Indicators of good health practices for the homeless population: a scoping review

Hino, Paula; Fornari, Lucimara Fabiana; Egry, Emiko Yoshikawa; Santana, Carmen Lúcia Albuquerque de; Oliveira, Elda de

doi:10.37689/acta-ape/2022AR0047666

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Acta Paulista de Enfermagem

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Review Article • Acta Paul Enferm 35 • 2022 • https://doi.org/10.37689/acta-ape/2022AR0047666 copy

Indicators of good health practices for the homeless population: a scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To identify the indicators used to support good health practices for the homeless population.

Methods

This is a scoping review whose selection of articles took place in December 2019 and was updated in August 2020. The terms used for the search were: homeless persons, homeless, runway, foster care, street people, health status indicators, primary nursing care and primary health care. Studies published in English, Spanish and Portuguese were included, without limitation of publication time.

Results

A total of 29 articles were selected. From the reading in full, four empirical categories of indicators emerged: User relationship with service; Assessment of health conditions and disease; Assessment of social inclusion; and Assessment of changes in behavioral and psychological characteristics. The studies found used indicators mostly to perceive compliance with the purpose of the intervention project targeting the homeless population.

Conclusion

The way to verify these indicators was varied, as well as the intervention projects, there is no consensus about what type of indicators would be fertile for assessment of the actions carried out.

Homeless persons; Primary health care; Health Status indicators; Social indicators

First author, year of publication	Objective	Study design/Indicators
1. Díez El. (1996)⁽¹³⁾	Assess a social assistance and health monitoring program aimed at homeless people.	*Relationship with services: number and frequency of hospitalization; Health-disease conditions.
2. Orwin RG. (1999)⁽¹⁴⁾	Study an intervention program for homeless people with alcohol and other drug problems.	♠ Relationship with services: reasons for staying and leaving the program; Social inclusion: homeless time and satisfaction with housing; Health-disease conditions: frequency of substance use.
3. Lam JÁ. (2000)⁽¹⁵⁾	Study the relationship between improvement of quality of life among homeless people with severe mental illness.	*Psychological characteristics: improvement of quality of life; Social inclusion: homeless time, satisfaction with housing, social support, employment and income; Health-disease condition: frequency of substance use.
4. Rosenheck RA. (2001)⁽¹⁶⁾	Assess post-discharge changes in health status and in the use of services associated with a community treatment model.	*User relationship with services: reasons for permanence and exit of the program; Model fidelity^a.
5. Cook J. (2011)⁽¹⁷⁾	Study the results of 4,778 homeless people with severe mental illness enrolled in the Community Care Access Program and Effective Services and Support.	*User relationship with services: legal assistance and justice system; Social inclusion: social support, employment and income; Health-disease conditions: frequency of substance use, improvement of physical, mental and sexual health.
6. Clark C. (2003)⁽¹⁸⁾	Compare the effectiveness of two types of service programs in improving homelessness among people with severe mental illness.	*Social inclusion: homeless time, satisfaction with housing; Health-disease conditions: frequency of substance use; improving physical, mental and sexual health; Model fidelity^to.
7. Yanos PT. (2004)⁽¹⁹⁾	Investigate the response to housing and experience of integration in the community of former homeless people with severe mental illness.	♣Psychological characteristics: general satisfaction with life and health, subjective and functional results, life choices/changes, sense of security and protection; Social inclusion: improvement of interpersonal relationships, social and community participation; Health-disease conditions: improvement of physical, mental and infectious conditions.
8. Jarjoura D. (2004)⁽²⁰⁾	Check the efficacy of screening and treatment for depression among outpatients living on the streets.	*Psychological characteristics: improvement of quality of life; Health-disease conditions: improvement of physical, mental and sexual health, assessment of mental disorders, improvement of physical, mental and infectious conditions.
9. Graham-Jones S. (2004)⁽²¹⁾	Assess the effectiveness of a health advocate with homeless people in a primary care environment.	*User relationship with services: access and use of health services, access to the therapeutic project; Psychological characteristics: quality of life; Social inclusion: homeless time, satisfaction with housing, support and social support; Health-disease conditions: frequency of substance use; improvement of physical, mental and sexual conditions.
10. Nelson G. (2005)⁽²²⁾	Determine whether housing acquisition is associated with improvements in social support, community integration, significant activity and other aspects.	*Psychological characteristics: changes in life and feeling of hope.
11. Cheng AL. (2008)⁽²³⁾	Assess the impact of gender on the results of a public policy intervention aimed at homeless people with mental illness.	*Psychological characteristics: victimization; Social inclusion: homeless time, satisfaction with housing, improvement of interpersonal relationships, social and community participation, support and social support; Health-disease conditions: frequency of substance use.
12. Savage CL. (2008)⁽²⁴⁾	Compare specific health outcomes in a group of homeless people who received intervention from a nurse.	*User relationship with services: access and use of health services; Psychological characteristics: improvement of quality of life; Health-disease conditions: frequency of substance use.
13. McGuire J. (2009)⁽²⁵⁾	Examine the hypothesis that a clinical demonstration integrating primary care and mental health services can improve homeless people’s health.	*User relationship with services: improvement of access to care.
14. Herman D. (2011)⁽²⁶⁾	Assess the effectiveness of the Critical Time Intervention model.	*User relationship with services: complying with the therapeutic project; Social inclusion: homeless time and satisfaction with housing.
15. Van Vugt MD. (2011)⁽²⁷⁾	Investigate the association between model fidelity and outcome in the Dutch health system.	*User relationship with services: access and use of health services, frequency of hospitalization, doctor-patient relationship; Psychological characteristics: specific psychological care needs of homeless people, help-seeking behavior, mental and social functioning; Social inclusion: housing stability, housing status, time without satisfaction with housing, improvement of interpersonal relationships, social and community participation, employment and income; Model fidelity^a.
16. Tsai J. (2011)⁽²⁸⁾	Assess the satisfaction of housing of homeless people who received accommodation.	*Psychological characteristics: general satisfaction with life and health, subjective and functional results; Social inclusion: housing status, homeless time and satisfaction with housing.
17. Padgett DK. (2011)⁽²⁹⁾	Investigate substance abuse use treatment services among homeless people with mental illnesses enrolled in the Housing First and Treatment First programs.	♣User relationship with service: experiences in services; Psychological characteristics: physical and psychological needs, specific needs of homeless people; help-seeking behavior and mental and social functioning, clinical, existential, functional, physical and social recovery; Social inclusion: improvement of interpersonal relationships, social and community participation; Health-disease conditions: frequency of substance use; improved physical, mental and sexual health.
18. Patterson M. (2012)⁽³⁰⁾	Study the findings of the Homelessness Intervention Project.	*User relationship with services: access and use of health services, frequency of hospitalization, legal assistance, justice system; Social inclusion: support, social support, employment and income; Health-disease conditions: frequency of substance use.
19. Tomita A. (2012)⁽³¹⁾	Study the impact of Critical Time Intervention on reducing rehospitalization among former homeless people with severe mental illness.	*User relationship with services: frequency of hospitalization; Social inclusion: housing stability, housing status and homeless time.
20. Krabbenborg MAM. (2013)⁽³²⁾	Examine the effectiveness of Houvast in Dutch services for young homeless people.	*User relationship with services: access and use of health services, increased confidence in professionals; Psychological characteristics: improved quality of life, care and psychological needs, specific needs of homeless people, coping, resilience and intellectual disability; Health-disease conditions: frequency of substance use; improved physical, mental and sexual health.
21. Kertesz SG. (2013)⁽³³⁾	Compare the experiences of care of homeless people in health organizations.	*User relationship with services: doctor-patient relationship, quality of primary care, improvement of access to care; Psychological characteristics: physical and psychological needs, specific needs of homeless people, general satisfaction with life and health, subjective and functional outcomes, and behavioral model; Social inclusion: time without a roof and satisfaction with housing; Health-disease conditions: frequency of substance use, improvement of physical, mental and sexual health.
22. Patterson ML. (2014)⁽³⁴⁾	Investigate community integration among homeless adults with mental illness.	*Social inclusion: improvement of interpersonal relationships, social and community participation; Health-disease conditions: frequency of substance use, assessment of mental disorders, medical conditions and infectious diseases.
23. Padgett DK. (2016)⁽³⁵⁾	Investigate the recovery trajectory of 38 homeless people enrolled in housing support programs.	♣ Psychological characteristics: clinical, existential, functional, physical and social recovery.
24. Kriegel LS. (2016)⁽³⁶⁾	Compare housing first model fidelity and residential customer outcomes between forensic and non-forensic programs.	♣ Model fidelity^a.
25. Wittenberg E. (2016)⁽³⁷⁾	Demonstrate the application of the Best-Worst Scale in a primary care environment.	*Best-worst scaling (provider, configuration, procedure, fears and concerns).
26. Tsai J. (2019)⁽³⁸⁾	Investigate changes in the physical health of homeless people who participate in a housing program and the associations between changes in physical health, housing status and trust in care providers.	*User relationship with service: increased trust in professionals; Psychological characteristics: improved quality of life, satisfaction with life and health, subjective and functional outcomes; Social inclusion: time without a roof; Health-disease conditions: frequency of substance use, assessment of mental disorders, medical conditions and infectious diseases, and effectiveness of medical conditions.
27. Varley Al. (2020)⁽³⁹⁾	Investigate the main domains of primary care from a homeless person-centered model.	♣User relationship with service: access and use of health services, treatment to the therapeutic project, increased trust in professionals and doctor-patient relationship; Psychological characteristics: care and psychological needs, specific needs of homeless people; Social inclusion: improvement of interpersonal relationships, social and community participation; Health-disease conditions: frequency of substance use.
28. Chhabra M. (2020)⁽⁴⁰⁾	Investigate how housing stability affected the management of chronic diseases and social and community relations.	♣User relationship with service: access and use of health services; Psychological characteristics: feeling of security and protection, management of acute and chronic conditions; Social Inclusion: time without a roof, satisfaction with housing, improvement of interpersonal relationships, social and community participation; Health-disease conditions: frequency of substance use.
29. Zeitler M. (2020)⁽⁴¹⁾	Investigate the impact of the prevalence of chronic conditions and use of health care in a clinic for homeless people.	*User relationship with service: access and use of health services, access to the therapeutic project, quality of primary care; Social inclusion: support and social support; Health-disease conditions: frequency of substance use, improvement of physical, mental and sexual health, and effectiveness of medical conditions.

Empirical categories	Indicators	Articles mentioning indicators
a) User relationship with service	Access to and use of health services	(21) (27) (24) (30) (32) (39) (40) (41)
	Number and frequency of hospital or psychiatric hospitalization	(13) (27) (30) (31)
	Compliance with the therapeutic-care project	(21) (26) (39) (41)
	Increase of confidence in professionals	(32) (36) (38) (39)
	Working alliance and doctor-patient relationship	(27) (33) (39)
	Legal assistance and justice system	(17) (30)
	Reasons for staying and leaving the program	(14) (16)
	Primary care quality	(33)(41)
	Improvement of access to care	(25) (33)
	Service experiences	(29)
b) Assessment of health conditions and disease	Frequency and intensity of consumption of alcohol, tobacco and other psychoactive substances	(15) (14) (17) (18) (21) (23) (24) (29) (32) (33) (34) (38) (39) (40) (41)
	Improvement of physical, mental and sexual health	(17) (18) (20) (21) (29) (32) (33) (41)
	Improvement of quality of life	(15) (20) (21) (24) (32) (38)
	Assessment of mental disorders, medical conditions and infectious diseases	(19)(20)(34)(38)
	Effectiveness of medical conditions	(38) (41)
	Evolution of tuberculosis rates	(13)
c) Assessment of social inclusion	Housing stability, housing status, homeless weather and housing satisfaction	(14) (15) (18) (21) (23) (26) (27) (28) (31) (33) (40)
	Social participation and improvement of interpersonal and community relationships	(19) (23) (27) (29) (34) (39) (40)
	Social support	(15) (17) (21) (23) (30) (41)
	Employment and income	(15) (17) (27)(30)
d) Assessment of changes in behavioral and psychological characteristics	Psychological and specific care needs of homeless people	(27) (29) (32) (33) (39)
	Overall satisfaction with life and health, subjective and functional results	(19) (28) (33)
	Choices and changes of life	(19) (22)
	Sense of security and protection	(19) (40)
	Help-seeking behavior and mental and social functioning	(27) (29)
	Coping	(32)
	Resilience	(32)
	Victimization	(23)
	Feeling of hope	(22)
	Intellectual disability	(32)
	Behavioral model	(33)
	Clinical, existential, functional, physical and social recovery	(35)
	Management of acute and chronic conditions	(40)

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author: Paula Hino E-mail: paulahino@yahoo.com.br