abstract: 'Self-care, which refers to what people do to prevent disease and

  maintain good health, can alleviate negative health consequences of

  people experiencing homelessness. The aim of the study was to apply a

  theoretically informed approach in exploring engagement of people

  experiencing homelessness in self-care and to identify factors that can

  be targeted in future health and social care interventions. Qualitative

  semi-structured interviews were conducted with 28 participants

  opportunistically recruited from a specialist homelessness healthcare

  centre of North East Scotland, the United Kingdom (UK). An interview

  schedule was developed based on the theoretical domains framework (TDF).

  Interviews were audio-recorded and transcribed verbatim. Six aspects of

  self-care were explored, including (a) self-awareness of physical and

  mental health, (b) health literacy, including health seeking behaviour,

  (c) healthy eating, (d) risk avoidance or mitigation, (v) physical

  activity and sleep and (e) maintaining personal hygiene. Thematic

  analysis was conducted by two independent researchers following the

  Framework Approach. Participants described low engagement in self-care.

  Most of the barriers to engagement in self-care by participants were

  related to `environmental context and resources'' domain of TDF.

  Participants often resorted to stealing or begging for food. Many

  perceived having low health literacy to interpret health-related

  information. Visits to churches and charities to get a shower or to

  obtain free meals were commonplace. Participants expressed pessimism

  that there was `nothing'' they could do to improve their health and

  described perceived barriers often too big for them to overcome.

  Alienation, lack of social support and the perception that they had done

  irreversible damage to their health prevented their involvement in

  self-care. The theme of `social circle'' held examples of both enabler

  and barriers in participants'' uptake of risky behaviours. Health and

  social services should work with persons experiencing homelessness in

  designing and delivering targeted interventions that address contextual

  barriers, multi-morbidity, health literacy and self-efficacy.'
affiliation: 'Paudyal, V (Corresponding Author), Univ Birmingham, Sch Pharm, Insititute
  Clin Sci, Birmingham, W Midlands, England.

  Paudyal, Vibhu, Univ Birmingham, Inst Clin Sci, Birmingham, W Midlands, England.

  MacLure, Katie; McKenzie, Myra, Robert Gordon Univ, Fac Hlth \& Social Care, Aberdeen,
  Scotland.

  Forbes-McKay, Katrina, Robert Gordon Univ, Appl Social Studies, Aberdeen, Scotland.

  MacLeod, Joan, Aberdeen City Community Hlth Partnership, NHS Grampian South Cluster,
  Aberdeen, Scotland.

  Smith, Ann, Aberdeen City Community Hlth Partnership, NHS Grampian North Cluster,
  Aberdeen, Scotland.

  Stewart, Derek, Qatar Univ, Coll Pharm, Doha, Qatar.'
author: Paudyal, Vibhu and MacLure, Katie and Forbes-McKay, Katrina and McKenzie,
  Myra and MacLeod, Joan and Smith, Ann and Stewart, Derek
author-email: v.paudyal@bham.ac.uk
author_list:
- family: Paudyal
  given: Vibhu
- family: MacLure
  given: Katie
- family: Forbes-McKay
  given: Katrina
- family: McKenzie
  given: Myra
- family: MacLeod
  given: Joan
- family: Smith
  given: Ann
- family: Stewart
  given: Derek
da: '2023-09-28'
doi: 10.1111/hsc.12850
earlyaccessdate: SEP 2019
eissn: 1365-2524
files: []
issn: 0966-0410
journal: HEALTH \& SOCIAL CARE IN THE COMMUNITY
keywords: health behaviours; homelessness; self-care
keywords-plus: 'ASSERTIVE COMMUNITY TREATMENT; HIGH-INCOME COUNTRIES; USE DISORDERS;

  HOUSING 1ST; MORTALITY; INTERVENTIONS; OUTCOMES'
language: English
month: JAN
number: '1'
number-of-cited-references: '49'
orcid-numbers: 'MacLure, Katie/0000-0003-0686-948X

  Paudyal, Vibhu/0000-0002-4173-6490'
pages: 160-172
papis_id: 424cd547032eb4598fdc961678258074
ref: Paudyal2020ifi
researcherid-numbers: 'MacLure, Katie/GRJ-8912-2022

  '
times-cited: '17'
title: '`If I die, I die, I don''t care about my health'': Perspectives on self-care
  of people experiencing homelessness'
type: Article
unique-id: WOS:000485848000001
usage-count-last-180-days: '3'
usage-count-since-2013: '13'
volume: '28'
web-of-science-categories: Public, Environmental \& Occupational Health; Social Work
year: '2020'