Date of Award

2020

Degree Name

Doctor of Philosophy (College of Health Sciences)

Schools and Centres

Health Sciences

First Supervisor

Professor Jim Codde

Second Supervisor

Professor Caroline Bulsara

Third Supervisor

Professor Suzanne Robinson

Abstract

Women aged over 50 years represent the most rapidly growing cohort of the Australian homeless population. Despite an increasing awareness of older Australian women being at risk of homelessness, little is known of how their health contributes to, and changes due to their homelessness. Drawing on the principles of the World Health Organisation’s social determinants of health, this study sought to investigate the personal life circumstances of older homeless women who live in the Perth metropolitan area, their healthcare needs and to identify any barriers to their accessing healthcare.

The study used a convergent mixed methods approach using quantitative and qualitative methods to collect and analyse the data. Data collection was conducted in three phases. The first consisted of an on-line survey of specialist homelessness service providers to obtain basic information regarding their services to older homeless women and to seek their willingness to act a referral source for women for the study. The second phase comprised a survey and semi structured interview with 22 women. Semi structured interviews consisting of similar questions were also undertaken with representatives from the homeless and healthcare sectors. The third phase consisted of consideration of all the collected data to identify potential actions and strategies that could address the major themes arising from the second phase of the study before utilising a Delphi process with key stakeholders to review the recommendations and prioritise them.

The study highlighted that women experiencing homelessness had complex and inter-related issues that impacted on their health. The nine major themes that emerged from the interview data were categorised as accommodation and safety; financial insecurity; women’s experience of trauma and abuse; stigma, shame that led to embarrassment and fear of being judged; the health impact of their perceived inability to fulfil their role as family nurturer; mental health; complex interaction of physical and mental health issues; cost of healthcare service and pharmaceuticals; and the need for ongoing psychosocial and healthcare support once housed.

While provision of suitable long-term housing was seen as fundamental to addressing the health needs of these women, the study findings highlighted the need for greater understanding of the emotional and physical abuse these older women had experienced which continued to affect their mental and physical health even after suitable housing had been found. The Delphi Panel emphasized the need for structural solutions that incorporated intersectoral collaboration across commonwealth and state government funded agencies to provide health, housing and social support services. As such, the outcomes of the study recommend that policies and integrated service models should be developed within a social determinants of health framework through a consultative process that includes older women with lived experience of homelessness.

The outcomes of this research have direct implications for the development of policy, planning and service delivery within this important area.

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