JMIR Publications

ABSTRACT

Background:

Although the effects of digital health are getting wider scientific attention, very little is known about the characteristics of digitally engaged people experiencing homelessness, especially in Central and Eastern Europe. Our previous research revealed a considerable level of Internet use in the homeless population of Budapest, Hungary for general (52.9% - 350/662) and for medical purposes 34.6% (229/664), moreover, a digitally engaged subgroup was identified (19.5%, 129/662).

Objective:

This exploratory research aimed to map out the resources, attitudes, and behavior of digitally engaged homeless individuals in relation to digital technology to set the ground for potential health policy interventions, enabling better access to health services by strengthening the digital components of the existing healthcare system.

Methods:

Between 18 August and 27 October 2022, a total of 12 in-depth semi-structured interviews were conducted in 4 homeless shelters in Budapest, Hungary. Upon first analysis of three independent evaluators, 2 interviews were excluded. The interviewees were chosen based on purposive sampling with pre-defined inclusion criteria. Thematic analysis of the transcripts was conducted.

Results:

In the thematic analysis, four main themes (attitude, access, usage patterns and solutions for usage problems) emerged. Health-related technology use mostly appeared in health information seeking behavior. Online search for prescribed medication (5 interviews), their active ingredients (4 interviews), medical herbs believed to replace certain pills (2 interviews) or foods, natural materials (1 interviews) were present, as well as mobile health application use (3 interviews). The intention to circumvent or check on mainstream healthcare solutions was grounded mainly on previous negative experiences in the healthcare system. Several gaps to the daily use of technology were identified by the interviewees, however, more than half of them turned out to be contact points for their peers for digital problem-solving or basic digital literacy skill enhancement in the homeless shelters (6 interviews). Also, the lack of institutional support or special programs targeting senior clients was noted.

Conclusions:

Digitally engaged homeless individuals might become mediators between their peers and any comprehensive digital health program. They have the trust of their peers, recognize and harness the benefits of digital technology, and are able to provide meaningful help in technology- and usage-related issues as an expert by experience. Results show that digital health services could have great promise in community shelters for managing and preventing health issues, and digitally engaged individuals might be a key to their success.