Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
This cross-sectional study provides a deeper understanding of how the experience of homelessness affects occupational engagement and quality of life. Health-related disparities among persons experiencing homelessness and their implications for functioning in daily life were analyzed through the World Health Organization Disability Assessment Schedule 2.0. Results indicate that the emotional burden of health conditions had the greatest impact on daily functioning. Highly affected domains included participation, mobility, and life activities.
Primary Author and Speaker: John V. Rider
Additional Authors and Speakers: Justina Selim, Alexys Garcia
PURPOSE: People experiencing homelessness are a diverse group of individuals, each with their own unique blend of comorbidities and heavy burdens of hardships, such as unemployment, mental illness, lack of health insurance, and the inability to meet basic needs, including food, safety, and shelter (Bradley, Hersch, Reistetter, & Reed, 2011; Fazel, Geddes, & Kushel, 2014). A better understanding of the health disparities prevalent among the homeless population, and the impact these have on daily functioning, will enable occupational therapists to provide better care to people experiencing homelessness. Evaluation methods and interventions tailored to the specific needs of people experiencing homelessness are necessary to better serve this marginalized population (Rabiner & Weiner, 2012), as traditional rehabilitation models do not adequately address the needs of these individuals. The International Classification of Functioning, Disability, and Health (ICF) and the conceptually linked World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) provide an ideal framework and assessment tool for the evaluation of health disparities and their impact on daily life in people experiencing homelessness (Ãœstün & World Health Organization, 2010). The purpose of this study was to describe health disparities among the homeless population in Southern Nevada using the ICF as a framework for understanding the impact on daily activities.
DESIGN: A cross-sectional study design was employed. Participants (n = 88) were recruited using convenience sampling through local community health fairs for people experiencing homelessness in Southern Nevada. Inclusion criteria included individuals who were over the age of 18 years experiencing homelessness currently or in the last 6 months.
METHOD: Participants completed the WHODAS 2.0 12-item questionnaire by direct interview. The WHODAS 2.0 was chosen because it is short, simple, easy to administer, applicable across cultures, and designed to assess the level of functioning across six life domains (cognition, mobility, self-care, getting along, life activities, and participation). Descriptive statistics were used to analyze the most common reported difficulties by domain and individual questions.
RESULTS: The most common reported difficulty from people experiencing homelessness was the emotional burden of their health conditions (45% of participants reported extreme/cannot or severe difficulty). Globally, the most impacted domains were participation, mobility, and life activities. No significant differences were found between males and females or by age of participants.
CONCLUSION: Persons experiencing homelessness reported that health conditions had a profound influence on daily functioning. The emotional aspects of difficulties due to health problems most severely affected daily life. Following the emotional affect, the most impacted global domains within the ICF included joining in community activities (Participation), moving and getting around (Mobility), and domestic responsibilities such as leisure, work, and school (Life activities). The WHODAS 2.0 provided a quick, generic measure of how health and disability affect functioning across six life domains that directly correspond with the priorities of rehabilitation professionals. Healthcare practitioners can use this information to better serve this population.
IMPACT STATEMENT: The emotional impact of health problems among homeless individuals was the highest reported concern and should be addressed by all healthcare disciplines working with this population. This information can be used to improve education for occupational therapy students and better train practitioners to work with people experiencing homelessness.
References
Bradley, D. M., Hersch, G., Reistetter, T., & Reed, K. (2011). Occupational participation of homeless people. Occupational Therapy in Mental Health, 27(1), 26-35. https://doi.org/10.1080/0164212X.2010.518311
Fazel, S., Geddes, J. R., & Kushel, M. (2014). The health of homeless people in high-income countries: Descriptive epidemiology, health consequences, and clinical and policy recommendations. The Lancet, 384(9953), 1529-1540. https://doi.org/10.1016/S0140-6736(14)61132-6
Rabiner, M., & Weiner, A. (2012). Health care for homeless and unstably housed: Overcoming barriers. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine, 79(5), 586-592. https://doi.org/10.1002/msj.21339
Üstün, T. B., & World Health Organization. (2010). Measuring health and disability: Manual for WHO Disability Assessment Schedule WHODAS 2.0. Geneva: World Health Organization.
