how mobile Wi-Fi hotspots support unhoused individuals and couples through public library lending programs. This paper seeks to address a gap in mobile communication scholarship by contributing insights from a qualitative study of library patrons who checked out mobile hotspots from the Boston Public Library in Massachusetts, USA. The findings show that although mobile hotspots provided many benefits for public library patrons in general, these devices facilitated mobile communication with a different sense of urgency for six people experiencing homelessness who also happened to be in romantic relationships. More concretely, the study found that mobile Wi-Fi hotspots reduced stress and anxiety for unhoused patrons because without the devices, patrons without fixed residences worried they could not be found; that hotspots kept unhoused patrons more connected, and therefore safer, in their tents despite the cold weather and a lack of electricity; and that unhoused patrons were concerned about their devices getting stolen because of their precarious situation. Although the unhoused patrons who participated in this study also shared their recommendations regarding how mobile hotspot lending programs in public libraries could be improved, they also mentioned that the benefits of hotspot availability far outweighed their challenges. The findings have implications for those working to address homelessness, including community-based organizations, government agencies, and policymakers who seek further insights into the positive role that mobile hotspot devices can play in supporting positive health outcomes for individuals and couples experiencing homelessness.
... Lastly, while MORS/VOMS present some advantages in reducing harm reduction service barriers (i.e.: geographic access, stigma, routes of administration, and creating gender-responsive care environments [15,20] they currently do not support all individuals who use drugs. Statistics indicate that less than half of individuals accessing SCS [43] have access to a phone, in contrast, however, in a study of 421 homeless adults moving into permanent supportive housing, 94% possessed a cell phone [44]. Future studies should focus on the potential impacts of narrowing the digital divide for these populations and their resultant healthcare access. ...
Background
The overdose crisis continues across Canada which calls for novel harm reduction strategies. Previous research indicates that a majority of eHealth solutions are cost-effective however current literature on the cost-benefit of eHealth for harm reduction is sparse. The National Overdose Response Service (NORS) is a Canada-wide telephone-based harm reduction service. Service users can call the phone number and connect to a peer who can virtually monitor the substance use session and dispatch appropriate interventions in the case of overdose.
Objectives of the research/project
We aim to assess the cost-benefit of NORS by comparing the estimated cost-savings from prevented overdose mortality to the operating costs of the program, alongside healthcare costs associated with its operation.
Methods
Data around systems costs and operational costs were gathered for our calculations. Our primary outcome was cost-benefit ratios, derived from estimates and models of mortality rates in current literature and value of life lost. We presented our main results across a range of values for costs and the probability of death following an unwitnessed overdose. These values were utilized to calculate cost-benefit ratios and value per dollar spent on service provision by NORS over the length of the program’s operation (December 2020–2022).
Results
Over the total funded lifespan of the program, and using a Monte Carlo estimate, the benefit-to-cost ratio of the NORS program was 8.59 (1.53–15.28) per dollar spent, depending on estimated mortality rates following unwitnessed overdose and program operation costs. Further, we conservatively estimate that early community-based naloxone intervention results in healthcare system savings of $4470.82 per overdose response.
Conclusions
We found the NORS program to have a positive benefit-to-cost ratio when the probability of death following an unwitnessed overdose was greater than 5%. NORS and potentially other virtual overdose monitoring services have the potential to be cost-effective solutions for managing the drug poisoning crisis.
... A network of community partners and service providers posted a flier about the study on their social media accounts and at program sites. Cell phone use is common among people experiencing homelessness but often disrupted (Rhoades et al., 2017). Thus, we made the survey available in two formats to maximize participation: a web-based survey hosted by Qualtrics for people who had internet access, and a program called TextIt which allowed people with only SMS messaging to reply to our survey via an automated series of text messages that people could respond to directly. ...
How do people experiencing homelessness make decisions about accepting or avoiding social services and health care? The study presented here seeks to answer this question by drawing on remotely-gathered surveys (n=244) and in-depth interviews (n=57) with unhoused people during the first wave of the COVID-19 pandemic. In this paper, we explore service-seeking behaviors and processes to understand how to best support people experiencing homelessness during current and future public health disasters. We find that homelessness services systems are often fragmented, increasing administrative burdens such as learning costs (Herd & Moynihan 2018, 2020) and driving unhoused people away from seeking the support they actually need. Four organizing themes centered on temporary housing, health care and medical racism, precarious employment, and self-preservation became apparent within the broader systems challenges. Findings provide insight into the survival strategies of people experiencing homelessness, including how and why people avoid services. Findings point to systems-level recommendations for better aligning homelessness-serving systems with the actual needs of unhoused people themselves. Lastly, the research approach described here offers lessons learned regarding doing social science research with people experiencing homelessness during public health disasters.
... According to Hootsuite & We Are Social (Kemp, 2021) in October 2021 there were 4'88 billion Internet users in the world (61.8% of the population), 5.29 billion cell phone owners (59.5%) and 4.55 billion active users on social networks (57.6%). Even people with greater economic difficulties and more serious situations of exclusion (such as the homeless, for example) can access the Internet through mobile telephony and the use of public or free Wi-Fi networks (Rice & Barman-Adhikari, 2014;Rhoades, Wenzel, Rice, Winetrobe & Henwood, 2017). ...
... Although this was a viable approach to recruitment and data collection, thus far, 12% of phones have been lost. It is not clear to what extent study recruitment rates would have been different without distributing phones given the high rates of phone ownership in this population, although maintaining consistent phone service is challenging [29]. Given current recruitment numbers and retention rates that are over 90% (only 49 have been lost to follow-up), the study will be able to address a gap in the literature by considering the comparative effectiveness of PB-PSH versus SS-PSH on patient-centered quality of life, health care use, and health behaviors that reduce COVID-19 risk. ...
Background:
Permanent supportive housing (PSH) is an evidence-based practice to address homelessness that is implemented using 2 distinct approaches. The first approach is place-based PSH (PB-PSH), or single-site housing placement, in which an entire building with on-site services is designated for people experiencing homelessness. The second approach is scatter-site PSH (SS-PSH), which uses apartments rented from a private landlord while providing mobile case management services.
Objective:
This paper describes the protocols for a mixed methods comparative effectiveness study of 2 distinct approaches to implementing PSH and the patient-centered quality of life, health care use, and health behaviors that reduce COVID-19 risk.
Methods:
People experiencing homelessness who are placed in either PB-PSH or SS-PSH completed 6 monthly surveys after move-in using smartphones provided by the study team. A subsample of participants completed 3 qualitative interviews at baseline, 3 months, and 6 months that included photo elicitation interviewing. Two stakeholder advisory groups, including one featuring people with lived experience of homelessness, helped guide study decisions and interpretations of findings.
Results:
Study recruitment was supposed to occur over 6 months starting in January 2021 but was extended due to delays in recruitment. These delays included COVID-19 delays (eg, recruitment sites shut down due to outbreaks and study team members testing positive) and delays that may have been indirectly related to the COVID-19 pandemic, including high staff turnover or recruitment sites having competing priorities. In end-July 2022, in total, 641 people experiencing homelessness had been referred from 26 partnering recruitment sites, and 563 people experiencing homelessness had enrolled in the study and completed a baseline demographic survey. Of the 563 participants in the study, 452 had recently moved into the housing when they enrolled, with 272 placed in PB-PSH and 180 placed in SS-PSH. Another 111 participants were approved but are still waiting for housing placement. To date, 49 participants have been lost to follow-up, and 12% of phones (70 of the initial 563 distributed) were reported lost by participants.
Conclusions:
Recruitment during the pandemic, while successful, was challenging given that in-person contact was not permitted at times either by program sites or the research institutions during COVID-19 surges and high community transmission, which particularly affected homelessness programs in Los Angeles County. To overcome recruitment challenges, flexible strategies were used, which included extending the recruitment period and the distribution of cell phones with paid data plans. Given current recruitment numbers and retention rates that are over 90%, the study will be able to address a gap in the literature by considering the comparative effectiveness of PB-PSH versus SS-PSH on patient-centered quality of life, health care use, and health behaviors that reduce COVID-19 risk, which can influence future public health approaches to homelessness and infectious diseases.
Trial registration:
ClinicalTrials.gov NCT04769349; https://clinicaltrials.gov/ct2/show/NCT04769349.
International registered report identifier (irrid):
DERR1-10.2196/46782.
... 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.
... Despite these clinical and technological benefits of telehealth counseling, some studies suggested that a preference for in-person counseling (Hall et al., 2022), mis/distrust of telehealth (Rovner et al., 2021), and barriers to telehealth solutions (Zhai, 2021) might have affected the continuity of care and clients' intentions to continuously seek counseling services. The internet and digital devices seem ubiquitous nowadays, yet many individuals with pressing mental health concerns still encountered a variety of barriers to telehealth in the early phase of this pandemic, such as poor technological infrastructures in many regions (Struminger & Arora, 2019), inequalities around digital literacy (Hargittai, 2002;Humphry, 2019;Rhoades et al., 2017;Scheerder et al., 2019), insufficient telehealth training for counselors (Johnson & Rehfuss, 2021;Scharff et al., 2020), and regulatory/reimbursement restrictions (Whaibeh et al., 2020;Zhai, 2021). We wondered if these barriers and mixed attitudes toward telehealth counseling might have impeded clients' intentions to seek counseling services during the first year of this pandemic. ...
Practicing counselors swiftly shifted to telehealth after insurance payers changed their policy to cover telehealth counseling under the Expansion of Telehealth with 1135 waivers, which has led to concerns over the policy effects on clients’ continuing counseling service-seeking intentions. To determine if this shift to telehealth was associated with a change in clients’ counseling service-seeking intentions while adjusting for unmeasured confounders and time trends, we performed a difference-in-difference analysis (DiD; a quasi-experimental design) to compare changes between the client (treated) and non-client (control) groups through a large national sample of emerging adults (N = 52,237). The study findings indicated that the shift to telehealth was not associated with a change in clients’ counseling service-seeking intentions, providing support for the utility of telehealth counseling. Implications of these findings should be considered when assessing the merit of telehealth counseling to inform public policies and counseling practice in the post-pandemic era.
... 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). ...
Objective: Clinical data in the United States is 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 factor 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 providing basic information about demographics, insurance, payment, and medical conditions repeatedly. Traditional solutions that require complex governance, expensive technology, and risks to privacy and security of the data have failed to solve this interoperability problem adequately. We describe the technical design decisions of a patient-centric decentralized health identity management system using blockchain technology, called MediLinker, to address some of these challenges. Design: Our multi-disciplinary research group developed and implemented an identity wallet, that uses 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) 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 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 have successfully developed and tested a blockchain-based technical architecture, described in this paper, as an identity management system that may be operationalized and scaled for future implementation to improve patient experience and control over their personal information.
... 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). ...
Purpose
In 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.
Results
We 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.
Health leaders are increasingly interested in harnessing Artificial Intelligence (AI) to remotely conduct virtual triage for Emergency Department (ED) patients. This study explores equity considerations and patient attitudes to virtual triage in a Canadian ED. A cross-sectional study surveyed 150 ED patients, with 32 additional patients interviewed in-depth. Descriptive statistics and qualitative descriptive methodology were employed. 84.7% of patients would consider virtual triage. 71.3% were comfortable following advice to seek alternate care, including their General Practitioner or virtual ED. Approximately 38.2% of patients >60 years would require assistance using virtual triage, with confidence in using technology to direct care decreasing with age. Thematic analysis revealed five key themes: value of decision support; care access expectations; technological literacy demographics; trust in AI; and confidentiality. In conclusion, virtual triage is a viable and promising tool if barriers to technological literacy are addressed, and tools are endorsed by health providers and patients.
Background
Medications for opioid use disorder (MOUD), such as methadone and buprenorphine, are the gold standard for opioid use disorder (OUD) treatment. Owing to various barriers, MOUD access and retention are low in the United States. The internet presents a digital solution to mitigate barriers, but a comprehensive and reliable resource is lacking. We present a user-friendly, web-based resource, the MOUD Hub, that provides reliable information on MOUD.
Objective
This study aims to assess the safety, acceptability, feasibility of dissemination, and reach of the MOUD Hub using focus groups and advertising on 1 key search engine and 1 social media platform.
Methods
This protocol describes the development of the MOUD Hub and the descriptive observational feasibility study that will be undertaken. The MOUD Hub uses motivational interviewing principles to guide users through the stages of change. The website provides evidence-based information from national health and substance use agencies, harm reduction organizations, and peer-reviewed literature. First, pilot focus groups with 10 graduate students who have lived experience with OUD will be conducted to provide feedback on safety concerns. Then, focus groups with 20-30 potential MOUD Hub users (eg, people with OUD with and without MOUD experience, friends and family, and health care providers) will be conducted to assess safety, acceptability, reach, and usability. Data will be analyzed using inductive thematic analysis. The website will be advertised on Google and MOUD-specific Reddit forums to assess dissemination, reach, and user acceptability based on the total user volume, sociodemographic characteristics, pop-up survey responses, and 1-year engagement patterns. This information will be collected through Google Analytics. Potential differences between users from Google and Reddit will be assessed.
Results
The MOUD Hub will be launched in January 2025. Data collected from 5 focus groups (approximately 30-40 participants) will be used to improve the website before launching it. There is no target sample size for the second stage of the study as it aims to assess dissemination feasibility and reach. Data will be collected for a year, analyzed every 3 months, and used to improve the website.
Conclusions
The MOUD Hub offers an innovative theory-based approach, tailored to people with OUD and their family and friends, to increase access to and retention in MOUD treatment in the United States and provides broader harm reduction resources for those not currently in a position to receive treatment or those at risk of resuming illicit opioid use. Findings from this feasibility phase will serve to better tailor the MOUD Hub. After modifying the website based on our findings, we will use a randomized controlled trial to assess its efficacy in increasing MOUD access and retention, contributing to growing research on web-based interventions for OUD.
International Registered Report Identifier (IRRID)
PRR1-10.2196/57065
Background
Adolescents and young adults (AYAs) with cancer are at risk of poor psychosocial outcomes. AYAs grew up with the internet and digital technology, and mobile Health (mHealth) psychosocial interventions have the potential to overcome care access barriers.
Objective
This pilot randomized controlled trial (RCT) aimed to establish the feasibility, acceptability, and preliminary efficacy of a fully automated mobile app version of the Promoting Resilience in Stress Management intervention (mPRISM). Promoting Resilience in Stress Management is an evidence-based intervention developed in collaboration with AYAs, based on stress and coping theory, resilience theory, and evidence-based coping strategies. We hypothesized that mPRISM would be feasible, acceptable, and appropriate.
Methods
This is a parallel, 2-arm, single-site pilot RCT with a waitlist control design. The study will recruit 80 AYAs with cancer from a clinic. Eligible AYAs are aged 12 to 25 years, within 12 months of a new cancer diagnosis, receiving chemotherapy or radiation therapy, speak, read, or write in English, and are cognitively able to participate in study procedures. Recruitment by clinical research coordinators will occur remotely by phone, video, or text. Participants will be randomized to psychosocial usual care (UC) alone or UC plus mPRISM for an 8-week intervention period, and will remain unblinded to study condition. Enrolled participants will complete surveys at baseline before randomization, 8 weeks, and 3-month follow-up. Using a waitlist design, the UC arm will receive mPRISM upon completion of 3-month follow-up surveys. Those in the UC arm will complete 2 additional measurement points at immediate posttreatment and 3 months later. The primary outcomes of interest are feasibility, defined as ≥60% enrollment and ≥70% retention (ie, percentage of participants who completed the study), and “feasibility, acceptability, and appropriateness” as defined by cut-off scores ≥4/5 on 3 brief validated implementation outcome measures (feasibility of implementation measure, acceptability of intervention measure [AIM], intervention appropriateness measure [IAM]). We will apply top-box scoring for the implementation measures. Exploratory outcomes of interest include patient-reported health-related quality of life, resilience, distress, anxiety, depression, pain, and sleep. We will conduct an intention-to-treat analysis to compare the outcomes of the mPRISM arm versus the control arm with covariate-adjusted regression models. We will summarize individual digital usage metrics using descriptive statistics.
Results
Since September 2023, we have enrolled 20 participants and recruitment is ongoing.
Conclusions
Although our previous work suggests AYAs with cancer are interested in mHealth psychosocial interventions, such interventions have not yet been sufficiently evaluated or implemented among AYA oncology patients. mPRISM may serve as a potential mHealth intervention to fill this gap. In this study, we will test the feasibility, acceptability, and preliminary efficacy of mPRISM. This work will inform future larger-scale RCTs powered for efficacy outcomes.
Trial Registration
ClinicalTrials.gov NCT05842902; https://clinicaltrials.gov/study/NCT05842902
International Registered Report Identifier (IRRID)
DERR1-10.2196/57950
Roofless people are among the most vulnerable, marginalized, and silenced societal groups. However, access to social media through mobile devices may provide opportunities for battling their stigmatization, social exclusion, low self-esteem, and self-acceptance. This study aims to explore how people who are experiencing rooflessness use and represent themselves on social media. This qualitative study, using thematic analysis of 16 in-depth interviews, reveals that roofless people may use social media to increase their social capital, advocate for other homeless people, and, most importantly, escape or reconstruct the reality of life on the street through continuous online social interaction and revalidation of oneself.
Background and objectives:
Although digital health promises improved healthcare efficiency and equity, access and uptake might be low in disadvantaged populations. We measured access to digital health technology, the uptake of digital health, digital health literacy and COVID-19 vaccination intentions in an inner-city Australian population experiencing homelessness.
Method:
An existing Australian survey, including a validated digital health literacy measure (eHealth Literacy Scale [eHEALS]), was modified and distributed in three general practices specifically targeting the homeless population. Data analysis used appropriate descriptive statistics and correlation coefficients.
Results:
Eighty-three respondents completed the survey in 2021. Digital health uptake was much lower than in the general Australian population in 2019-20, despite good access to working smart phones and connectivity. Digital health literacy was positively associated with uptake. Internet-sourced information was trusted less than information from a general practitioner.
Discussion:
Further work is needed to understand the perceived usefulness and sociocultural compatibility of digital health in different subpopulations experiencing homelessness, including susceptibility to misinformation.
Promoting equitable health care is to ensure that everyone has access to high-quality medical services and appropriate treatment options. The definition of health equity often can be misinterpreted, and there are challenges in fully understanding the disparities and costs of health care and when measuring the outcomes of treatment. However, these topics play an important role in promoting health equity. The COVID-19 pandemic has made us more aware of profound health-care disparities and systemic racism, which, in turn, has prompted many academic medical centers and health-care systems to increase their efforts surrounding diversity, equity, and inclusion. Therefore, it is important to understand the problems that some patients have in accessing care, promote health care that is culturally competent, create policies and standard operating procedures (at the federal, state, regional, or institutional level), and be innovative to provide cost-effective care for the underserved population. All of these efforts can assist in promoting equitable care and thus result in a more just and healthier society.
Background and Objectives
Strategic recruitment is necessary to reach recruiting goals when conducting research with vulnerable and transient populations, such as postpartum women experiencing homelessness. The current study evaluated the recruitment process for a qualitative study using the Plan-Do-Study-Act (PDSA) method.
Methods
In a study conducting semistructured interviews about reproductive interconception care barriers and facilitators for local women who were recently pregnant and homeless in 2022, PDSA cycles were used to improve community organizations' assistance with identifying participants, facilitate screening and interviewing processes, and ensure participants were safeguarded.
Results
Iterative PDSA cycles were conducted across a 20-week period. Ultimately, 12 women were interviewed, with increasing participant location and organizational assistance over time. Following 4 key lessons were identified: provide in-person and remote options for conducting data collection; include fair compensation that balances time versus study coercion; weigh feasibility versus importance of sample size with eligibility criteria; and support partnerships with organization connections.
Conclusions
The PDSA method served as a parsimonious framework for evaluation. The lessons learned will help facilitate future recruitment efforts for this difficult-to-recruit and vulnerable population.
With the number of mobile phone subscribers increasing across all sections of society, this paper aims to understand if homeless women in shelter-homes of India have access to mobile phones and, if so, what are their usage patterns. Facilitated by issues ranging from domestic violence to lack of employment to forced migration and even to human trafficking and rape, women residing in the shelter-homes of India have a myriad of stories to tell. Not all of them have been on streets forever and many have the basic literacy to understand how to use a mobile phone. For the purposes of the study, the researchers engaged with women above 18 years of age up to the age of 45 in a series of open-ended interviews to understand their access to mobile phones and contextualize their homelessness within an affordances-based framework for mobile phone access. This paper takes into account the dual barriers of gender and the lack of a home to study the digital divide experienced by homeless women in India, expanding on how both these factors shape their access and usage, eventually bridging the digital divide, and whether mobile phones are required/desired by the women themselves. The study found that the women staying in shelter-homes see a window of hope in their use of mobile phones in the form of an independent financial future or an independent marital life, but the biased perception of using a mobile phone among women hinders women’s access to and use of these devices, which ultimately results in the loss of any kind of opportunity before it has even been explored, perhaps leading to the loss of a chance at a bright future.
Although access to water and sanitation have been recognized by the United Nations as human rights since 2010, that access continues to be a site of struggle in everyday life, especially among homeless populations. In this paper, we draw from two summers of a fieldwork-based course on homelessness and Water, Sanitation, and Hygiene in Denver, Colorado to consider whether a Google Map of public restrooms in the city might be useful for unhoused people. The paper's conceptual framework stems from Hartmann's idea of “homing”—which refers to how digital media can help unhoused people create everyday routines, exercise some control over their lives and spaces, and gradually create a safe environment—to consider whether the Google Water, Sanitation & Hygiene Map might help unhoused people integrate bathroom access into routines, rounding out the so-called “mobile home” to provide relief and personal agency. The effort runs up against digital literacy issues that mitigate “access” and point to the limits of techno-solutions. This paper points to the need to consider both media literacies and inclusive design in creating digital solutions to address issues faced by unhoused people. We also argue that planners should think holistically about how digital and telecom-focused “solutions” relate to other necessary infrastructures—in this case, public toilets and water access.
Experts from the top hospitals in America's largest cities provide their insights into the disease states, injuries, patient populations, practice barriers, and societal conditions which present disproportionality in urban emergency departments. Distilling the authors' special expertise and skills in a clear and user-friendly way, this book enables the reader to recognize the impact of healthcare disparities on patient well-being and identify and manage the needs of special patient populations, including victims of substance abuse and intimate partner violence. Clinical chapters define conditions through case studies, discussing their prevalence in the urban setting, and offer expert advice for immediate and effective management. In addition, the book helpfully provides context and valuable tips for best practice and introduces new ways of thinking about the diseases and the problems discussed. Essential reading for clinicians looking to improve their knowledge of urban emergency medicine, from students through to senior attending practitioners.
Reducing failures to appear (FTA) in court is a top priority for criminal justice practitioners and advocates. However, existing work on reducing FTAs through text message reminders focuses on large urban jurisdictions and defendants who are housed. Using a field study in Shasta County, California, we evaluate whether text message outreach can increase court appearances for housed and unhoused populations. We find housed defendants randomly assigned to the treatment group were 10% less likely to miss their next scheduled court date than defendants in the control group. We find no statistical difference in the FTA rate of unhoused individuals assigned to treatment or control groups, and cannot rule out large positive or negative effects. We find that improving the quality of contact information in court records could lead to large reductions in FTAs. Partnering with local social service providers may not, but more research is needed.
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
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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