ABSTRACT
BACKGROUND: Permanent supportive housing (PSH) is an evidence-based practice to address homelessness that is implemented using 2 distinct approaches. The first approach is place-based PSH (PB-PSH), or single-site housing placement, in which an entire building with on-site services is designated for people experiencing homelessness. The second approach is scatter-site PSH (SS-PSH), which uses apartments rented from a private landlord while providing mobile case management services. OBJECTIVE: This paper describes the protocols for a mixed methods comparative effectiveness study of 2 distinct approaches to implementing PSH and the patient-centered quality of life, health care use, and health behaviors that reduce COVID-19 risk. METHODS: People experiencing homelessness who are placed in either PB-PSH or SS-PSH completed 6 monthly surveys after move-in using smartphones provided by the study team. A subsample of participants completed 3 qualitative interviews at baseline, 3 months, and 6 months that included photo elicitation interviewing. Two stakeholder advisory groups, including one featuring people with lived experience of homelessness, helped guide study decisions and interpretations of findings. RESULTS: Study recruitment was supposed to occur over 6 months starting in January 2021 but was extended due to delays in recruitment. These delays included COVID-19 delays (eg, recruitment sites shut down due to outbreaks and study team members testing positive) and delays that may have been indirectly related to the COVID-19 pandemic, including high staff turnover or recruitment sites having competing priorities. In end-July 2022, in total, 641 people experiencing homelessness had been referred from 26 partnering recruitment sites, and 563 people experiencing homelessness had enrolled in the study and completed a baseline demographic survey. Of the 563 participants in the study, 452 had recently moved into the housing when they enrolled, with 272 placed in PB-PSH and 180 placed in SS-PSH. Another 111 participants were approved but are still waiting for housing placement. To date, 49 participants have been lost to follow-up, and 12% of phones (70 of the initial 563 distributed) were reported lost by participants. CONCLUSIONS: Recruitment during the pandemic, while successful, was challenging given that in-person contact was not permitted at times either by program sites or the research institutions during COVID-19 surges and high community transmission, which particularly affected homelessness programs in Los Angeles County. To overcome recruitment challenges, flexible strategies were used, which included extending the recruitment period and the distribution of cell phones with paid data plans. Given current recruitment numbers and retention rates that are over 90%, the study will be able to address a gap in the literature by considering the comparative effectiveness of PB-PSH versus SS-PSH on patient-centered quality of life, health care use, and health behaviors that reduce COVID-19 risk, which can influence future public health approaches to homelessness and infectious diseases. TRIAL REGISTRATION: ClinicalTrials.gov NCT04769349; https://clinicaltrials.gov/ct2/show/NCT04769349. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46782.
ABSTRACT
This qualitative study investigated creative adolescent perceptions of their educational and mental health experiences during the coronavirus disease 2019 (COVID-19) pandemic. Participants were 25 English-speaking adolescents from the Midwest in the United States. They were identified as creative by their teachers according to known creative profiles. Participants attended an all-day creative career workshop in the Spring 2021 semester. The five focus groups guided by semi-structured interviews conducted for this study occurred during the workshop. This study was phenomenological in nature with constructivist and transformative paradigms, and transcripts were analyzed using reflexive thematic analysis by the first, second, and third authors. Creative adolescents' education during the pandemic was marked by classroom changes based on COVID-19 policies, experiences of disconnection, disengagement, and disappointment, as well as feelings of empathy and appreciation for their educators. Creative adolescents experienced mental health challenges related to adjustment issues, powerlessness and hopelessness, and isolation. Implications of results are discussed.
ABSTRACT
This study investigated how COVID-19 impacted creative adolescent engagement with their creative activities, as well as how they utilized technology to cope with the pandemic. Using qualitative methods, this study was guided by phenomenology using both constructivist and transformative paradigms. Participants were English-speaking adolescents from the Midwest in the United States. They were identified as creative by their teachers according to known creative profiles and were invited to attend an all-day creative career workshop over Zoom, where the focus groups occurred for this study. Five focus groups, consisting of 25 participants, were conducted, guided by semi-structured interviews. The transcripts from the focus groups were analyzed using reflexive thematic analysis by the first, second, and third authors. Results indicated that COVID-19 affected creative adolescent engagement with creative activities in positive and negative ways, caused changes in emotions and motivation, and increased virtual creative engagement. Creative adolescents coped with COVID-19 using digital technology to connect with others virtually, to engage in virtual creative expression, inspiration, and growth, and to meet their personal needs. Implication of results is discussed.
ABSTRACT
Veterans in rural areas of the United States face barriers to accessing healthcare and other services, which are intensified for those experiencing housing instability. Recent legislative acts have the potential to address obstacles faced by rural patients in the U.S. This study explores how infrastructure-including features related to the physical and digital environment-impacts the ability of rural Veterans experiencing housing instability to access healthcare and related services from the perspective of homeless service providers within the Veterans Health Administration (VHA). We conducted semi-structured telephone interviews (n = 22) with providers in high/low performing and/or resourced communities across the U.S. in May and June 2021 and analysed transcripts using template analysis. Themes described by providers highlight how infrastructure limitations in rural areas can exacerbate health disparities for Veterans experiencing housing instability, the impact of COVID-19 on service access, and recommendations to enhance service delivery. Providers suggested that VHA reconfigure where and how staff work, identify additional resources for transportation and/or alternative transportation models, and increase Veterans' access to technology and broadband Internet. Federal infrastructure investments should address challenges faced by Veterans experiencing housing instability in rural areas and the concerns of providers connecting them with care.
ABSTRACT
This qualitative study investigated creative adolescent perceptions of their educational and mental health experiences during the coronavirus disease 2019 (COVID‐19) pandemic. Participants were 25 English‐speaking adolescents from the Midwest in the United States. They were identified as creative by their teachers according to known creative profiles. Participants attended an all‐day creative career workshop in the Spring 2021 semester. The five focus groups guided by semi‐structured interviews conducted for this study occurred during the workshop. This study was phenomenological in nature with constructivist and transformative paradigms, and transcripts were analyzed using reflexive thematic analysis by the first, second, and third authors. Creative adolescents' education during the pandemic was marked by classroom changes based on COVID‐19 policies, experiences of disconnection, disengagement, and disappointment, as well as feelings of empathy and appreciation for their educators. Creative adolescents experienced mental health challenges related to adjustment issues, powerlessness and hopelessness, and isolation. Implications of results are discussed. Practitioner points Creative adolescents' education was negatively impacted by the pandemic, but they experienced empathy and appreciation for their educators Creative adolescents experienced adjustment issues, powerlessness, hopelessness, and isolation amid COVID‐19 Results suggested potential risk and protective factors in adolescent mental health and educational experiences
ABSTRACT
BACKGROUND: Poor sleep quality is one of the most prominent patient-reported problems in people with multiple sclerosis (PwMS). The COVID-19 pandemic resulted in PwMS having less contact with physicians, therapists, support groups, and family, which led to decreased access to typical supports. The purpose of this study was to assess how social support impacted sleep quality during the COVID-19 pandemic in PwMS within the United States. METHODS: Anonymous surveys were utilized to gather data from February - May 2021 from 209 PwMS during their return appointments (face-to-face and virtual) at the University of Kansas Medical Center (KUMC)'s MS Clinic in the United States. SPSS 27 was used to run four regressions in order to determine if social support predicted sleep quality with and without the inclusion of covariates (age, education, disability, anxiety/depression). RESULTS: The results indicate that overall feelings of being socially supported predict sleep quality. Additionally, various facets of social support predict sleep quality, even when controlling for covariates. Interestingly, while depression and anxiety were significant predictors of sleep quality, those constructs do not attenuate the social support-sleep relationship. CONCLUSION: These findings will provide key information pertaining to the association between social support and sleep in PwMS during COVID-19 where typical supports were limited. Understanding the challenges facing those living with chronic illnesses, specifically PwMS, will help researchers and clinicians alike create interventions to promote social support in the midst of a global pandemic.