"I can't even walk, you're expecting me to climb a mountain?" An exploration of service providers perception of vulnerability among individuals experiencing homelessness

Abstract

Those experiencing homelessness (IEHs) are more likely to have more health issues, more unmet health needs, higher occurrences of excess morbidity and mortality, have less control over manageable chronic health conditions, and are three to four times more likely to die prematurely than their housed counterparts. The causes of these health disparities are deeply rooted in the social context surrounding everyday life, where the interplay of various identity factors determines one’s vulnerability. Vulnerability thus represents the multiplicity and convergence of risk factors inherently tied to individuals marginalized identities and lived experiences. Therefore, in order to comprehensively understand the pathways leading to health disparities, a deeper understanding of the social context of vulnerability as a determinant of health is needed. The injustices experienced by IEHs happen in their everyday lives where interactions with the domiciled populations further influence the occurrence and impact of marginalization. Research well supports how these occur from the homeless populations perspectives, but insight from service providers (SPs) is lacking in regards to understanding how vulnerability among IEHs manifests in the lived context, specifically the service provision setting.

The goal of this study was to understand how vulnerability manifests in the lived context by allowing study participants the opportunity to tell their story. Through interviews and digital storytelling, this study proposes to understand service providers’ perception of vulnerability as experienced by IEHs. Guided by an intersectionality framework, knowledge production was informed by eliciting SPs descriptions and viewpoints regarding IEHs experience with their primary identity of “being homeless” while allowing for other influential categories to be determined that lead to more occurrences of marginalization. The data collected included 8 ethnographic fieldwork participant observations, 7 semi- structured SP interviews and 5 digital stories and reflection interviews. This data was analyzed using standard content analysis and constant comparison to construct themes pertaining interactions between SPs and IEHs, and how vulnerability manifests in the service provision context. Three themes emerged from the data, focused on the “navigating” IEHs and SPs have to do in the service and lived context. These include navigating the meaning of time, navigating the system and navigating change.