Stigmatization and Healthcare Inequity Perceived by Individuals Served by Homeless Shelters in an Appalachian City.

INTRODUCTION

People experiencing homelessness are medically vulnerable and suffer disproportionately from chronic physical and mental health conditions. Evidence-based standards to inform decisions surrounding care would be valuable for this population. Studies exploring how homeless individuals in Appalachia perceive their interactions with the healthcare system remain limited, however.

PURPOSE: The purpose of this study is to assess perceptions of the healthcare system among homeless individuals served by temporary housing shelters in an Appalachian city.

METHODS

A voluntary anonymous survey was administered to residents at three shelters in Charleston, West Virginia (WV) from September 2023 - March 2024. Responses were collected utilizing REDCap by a medical student interest group that regularly provided services at the shelters.

RESULTS

Of 108 participants, 23.2% "agreed" or "strongly agreed" that they feel judged by healthcare workers, and 23.2% agreed/strongly agreed that they feel healthcare workers treat them differently from the non-homeless people in the hospital. Similarly, 19.4% agreed/strongly agreed that they do not like going to the hospital because of the way they are treated. Respondents with a history of a mental health diagnosis reported significantly higher levels of stigma or poor experience with providers (p =0.026). There was no significant difference in perceived stigma/judgement based on race, incarceration history, or employment status.

IMPLICATIONS: Perceived inequity in health care was prevalent amongst the homeless individuals surveyed. Survey participants with a history of mental health diagnoses were more likely to report dissatisfaction with care. More studies are needed to determine the impact of perceived stigmatization on healthcare disparities in the homeless population in WV.