REPLY POSTS:Reply separately to two of your classmates posts (See attached classmates posts, post#1 and post#2). When replying to your peers, think about the ethical considerations related to research
POST #2 OKEKE
Patient-centered care and effective communication is key in developing a collaborative relationship with patients and is especially important in the care of vulnerable patients. Homeless people are a vulnerable population that is underserved, medically disadvantaged, and poverty-stricken, making them increasingly susceptible to health problems and worse health outcomes. Homelessness remains a prevalent, pervasive public health issue in the United States despite years of legal and policy interventions offering short- and long-term solutions (Hodge Jr., DiPietro, & Horton-Newell, 2017). Many homeless individuals lack resources to enhance their ability to maintain and sustain health and well-being. Therefore, homeless people have high rates of chronic disease and acute illnesses, often associated with, or exacerbated by, their living situations (Morrison,2009). A considerable amount of published research on the health status and conditions of homeless persons also shows that they have a broad range of mental health and substance use needs (SAMHSA, 2011). They lack healthy lifestyles and are distrustful of the health system and health care providers, thus resulting in late-stage seeking to treat for chronic conditions.
According to a study conducted by Whitney (2013), most homeless people have a very strong aversion to medical care. This is often based on previous failed or disparaging encounters in the health system, including misdiagnosis, iatrogenesis, and discrimination, leading to both fear and loathing of professional health care.
Increased exposure to violence, malnutrition, extreme weather, and criminal charges are additional risk factors for homeless persons, contributing to poor health outcomes and premature death. Services critical to homeless persons, including adult dental care, case management, and housing support are needed. Additionally communities need to increase mental health and substance abuse treatment capacity, change laws that criminalize mental illness and addiction, and prioritize permanent and supportive housing over emergency shelters to help improve their quality of life (Hodge Jr., DiPietro, & Horton-Newell, 2017).
Community- Based Participatory Research (CBPR) is known to be an effective research process when conducting research with members of vulnerable populations. This approach is beneficial because the vulnerable populations being researched are working alongside researchers. CBPR allows vulnerable populations to be empowered. Homeless persons can advocate for increase access to health care, housing, and support for mental health and substance abuse concerns. Voicing their concerns, ideas for change and sharing their personal experiences can help further elicit change in their community. Health disparities and inequities in the homeless population can benefit the project's success because many of them may be motivated for change because they want consistent food and housing security, access to health care, and improved quality of life. However, the project’s success can be hindered by the distrusting mindset of the homeless population. They may have lost hope or are unmotivated because of their past negative experiences with medical professionals. Disadvantages of CBPR also include increased time to develop trusting relationships with community members, or exclusion of a vast amount of members of the vulnerable population, to adequately represent the population. Therefore results may not be inclusive of the majority of the vulnerable population.
Although the vulnerable share characteristics making them vulnerable to health concerns, they remain unique. Researchers should be mindful of this when conducting community-based participatory research. Nonetheless, CBPR is crucial in addressing health disparities in socially disadvantaged population groups and an ideal way to fight for health equity.
References
D.S. Morrison. (2009). “Homelessness as an Independent Risk Factor for Mortality: Results from a Retrospective Cohort Study,” International Journal of Epidemiology 28, no.3. 877-883.
Hodge Jr., J. G., DiPietro, B., & Horton-Newell, A. E. (2017). Homelessness and the Public’s Health: Legal Responses. Journal of Law, Medicine & Ethics, 45, 28–32. https://doi.org/10.1177/1073110517703314
U.S. Department of Substance Abuse and Mental Health Services Administration (SAMHSA) (2011).
Whitley, R. (2013). Fear and loathing in New England: examining the health-care perspectives of homeless people in rural areas. Anthropology & Medicine, 20(3), 232–243. https://doi.org/10.1080/13648470.2013.853597
