Qualitative interviews with persons who have had experience with homelessness: Lessons learned – S/A

Background/Significance: General qualitative methods provide guidelines for interviewing populations with clear cognition and some familiarity with the interview process. These advantages may not hold for homeless persons, who are often affected by social marginalization, mental illness, addiction, and cognitive challenges, and a history of negative interactions with institutions. The purpose of this presentation is to delineate “lessons learned” in conducting a qualitative study of health services in a homeless population. Methods: Lessons were derived from a VA study of primary care for the homeless involving multiple collaborators responsible for interview quality. Three interviewers conducted 36 semi-structured interviews with patients who received services from different health organizations. Results: Lessons learned included: (a) understanding homelessness; (b) establishing trust and rapport; (c) having effective methods of training; and (d) understanding the varied experiences of veterans. Discussion: Our “lessons learned” include: (a-1) being comfortable with issues common in homeless populations, such as substance abuse, mental illness, history of trauma, and distrust and hostility towards institutions; (a-2) acknowledging unpredictability of homelessness by providing flexibility both in recruitment and interviewing; willingness to explore with individuals ideas that are poorly expressed due to impaired cognition, intoxication, or illiteracy; (b) having greater responsibility in building trust than with non-homeless subjects, while maintaining awareness of power dynamics; (c) training from qualitative experts and persons who have familiarity with homeless persons; (e) competency with issues unique to veterans, such as combat-related post-traumatic stress disorder. A summary of these insights should enhance qualitative research interviews with subjects who have experienced homelessness.