Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA.
Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Asheville, NC, USA.
Health Soc Care Community. 2022 Jan;30(1):154-164. doi: 10.1111/hsc.13384. Epub 2021 Apr 24.
Individuals who have experienced chronic homelessness often have unmet physical and mental health needs and experiences of trauma and stigma. This study aimed to measure, for the first time, health activation (self-advocacy and empowerment) levels among formerly homeless adults living in Permanent Supportive Housing or PSH (referred to hereafter as residents). In addition, residents' experiences accessing health services, and their sense of health activation and efforts to manage their health within PSH settings, were explored. A mixed-methods study was conducted in Southern California (October 2018-June 2019) using a validated survey and interviews with a randomly selected group of residents (n = 61) from three PSH agencies. Activation levels were measured using the Patient Activation Measure. Descriptive and univariate survey analyses were conducted. Interview data was analysed using NVivo. Two coders coded all transcripts, and team meetings were held to reach consensus. Results showed most residents were female (64%), racial and ethnic minorities (66%), on average 54-year-olds, with 37 months of PSH residency, and 43% were taking some action to manage their health (intermediate activation level). Challenges accessing care were due to breakdowns in care, unpleasant experiences with providers, low health literacy and feeling overwhelmed by co-occurring chronic conditions. Health activation related to knowing when to take care of their health on their own and when to seek care. Unique challenges emerged related to PSH, such as lack of resident control within the housing setting and limited personnel responding to health emergencies. These challenges were magnified because residents live alone, per PSH requirements.
长期无家可归的人通常存在未满足的身心健康需求，且有过创伤和耻辱经历。本研究旨在首次衡量居住在永久性支持性住房（简称 PSH）中的前无家可归成年人的健康激活（自我倡导和赋权）水平。此外，还探讨了居民在获取健康服务方面的体验、他们在 PSH 环境中对健康激活的感知以及努力管理自身健康的情况。本研究在加利福尼亚州南部开展了一项混合方法研究（2018 年 10 月至 2019 年 6 月），使用了经过验证的调查和对来自三个 PSH 机构的随机选择的一组居民（n=61）的访谈。使用患者激活度量表来衡量激活水平。进行了描述性和单变量调查分析。使用 NVivo 对访谈数据进行分析。两位编码员对所有转录本进行编码，并举行团队会议达成共识。结果显示，大多数居民为女性（64%）、少数族裔（66%），平均年龄为 54 岁，在 PSH 的居住时间为 37 个月，有 43%的人正在采取一些措施来管理他们的健康（处于中等激活水平）。在获取医疗服务方面存在挑战，原因是医疗服务中断、提供者提供的服务不愉快、健康素养低以及同时患有多种慢性疾病而感到不知所措。健康激活与知道何时自行照顾健康以及何时寻求医疗帮助有关。还出现了与 PSH 相关的独特挑战，例如住房环境中居民缺乏控制权以及应对健康紧急情况的人员有限。由于居民按照 PSH 的要求独自居住，这些挑战被放大了。
