Homeless Youths and Health Care Needs Research Paper

Introduction

Quality heath care measurements have turned into a fundamental focal point for scholars and researchers alike, since an assessment of quality health care provision is usually seen as a crucial step when it comes to enhancing the general population health statuses. This is in addition to ensuring that the cost of health care that appears to rise by the day is contained, as well as increasing the levels of confidence amongst the health care system consumers (Beltran 2000). On a global scale, homelessness continues to be a public and social health problem. Nathaniel, Stephanie and Wells (2008) contend that closes to 100 million around the globe are faced with a relative or an absolute level of homelessness.

In 2007, it was estimated that 141,000 individuals in the United Kingdom, bore the status of the homeless (Nathaniel et al 2008). This statistic was not inclusive of the homeless in Northern Ireland. According to BBC News (2006), there has been an increase in terms of the number of homeless people in England for the past four decades. What this means therefore is that the provision of services, such as social healthcare by the government, has been rather overstretched.

Since homeless individuals are more likely to be also uninsured and by extension, have a reduced access to affordable health care (Adèr, Mellenbergh & Hand 2008), they get by with no medical care, up to a point whereby otherwise minor medical problems turns into an emergency, requiring instant medical attention. In the end, a majority of the homeless persons ends up without treatment (Bardach 2005). Some of the communicable diseases that are both undetected and untreated pose a danger to the rest of the homeless persons (Cymorth 2007) and by extensions, to the larger society.

When the homeless individuals ends up not gaining access adequate healthcare, they become vulnerable to a host of illnesses (English & Morreale 2003), in effect drastically reducing their lifespan (Hwang 2001). Griffiths (2002) contend that the average number of years a homeless person may be expected to live is 42 years. From such a perspective therefore, it is the intention of this research study to explore the issue of the challenges that are faced by the homeless youths in Cardiff, in the United Kingdom, as regards access to and provision of health care.

Research studies indicate that compared to their adult counterparts, the homeless youths are far more vulnerable, and increasingly underserved, when it comes to the issue of gaining access to health care (Shaw 2000). In order to facilitate in the collection of primary data, to gain insight into the health care need for this vulnerable group, use shall be made of interviews and a semi-structured self-administered questionnaire, as data collection tools. Additionally, focus group interviews will also be conducted, to further explore the issue of health needs for the youths, as a vulnerable group.

Throughout the data collection process and by extension, the period for which the research study shall be underway, ethical consideration shall be observed, in the collection of data and maintenance of privacy of the participants to the study. Data analysis shall be via the use of such statistical tools as the Scientific Package for Social Sciences (SPSS) and Microsoft Excel (MS Excel). The research findings shall be tabulated and presented for purposes of discussion, relative to available evidence from literature.

Background study

Problem statement

Homeless people have been shown to be increasingly vulnerable to a wide array of illnesses (Shaw 2000; Raoult 2002; Laurie 2004), even as a proper access to health care remains a pipe dream to this vulnerable group. A 2006 study that was published in the ‘’British Journal of General Practice’’ revealed that ‘drug dependence, alcohol dependence and mental illness are the most frequently expressed health needs of homeless people’ (Wright & Tompkins 2006). Even then, it is not to be deduced here that these problems so identified, are mutually exclusive.

Perini and colleagues (2008), through a study that they carried out, and which involved interviewing a total of 107 consultants that had been working with homeless patients, revealed that 60 percent of the consultants had handled homeless patients that were at least dependent on alcoholic, drug dependent, or mentally ill. Another group of 260 consultants that had sought to handle individuals within the hosed population, had below 4 percent chance of presenting with the problems described above (Perini et al 2008).

Mental illness, along with substance abuse, has been associated with co-morbidities, and this could possibly offer an explanation as to why the life expectancy of say, a homeless man, may be 42 years (Griffiths 2006). Due to their overindulgence in alcohol, the homeless are at an even greater risk of suffering from liver disease, when compared with their non-homeless counterparts. Malnutrition, poor oral hygiene, as well as a sustained intake of alcohol all plays a pivotal role in exacerbating the already poor health status of the homeless people. When faced with these levels of stressors, many a homeless person has often found the going getting tough. It is not a wonder therefore, that a majority of them have opted to take their own lives.

Greiner (1996) has reported of a research study that was carried out in the city of London amongst the homeless population. According to the findings of this research study, rough sleepers were found to have a 35 percent more likelihood of taking their own lives, by way of committing suicide, relative to the members of the general population. Further, this study also revealed that poor access to effective health care services was also a contributing factor, as regards the social isolation and stigma that accompanies the status of being homeless.

From a medical point of view, the homeless youths within the United Kingdom may be said to be both vulnerable and underserved. Similar sentiments have also been echoed by Shaw (2000), who has reported of a national household representative research that was carried out on the homeless youths, ob between 12 and 17 years. The research findings of this survey revealed that when compared with their adult counterparts, the homeless adolescents were more likely to be underserved medically, in effect meaning that they are more vulnerable to health problems, more than any other population segment in the larger society.

Within the United Kingdom and indeed, the world over, countless policies and a lot of resources are committed for purposes of addressing the needs as well as the problems that often faces the youth (McGlynn & Halfon 1998; Wright & Tompkins 2006). On the other hand, comparatively lesser resources gets set aside for purposes of assessing the impact that such programs and policies have on the youths that are homeless, in terms of their overall wellbeing. By implementing procedures for measuring the levels of health care quality that the homeless youths often receives, this would go a long way into assisting health program administrators institute performance monitoring, with a view to examining and refining the best approaches to pursue, in as far as the provision of sound health care to the homeless youths is concerned.

Having already established the high level of vulnerability that homeless youths are usually faced with, with respect to health care provision, they are thus even at a greater risk of encountering negative health. What this implies is that there is a need to enhance the levels of health care quality that the homeless youths access. By and large, adolescents usually experiences unique challenges, when it comes to the issue of accessing health care services that are both sound and appropriate (Morse 2000). In addition, English and Morreale (2003) contend that the youths often presents with primary patterns of health care that are poor in nature.

Some of the barriers that the youths shall be faced with, in as far as accessing quality health care is concerned includes a conflict between on the one hand, school hours and on the other hand, office hours, when they can have access to a health care consultant (Nathaniel et al 2008). There is also the issue of consenting legally (Klein et al 2000), that they are in a position to take care of themselves, in addition to an added discomfort with the conventional settings of the health care systems that is more adult-oriented (Klein et al. 1999). Homeless persons (and these takes into account the adolescents, as well as the adults) are usually characterized by insufficient access and provision of primary health care. In addition, the homeless persons have been shown to seek for medical attention when they are faced with an emergency; at a time when their health conditions has greatly deteriorated (Zerger 2002).

When one is homeless, one gets faced with a multitude of health problems (Trueman 2003), meaning that the very access to health care becomes a pipe dream. This is because food and clothing usually takes precedence, thereby making health care a luxury (Klein et al. 2000). The homeless adolescents are especially faced with greater problems, when it comes to gaining access to health care, as compared with their counterparts that are not homeless, or even their fellow homeless adults (Cymorth 2007). Such vulnerability to a restricted access to health care also takes into account an enhanced anxiety with respect to confidentiality, increased level of anxiety, reduce tolerance levels when it comes to filing out intake forms, and waiting times, and also a diminished payment sources, if not lack of health care insurance (Klein et al 2000).

One very vital elements, and which is often times overlooked, is the fact that unlike their counterparts that have a home, the homeless youths do not have a parent, or an adult for that matter, to assist them as they try to navigate through a system of health care that is becoming rather complex by the day (Beltran 2000). It is important therefore for this research study to try and explore the level to which this may be viewed as a challenge by the homeless youths themselves.

Aim

The aim of this research paper is to explore the challenges that are usually faced by the homeless youths in Cardiff, in the United Kingdom, as a vulnerable group, in their quest to access health care services. The healthcare policies and programs that are in place appear to address the plight of members of the larger community, leaving the homeless people quite vulnerable. Usually, the homeless youths are affected most, because they lack a person to guide them through the complex system of healthcare.

Furthermore, they are also more likely to access health care service at a time when they are faced with an emergency, further exacerbating an already bad situation. On the other hand, homeless youths have been shown to harbor an opinion that the health care system is more adult-oriented, and this could possibly explain why a lot of them have lost confidence in it. In light of this, this research study shall endeavor to explore the views and opinions of the homeless youths, in order to gain an insight into the challenges that they are faced with, as regards access to quality health care. This shall therefore form a basis for the study’s recommendations.

Methodology

Research design

Creswell (2008) has defined a research design as a framework for data collection, with a view to yielding appropriate and logical findings, with a lot of accuracy. This research study shall lay emphasis on the challenges that are faced by the homeless youths in Cardiff, in the UK, as they try to access the health care system. Towards this end, a qualitative research design is viewed as the most ideal methodology that would assist in the interpretation of the research questionnaires and consequently, the attainment of the objectives of the study.

According to Creswell (2008), a qualitative approach is the most applicable in studies focused on “people’s attitudes, behaviors, value systems, concerns, motivations, aspirations, cultures, and lifestyles” (p. 123). Haas and Springer (1998) has written on the use of qualitative research for the understanding and exploration of various public and social policy issues, noting that it has been on the increase, for the past two decades.

Research instruments

Questionnaire

This research study hopes to make use of an open-ended questionnaire as a tool for primary data collection. Creswell (2008) opines that for the reduction of errors in data collection, the bets technique is the application of “a good [research] instrument” (p. 394). Separately, Cohen and colleagues (2007) contend that the utilisation of open-ended questions in a research survey allows the participants to freely express their views. Cohen, Manion and Morrison (2002 p. 255) further asserts, “Closed and open ended questions can catch the authenticity, richness, depth of response, honesty and candour which is […] the hallmarks of quantitative data”. For this reasons, in order to gain a useful insight into the plight of the homeless youths in Cardiff, with respect to the challenges they face while receiving health care, the most appropriate research toll to apply is an opened-ended questionnaire.

The research questionnaires shall be administered personally. Creswell (2008) argues that one of the benefits of self-administered questionnaire is personally administered is a better comprehension of the concepts involved, as well as the research questions themselves. Furthermore, the respondents also have a chance to make clarifications. According to Lee and Johnson (1999), refusal rates amongst respondents while using personably administered questionnaires are the lowest.

Questionnaire design

The questionnaire that is to be developed for this research study shall be a self completed research tool. A majority of the questions that are to be included will be closed-ended, thereby implying that the questionnaire shall be highly structured. Cohen and colleagues (2007) contend that factual data is best collected using questionnaires and thus appropriate questionnaire design is crucial in making sure research questions elicits valid responses.

The questionnaire that is to be developed for this particular research study shall mainly be geared towards recording of the experiences that the homeless teenagers in Cardiff usual encountered in their quest to gain access to quality health care. Therefore, the challenges that they are usually faced with, will be assessed, along with their views about the circumstances surrounding their inability to gain adequate healthcare.

Focus groups

6 group interviews shall also be conducted with the homeless teenagers, each consisting of 10 participants. Another separate group made up of 5 professionals that have thus far been working with theses homeless youths, shall also be subjected to a group interview. The aim of these focus groups is to assess the health status of homeless youths, the motivation (or lack of) towards their dealing with issues of health, as well as potentials barriers that they could encounter, while dealing with health needs. This shall also take into account the ability of these youths to access quality healthcare.

Sampling

Creswell (2008) asserts that sampling is one element of the statistical practices which about a study population, with a view to establishing statistical inferences. Given the difficulty and cost of for example, interviewing an entire population for a research study, use is made of a representative sample. In order to arrive at a representative sample, this research study shall make use of a systematic sampling. In this case, the researcher shall identify a total of 4 shelter houses for the homeless, within London, to gain access to the youths.

Nonetheless, any researcher who wishes to apply a systematic random sampling is required to ensure that first the interval of sampling a population does not in any way conceal any pattern. This is to avoid threatening of the randomness of a sample (Huberman & Miles 2002). In this case, every 10^th teenager from the database of the shelter homes that shall be identified by this study will be considered for participation in the research. The criteria for participation in the research study shall hinge upon first being homeless, and secondly one being a youth; that is, between the age of 13 and 19 years. This study hopes to interview a total of 60 respondents.

Data analysis

Following the completions of data collection, analysis shall be done using such statistical tools as Scientific Package for Social Sciences (SPSS) and Microsoft Excel (MS Excel), in order to generate meaningful research findings for tabulation and presentation.

Ethical Considerations

Prior to the start of the research study, the researcher shall inform all the participants the purpose of the study, in addition to assuring them that the research would guarantee their anonymity. Sekeran (1992) has opined that a researcher should desists from (1992), a researcher should not “use the research results to the disadvantage of the participants, or for purposes that participants will not like; not allowing them to withdraw from the research when they want to; exposing participants to physical and mental stress; deceiving subject by deliberately misleading them as to the true purpose of the research; asking demeaning questions that diminish their self-respect and putting pressure on individuals to participate in the research” (Sekeran 1992 p. 23).

Consent shall be sought from the learning institutions for which this researcher is a student, prior to carrying out of the study, as well as from the shelter homes where the study participants, in this case the homeless youths, are to be found. The researcher shall also inform the respondents that their participation is on voluntary basis, and that the information they give shall only be used for purposes of the research study only.

Project management schedule

The entire process of questionnaire formulation, data collection analysis and presentation of research findings, has been projected to take at the most, 6 months. There shall only be one researcher to undertake all the research, owing to a limitation on finances.

Budget

Bellow is a breakdown of the expected budgetary items necessary to facilitate the research study.

Capacity of the researcher

In this particular research study, the role of the researcher will be to formulate the research questions, in line with the aims and objectives of the study. In addition, the researcher shall also ensure that the questions are first pre-tested for relevancy, and also to ensure that typographic and grammatical errors are removed, prior to administering the questionnaire to the participants. The researcher shall also have to seek consent to carry out the research, first from the university authorities, and secondly, from the shelter homes for the homeless youths. The activity of data collections shall also be the responsibility of the researcher, along with data analysis, and the writing of the final report.

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