Health Related Quality of Life Among People Experiencing Homelessness: The Impact of Substance Use, Access to Care and Trauma Informed Care

Homelessness in the United States (U.S.) has been a concern for researchers and health care providers for decades. The increased morbidity and mortality experienced by this population is staggering, common conditions are reported to be poorly controlled in this population and life expectancy is estimated to be between 42-52 years old compared to the average U.S. citizens’ life expectancy of 78 years. These disparities have led to increased research into root causes of homelessness and interventions to reduce the morbidity and mortality experienced by people experiencing homelessness (PEH). This dissertation aimed to contribute to the research conducted among PEH with three publications. First, a mixed studies systematic review that examined the definitions of homelessness and vulnerable-housing in research studies proposed a comprehensive definition of homelessness and vulnerably-housed persons for use in future research. Second, a mixed studies systematic review of the factors that affect quality of life among people experiencing homelessness elucidated the factors that influence quality of life. This research revealed that relationships with providers and respectful and trustworthy care that emphasized choice were associated with improved quality of life. These findings were indicative of trauma informed care (TIC), which was further explored in the third study. The third study of this dissertation was a secondary analysis of homeless and vulnerably-housed participants from the health care center patient survey, a self-report survey of federally funded health care centers. Ordinal logistic regression was used to examine two hypotheses: 1) TIC would moderate the relationship between substance use and HRQoL and 2) TIC is a mediator in the relationship between access to care and HRQoL. Results revealed that the hypothesized moderation and mediation effects were not supported. However, significant negative relationship between substance use and HRQoL and a significant positive relationship between access to care and HRQoL resulted from this study. Further research should examine the relationship between TIC and HRQoL in populations recruited outside health care centers to capture PEH who do not have access to health care. Taken together, this dissertation highlights factors which impact health related quality of life among PEH and provides implications for practice and policy