Characterising homeless people in Scotland
: can oral health, health and psycho-social wellbeing enhance the ETHOS typology of homelessness?

  • Jennifer Collins

    Student thesis: Doctoral ThesisDoctor of Philosophy


    The issue of healthcare provision for homeless people provides an ongoing concern throughout Scotland. Homeless people have been shown to experience high levels of ill-health, including oral diseases and are disproportionately affected by mental health problems.
    This thesis sought to establish the health, oral health and psychosocial well-being needs of Scottish homeless people with a view to enhancing understanding, and providing a basis for improving models of care and service delivery for this group of vulnerable individuals. Two literature reviews were carried out, a narrative review of the available literature relevant to concepts of homelessness and relevant to the health of homeless people, and a structured review which allowed a detailed systematic examination of the literature specifically pertaining to the oral health of homeless people.
    In order to provide greater context, the information gathered in this survey was evaluated against a framework of typology; typologies being frequently used to characterise homelessness. The ETHOS typology, internationally recognised and considered to be a valid and reliable construct of homelessness, was selected for use in this context of this thesis. Thus the aim was to investigate if oral health, health and psycho-social wellbeing could be used as additional descriptors of the ETHOS typology of homelessness for a Scotland-wide homeless population to inform the development of a tailored service provision to increase engagement with health services.
    In order to achieve this aim, homeless people throughout seven NHS Boards in Scotland were sampled. Participants were asked to complete a questionnaire which assessed demography, general health and associated health-related behaviours, psycho-social wellbeing, oral health and oral health-related attitudes and behaviours. An oral examination was conducted to evaluate the prevalence of obvious decay experience, levels of plaque present, oral mucosal disease, and denture wear.
    Eight hundred and fifty three homeless people participated, 85% of whom had an oral examination. Using the data obtained it was possible to show that demographic, oral health, health and psycho-social wellbeing descriptors existed which could characterise the various dimensions of the ETHOS typology, allowing an enhanced ETHOS typology to be developed. It is recommended that this enhanced ETHOS typology could act as a framework against which targeted and tailored health service provision for specific groups of homeless people could be developed. It is proposed that such a tailored health service provision is necessary, and would allow health services to improve their engagement of homeless populations.
    Date of Award2012
    Original languageEnglish
    SupervisorRuth Freeman (Supervisor)

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