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2017Wachira.Pdf (1.862Mb) “I CAN’T EVEN WALK, YOU’RE EXPECTING ME TO CLIMB A MOUNTAIN?” AN EXPLORATION OF SERVICE PROVIDERS PERCEPTION OF VULNERABILITY AMONG INDIVIDUALS EXPERIENCING HOMELESSNESS A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN THE GRADUATE SCHOOL OF THE TEXAS WOMAN’S UNIVERSITY DEPARTMENT OF HEALTH STUDIES COLLEGE OF HEALTH SCIENCES BY ELIZAETH W. WACHIRA BSN, MPH DENTON, TEXAS MAY 2017 Copyright © Elizabeth Wachira, 2017 all rights reserved. iii DEDICATION For the men and women that work tirelessly every day to make a difference in the lives of the invisible and easily forgotten members of our society. For my family, thank you for your love, support, and patience. iv ACKNOWLEDGEMENTS I would like to thank those who have walked and pushed me along this PhD journey. I would like to thank my committee chair and mentor Dr. Kimberly A. Parker for seeing the potential in me even when I did not see it or was too afraid to see it. For pushing me to think harder, think bigger, and reach higher by allowing me room to grow into my topic, make mistakes, and silently guide me in correcting those. To the members of my committee Dr. Wiginton and Dr. Menn, thank you for lending your voice and insight in those times of uncertainty and insecurity. Your vote of confidence pushed me to continue. First and foremost I would like to give honor and thanks to my God and Savior, Jesus. The ability and opportunity to learn and grow in this way is a blessing and a miracle that I do not take for granted. To my parents, who taught me the greatest decision I can make is living a life of significance. A life where my efforts help make someone better. To my daddy, Dr. Solomon Waigwa, thank you for being the greatest father and mentor anyone could ask for. I can see far because I have stood on your shoulders and learned what humility and wisdom looks like. To my mom, Mrs. Tabitha Wachira, thank you for being my greatest cheerleader who always knew when I needed cheering. For always telling me “you WILL make it” especially when things got uncertain; you stood firm and never changed your song. I love you mom. To my Womblings: the best brother and sister any girl can ask for. Dr. David, from day one, I have looked to you to show me which way to go or what I should say to mom to avoid getting in trouble. Thank you for your words of love and wisdom and being one step ahead of me as the big brother. You use my love of competition to keep me going even when I feel like settling. My comedian and little sister, Priscilla. Your crazy antics have kept me laughing when all I wanted to do was cry. You always knew when I needed to be disrupted from long working hours with a joke, a silly dance, or a laugh. Those 2 a.m. random bursts of laughter kept me grounded and moving along. To my cosas de la vida friend, Kimberly Camacho. Thank you for always being there to listen, particularly in those moments I spoke with no words. For joining Priscilla and me on getaway weekends so I can get rejuvenated for the next semester. For allowing me to be crazy but still calling me your v smartest friend. For laughing, crying, and celebrating the ups and downs in our cosas de la vida. To Sanimeh, thank you for your calming and ever present voice of encouragement and assurance. To my family and friends both near and far: in Kenya, my church family, my young people, and my For Life family, thank you for always cheering me on. For always believing in me and celebrating every small victory; today, we celebrate another victory. vi ABSTRACT ELIZABETH W. WACHIRA I CAN’T EVEN WALK, YOU’RE EXPECTING ME TO CLIMB A MOUNTAIN?” AN EXPLORATION OF SERVICE PROVIDERS PERCEPTION OF VULNERABILITY AMONG INDIVIDUALS EXPERIENCING HOMELESSNESS MAY 2017 Those experiencing homelessness (IEHs) are more likely to have more health issues, more unmet health needs, higher occurrences of excess morbidity and mortality, have less control over manageable chronic health conditions, and are three to four times more likely to die prematurely than their housed counterparts. The causes of these health disparities are deeply rooted in the social context surrounding everyday life, where the interplay of various identity factors determines one’s vulnerability. Vulnerability thus represents the multiplicity and convergence of risk factors inherently tied to individuals marginalized identities and lived experiences. Therefore, in order to comprehensively understand the pathways leading to health disparities, a deeper understanding of the social context of vulnerability as a determinant of health is needed. The injustices experienced by IEHs happen in their everyday lives where interactions with the domiciled populations further influence the occurrence and impact of marginalization. Research well supports how these occur from the homeless populations perspectives, but insight from service providers (SPs) is lacking in regards to understanding how vulnerability among IEHs manifests in the lived context, specifically the service provision setting. The goal of this study was to understand how vulnerability manifests in the lived context by allowing study participants the opportunity to tell their story. Through interviews and digital storytelling, this study proposes to understand service providers’ perception of vulnerability as experienced by IEHs. Guided by an intersectionality framework, knowledge production was informed by eliciting SPs descriptions and viewpoints regarding IEHs experience with their primary identity of “being homeless” while allowing for other influential categories to be determined that lead to more occurrences of marginalization. The data collected included 8 ethnographic fieldwork participant observations, 7 semi- vii structured SP interviews and 5 digital stories and reflection interviews. This data was analyzed using standard content analysis and constant comparison to construct themes pertaining interactions between SPs and IEHs, and how vulnerability manifests in the service provision context. Three themes emerged from the data, focused on the “navigating” IEHs and SPs have to do in the service and lived context. These include navigating the meaning of time, navigating the system and navigating change. viii TABLE OF CONTENTS Page COPYRIGHT ........................................................................................................................................ iii DEDICATION ..................................................................................................................................... iv ACKNOWLEDGMENTS ..................................................................................................................... v ABSTRACT ......................................................................................................................................... vii Chapter I. INTRODUCTION................................................................................................................................ 1 Statement of Purpose ......................................................................................................................... 1 Research Questions ........................................................................................................................... 2 Delimitations ..................................................................................................................................... 2 Limitations ........................................................................................................................................ 3 Assumptions ...................................................................................................................................... 3 Importance of the Study .................................................................................................................... 3 II. REVIEW OF LITERATURE ............................................................................................................ 5 Definitions ..................................................................................................................................... 5 Disparities/inequalities, Inequities, Equity .................................................................................... 5 Existence of Health Disparities ..................................................................................................... 6 Nationally ................................................................................................................................. 6 Homelessness .......................................................................................................................... 7 Health Disparities of the Homeless ............................................................................................... 8 Acute and Chronic Conditions ................................................................................................. 8 Hospitalization ....................................................................................................................... 10 Life Expectancy ...................................................................................................................... 11 Homelessness: A Public Health Issue ........................................................................................ 11 Health Disparity Principles.......................................................................................................... 12 Historical Overview
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