Researching Health and Homelessness: Methodological Challenges for Researchers Working with a Vulnerable, Hard to Reach, Transient Population

Sue Booth

doi:10.1071/py99037

Researching Health and Homelessness: Methodological Challenges for Researchers Working with a Vulnerable, Hard to Reach, Transient Population

Australian Journal of Primary Health ◽

10.1071/py99037 ◽

1999 ◽

Vol 5 (3) ◽

pp. 76 ◽

Cited By ~ 12

Author(s):

Sue Booth

Keyword(s):

Mental Illness ◽

Inner City ◽

Sex Workers ◽

Drug Users ◽

Daily Basis ◽

People With Mental Illness ◽

Transient Population ◽

Food And Nutrition ◽

Hard To Reach Populations ◽

Methodological Considerations

The purpose of this paper is to outline some methodological considerations for researchers working with vulnerable, transient, hard-to-reach populations. The research has been developed from reflecting on planning a study to examine the food and nutrition issues for homeless young people in inner city Adelaide. Homelessness is discussed as an example, however, many of the points are transferable to other 'hidden' or hard-to-reach populations. This applies particularly to those whose lives can be characterised by stigmatisation and powerlessness, for example, people with mental illness, sex workers, drug users/dealers, or transsexuals; that is, many groups which are relatively 'invisible' on a daily basis.

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Management aspects of care for the homeless mentally ill

Advances in Psychiatric Treatment ◽

10.1192/apt.2.4.158 ◽

1996 ◽

Vol 2 (4) ◽

pp. 158-165 ◽

Cited By ~ 3

Author(s):

P. Timms

Keyword(s):

Mental Illness ◽

Inner City ◽

Severe Mental Illness ◽

Social Service ◽

Mentally Ill ◽

Economically Disadvantaged ◽

High Unemployment ◽

People With Mental Illness ◽

Homeless Mentally Ill ◽

The Continuum

People with mental illness have always been marginalised and economically disadvantaged. Warner (1987) has shown that this is particularly true in times of high unemployment. Poor inner-city areas have excessive rates of severe mental illness, usually without the health, housing and social service provisions necessary to deal with them (Faris & Dunham, 1959). The majority of those who suffer major mental illness live in impoverished circumstances somewhere along the continuum of poverty. Homelessness, however defined, is the extreme and most marginalised end of this continuum, and it is here that we find disproportionate numbers of the mentally ill.

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Stickiness of respondent-driven sampling recruitment chains

Network Science ◽

10.1017/nws.2014.16 ◽

2014 ◽

Vol 2 (2) ◽

pp. 298-301 ◽

Cited By ~ 5

Author(s):

JACOB C. FISHER ◽

M. GIOVANNA MERLI

Keyword(s):

Risk Behaviors ◽

Sex Workers ◽

Drug Users ◽

Female Sex Workers ◽

Sampling Method ◽

Respondent Driven Sampling ◽

Hidden Populations ◽

Sampling Process ◽

Population Subgroup ◽

Hard To Reach Populations

Respondent-driven sampling (RDS) is an increasingly popular chain-referral sampling method. Although it has proved effective at generating samples of hard to reach populations—meaning populations for which sampling frames are not available because they are hidden or socially stigmatized like sex workers or injecting drug users—quickly and cost-effectively, the ease of collecting the sample comes with a cost: bias or inefficiency in the estimates of population parameters (Gile & Handcock, 2010; Goel & Salganik, 2010). One way that RDS can produce inefficient estimates is if one or more of the recruitment chains gets stuck among members of a cohesive subpopulation, preventing the RDS sampling process from exploring other areas of the network. If that happens, members of the population subgroup recruit one another repeatedly, leading to an increase in sample size without increasing the diversity of the sample. This type of stickiness is particularly likely when hidden populations are stratified, and the stratified groups are organized into venues that provide opportunities to recruit other members of the same stratum. Female sex workers (FSW) in China, who are stratified into tiers of sex work that are correlated with marital status, age, and risk behaviors, are a prime example (Merli et al., 2014; Yamanis et al., 2013). Chinese FSW recruit clients from venues such as karaoke bars, massage parlors, or street corners. At larger venues, sex workers who participate in an RDS study might recruit other members of the same venue into the study at a higher rate than expected, leading to inefficient estimates. In short, the chain could get stuck in a venue.

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Violence, homicide and suicide: Strong correlation and wide variation across districts

The British Journal of Psychiatry ◽

10.1192/bjp.175.5.462 ◽

1999 ◽

Vol 175 (5) ◽

pp. 462-466 ◽

Cited By ~ 42

Author(s):

H. G. Kennedy ◽

R. C. Y. Iveson ◽

O. Hill

Keyword(s):

Mental Illness ◽

Population Density ◽

Inner City ◽

Interpersonal Violence ◽

Individual Factors ◽

Strongly Correlated ◽

High Population Density ◽

Homicide Rates ◽

Validity Check ◽

People With Mental Illness

BackgroundThe clinical assessment and management of the risk of violence and suicide by people with mental illness may have to focus on environmental as well as individual factors.AimsTo investigate possible associations between violence, homicide and suicide rates, population density and indices of deprivation, with particular reference to inner-city boroughs.MethodCoroners' statistics in London for homicide and suicide were obtained, with police-reported homicide and violence rates as a validity check. Correlations were made between these data and population density, the Jarman under-privileged areas score, and the Mental Illness Needs Index for each of the 32 London boroughs.ResultsHomicide rates had a 14.3-fold range, suicide a 4.4-fold range and interpersonal violence a 6.6-fold range. The variables under study were strongly correlated with each other. Rates were highest in boroughs with high population density and deprivation scores. The associations persisted when covarying for deprivation, age structure or population density.ConclusionsBecause violence, homicide and suicide are so closely correlated, they are likely to be valid indices of the differences between adjacent boroughs; this has implications for the delivery of preventive and mental health services and for clinical management of risk.

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Fertile Imaginations: an inner city allotment group

Psychiatric Bulletin ◽

10.1192/pb.23.5.291 ◽

1999 ◽

Vol 23 (5) ◽

pp. 291-293 ◽

Cited By ~ 5

Author(s):

Joanna Seller ◽

Jon Fieldhouse ◽

Michael Phelan

Keyword(s):

Mental Illness ◽

Inner City ◽

Community Mental Health Team ◽

Mental Health Team ◽

Moral Treatment ◽

Health Team ◽

City Community ◽

The Past ◽

People With Mental Illness ◽

Kitchen Gardens

Engaging people with mental illness in horticultural activities is nothing new. Asylums encouraged patients to work on farms, in orchards and in kitchen gardens. This activity gradually became distilled, formalised and applied clinically as ‘moral treatment’, out of which occupational therapy evolved (Paterson, 1997). ‘Fertile Imaginations' is an attempt to offer horticultural activities to people with mental illness, within the framework of an inner city community mental health team (CMHT) and to ensure that the activities that engaged and benefited patients in the past, are not now denied.

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