Ashley A. Meehan, Centers for Disease Control and PreventionFollow
Sarah N. Cox, University of WashingtonFollow
Nicholas B. Thuo, University of WashingtonFollow
Julia H. Rogers, University of WashingtonFollow
Amy C. Link, University of WashingtonFollow
Miguel A. Martinez, University of WashingtonFollow
Natalie K. Lo, University of WashingtonFollow
Brian J. Manns, Centers for Disease Control and PreventionFollow
Melissa A. Rolfes, Centers for Disease Control and PreventionFollow
Eric J. Chow, University of Washington; Public Health – Seattle & King CountyFollow
Helen Y. Chu, University of WashingtonFollow
Emily Mosites, Centers for Disease Control and PreventionFollow
Morhaf Al Achkar, University of WashingtonFollow

homelessness, health care disparities, perceived discrimination, patient attitude, access

Purpose: The study purpose was to learn and describe 1) where homeless shelter residents receive health care, 2) what contributes to positive or negative health care experiences among shelter residents, and 3) shelter resident perceptions toward health care.

Methods: Semi-structured interviews (SSIs) utilizing purposive sampling and focus group discussions (FGDs) utilizing convenience sampling were conducted at 6 homeless shelters in Seattle-King County, Washington, during July–October 2021. All residents (age ≥ 18) were eligible to participate. SSIs were conducted with 25 residents, and 8 FGDs were held. Thematic analysis was conducted using Dedoose.

Results: Participants received health care in settings ranging from no regular care to primary care providers. Four elements emerged as contributing positively and negatively to health care experiences: 1) ability to access health care financially, physically, and technologically; 2) clarity of communication from providers and staff about appointment logistics, diagnoses, and treatment options; 3) ease of securing timely follow-up services; and 4) respect versus stigma and discrimination from providers and staff. Participants who felt positively toward health care found low- or no-cost care to be widely available and encouraged others to seek care. However, some participants described health care in the United States as greedy, classist, discriminatory, and untrustworthy. Participants reported delaying care and self-medicating in anticipation of discrimination.

Conclusions: Findings demonstrate that while people experiencing homelessness can have positive experiences with health care, many have faced negative interactions with health systems. Improving the patient experience for those experiencing homelessness can increase engagement and improve health outcomes.

Meehan AA, Cox SN, Thuo NB, Rogers JH, Link AC, Martinez MA, Lo NK, Manns BJ, Rolfes MA, Chow EJ, Chu HY, Mosites E, Al Achkar M. Previous health care experiences’ influence on health care perceptions among residents of six homeless shelters in Seattle, Washington, July–October 2021. J Patient Cent Res Rev. 2023;10:111-20.

September 6th, 2022

February 15th, 2023