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Homeless Persons' Decisions to Accept or Reject Public Health Disease-Detection Services


  • Valerie Swigart is Assistant Professor of Nursing, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania. Randall Kolb is Clinical Assistant Professor of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine and Medical Director, Family Health Center, Pittsburgh, Pennsylvania.

* Valerie Swigart, University of Pittsburgh School of Nursing, 440 Victoria Building, Pittsburgh, PA 15261. E-mail:


Abstract  The purpose of this study was to describe the factors that homeless persons report as influencing their decisions to utilize or reject a public health disease-detection program. Although there is copious literature on homelessness, few studies report the real-life perspectives of homeless persons toward health or health promotion. A convenience sample of 55 sheltered and street-dwelling homeless persons, who either resided in or were visiting seven shelters in a large northeastern U.S. city, were interviewed. The interview questions focused on the bases for decisions to accept or reject tuberculosis screening. The in-depth semistructured audio-taped interviews were transcribed, coded, and categorized using Ethnograph software. Interviews were analyzed using the constant comparative content analysis methods. The findings describe homeless persons' reasons for accepting or rejecting a tuberculosis-detection service, the prominent role of shelter personnel in recruitment for health-related interventions, and the confidentiality needs of women with children. This information can assist community health practitioners in designing and advertising health-promotion and disease-detection programming.