Why were COVID-19 infections lower than expected amongst people who are homeless in London, UK in 2020? Exploring community perspectives and the multiple pathways of health inequalities in pandemics

Guise, Andy; Burridge, Stan; Annand, P.J.; Burrows, Martin; Platt, Lucy; Rathod, Sujit D; Hosseini, Paniz; Cornes, Michelle

doi:10.1016/j.ssmqr.2021.100038

Cited by 3 publications

(2 citation statements)

References 29 publications

(39 reference statements)

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“…While a significant number of studies report trends in coronavirus cases, hospitalizations, and deaths [11], few consider the other numerous impacts of COVID-19 on people experiencing homelessness and scant have explored the impact from the perspective of people experiencing homelessness directly. Among the few studies that have qualitatively explored perspectives of people experiencing homelessness, most have been conducted outside the United States [12][13][14][15]. Findings from our previous work in Indiana [6] highlighted the need to hear and learn from people experiencing homelessness directly, in order to holistically understand the impact of the pandemic and to better inform responses that address the specific needs of this uniquely vulnerable population.…”

Section: Introductionmentioning

confidence: 99%

“COVID knocked me straight into the dirt”: perspectives from people experiencing homelessness on the impacts of the COVID-19 pandemic

et al. 2022

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Background People experiencing homelessness are uniquely susceptible and disproportionately affected by the impacts of the COVID-19 pandemic. Understanding context-specific challenges, responses, and perspectives of people experiencing homelessness is essential to improving pandemic response and mitigating the long-term consequences of the pandemic on this vulnerable population. Methods As part of an ongoing community-based participatory research study in partnership with a homeless service organization in Indiana, semi-structured interviews were conducted with a total of 34 individuals experiencing homelessness between January and July 2021. Guided by the NIMHD Health Disparities Research Framework, which builds on the socio-ecological model, data was thematically coded using Nvivo12 qualitative coding software and themes were organized by levels of influence (individual, interpersonal, community, societal) and domains of influence (biological, behavioral, physical/built environment, sociocultural environment, health care system). Results Narratives revealed numerous and compounding factors affecting COVID-19 risks and health outcomes among people experiencing homelessness across all levels and domains of influence. At the individual level, people experiencing homelessness face unique challenges that heightened their susceptibility to COVID-19, including pre-existing physical and mental health conditions, substance use and behavioral health risks, socioeconomic precarity, and low health literacy and COVID-related knowledge. At the interpersonal level, poor communication between people experiencing homelessness and service providers led to limited understanding of and poor compliance with COVID safety measures. At the community level, closures and service disruptions restricted access to usual spaces and resources to meet basic needs. At a policy level, people experiencing homelessness were disregarded in ways that made pandemic relief resources largely inaccessible to them. Conclusions Our findings reveal important and mitigable issues with ongoing pandemic response efforts in homeless populations through direct, first-hand accounts of their experiences during COVID-19. These insights offer opportunities for multilevel interventions to improve outreach, communication, and impact mitigation strategies for people experiencing homelessness. This study highlights the importance of centering the voices of vulnerable communities to inform future pandemic response for homeless and other underserved and marginalized populations.

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Section: Introductionmentioning

confidence: 99%

“COVID knocked me straight into the dirt”: perspectives from people experiencing homelessness on the impacts of the COVID-19 pandemic

et al. 2022

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“…Changes in access to primary health care services and their impact on care for PEH has been recognized as an important topic, with publication of a study protocol which sets out to examine this, but the full findings are not yet in the public domain [ 15 ]. In the UK, qualitative research has been carried out exploring the response of one homeless service in Scotland [ 16 ], access to mental health and substance use support among PEH living in the North East of England [ 17 ], and community perspectives about why COVID-19 infections were lower than expected in London during 2020 [ 18 ]. These studies, which illuminate local perspectives, provide an extremely useful basis from which our research intends to build.…”

Section: Introductionmentioning

confidence: 99%

The Impact of the COVID-19 Pandemic and Associated Societal Restrictions on People Experiencing Homelessness (PEH): A Qualitative Interview Study with PEH and Service Providers in the UK

Dawes

May

Burton

2022

IJERPH

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People experiencing homelessness (PEH) faced unique challenges during the COVID-19 pandemic, including changes to accommodation availability, societal restrictions impacting access to essentials like food, and services moving to online and remote access. This in-depth qualitative research aims to add to the existing, but limited research exploring how the pandemic affected PEH. 33 semi-structured qualitative interviews (22 with PEH during the pandemic and 11 with homelessness sector service providers) were undertaken in the United Kingdom between April 2021 and January 2022. Interviews were audio-recorded, transcribed and analysed using reflexive thematic analysis. To ensure consistency of coding, 10% of interviews were coded by two researchers. The PEH sample was 50% female, aged 24–59 years, 59% white British, and included people who had lived in hostels/hotels, with friends/family, and on the streets during the COVID-19 pandemic. Providers came from varied services, including support charities, housing, and addiction services. Five key themes were identified: (i) the understanding of and adherence to public health guidance and restrictions; (ii) the experience of people accommodated by the ‘Everyone In’ initiative; (iii) the impact of social distancing guidelines on PEH experiences in public spaces; (iv) the importance of social support and connections to others; and (v) how homelessness services adapted their provision. Policy makers and public health communicators must learn from PEH to maximize the effectiveness of future public health strategies. Housing providers and support services should recognize the implications of imposing a lack of choice on people who need accommodation during a public health emergency. The loss of usual support for PEH triggered a loss of ability to rely on usual ‘survival strategies’, which negatively influenced their health. This research highlights successes and difficulties in supporting PEH during the COVID-19 pandemic and informs planning for similar public health events.

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COVID-19: Where Are We Now? What Have We Learned?

Searight¹

2023

Covid-19: Health Disparities and Ethical Challenges Across the Globe

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Why were COVID-19 infections lower than expected amongst people who are homeless in London, UK in 2020? Exploring community perspectives and the multiple pathways of health inequalities in pandemics

Cited by 3 publications

References 29 publications

“COVID knocked me straight into the dirt”: perspectives from people experiencing homelessness on the impacts of the COVID-19 pandemic

“COVID knocked me straight into the dirt”: perspectives from people experiencing homelessness on the impacts of the COVID-19 pandemic

The Impact of the COVID-19 Pandemic and Associated Societal Restrictions on People Experiencing Homelessness (PEH): A Qualitative Interview Study with PEH and Service Providers in the UK

COVID-19: Where Are We Now? What Have We Learned?

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