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Principal Investigator: Donald Keith McInnes
Organization: EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL
Fiscal Year: 2024
Funding agency: Veterans Affairs
Background: On a given night around 40,000 Veterans are homeless and another 300,000 are at risk. Many
of these Veterans have complex health and social needs, and they experience frequent residential transitions
which can disrupt access to healthcare and treatment adherence. Many persons who are housing unstable
experience frequent residential transitions, such as from transitional housing to shelter, or from doubled up with
family/friend to living out of a car. Disruptions caused by such transitions likely contribute to this population's
poor health by interfering with access to care and treatment adherence. Despite the potential harm, there is a
major gap in detailed, contextual knowledge of these transitions, especially from the perspective of the
individuals experiencing them – such as their in-the-moment emotions, behaviors, geographic movements, and
social support. Filling this gap would improve knowledge of Veterans' trajectories into and out of
homelessness and their day-to-day barriers to health care and other services. New approaches are needed.
Research has shown that most persons experiencing homelessness have mobile phones, and increasingly
they are smartphones. This provides an opportunity to gather near real-time information, at relatively low cost,
that would help improve understanding of Veterans' changes in housing, health, mood, and use of services.
Significance/Impact: Homelessness among Veterans represents one of the worst failures of our national and
VA health care and social service systems. Health is poor, and life expectancy for homeless persons is 10 to
20 years shorter than for housed populations. The work proposed here will contribute to VA priorities of
improving access to care, increasing virtual care/telehealth, and improving the health of homeless Veterans.
Innovation: We propose the first significant test of passive and active mobile phone data collection among
homeless Veterans, including the use of global positioning system (GPS) location and ecological momentary
assessment (EMA) to improve understanding of context, mobility, and distance to services. These methods
can change how health services researchers think about collecting data from marginalized and hidden
populations. These techniques can identify sequences of micro-temporal events, for example teasing apart the
events and experiences that immediately precede (and follow) the transition from one housing type to the next,
or the events that led to a missed healthcare opportunity (e.g. a missed appointment).
Specific Aims: This study assesses the feasibility of smartphone data collection from homeless Veterans.
Aim 1: Characterize the real-time lived experience of homeless Veterans, including day-to-day activities,
interactions with services, and residential transitions using a formative ethnographic approach;
Aim 2: Refine and tailor smartphone data collection methods;
Aim 3: Conduct a 4-week demonstration of smartphone data collection to evaluate its acceptability and
feasibility with Veterans experiencing homelessness. Integrate quantitative (GPS, EMA, mobile survey,
medical records) and qualitative data; identify distinct patterns (or typologies) of residential transitions; and,
assess associations among residential transitions, mobility, mood, health services, and adherence.
Methodology: Ethnographic interview methods are used in Aim 1; focus groups and usability assessments in
Aim 2; and smartphone data collection in Aim 3.
Next Steps/Implementation: Using the methods and findings from this study, next steps will be to develop
interventions to identify and intervene at timepoints when there is rapid deterioration in Veterans' housing
stability or health to prevent major housing disruptions and health crises. Interventions will also contribute to
enhancing access to care and adherence to treatments.
Terms: <Access to Care><Address><Adherence><Adoption><Appointment><Behavior><Bionomics><Cell Phone><Cellular Phone><Cellular Telephone><Clinical><Communication><Complex><Data><Data Collection><Deterioration><Development><ED visit><ER visit><Early Intervention><Ecological momentary assessment><Ecology><Economics><Effectiveness><Electronic Health Record><Elements><Emergency care visit><Emergency department visit><Emergency hospital visit><Emergency room visit><Emotions><Enhancement Technology><Ethnography><Event><Failure><Family><Focus Groups><Friends><Future><Geography><Global Positioning System><Goals><Health><Health Priorities><Health Services><Health Services Accessibility><Healthcare><Homeless persons><Homelessness><Housing><Improve Access><Individual><Intervention><Intervention Strategies><Interview><Investigators><Knowledge><Life Expectancy><Lived experience><Lived experiences><Location><Measures><Medical Records><Methodology><Methods><Mobile Phones><Monitor><Moods><Movement><Overdose><Patients><Pattern><Persons><Population><Prospective Studies><Prospective, cohort study><Questionnaires><Research><Research Methodology><Research Methods><Research Personnel><Research Resources><Researchers><Resources><Risk><Services><Shelter facility><Social Service><Social Work><Social support><Specialist><Structure><Suicide precaution><Suicide prevention><Survey Instrument><Surveys><System><Techniques><Technology><Testing><Time><Translating><Trust><Typology><Veterans><Vulnerable Populations><Work><acceptability and feasibility><access to health care><access to health services><access to healthcare><access to services><access to treatment><accessibility of health care><accessibility to health care><accessibility to health services><accessibility to healthcare><availability of services><barrier to care><barrier to health care><barrier to healthcare><barrier to treatment><body movement><care access><cost><developmental><economic><electronic health care record><electronic health medical record><electronic health plan record><electronic health registry><electronic medical health record><ethnographic><experience><health care><health care access><health care availability><health care service><health care service access><health care service availability><health service access><health service use><health service utilization><health services availability><healthcare access><healthcare accessibility><healthcare availability><healthcare service><healthcare service access><healthcare service availability><high risk><homeless><homeless group><homeless individual><homeless population><homeless shelters><housing instability><iPhone><improved><innovate><innovation><innovative><instably housed><interventional strategy><m-Health><mHealth><marginalization><mobile computing><mobile health><mobile platform><mobile technology><new approaches><novel approaches><novel strategies><novel strategy><obstacle to care><obstacle to healthcare><opiate use disorder><opioid use disorder><outreach><peer><prevent><prevent suicidality><prevent suicide><preventing><programs><real time monitoring><realtime monitoring><research and methods><response><service availability><shelter><shelter housing><shelters><smart phone><smartphone><social><social support network><suicidality prevention><suicide intervention><telehealth><theories><tool><transitional housing><transitionally housed><treatment access><treatment adherence><treatment compliance><unhoused><unstable housing><unstably housed><usability><video visit><virtual care><virtual health care><virtual healthcare><vulnerable group><vulnerable individual><vulnerable people><willingness>