A qualitative exploration of the public and private faces of homelessness: engaging homeless people with health promotion

Citation

Coles E (2013) A qualitative exploration of the public and private faces of homelessness: engaging homeless people with health promotion. Doctor of Philosophy. University of Dundee.

Abstract
This qualitative exploration takes place within the context of homelessness, oral health and health promotion. The idea for this work was associated with 'An Action Plan for Improving Oral Health and Modernising NHS Dental Services in Scotland', which identified homeless people as a priority group. This led to ‘Something to Smile About' (STSA), a pilot oral health promotion intervention for homelessness sector practitioners and homeless clients. An evaluation of STSA, which was judged to have failed, highlighted the interplay between intervention design, and the two principal stakeholders: practitioners and homeless clients.The aim of the research was to explore the contextual and experiential elements of homelessness that influence homeless people's engagement with health promotion. As the research progressed, these two factors were conceptualised as the public and private faces of homelessness. It became apparent that to fully understand the issues surrounding homeless people's engagement, it would be necessary to explore the private, innermost elements of homelessness.Seventeen homelessness sector practitioners and 34 homeless people took part in a qualitative exploration, in order to examine the engagement process from the perspective of both stakeholders. It emerged that that the homelessness policy context, coupled with work environments and perceptions of clients, shaped practitioners' interactions and thus influenced client engagement. Practitioners utilised a narrow ‘window of engagement opportunity' within a wider framework of managing client health problems and preparation for engagement, engaging with clients, and finally, disengaging from clients. From the work with homeless people, a ‘journey' through homelessness emerged, in the form of a trajectory from ‘deconstruction' of pre-homeless identity, to ‘construction' of a homeless identity, and finally, to ‘reconstruction' of a post-homeless, ‘reclaimed' life. Appropriate points for engagement on this trajectory were identified.The thesis ends with a set of recommendations to assist practitioners to engage their homeless clients, and from the client perspective, encourage and facilitate engagement with practitioners and health promotion services.