Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Health and Rehabilitation Sciences

Supervisor

Shelley, Jacob

Abstract

Comprehensive strategies to end all homelessness must include prevention-focused approaches in addition to the provision of emergency services and responsive housing programs. This qualitative descriptive study examines nurse practitioners’ and physicians’ perceptions of their roles in homelessness prevention and their current involvement in prevention-oriented activities. Data from interviews with health care providers was analyzed using a blended inductive and deductive approach, guided by a Framework for Homelessness Prevention and findings from a document analysis. The results highlighted health care providers’ conceptualizations of poverty, housing instability, and associated risk factors and found that providers consider information about patients’ social and economic issues, including housing instability, for the ‘purpose’ of care and to contextualize medical care and treatment plans. Findings suggest that providers feel they share responsibility for homelessness prevention with other health professionals. Still, there remain opportunities for physicians and nurse practitioners to be involved at all levels of change.

Summary for Lay Audience

Homelessness remains a prevalent issue in Canada involving extreme cases of poverty where individuals lack a consistent or safe place to stay. Individuals experiencing homelessness may sleep in emergency shelters, outdoor spaces, or ‘couchsurf’ with family or friends for some period of time. There are known factors that increase someone’s risk of homelessness, for example, living in housing that is not affordable, experiencing job loss (affecting income), mental illness, other health issues, addictions, family and relationship crises, violence, or incarceration. To decrease overall rates of homelessness, action is needed to mitigate these risk factors and prevent individuals and families from becoming homeless in the first place.

Recognizing that health systems share in supporting individuals experiencing homelessness, this thesis explores opportunities for homelessness prevention within the provision of health care. In particular, this thesis considers the role that nurse practitioners and physicians play in assessing a patient’s risk of homelessness and connecting patients to community supports and services that can help to prevent housing loss.

To this end, nurse practitioners and physicians were recruited to participate in interviews to seek their opinions and perceptions of their involvement in preventing homelessness. Participating health care providers shared similar understandings of poverty and housing instability and demonstrated general awareness of risk factors associated with homelessness. Providers explained that knowing and asking questions about a patient’s housing situation was an important part of providing good health care and individualized treatment plans. This study revealed that nurse practitioners and physicians believe they share in efforts to prevent homelessness but may defer responsibility for patients’ housing issues to other providers (mainly social workers) who they feel have more appropriate knowledge and training. Nonetheless, this study highlights opportunities for health care provider involvement in various prevention-oriented activities, including patient advocacy for increased income supports and healthy housing conditions, supporting eviction prevention, assessing homelessness risk, and enhancing patients’ access to other community supports. Overall, this research contributes to knowledge about homelessness prevention in Canada and the appropriate role of health care providers as partners in this work.

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