The health and housing in transition study: A longitudinal study of the health of homeless and vulnerably housed adults in three Canadian cities

Objectives: While substantial research has demonstrated the poor health status of homeless populations, the health status of vulnerably housed individuals is largely unknown. Furthermore, few longitudinal studies have assessed the impact of housing transitions on health. The health and housing in transition (HHiT) study is a prospective cohort study that aims to track the health and housing status of a representative sample of homeless and vulnerably housed single adults in three Canadian cities (Toronto, Ottawa, and Vancouver). This paper discusses the HHiT study methodological recruitment strategies and follow-up procedures, including a discussion of the limitations and challenges experienced to date. Methods: Participants (n = 1,192) were randomly selected at shelters, meal programmes, community health centres, drop-in centres, rooming houses, and single-room occupancy hotels from January to December 2009 and are being re-interviewed every 12 months for a 2-year period. Results: At baseline, over 85% of participants reported having at least one chronic health condition, and over 50% reported being diagnosed with a mental health problem. Conclusions: Our findings suggest that, regardless of housing status, participants had extremely poor overall health

Injection Drug User Quality of Life Scale (IDUQOL): Findings from a content validation study

Background: Quality of life studies among injection drug users have primarily focused on health-related measures. The chaotic life-style of many injection drug users (IDUs), however, extends far beyond their health, and impacts upon social relationships, employment opportunities, housing, and day to day survival. Most current quality of life instruments do not capture the realities of people living with addictions. The Injection Drug Users' Quality of Life Scale (IDUQOL) was developed to reflect the life areas of relevance to IDUs. The present study examined the content validity of the IDUQOL using judgmental methods based on subject matter experts' (SMEs) ratings of various elements of this measure (e.g., appropriateness of life areas or items, names and descriptions of life areas, instructions for administration and scoring). Methods Six SMEs were provided with a copy of the IDUQOL and its administration and scoring manual and a detailed content validation questionnaire. Two commonly used judgmental measures of inter-rater agreement, the Content Validity Index (CVI) and the Average Deviation Mean Index (ADM), were used to evaluate SMEs' agreement on ratings of IDUQOL elements. Results A total of 75 elements of the IDUQOL were examined. The CVI results showed that all elements were endorsed by the required number of SMEs or more. The ADM results showed that acceptable agreement (i.e., practical significance) was obtained for all elements but statistically significant agreement was missed for nine elements. For these elements, SMEs' feedback was examined for ways to improve the elements. Open-ended feedback also provided suggestions for other revisions to the IDUQOL. Conclusion The results of the study provided strong evidence in support of the content validity of the IDUQOL and direction for the revision of some IDUQOL elements.Education, Faculty ofEducational and Counselling Psychology, and Special Education (ECPS), Department ofMedicine, Department ofMedicine, Faculty ofNon UBCReviewedFacult

Injection Drug Use Quality of Life scale (IDUQOL): A validation study

Background: Existing measures of injection drug users' quality of life have focused primarily on health and health-related factors. Clearly, however, quality of life among injection drug users is impacted by a range of unique cultural, socioeconomic, medical, and geographic factors that must also be considered in any measure. The Injection Drug User Quality of Life (IDUQOL) scale was designed to capture the unique and individual circumstances that determine quality of life among injection drug users. The overall purpose of the present study was to examine the validity of inferences made from the IDUQOL by examining the (a) dimensionality, (b) reliability of scores, (c) criterion-related validity evidence, and (d) both convergent and discriminant validity evidence. Methods An exploratory factor analysis using principal axis factoring in SPSS 12.0 was conducted to determine whether the use of a total score on the IDUQOL was advisable. Reliability of scores from the IDUQOL was obtained using internal consistency and one-week test-retest reliability estimates. Criterion-related validity evidence was gathered using variables such as stability of housing, sex trade involvement, high-risk injection behaviours, involvement in treatment programs, emergency treatment or overdose over the previous six months, hospitalization and emergency treatment over the subsequent six month period post data collection. Convergent and discriminant validity evidence was gathered using measures of life satisfaction, self-esteem, and social desirability. Results The sample consisted of 241 injection drug users ranging in age from 19 to 61 years. Factor analysis supports the use of a total score. Both internal consistency (alpha = .88) and one-week test-retest reliability (r = .78) for IDUQOL total scores were good. Criterion-related, convergent, and discriminant validity evidence supports the interpretation of IDUQOL total scores as measuring a construct consistent with quality of life. Conclusion The findings from this study provide initial evidence to support the use of the IDUQOL total score. The results of the study also suggest the IDUQOL could be further strengthened with additional attention to how some IDUQOL domains are described and satisfaction is measured.Educational and Counselling Psychology, and Special Education (ECPS), Department ofMedicine, Department ofMedicine, Faculty ofOther UBCNon UBCReviewedFacult

Quality of life themes in Canadian adults and street youth who are homeless or hard-to-house: A multi-site focus group study

Background: The aim of this study was to identify what is most important to the quality of life (QoL) of those who experience homelessness by directly soliciting the views of homeless and hard-to-house Canadians themselves. These individuals live within a unique social context that differs considerably from that of the general population. To understand the life areas that are most important to them, it is critical to have direct input from target populations of homeless and hard-to-house persons. Methods: Focus groups were conducted with 140 individuals aged 15 to 73 years who were homeless or hard-to-house to explore the circumstances in which they were living and to capture what they find to be important and relevant domains of QoL. Participants were recruited in Toronto, Ottawa, Montreal, and Vancouver. Content analysis was used to analyze the data. Results: Six major content themes emerged: Health/health care; Living conditions; Financial situation; Employment situation; Relationships; and Recreational and leisure activities. These themes were linked to broader concepts that included having choices, stability, respect, and the same rights as other members of society. Conclusions: These findings not only aid our understanding of QoL in this group, but may be used to develop measures that capture QoL in this population and help programs and policies become more effective in improving the life situation for persons who are homeless and hard-to-house. Quality of life themes in Canadian adults and street youth who are homeless or hard-to-house: A multi-site focus group study.Education, Faculty ofEducational and Counselling Psychology, and Special Education (ECPS), Department ofOther UBCNon UBCReviewedFacult

Longitudinal Associations between Perceived Quality of Living Spaces and Health-Related Quality of Life among Homeless and Vulnerably Housed Individuals Living in Three Canadian Cities

The objective of this study was to examine longitudinal associations between perceived quality of living spaces and mental and physical health-related quality of life (HRQoL) among homeless and vulnerably housed individuals living in three Canadian cities. The Health and Housing in Transition (HHiT) study was a prospective cohort study conducted between 2009 and 2013 of N = 1190 individuals who were homeless and vulnerably housed at baseline. Perceived quality of living spaces (based on rated comfort, safety, spaciousness, privacy, friendliness and overall quality) and both mental and physical HRQoL were assessed at baseline and at four annual follow up points. Generalized estimating equation (GEE) analyses were used to examine associations between perceived quality of living spaces and both mental and physical HRQoL over the four-year study period, controlling for time-varying housing status, health and socio-demographic variables. The results showed that higher perceived quality of living spaces was positively associated with mental (b = 0.42; 95% CI 0.38—0.47) and physical (b = 0.11; 95% CI 0.07—0.15) HRQoL over the four-year study period. Findings indicate that policies aimed at increasing HRQoL in this population should prioritize improving their experienced quality of living spaces.Education, Faculty ofMedicine, Faculty ofOther UBCNon UBCEducational and Counselling Psychology, and Special Education (ECPS), Department ofGeneral Internal Medicine, Division ofMedicine, Department ofPopulation and Public Health (SPPH), School ofReviewedFacult