CoChat
Sign Up
Cited by 158Homelessness and Social IssuesFood Security and Health in Diverse PopulationsUrban and Rural Development Challenges

Health care for homeless women: Unmet needs and barriers to care

Open access
Lewis, Joy H., Andersen, Ronald M., Gelberg, Lillian·2003·Journal of General Internal Medicine
DOI 10.1046/j.1525-1497.2003.20909.xPMC PMC1494940
Open this paper in CoChat — free accountOpen PDF

Abstract

Objective Homelessness is a significant and growing problem in the United States. Women and families are the fastest growing segments of the homeless population. Homelessness increases the risk of having health problems and encountering barriers to care. This study determines how much perceived unmet need for medical care there is among homeless women, what homeless women perceive to be barriers to health care, and how barriers and other factors are associated with unmet needs. Design Cross-sectional study of homeless women, utilizing structured interviews. Setting and participants Community-based probability sample of 974 homeless women aged 15 to 44 years. Main outcome measures Perceived unmet need for medical care in the past 60 days. Relationship between unmet need and demographic variables, place of stay, source of health care, insurance, and perceived barriers to care. Results Of the 974 women, 37% reported unmet need for medical care. Controlling for other factors, the odds of unmet need were lower among those with a regular source of care (odds ratio [OR] to.35, 95% confidence interval [CI],.21 to 58), while having health insurance was not significantly associated. The odds of unmet need were higher among those who experienced the barriers: not knowing where to go (OR 2.27, 95% CI, 1.40 to 3.69), long office waiting times (OR 1.89, 95% CI 1.27 to 2.83) and being too sick to seek care (OR 2.03, 95% CI, 1.14 to 3.62). Conclusions There is significant unmet need for medical care among homeless women. Having a regular source of care was more important than health insurance in lowering the odds of unmet need. Homeless women must be educated regarding sources of care, and clinics serving the homeless must decrease waiting times.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1046/j.1525-1497.2003.20909.x

Cites

7 of 7 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 29

  1. Link BG, Susser E, Stueve A, Phelan J, Moore RE, Struening E. Lifetime and five-year prevalence of homelessness in the United States. Am J Public Health. 1994;84:1907-12.
  2. O'Toole TP, Gibbon JL, Hanusa BH, Fine MJ. Utilization of health care services among subgroups of urban homeless and housed poor. J Health Polit Policy Law. 1999;24:91-114.
  3. Gallagher TC, Andersen RM, Koegel P, Gelberg L. Determinants of regular source of care among homeless adults in Los Angeles. Med Care. 1997;35:814 -30.
  4. Wood D, Valdez RB. Barriers to medical care for homeless families compared with housed poor families. Am J Dis Child. 1991;145:1109 -15.
  5. Miller DS, Lin EH. Children in sheltered homeless families. Reported health status and use of health services. Pediatrics. 1988;81:668-73.
  6. Rosenheck R, Lam JA. Client and site characteristics as barriers to service use by homeless persons with serious mental illness. Psy- chiatr Serv. 1997;48:387 -90.
  7. Cousineau MR. Health status and access to health services by residents of urban encampments in Los Angeles. J Health Care Poor Underserved. 1997;8:70 -82.
  8. Jezewski MA. Staying connected. The core of facilitating health care for homeless persons. Public Health Nurs. 1995;12:203 -10.
  9. Robertson MJ, Cousineau MR. Health status and access to health services among the urban homeless. Am J Public Health. 1986;76:561-3.
  10. Riemer JG, Van Cleve L, Galbraith M. Barriers to well child care for homeless children under age 13. Public Health Nurs. 1995;12:61-6.
  11. Kushel MB, Vittinghoff E, Haas JS. Factors associated with the health care utilization of homeless persons. JAMA. 2001;285:200 - 6.
  12. Koegel P, Burnam MA. Alcoholism among homeless adults in the inner city of Los Angeles. Arch Gen Psychiatry. 1988;45:1011-8.
  13. Sumner G, Andersen R, Wenzel S, Gelberg L. Weighting for period perspective in samples of the homeless. Am Behav Sci. 2001;45:80 - 104.
  14. Gelberg L, Andersen RM, Leake BD. The behavioral model for vul- nerable populations. Application to medical care use and outcomes. Health Serv Res. 2000;34:1273-302.
  15. Rost K, Burnam MA, Smith GR. Development of screeners for depressive disorder and substance disorder history. Med Care. 1993;31:189-200.
  16. Rubenstein LV, Calkins DR, Young RT, et al. Improving patient function: a randomized trial of functional disability screening. Ann Intern Med. 1989;111:836 -42.
  17. Robins LN, Helzer JE, Croughan J, Ratcliff KS. The NIMH diagnostic interview schedules: its history, characteristics and validity. Arch Gen Psychiatry. 1981;38:381-9.
  18. Wenzel SL, Leake BD, Gelberg L. Health of homeless women with recent experience of rape. J Gen Intern Med. 2000;15:265 -9.
  19. Bloom B, Simpson G, Cohen RA, Parsons PE. Access to health care. Part 2: working-age adults. Vital Health Stat 10. 1997;197:1- 47.
  20. Gelberg L, Linn LS, Mayer-Oakes A. Differences in health status between older and younger homeless adults. J Am Geriatr Soc. 1990;38:1220 -9.
  21. Wojtusik L, White MC. Health status, needs, and health care bar- riers among the homeless. J Health Care Poor Underserved. 1998;9:140 -52.
  22. Stein JA, Andersen RM, Koegel P, Gelberg L. Predicting health serv- ices utilization among homeless adults: a prospective analysis. J Health Care Poor Underserved. 2000;11:212-30.
  23. Kilpatrick D, Resnick H, Saunders B, Best C. Victimization, post- traumatic stress disorder, and substance use among women. In: Wetherington C, Roman A. Drug Addiction Research and the Health of Women. Rockville, MD: National Institute on Drug Abuse; 1998:285-307.
  24. Sanders-Phillips K. Factors influencing health behaviors and drug abuse among low-income Black and Latino women. In: Wethering- ton C, Roman A, eds. Drug Addiction Research and the Health of Women. Rockville, MD: National Institute on Drug Abuse; 1998: 439-65.
  25. Bassuk EL, Melnick S, Browne A. Responding to the needs of low- income and homeless women who are survivors of family violence. J Am Med Womens Assoc. 1998;53:57-64.
  26. Wenzel S, Andersen R, Gifford D, Gelberg L. Homeless women's gynecological symptoms and use of medical care. J Health Care Poor Underserved. 2001;12:323 -41.
  27. Matte TD, Jacobs DE. Housing and health-current issues and implications for research and programs. J Urban Health. 2000;77:7-25.
  28. Kreider B, Nicholson S. Health insurance and the homeless. Health Econ. 1997;6:31-41.
  29. Lambe S, Washington DL, Fink A, et al. Waiting times in California's emergency departments. Ann Emerg Med. 2003;41:35 -44.

Cited by

Sorted by citations

Authors
Lewis, J. H., Andersen, R. M., & Gelberg, L.
Affiliations
University of California, Los Angeles (US)
Corresponding author
Lewis, Joy H.
ORCID
Venue
Journal of General Internal Medicine
Publisher
Springer Science and Business Media LLC
Published
2003-11
Volume
18
Issue
11
Pages
921-928
ISSN
  • 0884-8734 (ISSN-L)
  • 1525-1497
DOI
10.1046/j.1525-1497.2003.20909.x
PMC
PMC1494940
OpenAlex
W1500910147
Cited by
158
References
7
Citations by year
2026: 2 · 2025: 2 · 2024: 6 · 2023: 6 · 2022: 3 · 2021: 8 · 2020: 10 · 2019: 3 · 2018: 4 · 2017: 11 · 2016: 7 · 2015: 10 · 2014: 12 · 2013: 12 · 2012: 10
FWCI
5.70
Type
journal article
Language
en
Open access
Locations
  • Journal of General Internal Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Funders
  • Agency for Healthcare Research and Quality (R01 HS008323, R01 HS 08323)
  • National Institute on Alcohol Abuse and Alcoholism (R21 AA13398, R21AA013398)
  • National Institute on Drug Abuse (R01 DA14835, R01DA014835)
Topics
  • Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
  • Health Sciences › Health Professions › General Health Professions › Food Security and Health in Diverse Populations
  • Social Sciences › Urban Studies › Urban and Rural Development Challenges
Keywords
homelessness, homeless women, unmet medical needs, barriers to care, usual source of care, health insurance, health care access, waiting time, health care utilization
MeSH terms
Adolescent, Adult, Attitude to Health, Cross-Sectional Studies, Delivery of Health Care, Female, Health Status, Ill-Housed Persons, Humans, Women's Health Services, Los Angeles, Women's Health, Needs Assessment

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review