Examining the Care Experiences of People Experiencing Homelessness in Kingston

Background Across Canada, approximately 235,000 individuals face housing instability, and homelessness has been associated with an increased use of emergency department (ED) care. EDs are a safety net for people experiencing homelessness (PEH), when faced with limitations to primary care access, such as limited service hours and locations. PEH have reported negative ED care experiences, including feeling judged, not having health concerns taken seriously, and experiencing stigmatizing behaviour. Prior negative experiences contribute to the avoidance of care services, exacerbating issues for PEH. Objective This study examines the experiences of unhoused populations accessing ED services, to better understand the adversity they face. Methods The study is participatory and cross-sectional, using the sensemaking Spryng.io platform to survey patients at the Kingston Health Sciences Centre EDs. Sensemaking methodology (SM) uses a mixed-methods research approach that collects data through storytelling. This enables individuals to naturally convey complex information and make sense of their experiences. Within the sensemaking survey, individuals who self-identified as a PEH answered an additional subset of questions about their experiences accessing care. Follow-up focus group discussions (FGDs) will take place at St. Vincent de Paul, an organization that supports people in Kingston with resources such as food, clothes, and housing. FGDs will be used to validate the sensemaking results and co-create care improvement strategies. Conclusion By engaging PEH, our results can lead to actionable care improvement strategies. The study is also a foundation for future research collaborating with PEH and community partners, to mitigate negative care experiences.