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Original article

Vol. 155 No. 2 (2025)

Healthcare needs, expectations and experiences of people experiencing homelessness in Western Switzerland: a qualitative and quantitative descriptive study

DOI
https://doi.org/10.57187/s.3659
Cite this as:
Swiss Med Wkly. 2025;155:3659
Published
04.02.2025

Summary

AIMS: The literature from Canada, the UK and the USA reports health inequities among people experiencing homelessness; however little is known about this population’s health in Switzerland. Our study is the first to comprehensively assess health needs, expectations and experiences of people experiencing homelessness in Switzerland.

METHODS: We describe the health needs, expectations and experiences of people experiencing homelessness in French-speaking Switzerland, using both quantitative and qualitative methods. From May to August 2022, 123 people experiencing homelessness completed quantitative questionnaires about health needs, expectations and experiences. Recruitment took place in 10 homeless-serving institutions across four cities in the Canton of Vaud. A total of 18 people experiencing homelessness and 13 professionals involved in the homeless-serving sector completed qualitative interviews. For the qualitative strand, we selected people experiencing homelessness using quota sampling based on health insurance, residency status and sex representativeness according to the study population. For homeless-serving sector professionals, we used quota sampling by professions (i.e. night watcher in shelters; social/healthcare workers) ensuring balance. In addition, we aimed to recruit at least one homeless-serving sector professional from each of the ten institutions included in the parent research project.

RESULTS: The most common health issues reported were musculoskeletal, dental and psychiatric. Thirty-one percent of people experiencing homelessness had visited emergency rooms and 27% a community health centre in the prior 6 months. People experiencing homelessness reported low quality of life according to the WHOQOL, especially in social and environmental domains; 33% reported moderate and 17% high grade of psychological distress. Findings indicated that up to 32% of participants reported facing difficulties in reaching out to the healthcare system. In qualitative interviews, people experiencing homelessness described positive perceptions about the Swiss healthcare system. However, people experiencing homelessness reported various barriers encountered while seeking healthcare (e.g., health insurance, financial barriers, appointment delays, hesitancy in accessing care, prioritising other needs). Both groups commonly reported that social situations impacted the health and healthcare use of people experiencing homelessness.

CONCLUSION: People experiencing homelessness in Switzerland are not spared by the common health inequities reported in Canada, the USA and the UK. Our results provide interesting foundations on which to build public health actions towards health equity for people experiencing homelessness in Switzerland and suggest that they could benefit from additional medical follow-up and tailored interventions.

References

  1. Commission staff working document: Confronting Homelessness in the European Union. Towards Social Investment for Growth and Cohesion - including implementing the European Social Fund 2014-2020. 2013. https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=celex%3A52013SC0042
  2. Fazel S, Geddes JR, Kushel M. The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. Lancet. 2014 Oct;384(9953):1529–40. doi: https://doi.org/10.1016/S0140-6736(14)61132-6 DOI: https://doi.org/10.1016/S0140-6736(14)61132-6
  3. Knörle U, Gutwinski S, Willich SN, Berghöfer A. [Associations of mental illness and homelessness: results of a secondary data analysis at a Berlin health center for the homeless]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2022 Jun;65(6):677–87. DOI: https://doi.org/10.1007/s00103-022-03536-9
  4. Baggett TP, Chang Y, Singer DE, Porneala BC, Gaeta JM, O’Connell JJ, et al. Tobacco-, alcohol-, and drug-attributable deaths and their contribution to mortality disparities in a cohort of homeless adults in Boston. Am J Public Health. 2015 Jun;105(6):1189–97. doi: https://doi.org/10.2105/AJPH.2014.302248 DOI: https://doi.org/10.2105/AJPH.2014.302248
  5. Moretti DF, Dory É, Favrat PB, Winterton DN. Berger Jé. Précarité et problèmes cutanés. Rev Med Suisse. 2015;•••:5. DOI: https://doi.org/10.53738/REVMED.2015.11.496.2243
  6. Bernstein RS, Meurer LN, Plumb EJ, Jackson JL. Diabetes and hypertension prevalence in homeless adults in the United States: a systematic review and meta-analysis. Am J Public Health. 2015 Feb;105(2):e46–60. doi: https://doi.org/10.2105/AJPH.2014.302330 DOI: https://doi.org/10.2105/AJPH.2014.302330
  7. Topolovec-Vranic J, Ennis N, Colantonio A, Cusimano MD, Hwang SW, Kontos P, et al. Traumatic brain injury among people who are homeless: a systematic review. BMC Public Health. 2012 Dec;12(1):1059. doi: https://doi.org/10.1186/1471-2458-12-1059 DOI: https://doi.org/10.1186/1471-2458-12-1059
  8. Khandor E, Mason K, Chambers C, Rossiter K, Cowan L, Hwang SW. Access to primary health care among homeless adults in Toronto, Canada: results from the Street Health survey. Open Med. 2011;5(2):e94–103.
  9. Campbell RB, Larsen M, DiGiandomenico A, Davidson MA, Booth GL, Hwang SW, et al. The challenges of managing diabetes while homeless: a qualitative study using photovoice methodology. CMAJ. 2021;193(27):E1034–41. doi: https://doi.org/10.1503/cmaj.202537 DOI: https://doi.org/10.1503/cmaj.202537
  10. Capp R, Rosenthal MS, Desai MM, Kelley L, Borgstrom C, Cobbs-Lomax DL, et al. Characteristics of Medicaid enrollees with frequent ED use. Am J Emerg Med. 2013 Sep;31(9):1333–7. doi: https://doi.org/10.1016/j.ajem.2013.05.050 DOI: https://doi.org/10.1016/j.ajem.2013.05.050
  11. Abramson TM, Sanko S, Eckstein M. Emergency Medical Services Utilization by Homeless Patients. Prehosp Emerg Care. 2021;25(3):333–40. doi: https://doi.org/10.1080/10903127.2020.1777234 DOI: https://doi.org/10.1080/10903127.2020.1777234
  12. Salit SA, Kuhn EM, Hartz AJ, Vu JM, Mosso AL. Hospitalization costs associated with homelessness in New York City. N Engl J Med. 1998 Jun;338(24):1734–40. doi: https://doi.org/10.1056/NEJM199806113382406 DOI: https://doi.org/10.1056/NEJM199806113382406
  13. Nusselder WJ, Slockers MT, Krol L, Slockers CT, Looman CW, van Beeck EF. Mortality and life expectancy in homeless men and women in Rotterdam: 2001-2010. PLoS One. 2013 Oct;8(10):e73979. doi: https://doi.org/10.1371/journal.pone.0073979 DOI: https://doi.org/10.1371/journal.pone.0073979
  14. Le nombre de sans-abri suisses augmente. Le Temps 17 nov 2018 https://www.letemps.ch/suisse/vaud/nombre-sansabri-suisses-augmente
  15. Briner D, Jäger M, Kawohl W, Baumgartner-Nietlisbach G. [Mental Disorder and Self-Rated Health Among Homeless People in Zurich - First Epidemiological Data from Switzerland]. Psychiatr Prax. 2017 Sep;44(6):339–47. DOI: https://doi.org/10.1055/s-0042-111742
  16. Lauber C, Lay B, Rössler W. Homelessness among people with severe mental illness in Switzerland. Swiss Med Wkly. 2005 Jan;135(3-4):50–6. 10.4414/smw.2005.10815 DOI: https://doi.org/10.4414/smw.2005.10815
  17. Lauber C, Lay B, Rössler W. Homeless people at disadvantage in mental health services. Eur Arch Psychiatry Clin Neurosci. 2006 Apr;256(3):138–45. doi: https://doi.org/10.1007/s00406-005-0616-4 DOI: https://doi.org/10.1007/s00406-005-0616-4
  18. Janssens JP, Wuillemin T, Adler D, Jackson Y. Screening for tuberculosis in an urban shelter for homeless in Switzerland: a prospective study. BMC Infect Dis. 2017 May;17(1):347. doi: https://doi.org/10.1186/s12879-017-2449-y DOI: https://doi.org/10.1186/s12879-017-2449-y
  19. Baggio S, Jacquerioz F, Salamun J, Spechbach H, Jackson Y. Equity in access to COVID-19 testing for undocumented migrants and homeless persons during the initial phase of the pandemic. J Migr Health. 2021;4:100051. doi: https://doi.org/10.1016/j.jmh.2021.100051 DOI: https://doi.org/10.1016/j.jmh.2021.100051
  20. Pendyal A, Rosenthal MS, Spatz ES, Cunningham A, Bliesener D, Keene DE. “When you’re homeless, they look down on you”: A qualitative, community-based study of homeless individuals with heart failure. Heart Lung. 2021;50(1):80–5. doi: https://doi.org/10.1016/j.hrtlng.2020.08.001 DOI: https://doi.org/10.1016/j.hrtlng.2020.08.001
  21. Heaslip V, Green S, Simkhada B, Dogan H, Richer S. How Do People Who Are Homeless Find Out about Local Health and Social Care Services: A Mixed Method Study. Int J Environ Res Public Health. 2021 Dec;19(1):46. doi: https://doi.org/10.3390/ijerph19010046 DOI: https://doi.org/10.3390/ijerph19010046
  22. Omerov P, Craftman ÅG, Mattsson E, Klarare A. Homeless persons’ experiences of health- and social care: A systematic integrative review. Health Soc Care Community. 2020 Jan;28(1):1–11. doi: https://doi.org/10.1111/hsc.12857
  23. Paudyal V, MacLure K, Buchanan C, Wilson L, Macleod J, Stewart D. ‘When you are homeless, you are not thinking about your medication, but your food, shelter or heat for the night’: behavioural determinants of homeless patients’ adherence to prescribed medicines. Public Health. 2017 Jul;148:1–8. doi: https://doi.org/10.1016/j.puhe.2017.03.002 DOI: https://doi.org/10.1016/j.puhe.2017.03.002
  24. McNeill S, O’Donovan D, Hart N. Access to healthcare for people experiencing homelessness in the UK and Ireland: a scoping review. BMC Health Serv Res. 2022 Jul;22(1):910. doi: https://doi.org/10.1186/s12913-022-08265-y DOI: https://doi.org/10.1186/s12913-022-08265-y
  25. Klop HT, Evenblij K, Gootjes JR, de Veer AJ, Onwuteaka-Philipsen BD. Care avoidance among homeless people and access to care: an interview study among spiritual caregivers, street pastors, homeless outreach workers and formerly homeless people. BMC Public Health. 2018 Sep;18(1):1095. doi: https://doi.org/10.1186/s12889-018-5989-1 DOI: https://doi.org/10.1186/s12889-018-5989-1
  26. Cernadas A, Fernández Á. Healthcare inequities and barriers to access for homeless individuals: a qualitative study in Barcelona (Spain). Int J Equity Health. 2021 Mar;20(1):84. doi: https://doi.org/10.1186/s12939-021-01409-2 DOI: https://doi.org/10.1186/s12939-021-01409-2
  27. Kneck Å, Mattsson E, Salzmann-Erikson M, Klarare A; in collaboration with Women Advisory Board for Inclusion Health. “Stripped of dignity” - Women in homelessness and their perspectives of healthcare services: A qualitative study. Int J Nurs Stud. 2021 Aug;120:103974. doi: https://doi.org/10.1016/j.ijnurstu.2021.103974 DOI: https://doi.org/10.1016/j.ijnurstu.2021.103974
  28. Bell L, Whelan M, Fernandez E, Lycett D. Nurse-led mental and physical healthcare for the homeless community: A qualitative evaluation. Health Soc Care Community. 2022 Nov;30(6):2282–91. 10.1111/hsc.13778 DOI: https://doi.org/10.1111/hsc.13778
  29. Jackson Y, Wuillemin T, Bodenmann P. Santé et soins des personnes sans abri. Rev Med Suisse. 2016 Oct;12(533):1671–5. doi: https://doi.org/10.53738/REVMED.2016.12.533.1671 DOI: https://doi.org/10.53738/REVMED.2016.12.533.1671
  30. Federal Statistical Office. Population résidante permanente selon la catégorie de nationalité, l’âge et le canton, 3e trimestre 2022 - 1.1.2022-30.9.2022 | Tableau. Federal Statistical Office. 2022. https://www.bfs.admin.ch/asset/fr/23728335
  31. Center for Primary Care and Public Health (Unisante), University of Lausanne, Switzerland. Homeless People in French-speaking Switzerland and Integrative Medicine: A Pilot Intervention in Music Therapy. clinicaltrials.gov; 2023 nov [cité 1 janv 2024]. Report No.: NCT05873491. Disponible sur: https://clinicaltrials.gov/study/NCT05873491
  32. Östlund U, Kidd L, Wengström Y, Rowa-Dewar N. Combining qualitative and quantitative research within mixed method research designs: a methodological review. Int J Nurs Stud. 2011 Mar;48(3):369–83. doi: https://doi.org/10.1016/j.ijnurstu.2010.10.005 DOI: https://doi.org/10.1016/j.ijnurstu.2010.10.005
  33. O’Cathain A, Thomas KJ, Drabble SJ, Rudolph A, Hewison J. What can qualitative research do for randomised controlled trials? A systematic mapping review. BMJ Open. 2013 Jun;3(6):e002889. doi: https://doi.org/10.1136/bmjopen-2013-002889 DOI: https://doi.org/10.1136/bmjopen-2013-002889
  34. Palinkas LA. Qualitative and mixed methods in mental health services and implementation research. J Clin Child Adolesc Psychol. 2014;43(6):851–61. doi: https://doi.org/10.1080/15374416.2014.910791 DOI: https://doi.org/10.1080/15374416.2014.910791
  35. Lingard L, Albert M, Levinson W. Grounded theory, mixed methods, and action research. BMJ. 2008 Aug;337 aug07 3:a567. doi: https://doi.org/10.1136/bmj.39602.690162.47 DOI: https://doi.org/10.1136/bmj.39602.690162.47
  36. ETHOS Typology on Homelessness and Housing Exclusion. [cité 16 févr 2023]. Disponible sur: https://www.feantsa.org/en/toolkit/2005/04/01/ethos-typology-on-homelessness-and-housing-exclusion
  37. Skevington SM, Lotfy M, O’Connell KA; WHOQOL Group. The World Health Organization’s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res. 2004 Mar;13(2):299–310. doi: https://doi.org/10.1023/B:QURE.0000018486.91360.00 DOI: https://doi.org/10.1023/B:QURE.0000018486.91360.00
  38. Furukawa TA, Kessler RC, Slade T, Andrews G. The performance of the K6 and K10 screening scales for psychological distress in the Australian National Survey of Mental Health and Well-Being. Psychol Med. 2003 Feb;33(2):357–62. doi: https://doi.org/10.1017/S0033291702006700 DOI: https://doi.org/10.1017/S0033291702006700
  39. Prochaska JJ, Sung HY, Max W, Shi Y, Ong M. Validity study of the K6 scale as a measure of moderate mental distress based on mental health treatment need and utilization. Int J Methods Psychiatr Res. 2012 Jun;21(2):88–97. doi: https://doi.org/10.1002/mpr.1349 DOI: https://doi.org/10.1002/mpr.1349
  40. Ajzen I. The theory of planned behaviour: reactions and reflections. Psychol Health. 2011 Sep;26(9):1113–27. doi: https://doi.org/10.1080/08870446.2011.613995 DOI: https://doi.org/10.1080/08870446.2011.613995
  41. Chamaz K. Coding in Grounded Theory Practice. Constructing Grounded Theory : a practical guide through qualitative analysis. Los Angeles: Sage Publications; 2006.
  42. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005 Nov;15(9):1277–88. doi: https://doi.org/10.1177/1049732305276687 DOI: https://doi.org/10.1177/1049732305276687
  43. Federal Statistical Office. Health - Pocket Statistics 2023 | Publication. Office fédéral de la statistique. 2023 [cité 4 avr 2023]. Disponible sur: https://www.bfs.admin.ch/asset/fr/24131868
  44. Gutwinski S, Schreiter S, Deutscher K, Fazel S. The prevalence of mental disorders among homeless people in high-income countries: an updated systematic review and meta-regression analysis. PLoS Med. 2021 Aug;18(8):e1003750. doi: https://doi.org/10.1371/journal.pmed.1003750 DOI: https://doi.org/10.1371/journal.pmed.1003750
  45. Sun S, Irestig R, Burström B, Beijer U, Burström K. Health-related quality of life (EQ-5D) among homeless persons compared to a general population sample in Stockholm County, 2006. Scand J Public Health. 2012 Mar;40(2):115–25. doi: https://doi.org/10.1177/1403494811435493 DOI: https://doi.org/10.1177/1403494811435493
  46. Noerholm V, Groenvold M, Watt T, Bjorner JB, Rasmussen NA, Bech P. Quality of life in the Danish general population—normative data and validity of WHOQOL-BREF using Rasch and item response theory models. Qual Life Res. 2004 Mar;13(2):531–40. doi: https://doi.org/10.1023/B:QURE.0000018485.05372.d6 DOI: https://doi.org/10.1023/B:QURE.0000018485.05372.d6
  47. Hwang SW, Burns T. Health interventions for people who are homeless. Lancet. 2014 Oct;384(9953):1541–7. doi: https://doi.org/10.1016/S0140-6736(14)61133-8 DOI: https://doi.org/10.1016/S0140-6736(14)61133-8
  48. Collins SE, Taylor EM, King VL, Hatsukami AS, Jones MB, Lee CY, et al. Suicidality Among Chronically Homeless People with Alcohol Problems Attenuates Following Exposure to Housing First. Suicide Life Threat Behav. 2016 Dec;46(6):655–63. doi: https://doi.org/10.1111/sltb.12250 DOI: https://doi.org/10.1111/sltb.12250
  49. Tinland A, Loubière S, Boucekine M, Boyer L, Fond G, Girard V, et al. Effectiveness of a housing support team intervention with a recovery-oriented approach on hospital and emergency department use by homeless people with severe mental illness: a randomised controlled trial. Epidemiol Psychiatr Sci. 2020 Sep;29:e169. doi: https://doi.org/10.1017/S2045796020000785 DOI: https://doi.org/10.1017/S2045796020000785
  50. Loubière S, Lemoine C, Boucekine M, Boyer L, Girard V, Tinland A, et al. Housing First for homeless people with severe mental illness: extended 4-year follow-up and analysis of recovery and housing stability from the randomized Un Chez Soi d’Abord trial. Epidemiology and Psychiatric Sciences. ed 2022;31:e14. DOI: https://doi.org/10.1017/S2045796022000026
  51. Garcia Gonzalez De Ara C, Morandi S, Lippuner M, Delmatti J, Golay P, Bonsack C. [Housing first : at home recovery of severe mental disorder]. Rev Med Suisse. 2017 Sep;13(575):1605–9. DOI: https://doi.org/10.53738/REVMED.2017.13.575.1605
  52. Swiss Health Observatory. Le recours aux services d’urgences en Suisse. OBSAN. 2018 [cité 3 avr 2023]. Disponible sur: https://www.obsan.admin.ch/fr/publications/2018-le-recours-aux-services-durgences-en-suisse
  53. James M, Greenhill M, Sullivan D. Introduction of a homeless health outreach team in Northern New South Wales: is acute service usage reduced? Australas Psychiatry. 2023 Aug;31(4):441–4. doi: https://doi.org/10.1177/10398562231164869 DOI: https://doi.org/10.1177/10398562231164869
  54. Purkey E, MacKenzie M. Experience of healthcare among the homeless and vulnerably housed a qualitative study: opportunities for equity-oriented health care. Int J Equity Health. 2019 Jul;18(1):101. doi: https://doi.org/10.1186/s12939-019-1004-4 DOI: https://doi.org/10.1186/s12939-019-1004-4
  55. Nickasch B, Marnocha SK. Healthcare experiences of the homeless. J Am Acad Nurse Pract. 2009 Jan;21(1):39–46. doi: https://doi.org/10.1111/j.1745-7599.2008.00371.x DOI: https://doi.org/10.1111/j.1745-7599.2008.00371.x
  56. Rae BE, Rees S. The perceptions of homeless people regarding their healthcare needs and experiences of receiving health care. J Adv Nurs. 2015 Sep;71(9):2096–107. doi: https://doi.org/10.1111/jan.12675 DOI: https://doi.org/10.1111/jan.12675
  57. Farrell SJ, Dunn M, Huff J; Psychiatric Outreach Team; Royal Ottawa Health Care Group. Examining Health Literacy Levels in Homeless Persons and Vulnerably Housed Persons with Mental Health Disorders. Community Ment Health J. 2020 May;56(4):645–51. doi: https://doi.org/10.1007/s10597-019-00525-2 DOI: https://doi.org/10.1007/s10597-019-00525-2
  58. Omerov P, Craftman ÅG, Mattsson E, Klarare A. Homeless persons’ experiences of health- and social care: A systematic integrative review. Health Soc Care Community. 2020 Jan;28(1):1–11. doi: https://doi.org/10.1111/hsc.12857 DOI: https://doi.org/10.1111/hsc.12857
  59. Stadelmann S, Debons J, Samitca S. Profils et trajectoires des bénéficiaires des hébergements d’urgence dans le canton de Vaud en 2021. Centre universitaire de médecine générale et santé publique (Unisanté); 2022. https://www.unisante.ch/fr/formation-recherche/recherche/publications/raisons-sante/raisons-sante-338
  60. Dittmann J, Dietrich S, Stroezel H, Drilling M, Young C, Roduit S. Ausmass, Profil und Erklärungen der Obdachlosigkeit in 8 der grössten Städte der Schweiz. 2022. https://www.centre-lives.ch/fr/bibcite/reference/104

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