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Understanding the Determinants of Homelessness through Examining the life Stories of Homeless People and those who Work with them: A Qualitative Research Protocol

Mzwandile A Mabhala

Faculty of Health and Social Care, Department of Public Health and Wellbeing, University of CHESTER, Riverside Campus, Chester, CH1 1SL, UK

Basma Ellahi

Faculty of Health and Social Care, Department of Public Health and Wellbeing, University of CHESTER, Riverside Campus, Chester, CH1 1SL, UK

Alan Massey

Faculty of Health and Social Care, Department of Acute Adult Care, University of CHESTER, Padgate Campus, Warrington, UK

Paul Kingston

Faculty of Health and Social Care, Department of Public Health and Wellbeing, University of CHESTER, Riverside Campus, Chester, CH1 1SL, UK

*Corresponding Author:
Marcos Edgar Fernández-Cuadros
Calle del Ánsar, 44, piso segundo. 28047. Madrid, Spain
Tel: +34 620314558
E-mail: [email protected]; [email protected]

Submitted date: June 13, 2016; Accepted date: June 27, 2016; Published date: July 04, 2016

 
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Abstract

There has been a sharp increase in homelessness following recent UK welfare and other social policy reforms; these reforms included public expenditure reductions, compounded by benefit cuts which lowered/capped housing benefits and weakened welfare protection and the housing safety net. The increase occurred despite efforts by the government and charitable organisations to mitigate it, which raises questions about their strategies’ effectiveness and about policymakers’ understanding of homelessness. This study aims to gain insight into the determinants of homelessness through examining the life stories of homeless people and those who work with them. Constructivist grounded theory (CGT) is used to develop a theoretical explanation of the determinants of homelessness. Qualitative in-depth semi-structured interviews are being conducted in several centres for homeless people in the north west of England, UK. Initial analysis of the stories of homeless people reveals four determinants of homelessness: home and childhood environments; experiences during school life; type of social lifestyle; and opportunities for access to social goods. Participants see their homelessness as a manifestation of fundamental determinants of social inequalities such as education; income inequality; unemployment and welfare; barriers to housing and other services; crime and living environment.

Keywords

Homeless; Inequalities in health; Public health; Socioeconomic determinants

Background

There has been a sharp increase in homelessness since the beginning of the United Kingdom (UK) Coalition government’s welfare and other social policy reforms; these included public expenditure reductions (Fitzpatrick et al., 2012, Fitzpatrick et al., 2015, Loopstra et al., 2014, Clarke et al., 2015), and were compounded by benefit cuts which lowered/capped housing benefits, and weakened welfare protection and the housing safety net (Fitzpatrick et al., 2012). Furthermore, reductions in local authority (LA) funding for housing-related support led to substantial changes to the options available for the homeless, and to the private rented sector becoming the main housing provider for people in low income households.

The UK government, and national and local charities, are acting to prevent and mitigate homelessness (Department for communities and local goverment and Home and Communities Agency, 2015, Department for Communities and Local Government, 2014, Department for Communities and Local Government, 2015). However, some groups in society remain vulnerable (Loopstra et al., 2014). For example, the studies that monitor homelessness trends in England (2011-2015) are indicating that annual statutory ‘homelessness acceptances’ were 12,000 higher in 2013/14 than in 2009/10 (Fitzpatrick et al., 2015). Similarly, Loopstra et al (2014) examined data covering fiscal years 2004/05 to 2012/13 for lower tier LAs in England: between 2004 and 2009, homelessness claims steadily declined, but then rose about 20%, from 3.5 claims per 1000 households in 2009 to 4.1 in 2012 (Loopstra et al., 2014). This raises questions about these strategies’ effectiveness and about policymakers’ understanding of homelessness.

Furthermore, the lack of consensus on what constitutes homelessness serves to detract the efforts to tackle the fundamental causes of homelessness. Several studies provide definitions of homelessness and theoretical explanations of its causes (Loopstra et al., 2014, Fitzpatrick et al., 2012, Fitzpatrick et al., 2015, Anderson and Christian, 2003). Most explanations see homelessness as a housing problem with implications for individual health and wellbeing (Anderson and Christian, 2003). Consequently, considerable efforts focus on monitoring its incidence and prevalence, and on interventions to mitigate its health and social implications (Homeless Link, 2015, Loopstra et al., 2014). Very little research is published on its fundamental determinants (Raine et al., 2004).

This study adopts Anderson and Christian’s (2003) definition, which sees homelessness as a ‘function of gaining access to adequate, affordable housing, and any necessary social support needed to ensure the success of the tenancy’. This supports the key argument of this study: homelessness needs to be considered in relation to individuals’ circumstances as well as wider social, economic and welfare policies, because these influence provision available from the welfare state and greatly impact upon the causes of homelessness.

This article examines the determinants of homelessness through the life stories of homeless people and those who work with them. It is the first article from an on-going project which started in January 2016, and presents a study protocol and preliminary findings. Its main contribution is a model that allows conceptualisation of the life course of determinants of homelessness. Representing homelessness in this form illustrates opportunities for intervention at fundamental determinants level to interrupt the process of becoming homeless.

Study Design

Constructivist grounded theory (CGT) was considered to be epistemologically and ontologically consistent with the study’s aims and context (Charmaz, 2006). The first aspect of CGT that fits with the research aim relates to the researchers’ belief that the phenomenon of homelessness is situated within a broader context of socioeconomic determinants of inequalities and social justice. This is consistent with CGT, which recognises the importance of the social context within which data collection and analysis are situated (Charmaz, 2006).

The second is recognition within CGT that researchers bring their values, beliefs and experiences to the research field (Charmaz, 2006). In several publications, Mabhala argues that social inequalities are created by social policies and institutions in society favouring certain starting places over others, and that social justice principles are the foundation for strategies to reduce socioeconomic inequalities (Mabhala, 2012, 2013, 2015). His established position is consistent with the CGT view that differences in power and opportunity maintain and perpetuate social inequalities (Charmaz, 2006). The CGT approach advocates the investigation of conditions under which such differences arise and are maintained (Charmaz, 2006, p. 131).

The third aspect is CGT’s acknowledgement that the researchers’ resulting theoretical explanation constitutes their interpretation of the meanings that participants ascribe to their own situations and actions in their contexts (Charmaz, 2006). This outlines CGT’s fundamental ontological belief in multiple realities constructed through the experience and understanding of different participants’ perspectives, and generated from their different demographic, social, cultural and political backgrounds.

The fourth aspect is CGT’s epistemological belief that knowledge is shaped by the cultural, historical and social norms that operate within that context and time. These assumptions outline the importance of taking account of the influence of the researchers’ involvement, and the influence of the contexts that surround data collection, analysis and interpretation of findings (Charmaz, 2006). They also support the researchers’ desire to learn how and to what extent homelessness is embedded in wider social contexts (Charmaz, 2006).

Setting and sampling strategy

The settings for this study were two centres for homeless people in Chester, UK. Each serves twenty to thirty five homeless people per day. Two sampling strategies were used in this study: purposive and theoretical. The study started with purposive sampling and in-depth one-to-one semi-structured interviews with eight homeless people to generate themes for further exploration.

One of the main considerations for the recruitment strategy was to ensure that the process complied with the ethical principles of voluntary participation and equal opportunity to participate. To achieve this, all users of the homeless centres and workers who were available at the time of the investigators’ visit to the centres weree offered an opportunity to participate.

To help potential participants make a self-assessment of their suitability to participate without unfairly depriving others of the opportunity, potential participants were required to meet the following criteria: at the time of consenting to and commencing the interview, the participant had to appear to be under no influence of alcohol or drugs, not have a diagnosis of mental ill-health, be able to speak English, and be free from physical pain or discomfort.

As categories emerge from the data analysis, theoretical sampling will be used to refine undeveloped categories in accordance with Strauss and Corbin’s, (1998) recommendations. In this study this will be done through focusing data collection on returning to key participants, asking them to give more information on topics that seem central to the emerging category (Strauss and Corbin, 1998).

Data collection

So far eight semi-structured interviews have been used to collect data. Each interview was scheduled to last 45 to 60 minutes. All interviews were conducted within the centre offices. The centre managers granted access once ethical approval had been obtained.

Interviews were tape-recorded and then transcribed verbatim by the investigators. Data collection commenced as soon as ethical approval was granted and will continue until ‘theoretical sufficiency’ (Díaz Andrade, 2009, p. 117) has been achieved. This study adopted the definition of theoretical sufficiency used by Díaz Andrade (2009), which is ‘that categories have been developed to a sufficient extent, so that it is possible to explore their relationships and draw some conclusions’(Strauss and Corbin, 1998, p. 48). Though some would describe this as theoretical saturation Strauss and Corbin (1998), in this study theoretical sufficiency is considered more appropriate: while both indicate that the data have been properly analysed, the latter acknowledges that the process of generating categories can never be absolutely exhaustive (Dey, 1999, Díaz Andrade, 2009).

Method(s) of data analysis

In this study data collection and analysis occurred simultaneously. Analysis drew on Strauss and Corbin’s (1998) grounded theory principles of constant comparative analysis, and the iterative process of data collection and data analysis, to build theory inductively. The data analysis was broadly organised according to the two phases of comparative analysis – making a constant comparative analysis and making a theoretical comparison (Corbin and Strauss, 2008) – a process summarised in Figure 1.

diversityhealthcare-Summary-CGT

Figure 1: Summary of CGT process of data analysis and theory building (Mabhala, 2013).

The project is currently at the comparative analysis phase (Figure 1). Each interview transcript is read line-by-line to identify segments of data that contain significant incidents, that is, incidents that appear to have potential to render an explanation of the core phenomenon under investigation.

The theoretically significant incidents will be coded in accordance with Strauss and Corbin’s (1998) open coding, defined as an ‘analytic process through which concepts are identified and their properties and dimensions are discovered in data’ (Strauss and Corbin, 1998, p. 101).

As data collection and analysis progress, each incident in the data will be compared with incidents from both the same participant and other participants, looking for similarities and differences (Strauss and Corbin, 1998).

Significant incidents will be coded or given labels that represent what they stand for and given similar labels when they are judged to be about the same topic, theme or concept (Strauss and Corbin, 1998).

Once the major categories have been developed, the next step will consist of a combination of theoretical comparison and theoretical sampling. The emerging categories will be theoretically compared with the existing literature (Strauss and Corbin, 1998). Once this is achieved, the next step will be filling-in and refining the poorly defined categories. This process will continued until theoretical sufficiency is achieved.

Ethics approval and consent to participate

Ethical approval was obtained from the University’s Research Ethics Committee after their review of the study design, tool used and other research material, and of the participant information sheet which included a letter of invitation highlighting that participation was voluntary.

To comply with the principles of voluntary and informed consent, potential participants are provided with information about the study (Aims, objectives, and the voluntary nature of participation) and were then invited to take part.

Confidentiality of data and anonymity of participants are being oberved. The participants’ identifiable information is being removed from transcripts, and data is stored in a secure location, reported in aggregate form and accessible to researchers only.

Results

Initial analysis of the stories of homeless people reveals four layers of determinants of homelessness: home and childhood environments; experiences during school life; type of social network lifestyle; and opportunities for access to social goods. Figure 2 illustrates these.

diversityhealthcare-Layers-determinants

Figure 2: Layers of determinants of homelessness.

Home and childhood environments

It would appear that childhood experiences remain resonant in the minds of homeless participants, who perceive that these childhood experiences have a bearing on their homelessness. Their influence is best articulated in the extracts below. When participants were asked to tell their stories of what led to them becoming homeless, some of the examples of their opening lines were:

What basically happened is that I had a childhood of so much persistent, consistent abuse from my mother and what was my stepfather. Literally consistent, we went around with my mother one Sunday where a friend had asked us to stay for dinner and mother took the invitation up because it saved her from getting off her ass basically and do anything. I came away from that dinner genuinely believing that the children in that house weren’t loved and cared for, because they were not being hit, there was no shouting, no door slamming.’ [Matt]

I think it started off when I was a child; I was neglected by my mum. I was physically and mentally abused by my mum. I got put into foster care, when I left foster care I was put in the hostel; from there I turn into alcoholic. Then I was homeless all the time because I got kicked out of the hostels, because you are not allowed to drink in the hostel.’ [Dan]

Experiences during school life

All participants cited poor education experiences as a major contributor to their homelessness. However, the stories presented below are just a few examples, to illustrate how participants linked their homelessness with poor education experiences. For example, when asked to tell the story of the lead-up to his homelessness, Pat’s response was:

I did not go to school because I kept on bunking. When I was fifteen I left school because I was caught robbing, the police took me home and my mum told me you’re not going back to school again, you are now off for good. Because if you go back to school you keep on thieving, she said I keep away from them lads. I said fair enough. When I was seventeen I got run over by a car.’ [Pat]

Similarly, Lee recalls his education experience. He explained:

I left school when I was fifteen because I was the youngest in my year. Left school then I went off the rails. I got kidnapped for three and half months. When I came back I was just more interested in crime. When I left school I was supposed to go to College, but I went with travellers. I was just more interested in getting arrested every weekend, until my mum say right I have enough of you. I was only seventeen. I went through the hostels when I was seventeen.’ [Liam]

He describes the school he went to as:

The school I came from a rough school, it was a main school, it was A, B, C, D and E. I was in the lowest set; I was in E because of my English and maths. I was not interested, I was more interested in going outside with big lads smoking weed, bunking school. I use to bunk school inside school. I used to bunk where all cameras can catch me. They caught me and reported me back to my parents. My mum had a phone call from school asking where your son is. My mum grounded me. While my mum grounded me I had a drain pipe outside my house, I climbed down the drain pipe outside my bedroom window. I used to climb back inside.’ [Liam]

Matt describes his school as:

It was hard school, pernicious I would go as far as saying. I never felt welcome in that school, I felt like a fish out of the water, being persistently bullied, did my head in.’ [Matt]

Personal (adult lifestyle)

Participants in this study described their adult lifestyle consisting of substance use, engagement with criminal activities, and movement between jail, hospital and street:

I got put into foster care. When I left foster care I was put in the hostel, from there I turn into alcoholic. Then I was homeless all the time because I got kicked out of the hostels, because you are not allowed to drink in the hostel, it’s been going on now for about…I was thirty one on Wednesday, so it’s been going on for about thirteen years, homeless on and off. Otherwise if not having shoplifted for food and then go to jail, and when I don’t drink I have lot of seizures and I end up in the hospital. Every time I end up on the street.’ [Dan]

I trained as a chef, I have not qualified yet, because of alcohol addiction, it didn’t go very well. I did couple of jobs in restaurants and diners; I got caught taking a drink.’ [Dan]

Social system: Opportunities for access to social goods

Participants identified connect between the experiences that led them to homeless and their abilities to access the opportunities for social good such as housing, employment and health and social care services. These are just some of the examples of their stories that illustrate their difficulties with accessing the opportunities:

‘…but consistently being put down, consistently being told I was thick, I started taking jobs and having employers’ effing and blinding at me. One employer actually used a ‘c’ word ending in‘t’ at me quite frequently and I thought it was acceptable, which obviously….’ [Matt]

Pat explains his difficulties with healthcare services.

I want a proper medical, which is what I need but the doctors is not giving to me, all she is doing is blood tests. I want full treatment I’m now getting off her. They don’t like me in the hospital they think I am a pain. That’s what they think at the hospital”.

Discussion

Analysis of the homeless people’s stories revealed that they see their experiences as manifestations of fundamental determinants of social inequalities. It was clear from listening to their stories that homelessness is a social and economic phenomenon with adverse implications for health and social wellbeing of individuals, communities and the public. This was evidenced in their descriptions, narratives of an existence which consists of a vicious cycle of moving from social institutions such as temporary accommodation and prisons, then healthcare institutions, general practices and hospitals, and then back to sleeping rough on the street.

This study differs from several studies of homelessness that take a population approach, citing how changes in housing, employment, economic climate, and social and healthcare services have caused homelessness (Lee and Farrell, 2003, Lee and Greif, 2008, Lee et al., 2003, Byrne et al., 2013, Fitzpatrick et al., 2012, Fitzpatrick et al., 2015). It compares favourably to the very few studies that look at individual characteristics and experiences that increased participants’ likelihood of becoming homeless. It represents participants’ stories as a life course of determinants (Loopstra et al., 2014, Anderson and Christian, 2003), and it is believed that representing it in this form illustrates opportunities for intervention at fundamental determinants level to interrupt the process of becoming homeless.

These preliminary findings support the key argument that homelessness needs to be considered in relation to individuals’ circumstances, as well as wider social, economic and welfare policies, because these influence provision available from the welfare state and greatly impact upon the causes of homelessness.They have important implications for social policy, as intervention at this fundamental level of social determinants requires changes in social policy. These findings will be explored in detail in the next stage of the project.

Competing Interests

The authors declare that they have no competing interest.

Funding

The project was funded through research Quality-related Framework funding (QRF). The research funding body has no influence or role in the design of the study, in the collection, analysis, and interpretation of data, and in writing the manuscript.

Authors' Contributions

The authors:

1. Wrote the entire manuscript, designed the study, collected data, analysed and interpreted data and presented the findings.

2. Were involved in drafting the protocol for ethical approval, and also provided advice during the process of research.

3. Was involved in drafting a protocol for ethical approval and helped to shape the objective of the study.

4. Agreed to take responsibility for proofreading and ensuring content accuracy.

Acknowledgement

The author wishes to thank all participants in this study; without their contribution it would not have been possible to undertake the research. A very special thanks to Robert Whitehall, John and all the staff at the centres for homeless people for their help in creating a conducive environment for this study to take place; and to Roger Whiteley for editorial support. A very special gratitude goes to the reviewers of this paper, who will have expended considerable effort on our behalf.

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