Accepted for/Published in: JMIR Research Protocols
Date Submitted: Mar 21, 2025
Date Accepted: Jun 25, 2025
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Periodic Assessment of Trajectories of Housing, Homelessness and Health Study (PATHS): Protocol for a prospective cohort study of people experiencing homelessness
ABSTRACT
Background:
The past decade has seen a dramatic rise in the number of people experiencing unsheltered homelessness. The unsheltered population faces heightened health and social risks, yet research on their experiences remains limited.
Objective:
This paper presents the protocol for the Periodic Assessment of Trajectories of Housing, Homelessness, and Health Study (PATHS), a longitudinal study that leverages mobile phone technology and online surveys to track the housing and health trajectories of people experiencing unsheltered homelessness in Los Angeles County.
Methods:
Participants were recruited from the Los Angeles County Homeless Count Demographic Survey, an annual representative survey of the county’s unsheltered population. Eligibility criteria included being 18 years or older, living in an unsheltered location or homeless shelter at least one night in the past month, and residing in Los Angeles County. The study utilizes a web-based survey platform accessed via mobile phones and provides electronic gift card incentives for participation. Data on housing, health, and social outcomes are collected monthly through trauma-informed, equity-sensitive surveys, designed for diverse literacy levels with a user-friendly interface that includes buffers for sensitive topics.
Results:
Since the study launched in December 2021, 2,058 individuals were screened and eligible. Of these, 57% (1,182) completed the baseline survey, and 75% (892) completed at least one monthly survey. By December 2024, participants had contributed 7,585 monthly surveys (average of 8.5 per respondent and median of 6). Compared to the unsheltered population of Los Angeles County, the PATHS sample overrepresents young adults (54% vs. 39% under age 40) and females (43% vs. 28%). Preliminary findings reveal a high burden of health risks among PATHS participants relative to the housed population, with 47% reporting symptoms of anxiety (vs. 30%), 45% with symptoms of depression (vs. 24%), 35% reporting a disability (vs. 13%), and 69% experiencing food insecurity (vs. 15%). Monthly tracking highlights their unstable housing trajectories, with 45% of participants remaining persistently unsheltered, and 24% moving in and out of shelters, institutions, and housing before returning to being unsheltered.
Conclusions:
PATHS offers an innovative platform for real-time monitoring of the housing, health, and service needs of people experiencing unsheltered homelessness in Los Angeles County. By leveraging continuous, in-depth data collection via mobile surveys, PATHS provides valuable insights into the evolving challenges faced by this population. Addressing critical gaps in longitudinal research, PATHS has the potential to drive more informed policy decisions and interventions that improve outcomes for this vulnerable population. Clinical Trial: N/A
Citation
