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BMC Public Health ; 19(1): 1081, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399028


BACKGROUND: Internationally, acute homelessness is commonly associated with complex health and social care needs. While homelessness can be understood as an outcome of structural housing exclusion requiring housing led solutions, the health care issues faced by homeless people equally require attention. A substantive evidence base on the health needs of homeless people exists, but relatively little is known about what influences the self-rated health of homeless people. This article presents new evidence on whether drug use (alcohol consumption, ever having used drugs), health variables (visiting a hospital once in the last year, visiting the doctor in the last month, having a health card, sleeping difficulties, and having a disabling impairment) and sociodemographic characteristics are significantly associated with Self-Rated Health (SRH) among Spanish homeless people. METHOD: The approach applies secondary analysis to cross-sectional data from a sample of 2437 homeless adults in Spain (83.8% were male). Multinomial logistic regression modelling was used to analyse the relationships between drug use, other health variables and SRH. RESULTS: Being male, an abstainer, having a health card and being in the youngest age groups were significant factors associated with perceived good health. On the other hand, ever having used drugs, having been a night in hospital, having gone to the doctor in the last month, having sleeping difficulties, having a disabling impairment and being in the older age group were all significant risk factors associated with perceived poor health. CONCLUSIONS: These results help to improve understanding of the key factors that influence the SRH among homeless people. The findings can contribute to development and delivery of preventive policies, suggesting that interventions to reduce drug consumption and ensure access to a health card/health services, as well as enhancing services for older, female and disabled homeless people are all measures which could improve health and well-being for those who face homelessness. Effective housing interventions (e.g. Housing First or Permanent Supported Housing programmes) are equally important to underpin the effectiveness of measures to improve the self-rated health of homeless people.

Autoavaliação Diagnóstica , Pessoas em Situação de Rua/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espanha , Inquéritos e Questionários
Artigo em Inglês | MEDLINE | ID: mdl-31164989


Background: While people who are homeless often experience poor mental and physical health and problem substance use, getting access to appropriate services can be challenging. The development of trusting relationships with non-judgemental staff can facilitate initial and sustained engagement with health and wider support services. Peer-delivered approaches seem to have particular promise, but there is limited evidence regarding peer interventions that are both acceptable to, and effective for, people who are homeless and using drugs and/or alcohol. In the proposed study, we will develop and test the use of a peer-to-peer relational intervention with people experiencing homelessness. Drawing on the concept of psychologically informed environments, it will focus on building trusting and supportive relationships and providing practical elements of support such as access to primary care, treatment and housing options. Methods: A mixed-method feasibility study with concurrent process evaluation will be conducted to explore the feasibility and acceptability of a peer-delivered, relational intervention for people with problem substance use who are homeless. Peer Navigators will be based in homelessness outreach and residential services in Scotland and England. Peer Navigators will work with a small number of participants for up to 12 months providing both practical and emotional support. The sample size for the intervention is 60. Those receiving the intervention must be currently homeless or at risk of homelessness, over the age of 18 years and self-report alcohol/drug problems. A holistic health check will be conducted in the first few months of the intervention and repeated towards the end. Health checks will be conducted by a researcher in the service where the Peer Navigator is based. Semi-structured qualitative interviews with intervention participants and staff in both intervention and standard care settings, and all Peer Navigators, will be conducted to explore their experiences with the intervention. Non-participant observation will be conducted in intervention and standard care sites to document similarities and differences between care pathways. Discussion: The SHARPS study will provide evidence regarding whether a peer-delivered harm reduction intervention is feasible and acceptable to people experiencing homelessness and problem substance use in order to develop a definitive trial. Trial registration: SRCTN registry ISRCTN15900054, protocol version 1.3, March 12, 2018.

Dent J (Basel) ; 6(4)2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30513716


Smile4life is an intervention aimed at improving the oral health of people experiencing homelessness in Scotland. The purpose of this research was to determine how this intervention was being translated from guidance into action. Data concerning Smile4life working practices were collected in three NHS Boards using participant observation. Fieldnotes taken during these observations were analysed using content analysis. This analysis revealed that there were working alliances between the oral health practitioner, the Third Sector staff, and the homeless service users, and that these alliances were affected by various barriers and enablers. The observation sessions also highlighted variations in working practices.

J Interprof Care ; 19(4): 317-25, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16076593


Substantiated cases of elder self-neglect have been reported to be more common than either elder abuse or neglect. It is a problem that often requires the active involvement of a whole range of health, social, housing, police and voluntary agencies. The ways in which these various agencies respond to self-neglect and how they interact with one another is not known. This research explored the ways in which different health and social care organizations respond to the problems associated with self-neglect. Research methods involved qualitative in-depth interviews with housing, healthcare, environmental health and social workers and a sample of their clients who were described as living in self-neglecting circumstances. This study revealed a lack of joint working across the relevant professions in relation to self-neglect. Better co-ordinated intervention could improve effectiveness and help make available resources go further. The study also suggests a need for a preventative approach to self-neglect, although further work would be required to develop indicators for early intervention.

Agentes Comunitários de Saúde/organização & administração , Saúde Ambiental , Serviços de Assistência Domiciliar/organização & administração , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Autocuidado , Serviço Social/métodos , Idoso , Humanos , Higiene , Apoio Social
J Adv Nurs ; 40(3): 331-8, 2002 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-12383184


BACKGROUND: Self-neglect can be defined as the failure to engage in those self-care actions necessary to maintain a socially acceptable standard of personal and household hygiene and/or a failure to adequately care for one's own health. It is generally acknowledged that research and practice in the area of self-neglect has been hampered by a lack of theoretical development. Socio-psychological theories, such as 'social constructivism' and 'negotiated interactionism' can contribute to a deeper understanding of the phenomenon and to the further development of self-neglect theory. AIMS: This paper seeks to apply social and psychological theories to understanding self-neglect. Self-neglect is an underconceptualized phenomenon, which requires to be studied within a broader theoretical context than is at present the case. IMPLICATIONS: Sociological and psychological theories offer radically different ways of looking at self-neglect, as opposed to the medical model, as they seek to explain and understand, rather than simply classify it as a medical disorder caused by some form of underlying psychopathology. These theories emphasize the dynamic and interpretative nature of self-neglect and illustrate the arbitrary way in which this label is applied.

Modelos Psicológicos , Teoria Psicológica , Autocuidado/psicologia , Comportamento Autodestrutivo/psicologia , Comportamentos Relacionados com a Saúde , Humanos , Teoria da Construção Pessoal , Psicologia Social , Comportamento Autodestrutivo/etiologia , Sociologia Médica , Estereotipagem