Inclusion Health for Women in Homelessness

The project Inclusion health for women in homelessness is our contribution to the United Nations Agenda 2030. This is done by focusing on women in homelessness with extremely poor health and in poverty. Homeless women in high-income countries such as Sweden face extreme health-inequities resulting in an increased risk of premature death from treatable illnesses. The aim of this project is to develop and implement interventions for inclusion health and equal healthcare for women living in homelessness. This is done in close collaboration with women who have experience of homelessness.

The aim of the project is to develop and implement interventions for inclusion health and equal healthcare for women living in homelessness. Homelessness is widely considered a male phenomenon. This results in hidden vulnerability among unhoused women, thus increasing the marginalization of these women. There is limited information regarding the number of women living in homelessness in Sweden todayand the healthcare challenges these women face have not been sufficiently studied.

In general, the Swedish population has good health and access to healthcare services, but despite this, health inequality and gaps in access to healthcare as well as perceived reduced quality of care is increasing. People living in homelessness often reside in areas where diseases spread more easily and simultaneously access to healthcare is very limited. During recent years, the number of homeless women in Sweden has increased and for women, homelessness often correlates with mental health issues, substance use disorders, poverty and sexual violence. These women face extreme health inequities and face a significantly increased risk of dying from potentially treatable illnesses. A need to discontinue and prevent stigma and discrimination against homeless women has been identified in the project.

Domestic violence is seen as an important explanatory factor for homelessness in women, when these women no longer have a permanent residence, they are oftentimes exposed to additional male violence. Those who in addition to this develop substance use disorders are exposed to an alarming degree of male violence. This project has therefore identified a need to increase the knowledge of gender specific differences with regards to healthcare for unhoused men and women with substance use disorders.

Three areas of change constitute the basis of the project. Each area represents a barrier and an opportunity for change to take into account when addressing inclusion health for women in homelessness:

End stigmatization and discrimination in healthcare. This will be achieved by identifying and investigating barriers for inclusion health as perceived by women in homelessness and what interventions these women consider crucial for inclusion health. Further, ending stigma and discrimination is done by investigating caring behaviors among registered nurses, as well as nurses' attitudes and bias towards unhoused women, and how this affects the quality of care, as perceived by homeless women. Furthermore, the project aims to use knowledge and education to influence registered nurse´s attitudes and perceptions towards women in homelessness.

Use digitalization to increase access to health services. This area of change aims to investigate possibilities of using digitalization to increase access to healthcare services for women in homelessness. This is done by investigating the possibilities for these women to use mobile phones in their contact with health care services. Further, the project aims to identify and describe the barriers and facilitators of the use of digitalization as well as attitudes and perceptions in women towards health care engagements via mobile phones.

Increase knowledge of gender-specific differences regarding health and well-being among persons in homelessness. This is achieved by looking at a cohort of people experiencing homelessness as well as suffering from substance abuse disorders and investigating if there are gender-specific differences regarding care and treatment, in comparison with the National guidelines for substance use disorder. Furthermore, the project aims to develop and implement a national action plan for care of women in homelessness with experiences of abuse, assault and trauma.

By working closely with unhoused women and women with experience of homelessness, the work of changing this discrimination and removal of barriers and health-inequities can be accelerated. However, despite this, women in homelessness have previously been excluded from this process. This project assumes that inequalities and poor health can only be defeated by participation and influence. This is why this project closely collaborates with a group of women who has experiences with homelessness, called the Women Advisory Board. By utilizing the knowledge, experiences and motivations of these women, the work of change can be accelerated, and these women are a huge resource to adequately identify, develop and implement the necessary interventions for inclusion health for women in homelessness.

By collaborations with researchers, civil society organizations, health care providers and women who are experts through their personal experiences with homelessness, we hope to create a lasting change.

The project is a collaboration between Ersta Skönal Bräcke University College, Universty of Gävle, Uppsala University and the Women Advisary Board at Ersta Möjlighet. The project in funded by FORTE and the Swedish Research Council.