Edited by: M. Barton Laws, Brown University, United States
Reviewed by: Matthew Anderson, Eastern Washington University, United States; Mahboubeh Dadfar, Iran University of Medical Sciences, Iran; Karol Konaszewski, University of Białystok, Poland; Cecilia Colunga-Rodriguez, University of Guadalajara, Mexico
†ORCID: Grzegorz Bejda,
Agnieszka Kułak-Bejda,
Damian Czarnecki,
Marcin Ziółkowski,
Anna Mosiołek,
Agata Szulc,
Napoleon Waszkiewicz,
Anna Ślifirczyk,
Elżbieta Krajewska-Kułak,
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Homelessness is considered to be a global problem, independent of the material situation of a given country and occurring in most societies around the world.
Assessment of the preferred health behaviors of homeless people.
The study covered 153 men who are homeless and 312 men who are not homeless. The original questionnaire of homeless, and validated the Satisfaction with Life Scale (SWLS), the Health Behavior Inventory (HBI), the General Self-Efficacy Scale (GSES) and the Multidimensional Health Locus of Control (MHLC) Scale were used. The research covered fully completed questionnaires from 153 homeless men staying in Białystok and Gdańsk homelss centers.
On average, the homeless men assessed their health at 6.0 ± 2.7 points, and the non-homeless at 7.8 ± 2.2 points (
The level of the presented health behaviors showed statistically significant diversification with all dimensions of the health locus of control, and its internal dimension with age, homelessness phase, the respondents’ criminal history, being under constant medical care, and self-assessment of health.
Homelessness is considered to be a global problem, independent of the material situation of a given country and occurring in most societies around the world. The population of homeless people is internally very diversified, although it is possible to observe in it some life situations typical for this group, most often of a social, economic, psychological, legal or health nature (
Nearly 155 million people are thought to be homeless and stay in temporary shelters, refugee camps, and other transitional conditions, with another billion living without adequate shelter. It is estimated that by 2050, this number will reach 3 billion. The largest increase in the homelessness rate was recorded in Iceland (by 168% from 2009 to 2017, although the homelessness rate remained low, at 0.1% of the total population). In turn, Norway and Finland recorded the largest decreases in the homelessness rate (in Norway, it fell by 40% in 2012–2016, and in Finland by 39% in 2010–2018). In such countries as Austria, Canada, Denmark, Poland, Slovenia, and Sweden, the homelessness rate has remained relatively stable in recent years (
At this point, it is worth noting that compared to the countries of Western Europe and other developed countries of the world, where the issue of homelessness has been the subject of systematic reflection in social sciences for many decades, this phenomenon was scientifically diagnosed in Poland very late (
Homelessness is associated with poorer health status and affects men, women, children, and veterans (
Several recent studies indicated that 20–31% of homeless adults endorse such alcohol related problems (
In this study, we tried to evaluate the health behaviors in a group of men experiencing a homelessness crisis in Poland.
Health behaviors have been defined as ‘overt behavioral patterns, actions, and habits that relate to health maintenance, to health restoration, and to health improvement’ (
Many health psychology research has examined the psychological determinants of health behaviors (
Medical anthropology studies how health and illness are shaped, experienced, and understood in the context of cultural, historical, and political forces. Perhaps anthropology’s greatest contribution to our knowledge of homelessness has been a description and understanding of the methods of adaptation and survival in life on the streets and in the shelters (
Understanding the experiences, practices, and perceptions of homeless people in health behaviors is essential to perform effective interventions to improve health outcomes. Furthermore, there are few studies on health behaviors in homeless people.
We wanted to explore selected aspects of mental health including health behaviors, self-efficacy, and locus of control in homeless men. The detailed aims included the assessment of selected health behaviors, need for health care and education, life satisfaction, the strength of the general conviction of the respondents as to the effectiveness of coping with difficult situations and obstacles, sense of the health locus of control and the dependence of the above on the phase of homelessness in the group of people experiencing homelessness crisis compared to those who do not experience it.
The research performance received the consent of the Bioethics Committee, R-I- 449/2013. The main research was preceded by a pilot study in each group of 50 people, which made it possible to verify the clarity of the statements formulated in the questionnaires and to finally develop the original questionnaire. The research covered fully completed questionnaires from 153 homeless men staying in Białystok at the St. Brother Albert Home for the homeless of Caritas of the Archdiocese of Białystok, Men’s Night Shelter of Caritas of the Archdiocese of Białystok, Women’s Night Shelter of Caritas of the Archdiocese of Białystok, Emergency Help Point of the ELEOS Orthodox Mercy Center of the Białystok-Gdańsk Diocese and 312 people who do not experience a homelessness crisis (control group). The selection of the groups was purposeful, and the research was carried out with the diagnostic survey method with the use of:
The original questionnaires (version for the homeless and those who are not homeless) consisting of 40 particular questions and questions concerning various aspects of homelessness was used. This survey was not validated. It consists of three parts.
PART I
Gender.
Age.
Marital status.
Do you have any children?
If so, do you keep in touch with them?
Last place of permanent residence:
Last place of work.
Education.
Have you ever had a criminal record?
Do you have an ID card?
Do you have permanent registration?
What are your current sources of income?
Are you ready to start work in the coming days if possible?
Do you think it is possible to get out of homelessness?
PART II
What phase of homelessness are you in?
Why did you become homeless?
Please indicate where you have been staying in the last year.
Do you have health insurance?
Do you have a certified disability group or degree of disability?
Do you use social assistance?
What forms of social assistance do you use?
What social assistance facilities do you know for the homeless?
PART III
On a scale of 0 to 10, how would you rate your current health?
When were you last hospitalized, and why?
How often do you use medical care?
Are you under constant medical supervision?
How often did you use medical services during the last year?
Do you follow the doctor’s recommendations?
What do you usually do when you feel sick, in pain, or have any ailments?
What medications have you used in the last year?*.
What are the most important diseases that currently affect you?
How often do you have a bath during the week?
When you last visited physician or dentist, he had an x-ray of the lungs.
How often do you eat the following meals - first breakfast, second breakfast, lunch, afternoon tea, dinner.
Do you smoke cigarettes? If so, since when, how much per day, how often.
Do you drink alcohol? If so, since when, how much per day, how often.
Which ailments do you feel Headaches, Lumbar spine pain, Cervical spine pain, Abdominal pain, Pain in lower limbs, Physical fatigue, Mental fatigue, Susceptibility to stress, Insomnia, Other, what.
Do you have any difficulties in performing the following daily activities, such as washing, dressing, moving around, preparing meals.
Do you have access to health services?
Where is access to health services for the homeless hindered?
Which doctor do you have the most difficult access to?
The standardized Satisfaction with Life Scale (SWLS),
The standardized Health Behavior Inventory (HBI) according to Juczyński – containing 24 questions describing various types of health-related behaviors (eating habits, preventive behaviors, positive mental attitudes, health practices) in the last 12 months (
The General Self-Efficacy Scale (GSES)–R. Schwarzer, M. Jerusalern, Z. Juczyński–measuring the strength of an individual’s general conviction as to the effectiveness of coping with difficult situations and obstacles (
The Multidimensional Health Locus of Control (MHLC-B) Scale version B of B. Wallston, B. S. Wallston, R. DeVellis, in the Polish adaptation of Juczyński – assessing generalized expectations of the respondents in three dimensions of the health locus of control: internal (conviction that control over my own health depends on me); the impact of others (conviction that the state of my health is the result of the impact of others, mainly medical personnel) and chance (the state of health depends on chance or other external factors). The results obtained allow the classification of the respondents into the following types: Strong Internal, Strong External, Decreasing the Impact of Others; Increasing the Impact of Others; Decreasing the Impact of Chance; Increasing the Impact of Chance, Undifferentiated-Strong and Undifferentiated-Weak (
The Statistica 13.0 PL program was used for statistical calculations. The Chi2 test was used to compare response rates between groups. Statistical relationships between satisfaction with life, health behaviors, coping with difficult situations and dimensions of the health locus of control in the surveyed group of homeless men and age, phase of homelessness and criminal record calculated with the use of multiple regression analysis. Statistical significance was evaluated at
In the study group of 153 homeless men, the largest number was in the age range from 51 to 60 (36.6%), divorced men (55.5%), having children (59.5%), but not maintaining contact with them (53.6%). Most frequently, the respondents had a permanent address of residence in a city with a population over 200,000 (59.6%) and vocational education (52.3%), Details are shown in
Characteristics of the study group.
| Number of men/percentage | ||||
|---|---|---|---|---|
| Data | Homeless |
Not homeless |
||
| Age | ||||
| <20 years old | 3 | 1.9% | 0 | 0% |
| 21–30 years old | 13 | 8.5% | 58 | 18.6% |
| 31–40 years old | 28 | 18.3% | 92 | 29.5% |
| 41–50 years old | 25 | 16.3% | 64 | 20.5% |
| 51–60 years old | 56 | 36.6% | 72 | 23.1% |
| 61–70 years old | 25 | 16.3% | 14 | 4.5% |
| >70 years old | 3 | 1.3% | 12 | 3.8% |
| Permanent residential address | ||||
| City with a population over 200,000 | 91 | 59.6% | 140 | 44.9% |
| City with a population of 50,000-200,000 | 30 | 19.6% | 50 | 16.0% |
| City with a population below 50,000 | 16 | 10.5% | 58 | 18.6% |
| Rural | 13 | 8.5% | 64 | 20.5% |
| Education | ||||
| Master’s degree | 10 | 6.5% | 116 | 37.2 |
| Bachelor’s degree | 0 | 0 | 92 | 29.5% |
| Secondary education | 48 | 31.4% | 58 | 18.6% |
| Vocational education | 80 | 52.3% | 46 | 14.7% |
| Primary education | 3 | 1.9% | 0 | 0 |
| No data | 12 | 7.8% | 0 | 0 |
| Marital status | ||||
| Married | 17 | 11.1% | 162 | 51.9% |
| Widower | 13 | 8.5% | 62 | 19.9% |
| Single | 49 | 32.0% | 58 | 18.6% |
| Divorced | 68 | 55.5% | 18 | 5.8% |
| Separated | 3 | 2.0% | 12 | 3.8% |
| No data | 3 | 2.0% | 0 | 0% |
| With children | ||||
| Yes | 91 | 59.5% | 240 | 76.9% |
| Maintaining contact | 71 | 78.0% | 240 | 76.9% |
| Lack of contact | 20 | 22.0% | 0 | 0% |
| No | 62 | 40.5% | 72 | 23.1% |
| Last employment | ||||
| Job in a state-owned company | 79 | 51.6% | 200 | 64.1% |
| Job in a private company | 29 | 19.0% | 112 | 35.9% |
| Person who has never worked | 1 | 0.7% | 0 | 0 |
| Source of income | ||||
| No income | 38 | 24.8% | 0 | 0% |
| Social benefit | 54 | 35.3% | 0 | 0% |
| Disability pension | 3 | 3.9% | 38 | 12.2% |
| Pension | 6 | 3.9% | 40 | 12.8% |
| Begging | 3 | 2.0% | 0 | 0% |
| Gathering | 9 | 5.9% | 0 | 0% |
| Undeclared work | 14 | 9.2% | 0 | 0% |
| Intervention works | 8 | 5.3% | 0 | 0% |
| Occasional work | 1 | 0.7% | 0 | 0% |
| Recycling | 8 | 5.3% | 0 | 0% |
| Family help | 6 | 3.9% | 60 | 19.2% |
| Full-time job | 0 | 0 | 122 | 39.1% |
| Scholarship | 0 | 0 | 50 | 16% |
| Criminal record | ||||
| No | 75 | 49.1% | 0 | 0 |
| Yes | 78 | 50.9% | 312 | 100% |
| Having an ID card | ||||
| No | 19 | 12.4% | 0 | 0 |
| Yes | 134 | 87.6% | 312 | 100% |
| Having a permanent address | ||||
| Yes | 36 | 23.5% | 312 | 100% |
| No | 109 | 71.2% | 0 | 0 |
| Once yes | 8 | 5.3% | 0 | 0 |
The most common reasons for homelessness were eviction, residence address deregistration (41.8%), family conflicts (30.7%), unemployment, lack of work and lack of sources of income (22.2). Details are shown in
Selected aspects of homelessness in the group of respondents.
| Problem | Number of people |
Problem | Number of people |
||
|---|---|---|---|---|---|
| Causes of homelessness* | Place of last residence* | ||||
| Eviction, deregistration | 64 | 41.8% | Shelter | 38 | 24.8% |
| Family conflicts | 47 | 30.7% | Night shelter | 45 | 29.4% |
| Alcohol | 5 | 3.3% | Warming center | 53 | 34.6% |
| Gambling | 7 | 4.6% | Staircase | 12 | 7.8% |
| Domestic violence | 5 | 3.3% | Gazebos, allotment buildings | 17 | 11.1% |
| Debt | 4 | 2.6% | Basements | 6 | 3.9% |
| Unemployment, lack of work or other sources of income | 34 | 22.2% | Being put up by family or friends | 16 | 10.5% |
| Leaving prison | 7 | 4.6% | Attics | 4 | 2.6% |
| Poor health status | 5 | 3.3% | Park | 5 | 3.3% |
| Conflicts due to a lack of social tolerance | 8 | 5.2% | Stations, wagons, railway sidings | 1 | 0.7% |
| Disability | 4 | 2.6% | Heating pipes and nodes | 1 | 0.7% |
| Own free choice | 9 | 5.6% | Caritas facility | 8 | 5.2% |
| Nervous breakdown | 1 | 0.7% | Vacant buildings | 6 | 3.9% |
| Divorce | 3 | 2.0% | Forest | 1 | 0.7% |
| Depression | 1 | 0.7% | Penal institution | 2 | 1.4% |
| Apartment fire and lack of a substitute apartment | 1 | 0.7% | Center helping to leave homelessness | 2 | 1.4% |
| Death of both parents | 1 | 0.7% | Den | 7 | 4.6% |
| Children moving abroad | 1 | 0.7% | Monar | 1 | 0.7% |
| Arrest | 1 | 0.7% | No answer | 11 | 7.2% |
| Sale of an apartment | 1 | 0.7% | Having health insurance | ||
| Helplessness | 1 | 0.7% | Yes | 23 | 15.0% |
| Home burglary | 1 | 0.7% | No | 128 | 86.7% |
| Own decision | 2 | 1.4% | Not sure | 2 | 1.4% |
| Accident at work | 2 | 1.4% | Using social assistance | ||
| No light in the apartment | 1 | 0.7% | Yes | 101 | 66.0% |
| No water in the apartment | 1 | 0.7% | No | 52 | 34.0% |
| No data | 8 | 5.2% | Forms of social assistance* | ||
| Phase of homelessness | I do not use it | 52 | 34.0% | ||
| 0–1 | 35 | 22.9% | Financial assistance | 81 | 52.9% |
| 1 to 2 years | 9 | 5.6% | Meal | 44 | 28.8% |
| 2 to 4 years | 41 | 26.8% | Shelter | 43 | 28.1% |
| 4 to 6 years | 14 | 9.2% | Clothes | 17 | 11.1% |
| 6 to 10 years | 21 | 13.7% | Food | 18 | 11.8% |
| over 10 years | 24 | 15.7% | Food parcels | 3 | 2.0% |
| No data | 9 | 5.6% | Stay in a shelter | 3 | 2.0% |
| Is it possible to exit homelessness? | Benefit | 1 | 0.7% | ||
| No | 11 | 7.2% | |||
| Yes | 114 | 74.5% | |||
| Hard to say | 28 | 18.3% | |||
*Multiple answers possible.
The respondents indicated numerous social welfare facilities for the homeless, including night shelters (65.9%), warming centers (44.4%), and other shelters (people – 36.6%).
In the next part of the study, the health habits of the respondents were assessed. 92.2% of the surveyed homeless people and none of the men from the control group did not wash every day. The largest number of the homeless and men from the control group declared that they eat lunch (71.2 and 64.7% respectively) and dinner (77.1 and 58.3% respectively) every day. More than half (55%) of homeless drunk alcohol. Details are shown in
Selected aspects concerning the everyday life hygiene of the respondents.
| Problem | Number of men/percentage | |||||
|---|---|---|---|---|---|---|
| Homeless |
Not homeless |
|||||
| Washing/bathing | ||||||
| Daily washing | No | 141 | 92.2% | 0 | 0% | |
| Yes | 9 | 5.9% | 312 | 100% | ||
| It varies | 3 | 1.9% | 0 | 0% | NS | |
| Frequency of bathing during a week | At all | 17 | 11.1% | 0 | 0% | |
| Once | 19 | 12.4% | 24 | 7.7% | NS | |
| 2–3 times | 44 | 28.8% | 10 | 3.2% | ||
| More than 3 times | 2 | 1.3% | 92 | 29.5% | ||
| Every day | 9 | 5.9% | 146 | 46.8% | ||
| It varies | 62 | 40.5% | 0 | 0% | ||
| Eating meals | ||||||
| 1st breakfast | Every day | 13 | 8.5% | 164 | 52.6% | |
| Occasionally | 109 | 71.2% | 104 | 33.3% | NS | |
| At all | 31 | 20.2% | 44 | 14.1% | NS | |
| 2nd breakfast | Every day | 41 | 26.8% | 114 | 36.5% | |
| Occasionally | 31 | 20.2% | 126 | 40.4% | ||
| At all | 81 | 53.0% | 72 | 23.1% | NS | |
| Lunch | Every day | 109 | 71.2% | 202 | 58.3% | NS |
| Occasionally | 22 | 14.4% | 60 | 19.2% | NS | |
| At all | 22 | 14.4% | 50 | 16.0% | NS | |
| Afternoon snack | Every day | 36 | 23.5% | 80 | 25.6% | NS |
| Occasionally | 17 | 11.1% | 100 | 32.1% | ||
| At all | 100 | 65.4% | 132 | 42.3% | NS | |
| Dinner | Every day | 118 | 77.1% | 182 | 58.3% | NS |
| Occasionally | 17 | 11.1% | 72 | 23.1% | ||
| At all | 18 | 11.8% | 58 | 18.6% | NS | |
| Smoking | ||||||
| Smoking declaration | No | 26 | 17.0% | 14 | 4.5% | NS |
| Now not before yes | 9 | 5.9% | 60 | 19.1% | ||
| Occasionally | 11 | 7.2% | 42 | 13.5% | NS | |
| Yes | 107 | 69.9% | 196 | 62.8% | NS | |
| Average smoking period | 28.2 ± 12.2; |
18.9 ± 6.5; |
||||
| Alcohol consumption | ||||||
| Alcohol consumption declaration | No | 25 | 16.3% | 96 | 30.8% | |
| Now not before yes | 35 | 22.9% | 12 | 3.8% | ||
| Yes | 93 | 60.8% | 32 | 10.3% | ||
| Do not drink | 60 | 39.2% | 108 | 34.6% | NS | |
| Frequency of alcohol consumption | Every day | 33 | 21.6% | 20 | 6.4% | NS |
| Once a week | 17 | 11.1% | 24 | 7.7% | NS | |
| Several times a month | 22 | 14.4% | 66 | 21.2% | NS | |
| Several times a year | 21 | 13.7% | 94 | 30.1% | 0.003 | |
| Daily alcohol consumption | 380.3 mL ± 247.2 mL; |
120.6 mL ± 80.4 mL |
||||
| Type of alcohol | Do not drink | 60 | 39.2% | 108 | 34.6% | NS |
| Beer | 73 | 47.7% | 50 | 16.0% | NS | |
| Wine | 25 | 16.3% | 128 | 41.0% | ||
| Vodka | 35 | 22.9% | 116 | 37.2% | ||
| Whatever | 22 | 14.4% | 0 | 0% | ||
Chi-square test. Bold letters for significant values.
The respondents were asked to rate their health from 0 to 10 on a scale. Most frequently, the homeless chose 5 points in their health self-assessment (33 people–21.6%), and men from the control group chose 7 points (23.3%). The homeless men assessed their health poorer (6.0 ± 2.7 points) than the non-homeless (7.8 ± 2.2 points)(
In the homeless group, 98 (64.1%) and 312 (91.0%) in the control group did not have a disability degree certificate.
The respondents declared that:
they use professional medical assistance when necessary: the homeless–60 (39.2%) and the non-homeless – 80 (25.6%)–
they did not use it at all: the homeless–39 (25.5%) and the non-homeless–10 (3.2%)–(
several times a year: the homeless–12 (7.8%) and the non-homeless–62 (19.9%)–
several times a month: the homeless–7 people (4.6%) and the non-homeless–32 (10.3%)–NS
In a situation where they feel pain, any ailments:
they immediately went to the doctor and used medicines prescribed by them–49 (32%) homeless people and 130 (41.7%) men from the NS control group
they only used their own tested methods – 48 (31.4%) homeless people and 72 (23.1%) men from the NS control group
they did nothing and tried to wait out the ailments–28 (18.3%) homeless people and 50 (16%) men from the NS control group
they did not go to the doctor because they could not afford it–25 (16.3%) homeless people and 20 (6.4%) men from the control group
3 (2%) homeless people and 40 (12.8%) men from the control group had problems with the declaration on this issue
21 (13.7%) homeless people and 214 (68.6%) people from the control group (
In the last year, 48 (31.4%) surveyed homeless men and 70 (22.4%) from the control group did not use medical assistance–NS.
In the last year, 62 (40.5%) surveyed homeless men and 284 (91%) from the control group were not in hospital–
In the last year they took antibiotics–50 (32.7%) homeless men and 139 (44.6%) from the control group–NS; vitamins–47 (30.7%) homeless men and 176 (56.4%) from the control group–
During the study, 74 (48.4%) homeless men and 112 (35.9%) from the control group reported they did not suffer from any disorders. Others most often complained about hypertension–14 (9.2%) homeless men and 116 (37.1%) from the control group–
The respondents were asked about the declaration of visits for the internist, dentist and lung x-rays. Most often, the homeless claimed that they did not remember the last time they had visited an internist (53.6%), dentist (52.3%) and when they had a lung x-ray (51%). Details are shown in
Declaration of visits to the internist, the dentist, and for a lung X-ray.
| Number of men/percentage | ||||||
|---|---|---|---|---|---|---|
| Problem | Homeless |
Not homeless |
||||
| Last visit to the internist | 1–2 months ago | 35 | 22.9% | 66 | 21.2% | NS |
| Half a year ago | 11 | 7.2% | 84 | 26.9% | ||
| 1 year ago | 9 | 5.9% | 64 | 20.5% | ||
| Several years ago | 16 | 10.5% | 36 | 11.5% | NS | |
| I do not remember | 82 | 53.6% | 62 | 19.9% | NS | |
| Last visit to the dentist | 1–2 months ago | 16 | 10.5% | 118 | 37.8% | |
| Half a year ago | 5 | 3.3% | 94 | 30.1% | ||
| 1 year ago | 23 | 15.0% | 10 | 3.2% | NS | |
| Several years ago | 29 | 19.0% | 28 | 9.0% | NS | |
| I do not remember | 80 | 52.3% | 62 | 19.9% | NS | |
| Last lung X-ray | 1–2 months ago | 14 | 9.2% | 2 | 0.6% | |
| Half a year ago | 9 | 5.9% | 6 | 1.9% | NS | |
| 1 year ago | 18 | 11.8% | 34 | 10.9% | NS | |
| Several years ago | 34 | 22.2% | 10 | 3.2% | ||
| I do not remember | 78 | 51.0% | 260 | 83.3% | ||
Chi-square test; NS, not significant. Bold letters for significant values.
Homeless men reported, sometimes they have a headache (34%), stomachache (32.7%), physical fatigue (36.6%), mental fatigue (34. 6%), stress (33.3%), insomnia (32%), and, every day, lower back pain (30.7%), and lower limb pain (36.6%). Men from the control group most often had a headache (39.1%), stomachache (31.4%), mental fatigue (33.3%), stress (35.9%), insomnia (42.9%), lower back pain (42.9%), lower limb pain (40.4%), neck pain (37.8%), and, every day, physical fatigue (30.1%). The results are shown in
Declaration of the frequency of experiencing selected ailments.
| Health problem | Number of men/percentage | |||||
|---|---|---|---|---|---|---|
| Homeless |
Not homeless |
|||||
| Headaches | Every day | 32 | 20.9% | 52 | 16.7% | NS |
| Once a week | 19 | 12.4% | 48 | 15.4% | NS | |
| Several times a month | 22 | 14.4% | 46 | 14.7% | NS | |
| Sometimes | 52 | 34.0% | 122 | 39.1% | NS | |
| Never | 28 | 18.3% | 44 | 14.1% | NS | |
| Lower back pain | Every day | 47 | 30.7% | 40 | 12.8% | NS |
| Once a week | 17 | 11.1% | 48 | 15.4% | NS | |
| Several times a month | 20 | 13.1% | 32 | 10.3% | NS | |
| Sometimes | 42 | 27.5% | 134 | 42.9% | ||
| Never | 27 | 17.6% | 58 | 18.6% | NS | |
| Neck pain | Every day | 37 | 24.2% | 46 | 14.7% | NS |
| Once a week | 17 | 11.1% | 26 | 8.3% | NS | |
| Several times a month | 19 | 12.4% | 50 | 16.0% | NS | |
| Sometimes | 36 | 23.5% | 118 | 37.8% | ||
| Never | 44 | 28.8% | 72 | 23.1% | NS | |
| Stomachache | Every day | 29 | 19.0% | 24 | 7.7% | NS |
| Once a week | 19 | 12.4% | 14 | 4.5% | NS | |
| Several times a month | 22 | 14.4% | 42 | 13.5% | NS | |
| Sometimes | 50 | 32.7% | 98 | 31.4% | NS | |
| Never | 33 | 21.6% | 52 | 16.7% | NS | |
| Lower limb pain | Every day | 56 | 36.6% | 44 | 14.1% | NS |
| Once a week | 15 | 9.8% | 28 | 9.0% | NS | |
| Several times a month | 19 | 12.4% | 22 | 7.1% | NS | |
| Sometimes | 40 | 26.1% | 126 | 40.4% | ||
| Never | 23 | 15.0% | 92 | 29.5% | ||
| Physical fatigue | Every day | 40 | 26.1% | 94 | 30.1% | NS |
| Once a week | 17 | 11.1% | 50 | 16.0% | NS | |
| Several times a month | 28 | 18.3% | 42 | 13.5% | NS | |
| Sometimes | 56 | 36.6% | 86 | 27.6% | NS | |
| Never | 12 | 7.8% | 40 | 12.8% | NS | |
| Mental fatigue | Every day | 35 | 22.9% | 68 | 21.8% | NS |
| Once a week | 20 | 13.1% | 26 | 8.3% | NS | |
| Several times a month | 30 | 19.6% | 60 | 19.2% | NS | |
| Sometimes | 53 | 34.6% | 104 | 33.3% | NS | |
| Never | 15 | 9.8% | 54 | 17.3% | NS | |
| Feeling stressed | Every day | 31 | 20.3% | 22 | 7.1% | NS |
| Once a week | 20 | 13.1% | 32 | 10.3% | NS | |
| Several times a month | 25 | 16.3% | 58 | 18.6% | NS | |
| Sometimes | 51 | 33.3% | 112 | 35.9% | NS | |
| Never | 26 | 17.0% | 88 | 28.2% | 0.048 | |
| Insomnia | Every day | 39 | 25.5% | 26 | 8.3% | NS |
| Once a week | 19 | 12.4% | 32 | 10.3% | NS | |
| Several times a month | 25 | 16.3% | 18 | 5.8% | NS | |
| Sometimes | 49 | 32.0% | 134 | 42.9% | ||
| Never | 21 | 13.7% | 102 | 32.7% | ||
Chi-square test; NS, not significant. Bold letters for significant values.
In the assessment of satisfaction with life (SWLS), the homeless men obtained 15.4 ± 8.1 points on average (people rather dissatisfied with their lives), and in the control group – 23.2 ± 5.5 on average (people rather satisfied with their lives). In assessing the effectiveness of coping with difficult situations and obstacles, the homeless men obtained 18.5 ± 5.7 points, and the control group obtained 29.1 ± 1.2 points. The homeless in the point scale in the assessment of health behaviors (HBI) obtained 62.4 ± 21.9 points on average, and the control group obtained 82.1 ± 10.8 points. The homeless obtained the highest average values for positive mental attitude (2.9 ± 1.1 points on average), and the control group for health practices (3.9 ± 0.7). The homeless and the control group obtained the lowest mean values for proper eating habits (2.3 ± 1.0 and 3.5 ± 0.9, respectively). In assessing the dimensions of the health locus of control, the homeless obtained the highest average values in the dimension of chance – 19.2 ± 9.1 points on average, and the control group in the internal dimension (26.0 ± 5.2). Details are shown in
Results of the analysis using SWLS, GSES, HBI and MHCL-B scales.
| Number of men/percentage | |||||
|---|---|---|---|---|---|
| Homeless |
Not homeless |
||||
| SWLS–level of satisfaction with life | |||||
| Average values–points | 15.4 ± 8.1 | 23.2 ± 5.5 | |||
| Average level of satisfaction with life–sten scores | 3.8 ± 2.7 | 7.1 ± 1.2 | |||
| Person definitely dissatisfied with life | 39 | 25.5% | 26 | 8.3% | NS |
| Person very dissatisfied with life | 40 | 26.1% | 12 | 3.8% | |
| Person rather dissatisfied with life | 24 | 15.7% | 30 | 9.6% | NS |
| Person neither satisfied nor dissatisfied with life | 7 | 4.6% | 4 | 1.3% | NS |
| Person rather satisfied with life | 25 | 16.3% | 112 | 35.9% | |
| Person very satisfied with life | 12 | 7.8% | 76 | 24.4% | |
| Person definitely satisfied with life | 6 | 3.9% | 52 | 16.7% | |
| GSES–sense of self-efficacy | |||||
| Average values–points | 18.5 ± 5.7 | 29.1 ± 1.2 | |||
| Average values–sten scores | 2.7 ± 1.8 | 5.3 ± 2.1 | |||
| Low sense | 129 | 84.3% | 41 | 13.1% | |
| Average sense | 13 | 8.5% | 55 | 17.6% | |
| high sense | 11 | 7.2% | 216 | 69.3% | |
| HBI–Health Behavior Inventory | |||||
| Average value of the general HBI indicator | 62.4 ± 21.9 | 82.1 ± 10.8 | |||
| Medium sten scores | 3.7 ± 2.3 | 6.4 ± 1.8 | |||
| Correct eating habits | 2.3.0 ± 1.0 | 3.5 ± 0.9 | |||
| Preventive behaviors | 2.7 ± 1.1 | 3.8 ± 0.8 | |||
| Positive mental attitude | 2.9 ± 1.1 | 3.6 ± 0.7 | |||
| Health practices | 2.6 ± 0.9 | 3.9 ± 0.7 | |||
| Level of health-related behavior | |||||
| Low indicator of the intensity of health behaviors | 103 | 67.3% | 103 | 33.0% | NS |
| High indicator of the intensity of health behaviors | 20 | 13.1% | 131 | 42.0% | |
| Average indicator of the intensity of health behaviors | 30 | 19.6% | 78 | 25% | NS |
| MHCL-B–health control dimension | |||||
| Internal (I) | 17.9 ± 9.9 | 26.0 ± 5.2 | |||
| Impact of others (IO) | 17.7 ± 9.7 | 19.8 ± 4.9 | |||
| Chance (CH) | 19.2 ± 9.1 | 24.1 ± 6.8 | |||
| Strong internal type | 2 | 1.3% | 48 | 15.4% | |
| Strong external type | 15 | 9.8% | 44 | 14.1% | NS |
| Decreasing the impact of others type | 13 | 8.5% | 20 | 6.4% | NS |
| Increasing the impact of others type | 9 | 5.9% | 24 | 7.7% | NS |
| Decreasing the impact of chance type | 5 | 3.3% | 28 | 9.0% | |
| Increasing the impact of chance type | 12 | 7.8% | 40 | 12.8% | NS |
| Undifferentiated-strong type | 50 | 32.7% | 84 | 26.9% | NS |
| Undifferentiated-weak type | 47 | 30.7% | 24 | 7.7% | NS |
Chi-square test; NS, not significant. Bold letters for significant values.
Statistically significant correlations were found between the internal dimension of health behavior control and age, homelessness phase, criminal history of the respondents, being under constant medical care and health self-assessment. The ‘Impact of others’ dimension showed significant statistical differences with the level of health behaviors, and the ‘chance’ dimension with the criminal record of the respondents. The level of the presented health behaviors showed statistically significant differences with all dimensions of the health locus of control (
Statistical relationships between satisfaction with life, health behaviors, coping with difficult situations and dimensions of the health locus of control in the surveyed group of the homeless and age, homelessness phase and criminal record.
| SWLS | GSES | HBI | MHCL/DIMENSIONS | ||||
|---|---|---|---|---|---|---|---|
| IO | CH | ||||||
| SWLS | 1.00 | 0.268 | 0.669 | 0.111 | 0.791 | 0.622 | |
| GSES | 0.268 | 1.00 | 0.261 | 0.349 | 0.303 | 0.428 | |
| HBI | 0.669 | 0.069 | 1.00 | 0.261 | |||
| MHCL/Dimensions | I | 0.077 | 0.244 | 1.00 | 1.00 | 1.00 | |
| IO | 0.367 | 0.186 | 1.00 | 1.00 | 1.00 | ||
| CH | 0.714 | 0.997 | 1.00 | 1.00 | 1.00 | ||
| Age | 0.128 | 0.753 | 0.370 | 0.002 | 0.657 | 0.054 | |
| Phase of homelessness | 0.213 | 0.283 | 0.160 | 0.001 | 0.916 | 0.347 | |
| Criminal record | 0.057 | 0.128 | 0.116 | 0.206 | 0.005 | ||
| Being under medical care | 0.401 | 0.512 | 0.477 | 0.311 | 0.751 | ||
| Health self-assessment | 0.139 | 0.326 | 0.324 | 0.714 | 0.163 | ||
Multiple regression analysis. Bold letters for significant values.
In the present study, health behaviors of homeless men showed statistically significant diversification with all dimensions of the health locus of control, and its internal dimension with age, homelessness phase, the respondents’ criminal history, being under constant medical care, and self-assessment of health. We found significant differences between the homeless men and controls in selected aspects concerning the everyday life hygiene, health self-assessment, declarations of visits to a specialist and carrying out check-ups, level of satisfaction with life, coping with difficult situations, preferred pro-health behaviors and dimensions of health control.
In the study by Baranowski (
In the study by Baranowski (
The literature data show that the homeless population is also dominated by singles, divorcees, people in separation, children, and wives fleeing from home due to violence by their fathers or husbands (
In the literature on homelessness (
In the research by Baranowski (
In the literature (
The main sources of income for the others were: occasional work (15.4% each), social assistance (12.1%), charitable organizations’ assistance (8.8%), disability pension/pension (17.6%), and collecting and selling scrap (5.5%).
Buciński et al. (
People without a roof over their heads, more often than others, do not have health insurance or an ID card (
In the study of Śledzianowski (
Heszen (
The assessment of the health of the homeless in a shelter in Poznań city (
While examining the health of the homeless in a shelter for homeless men in Poznań, Przymeński (
Przymeński (
Błażej and Bartosz (
Doctors who care for homeless people notice the following health problems: cardiological problems, the digestive, respiratory, urinary, and hormonal systems, cancers, skin diseases, frostbite, dental deficiencies, and HIV/AIDS (
Homelessness brings such emotional effects as loneliness, powerlessness, fear, and anxiety (
In conclusion, it is worth emphasizing once again that the problem of homelessness is a broad and extremely complicated phenomenon (
The small size of the group and the lack of evaluation in the group of women can be considered as limitations of the study.
Homeless people should be provided with free health care.
Homeless people should have access to specialist doctors.
It is advisable to monitor the health behaviors of the homeless to get to know them better.
The research should be carried out on a larger population in different country regions.
Research should also include homeless women.
The level of the health behaviors showed statistically significant diversification with all dimensions of the health locus of control and its internal dimension with age, phase of homelessness, criminal history of the respondents, being under constant medical care, and self-assessment of health.
Significant differences were found between people experiencing a homelessness crisis and the control group in selected aspects concerning the everyday life hygiene of the respondents, health self-assessment, declarations of visits to a specialist and carrying out check-ups, level of satisfaction with life, coping with difficult situations, preferred pro-health behaviors and dimensions of health control.
The raw data supporting the conclusions of this article will be made available by the authors, without under reservation.
The studies involving humans were approved by the Bioethics Committee of the Medical University of Bialystok, R-I- 449/2013. The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation was not required from the participants or the participants’ legal guardians/next of kin in accordance with the national legislation and institutional requirements.
BR, DC, MZ, AM, AS, and AŚ collected the epidemiological and clinical data. NW processed statistical data. BR, GB, and AK-B drafted the manuscript. BR, GB, and NW revised the final manuscript. WK and EK-K is responsible for summarizing all epidemiological and clinical data. All authors contributed to the article and approved the submitted version.
Work carried out as part of a research project − /ST/ZB/15/009/3310; 153–196 48P.
We would like to express our sincere thanks to all participants of the study.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The reviewer KK declared a shared affiliation with the authors GB, AK-B, NW, WK, and EK-K to the handling editor at the time of review.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.