Applied Health Research Centre (Hodwitz, Parsons, Juando-Pratts), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Parsons, Kiran), University of Toronto; Department of Physical Therapy and Rehabilitation Sciences Institute (Parsons), University of Toronto; Dalla Lana School of Public Health (Juando-Pratts), University of Toronto; Department of Family and Community Medicine (Rosenthal, Das, Kiran), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Rosenthal, Das, Kiran), Faculty of Medicine, University of Toronto; MAP Centre for Urban Health Solutions (Craig-Neil, Hwang, Kiran), St. Michael's Hospital, Unity Health Toronto; Division of General Internal Medicine (Hwang), Department of Medicine, Faculty of Medicine, University of Toronto; Division of Emergency Medicine (Lockwood), Faculty of Medicine, University of Toronto; Department of Emergency Medicine (Lockwood), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.
CMAJ Open. 2022 Jul 19;10(3):E685-E691. doi: 10.9778/cmajo.20210334. Print 2022 Jul-Sep.
People experiencing homelessness are vulnerable to SARS-CoV-2 infection and its consequences. We aimed to understand the perspectives of people experiencing homelessness, and of the health care and shelter workers who cared for them, during the COVID-19 pandemic.
We conducted an interpretivist qualitative study in Toronto, Canada, from December 2020 to June 2021. Participants were people experiencing homelessness who received SARS-CoV-2 testing, health care workers and homeless shelter staff. We recruited participants via email, telephone or recruitment flyers. Using individual interviews conducted via telephone or video call, we explored the experiences of people who were homeless during the pandemic, their interaction with shelter and health care settings, and related system challenges. We analyzed the data using reflexive thematic analysis.
Among 26 participants were 11 men experiencing homelessness (aged 28-68 yr), 9 health care workers (aged 33-59 yr), 4 health care leaders (aged 37-60 yr) and 2 shelter managers (aged 47-57 yr). We generated 3 main themes: navigating the unknown, wherein participants grappled with evolving public health guidelines that did not adequately account for homeless individuals; confronting placelessness, as people experiencing homelessness often had nowhere to go owing to public closures and lack of isolation options; and struggling with powerlessness, since people experiencing homelessness lacked agency in their placelessness, and health care and shelter workers lacked control in the care they could provide.
Reduced shelter capacity, public closures and lack of isolation options during the COVID-19 pandemic exacerbated the displacement of people experiencing homelessness and led to moral distress among providers. Planning for future pandemics must account for the unique needs of those experiencing homelessness.
无家可归者易感染 SARS-CoV-2 病毒及其后果。我们旨在了解无家可归者以及照顾他们的医疗保健和收容所工作人员在 COVID-19 大流行期间的观点。
我们在加拿大多伦多进行了一项解释性定性研究，时间为 2020 年 12 月至 2021 年 6 月。参与者为接受 SARS-CoV-2 检测的无家可归者、医疗保健工作者和无家可归者收容所工作人员。我们通过电子邮件、电话或招聘传单招募参与者。通过电话或视频电话进行的个人访谈，我们探讨了大流行期间无家可归者的经历、他们与庇护所和医疗保健环境的互动以及相关的系统挑战。我们使用反思性主题分析对数据进行分析。
在 26 名参与者中，有 11 名男性无家可归者（年龄 28-68 岁）、9 名医疗保健工作者（年龄 33-59 岁）、4 名医疗保健领导者（年龄 37-60 岁）和 2 名庇护所经理（年龄 47-57 岁）。我们生成了 3 个主要主题：探索未知，参与者努力应对公共卫生指南的不断变化，这些指南没有充分考虑无家可归者；面临无家可归，由于公共关闭和缺乏隔离选择，无家可归者无处可去；以及无力感，由于无家可归者在无家可归时缺乏代理权，医疗保健和收容所工作人员在他们能够提供的护理方面缺乏控制权。
在 COVID-19 大流行期间，收容能力降低、公共关闭和缺乏隔离选择加剧了无家可归者的流离失所，并导致提供者感到道德困境。为未来的大流行做规划时必须考虑到无家可归者的独特需求。
