Medical Mistrust Among Individuals Experiencing Homelessness

Abstract

Meeting the healthcare needs of the homeless continues to be a significant challenge in the United States. Homeless individuals suffer a disproportionately high burden of both communicable and non-communicable diseases and are at increased risk of dying prematurely. Additionally, this population faces barriers to receiving healthcare that are less prevalent for non-homeless persons. These include difficulties physically accessing care, underinsurance, and highly comorbid mental health and substance use disorders, all of which contribute to nonadherence and loss to follow-up. As such, homeless individuals report unmet needs across multiple types of healthcare services. Homeless people’s perceptions and attitudes towards healthcare also affect their propensity to utilize services. As with all patients, homeless individuals articulate a desire for compassionate, person-centered care involving meaningful engagement and trust. Yet, this is often not the case. Stigma and perceived discrimination from healthcare providers on the basis of poverty, race, mental illness or substance use have made the homeless feel unwelcome in many healthcare settings. Homeless people often describe being treated less compassionately by providers, feeling invisible, dehumanized, or reduced to objects. Perceived prejudice may contribute to poorer adherence and more frequent utilization of acute care or emergency services compared to routine ambulatory care. In this thesis, I explore homeless individuals’ attitudes of trust or mistrust towards the healthcare system using qualitative methods. I interviewed participants who identified as homeless at Philadelphia FIGHT and Broad Street Ministry, two healthcare and social service organizations that serve the homeless community in Philadelphia. I conducted interviews using a semi-structured interview guide. Below, I discuss my rationale for doing this study, my study methods, and results through five participant narratives elucidating key themes that arose during interviews. In the last chapter, I discuss why these results matter and how they can be used to inform future practice and policy aimed at reducing healthcare disparities for the homeless.