Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Nursing

Supervisor

Forchuk, Dr. Cheryl

Affiliation

Western University

2nd Supervisor

Kerr, Dr. Michael

Affiliation

Western University

Abstract

Lifetime occurrence of head injury is disproportionately affecting people experiencing homelessness in Canada. Head injury in people experiencing homelessness is associated with victimization, housing instability and substance use (Topolovec-Vranic et al., 2017). However, individual factors including sex, race, social class and disability also produce social and health inequities which may have intersectional impacts on this population (McCall, 2005). Through secondary exploration of data from the No Fixed Address Version 2 (NFAv2) and No Fixed Address Version 2x (NFAv2x) studies (Forchuk et al., 2018; in press), and an intersectional lens, the purpose of this study was to explore relationships between individual factors as well as risks in relation to head injury in people experiencing homelessness. Four of the independent variables were statistically significant in the binary logistic regression model including; education, mental health issues, physical health issues and victimization. Findings help to explain multiple inequities faced by people experiencing homelessness that shape their experiences with head injury. Further research is needed to develop a greater understanding of head injury in people experiencing homelessness.

Summary for Lay Audience

People experiencing homelessness are more likely to have a head injury than the rest of the population. Most head injuries in this population are caused by assault or victimization. This may be associated with a number of factors such as psychiatric diagnosis, housing stability, relationships with family and others, substance use, or personal safety. Head injuries in people experiencing homelessness may also be associated with impaired cognition and health service use. The theory of intersectionality suggests that intersections of a person’s identity may overlap to cause further disadvantage to an individual. The core identities associated with intersectionality include sex, race, class, and disability which together marginalize and oppress certain populations. In this study we explored the relationships between sex, race, class, disability, housing instability, substance use and victimization. Relationships were found between disability, education and victimization and head injuries in people experiencing homelessness. Participants who reported having a head injury were 13 times more likely to also report being a victim of a violent crime in the past year. Participants who had completed less than high school education were more likely to report a head injury in their lifetime. participants who reported having a mental health issue in the past year were 7.6 times more likely to report a head injury in their lifetime. Finally, participants who reported having a physical health issue in the past year were 5.6 times more likely to report a head injury in their lifetime. In conclusion, there is a need for better follow-up care and long-term support of people who have experienced a head injury in their lifetime as it is associated with ongoing health issues and victimization. Education systems must also be aware of this association as accommodation and supports in schools may be required for people who have a head injury. In nursing, it is important for people experiencing homelessness to be assessed for head injury at each contact with the healthcare system due to the high rates of head injury in this population.

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