This study examines the association between violence exposure and psychological distress among women experiencing homelessness (n = 41). Using a cross-sectional survey design, we assessed emotional, physical, and sexual violence perpetrated by both close (e.g., intimate partners, family members) and non-close (e.g., acquaintances, strangers) individuals and their impact on mental well-being. Findings indicate high levels of violence, with greater exposure linked to increased distress. Each form of violence in close relationships was independently associated with distress, highlighting its broad health consequences. Addressing the significant burden of violence among women experiencing homelessness requires both healthcare recognition and structural interventions. Comprehensive, trauma-informed approaches are essential to mitigate the impact of violence on psychological well-being.

Introduction: The health of underserved populations, including sexual and gender minority forced migrants, is a pressing global concern. Public contribution in research has the potential to enhance prioritisation and aid in intervention development, but has been criticised due to a lack of sufficient diversity and engagement with underserved populations.

Methods: The core research team conducted eight workshops together with eight experts by lived experience to prioritise and guide future peer support intervention research. Activities included brainstorming, pathway mappings, ranking procedures, storytelling exercises, photovoice sessions and individual open‐ended writing sessions. Open‐ended reflective meetings and manifest content analysis of material, as well as documentation, guided the progress towards final results.

Results: Peer support was identified as an intervention with the potential to reduce mental health burdens, enhance the capacity to integrate into society and provide access to basic needs. Peer support interventions aiming to reduce health inequities by promoting language proficiency and employment attainment were identified as prioritised areas. A range ofconsiderations and barriers regarding the modality of interventions, the training of peer supporters and recruitment strategies needs further examination in research.

Conclusions: Our findings illustrate the importance of public contribution when planning research addressing support for under served and marginalised populations. Public contribution efforts targeting underserved populations such as ours will help researchers gain an in‐depth understanding of prioritised research questions and pragmatic study procedures. In regard to research for sexual and gender minority forced migrants, we recommend prioritisation of intervention development that promotes mental health and reduces loneliness through support from peers in group settings and from peer mentors, informational support and capacity‐building.

Patient or Public Contribution: Representatives acting as experts by lived experience contributed as research partners throughout the procedures and workshops.

Background and Objectives: People experiencing homelessness and older people experience barriers as health and social care services are increasingly delivered online, however, there is limited knowledge about how this relates to older and middle-aged women experiencing homelessness, especially those from minoritized and/or migrant communities. We aimed to explore how technology, including digital health, can help or hinder older and middle-aged women to navigate paths through and out of homelessness.

Research Design and Methods: This 16-month qualitative longitudinal study utilized narrative interviews and participant observations with seven older and two middle-aged women experiencing homelessness, in London, England. Additionally, we observed interactions between the women experiencing homelessness and two information and communications technology class facilitators. We collected and analyzed data using a narrative, interpretative approach. An advisory board of women with lived experiences of homelessness supported the interpretation of findings and development of practice and policy recommendations.

Results: We present our findings as three composite narrative vignettes co-constructed with the participants: (1) "No, I’m not taking this telephone appointment"; (2) "Technology doesn’t judge you"; and (3) "You have to be a digital person now". The findings illuminate determinants of digital health equity related to aging, gender, and migration status among older and middle-aged women experiencing homelessness.

Discussion and Implications: Using an intersectional lens, we provide recommendations about how to better align digital health to the needs of older and middle-aged women experiencing homelessness. The findings will inform intervention development.

Why are so few women given public assistance to relocate away from violence? This article will try to answer this question using findings from a study co-created by women with lived experiences and academic researchers. Public assistance for this group is, in Sweden, a right granted by the national Social Services Act, but a significant proportion of women in need of it do not receive it. A survey of local social services reveals a pattern of chance, low priorities, and lack of awareness of this group within the public administration. The pattern is the same for women with children, in spite of their additional legal protection.

People in homelessness face significant health inequities, with tri-morbidity, exposure to violence, substance use- and post-traumatic stress disorder. The aim of this scoping review was to describe treatments for trauma-related conditions for persons in homelessness. Systematic searches were performed in three databases: PubMed, PsycInfo and Scopus, guided by the PRISMA checklist. Nine studies fulfilled the criteria and were included in the review. Results show no randomized studies specifically focusing on treatment of trauma-related conditions for people in homelessness. Studies described interventions or programs that focused on consolidating and developing participants’ own strengths and skills to better navigate life with the challenges of homelessness, trauma, and PTSD. Treatment of trauma-related conditions may have positive effects for people in homelessness, as for others. Multimodal treatments, developing personal strengths and skills for people in homelessness, show potential to decrease trauma symptoms, however, more robust studies are needed for inferences and recommendations. 

This paper highlights the expertise of marginalised and underserved populations, placing them at the centre of understanding resilient information systems design. We present a collaborative project in which women experiencing homelessness, alongside researchers in information systems and healthcare sciences, co-produce digital health interventions aimed at addressing psychological distress and safety concerns. Homelessness is associated with exclusion, resource deprivation, trauma, and abuse. By learning from these deeply challenging lived experiences, marginalised and underserved communities offer invaluable insights into how information systems should be designed to support users during episodes of violence, trauma, and crisis. Key improvements include system covertness, robustness, responsiveness, timely activation, and personalised privacy settings. This study further provides critical insights into the value of collaborative, co-production-focused design research, illuminating the requirements of resilient information systems that serve a broader user base.

BACKGROUND: People experiencing homelessness are at increased risk of violence and abuse, however, there is insufficient knowledge about rates of inquiry or readiness of healthcare professionals to address violence and abuse among this population. This study aimed to explore healthcare professionals' experiences and perceptions of asking about violence and abuse among patients experiencing homelessness.

METHODS: This study used a qualitative, interpretive, and exploratory design. We performed focus group discussions with healthcare professionals (n = 22) working at an integrative healthcare unit for people experiencing homelessness. Data were analysed using reflexive thematic analysis, following Braun and Clarke's six-phase approach. Findings are reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

RESULTS: The overarching theme of the analysis is that addressing violence and abuse is at risk of "falling through the cracks". The theme is supported by three sub-themes: Hesitance to address violence and abuse, The complex dynamics of violence and abuse in homelessness, and Challenges in addressing violence and abuse amidst competing priorities and collaborative efforts. The normalisation of violence and abuse within the context of homelessness perpetuates a "cycle" where the severity and urgency of addressing violence and abuse are overlooked or minimised, hindering effective interventions. Moreover, healthcare professionals themselves may inadvertently contribute to this normalisation. The hesitance expressed by healthcare professionals in addressing the issue further reinforces the prevailing belief that violence and abuse are inherent aspects of homelessness. This normalisation within the healthcare system adds another layer of complexity to addressing these issues effectively.

CONCLUSIONS: The findings underscore the need for targeted interventions and coordinated efforts that not only address the immediate physical needs of people experiencing homelessness but also challenge and reshape the normalised perceptions surrounding violence and abuse. By prioritising awareness, education, and supportive interventions, we can begin to "break the cycle" and provide a safer environment where violence and abuse are not accepted or overlooked.

Interviews with individuals experiencing homelessness can be challenging for various reasons, including mental and physical health issues, substance use, and negative experiences with authority figures. Researchers have used photos to facilitate communication and empower participants during data collection. We analyzed data from a previous study to explore the use of researcher-generated photos during interviews about health with 13 women experiencing homelessness. Conversation analysis revealed clear patterns regarding the use of the photos during the interviews. The photos were referred to 118 times over the total interview length, 6 hours and 23 minutes, with the interviewer making 62% of the referrals and the women accounting for 38%. Fifty-nine percent of the referrals occurred within the first 5 minutes of the interviews. The women used the photos to trigger associations and emotions, to describe photo content, or in a minor role during the interview. Interpretations from an advisory board of six women with lived experiences of homelessness suggested that the photos did not engage participants as intended, highlighting the importance of considering participants’ perspectives when designing photo-elicitation methods. The feedback also provided valuable insights into interview locations and incentives in research that may have influenced the women’s willingness to use the photos. This study emphasizes the importance of understanding the complexity of choosing researcher-generated photos in interviews with underserved, hard-to-reach populations.

Background: People in homelessness have an increased risk of substance use disorders (SUDs) and poor health outcomes. This cohort study aimed to investigate the association between homelessness and mortality in people with SUDs, adjusting for age, sex, narcotic use, intravenous drug use and inpatient care for SUDs.

Methods: Data from the Swedish National Addiction Care Quality Register in the Stockholm region were used to analyse mortality risk in people with SUDs (n=8397), including 637 in homelessness, 1135 in precarious housing and 6625 in stable housing, at baseline. HRs and CIs were calculated using Cox regression.

Results: Mortality was increased for people in homelessness (HR 2.30; 95% CI 1.70 to 3.12) and precarious housing (HR 1.23; 95% CI 0.86 to 1.75) compared with those in stable housing. The association between homelessness and mortality decreased (HR 1.27; 95% CI 0.91 to 1.78) after adjusting for narcotic use (HR 1.28; 95% CI 1.00 to 1.63), intravenous drug use (HR 1.98; 95% CI 1.52 to 2.58) and inpatient care for SUDs (HR 1.96; 95% CI 1.57 to 2.45). Standardised mortality ratios (SMRs) showed that mortality among people in homelessness with SUDs was 13.6 times higher than the general population (SMR=13.6; 95% CI 10.2 to 17.9), and 3.7 times higher in people in stable housing with SUDs (SMR=3.7; 95% CI 3.2 to 4.1).

Conclusion: Homelessness increased mortality, but the risk decreased after adjusting for narcotic use, intravenous drug use and inpatient care for SUDs. Interventions are needed to reduce excess mortality among people in homelessness with SUDs.

Low health literacy (HL) has been linked to low self-rated health, reduced efficacy of behaviour change, and challenges in preventing, treating, or managing health conditions. People experiencing homelessness are at risk of poor HL; however, few studies have investigated HL in relation to mental and spiritual well-being among people experiencing homelessness in general, or women experiencing homelessness specifically. This cross-sectional study of 46 women experiencing homelessness in Stockholm, Sweden, recruited during the period October 2019–December 2020, aimed to examine how HL was associated with mental and spiritual well-being among women experiencing homelessness. Participants answered questions about socio-demographic characteristics (age, length of homelessness, education) and digital technology (mobile phone/the Internet) use, in addition to Swedish language versions of three questionnaires administered through structured, face-to-face interviews: the Communicative and Critical Health Literacy Scale, the General Health Questionnaire 12 and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being. Data were analysed using linear regression, which revealed statistically significant associations between HL and mental well-being (p = .009), and between HL and spiritual well-being (p = .022). However, neither socio-demographic characteristics nor digital technology use were significantly associated with HL. In conclusion, promoting HL may improve mental and spiritual well-being in this vulnerable population. An advisory board of women with lived experiences of homelessness (n = 5) supported the interpretation of the findings and emphasised the need to consider HL in relation to basic needs such as ‘housing first’. Moreover, health information and services should be accessible to people with different degrees of HL.