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Abstract
This research aimed to increase understanding of the relationship between the phenomenon of street homelessness and health. An exploratory study involving people sleeping rough, it focused on these individuals' narratives, with particular emphasis on their experiences of health, illness and healthcare provision while living on the streets. In this qualitative inquiry 58 people participated in tape-recorded reflexive interviews. Extensive periods of fieldwork provided essential context for the data. The information that was generated was subject to rigorous processes of thematic analysis, facilitating identification and description of recurrent patterns and themes. Four key themes emerged, forming a framework for theoretical discussion: management of life on the streets, experiences of health and illness, utilisation of healthcare facilities, and future hopes and aspirations. As analysis progressed, it became evident that constructs of inequality, disempowerment and marginalisation linked these themes together, contributing to the overarching theme of social exclusion and street homelessness. The findings highlight the complexities of sleeping rough with participants wanting recognition as unique individuals, as opposed to being marginalised and labelled as one homogeneous group, 'the homeless'. Their healthcare needs varied but similarities were apparent in terms of their living conditions and lifestyles. Despite differences in their personal experiences, there was a demand for less rigidity in the structure of mainstream service provision, and a call for more flexible responses from service providers themselves, taking into account the precarious nature of street life. While acknowledging positive events, participants also reported encountering inequality when accessing healthcare services. Individuals expressed concern about the limited involvement of people sleeping rough in the planning stages of health and social care services, indicating that a more inclusive approach could benefit service users and service providers alike. Overall, however, participants' belief that street homeless people could initiate change, or would be empowered to initiate change, remained weak.
