General and Health Systems Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
Health Services Research Program, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Health Expect. 2022 Jun;25(3):984-993. doi: 10.1111/hex.13442. Epub 2022 Feb 1.
Homelessness and mental illness are associated with poor service engagement, health and health service use outcomes. Existing literature suggests that financial incentives may effectively support service engagement of this population, but studies investigating key stakeholder perspectives are lacking. This study aimed to elicit, using qualitative methods, nuanced service user and provider experiences by using financial incentives to support service engagement among adults experiencing homelessness and mental illness.
This qualitative study is part of a larger mixed-methods pragmatic trial of financial incentives (Coordinated Access to Care for the Homeless-Financial Incentives [CATCH-FI]) within a community-based brief case management programme (CATCH) in Toronto, Ontario. Twenty-two CATCH-FI participants were purposefully recruited to participate in in-depth, semi-structured interviews; five CATCH service providers participated in a focus group and seven key informants in individual interviews. Data collection occurred between April 2019 and December 2020. All interviews and the focus group were audio-recorded and transcribed. Topic guides prompted participant perspectives on and experiences of using financial incentives to support engagement, health and well-being. Grounded theory and inductive thematic analysis guided coding and interpretation of transcripts. Triangulation and member-checking enhanced the analytical rigour and validity of findings.
CATCH service providers, key informants and subgroup of CATCH-FI participants perceived financial incentives to directly facilitate service engagement. The majority of CATCH-FI participants however highlighted that intrinsic motivation and service quality may be relatively more important facilitators of engagement. Most study participants across stakeholder groups perceived that financial incentives have direct positive influences on health and well-being in enabling access to basic needs and simple pleasures.
Our data suggest that for some adults experiencing homelessness and mental illness, financial incentives can directly support service engagement. In addition, financial incentives may positively impact health and well-being by easing financial stress and enabling deeper attention to individual health needs. Further research on the effectiveness and acceptability of financial incentives is needed to improve understanding and uptake of a promising intervention to support health and health service use outcomes in an underserved population.
Study participants provided input into the study research questions, study design, interview guides and interpretation of findings.
无家可归和精神疾病与较差的服务参与度、健康状况和卫生服务利用结果相关。现有文献表明，经济激励措施可能有效地支持这一人群的服务参与，但缺乏对关键利益相关者观点的研究。本研究旨在使用定性方法，通过经济激励措施来支持无家可归和精神疾病成年人的服务参与，细致地了解服务使用者和提供者的经验。
本定性研究是安大略省多伦多市基于社区的短期个案管理方案（CATCH）内经济激励措施（协调为无家可归者提供的医疗保健服务-FI）的一项更大的混合方法实用试验的一部分。22 名 CATCH-FI 参与者被有目的地招募来参加深入的半结构化访谈；5 名 CATCH 服务提供者参加了焦点小组，7 名关键知情人参加了个人访谈。数据收集于 2019 年 4 月至 2020 年 12 月进行。所有访谈和焦点小组均进行了录音和转录。主题指南提示参与者对使用经济激励措施支持参与、健康和福祉的看法和经验。扎根理论和归纳主题分析指导了对转录本的编码和解释。三角测量和成员检查提高了分析的严谨性和结果的有效性。
CATCH 服务提供者、关键知情人以及 CATCH-FI 参与者的一个亚组认为经济激励措施可以直接促进服务参与。然而，CATCH-FI 参与者中的大多数人强调，内在动机和服务质量可能是促进参与的相对更重要的因素。来自利益相关者群体的大多数研究参与者认为，经济激励措施通过满足基本需求和简单的乐趣，直接对健康和幸福感产生积极影响。
我们的数据表明，对于一些无家可归和精神疾病的成年人来说，经济激励措施可以直接支持服务参与。此外，经济激励措施可以通过减轻经济压力和更深入地关注个人健康需求，对健康和幸福感产生积极影响。需要进一步研究经济激励措施的有效性和可接受性，以改善对支持服务不足人群健康和卫生服务利用结果的一种有前途的干预措施的理解和采用。
研究参与者为研究问题、研究设计、访谈指南和研究结果的解释提供了意见。
