Lived Experiences of Homeless people in healthcare service utilization amidst COVID-

19 Pandemic

A Thesis Presented to
The Faculty of the College of Nursing
University of St. La Salle
Bacolod City

In Partial Fulfilment
Of the Requirements for
NCM 111 - Nursing Research

ELEA PHOEBE Q. SUAREZ

PRINCESS F. SUGATON
ALEXANDRA NICOLE S. TOLBO
MICAH MARIE EMMANUELLE P. VELEZ
ALTHEA MECAILAH P. VERTUDAZO

April 2022
 TABLE OF CONTENTS

TITLE PAGE i
ii
APPROVAL SHEET iii
ACKNOWLEDGMENT iv
v
TABLE OF CONTENTS vi
LIST OF TABLES vii
1
LIST OF FIGURES 1
ABSTRACT
INTRODUCTION
Background of the Study
Statement of the Problem
Theoretical and/or Conceptual Framework
Scope and Limitations
Significance of the Study
Definition of Terms
Review of Related Literature
 INTRODUCTION
 

Background of the Study

The COVID-19 pandemic has wreaked havoc on all aspects of life, including the

economy, society, and, most significantly, people's health.  As of September 2022, the

World Health Organization (2022)  reports that there are 612 million confirmed COVID-19

cases and 6.5 million deaths globally. About 3.94 million cases and 68,882 deaths have

been confirmed in the Philippines (World Health Organization, 2022). From March 2021 to

September 2022, 73,051,416 Filipinos have completed their COVID-19 vaccine doses

(Department of Health, 2022). In September 2021, the University of the Philippines

Diliman, in collaboration with the World Health Organization Philippines, organized a

vaccination for "individuals at risk," which included homeless people, in which 650 people

were vaccinated (Jadloc, 2021). The vulnerable, particularly the homeless, are the

unrecognized victims of this pandemic. Homeless people are more vulnerable to the virus

because they lack one basic human need: shelter. They lack access to clean water, food,

clothing, and other basic necessities because they live on the streets without permanent

housing.

According to the study by Tan, L.F., & Chia, J. W., (2020), homeless people are at

higher risk of different infectious diseases. Staff members should be mindful of this and

offer communication services, and assistance in a courteous way that recognizes and

accommodates this diversity. Furthermore, that the admonition to stay at home is unusable

to someone who does not have place, the same with COVID-19 prevention strategies such

as handwashing and social distancing is difficult since many "public" facilities are only for

customers' use which can be difficult to keep on the streets or in homeless people (Tan,
2021). Moreover, poor access is a big challenge despite the fact that persons experiencing

homelessness have a high degree of healthcare needs. It is important to explore whether

recent changes to the delivery of primary care in response to the COVID-19 pandemic

compromise the safety of people experiencing homelessness and exacerbate health

inequalities. This could have implications for how primary healthcare is delivered to those

experiencing homelessness not only for the duration of the pandemic but in the future

(Howells, 2021). The lack of shelter, potable water, proper nutrition, and essentially the

basic needs of an individual greatly affect the chances of one being affected no just by the

pandemic but any other disease that is present today. These are factors that contribute to

raising the risk of infection to the homeless. Coupled with the inability to seek medical help

because of financial incapacity, the current health status of the majority of homeless people

is at an all-time low. 

In contrast to other nations, where research has been done on ways to protect and

assist those without stable housing as well, the Philippines has not yet completed any

studies on the health experiences and healthcare service utilization of those without such

housing. Furthermore, there are only a few studies in the pool of literature that include

homeless persons as participants. They are a vulnerable group that has received little

attention especially in the Philippines.  No further research has been conducted to explore

their experiences during a time of a global health crisis. There is no information available in

the nation or even at the local level about the COVID-19 vaccine roll-out update and

healthcare services for the vulnerable population, specifically the homeless people.

In Bacolod City, there are no existing programs that cater to the basic healthcare

needs of homeless people.  Only community-led activities assist them in acquiring basic

healthcare needs, which are also limited. Despite the rise and fall of COVID-19 cases,
homeless people remain on the streets, with many lacking basic necessities such as masks

and alcohol to protect themselves from the virus. 

This study aims to investigate the health experiences and healthcare service

utilization of homeless people in Bacolod City in order to shed light on their conditions in

the midst of the pandemic and the availability of healthcare services and resources.  Another

goal of this research is to promote inclusive health care. The data gathered can be utilized to

prompt an action plan and develop a strategy to address the needs of homeless persons. It

can be a basis for healthcare organizations in the planning of interventions for the

vulnerable group, particularly the homeless population, in times of an epidemic or

pandemic. This study may be beneficial to the local government units, non-governmental

and healthcare organizations, medical professionals, nurses, barangay health workers, the

academe, student nurses, and future researchers.  

Statement of the Problem

This study aims to explore lived experiences of homeless persons in healthcare utilization

services during the COVID-19 pandemic.

Specific objectives 

Specifically, the study seeks to answer the following questions:

1. What are the health experiences of homeless persons during COVID-19 pandemic?

2. What healthcare services were utilized by homeless persons during COVID-19

pandemic?

Theoretical Framework

People who have been unwell for a while may occasionally be asked to perform to

the best of their ability. This is crucial in rehabilitation settings because after receiving care
from doctors and nurses, patients have a right to greater independence. By definition, self-

care is "the practice of acts that individuals start and undertake on their own behalf in

preserving life, health, and well-being," as articulated by Dorothea Orem.  This theory

concentrates on each person's ability to practice self-care. This hypothesis emphasizes that

persons who maintain a measure of responsibility over their own self-care are more likely to

recover (Iran, 2016). Those who are unable to care for themselves are said to have self-care

deficiencies. By connecting this theory to the research, it will be possible to find out how

homeless people maintain their health in the face of the spreading COVID19 worldwide

epidemic. This is to ascertain what strategies or methods of surviving in this epidemic

despite the lack of resources, including the need for money, healthcare, and a permanent

home. Given the fact that homeless people do not have enough knowledge in taking care of

themselves creates a gap in achieving their optimum health.

Sister Callista Roy, a nursing theorist, suggests that humans are able to adapt

through identifying the internal and external stimuli which can affect their adaptation (Roy,

1999). The stimuli could be something that the person is immediately faced with, something

that is helping to cause the main stimuli, or an unclear outcome of a situation. Health is a

reflection of how well a person's adaptive systems have adjusted to their ever-changing

environment (Tiedman, 2006). In this essence, homeless persons experience constant

changes in their environment thus their adaptive abilities are affected by the stimulus they

encounter daily. Roy's adaptation model is supported by this study because it will show how

homeless people adjust to changes in their environment, particularly in the midst of a global

health crisis. This will also depend on whether they respond well or poorly to stimuli.

"The state of the environment that people lived in is associated with people's health

and well-being" ( Thomas Münzel et al.,2018). Whereas environmental stress can be a

contributing factor in persons' health problems. According to Betty Nueman: Theory of

System Model, Human beings tend to respond to internal and external environment

stressors which affect their physiological, psychological and developmental well-being

( Gonzalo, 2021). Person's environment is one of the many factors that affects its overall

health and well-being. Living in an environment where you are exposed to poor nutrition

and multiple environmental stressors such as exposure to pollution, viruses, infection,

changes in temperature and many more can lead to serious health problems. Unfortunately,

this is the kind of life that homeless persons live. Anchored in this theory, this study will

shed light on how homeless persons experience these environmental stressors, if they were

able to manifest different kinds of health problems, how they were able to address it with

limited healthcare resources and if they were able to utilize the different healthcare services

that was given by the government and their experiences to the services given.

Conceptual Framework

Figure 1 is the schematic diagram of the study. It demonstrates the relation between

the independent and dependent variables. The independent variables considered in this

study is when  the participants are grouped according to their  age, sex, number of people in

their family, location, and vaccination status are taken into consideration in the analysis. 

Their coping mechanism, health status, health seeking behaviors, and  the availability and

utilization of healthcare services are the variables that could affect their experiences during

the COVID-19 pandemic. This is where the different variables leads to the title of the study

in which the independent variables first are arranged and categorized and precedes to the

intervening variables where this will acts as a guide and the outcome of this variables can

be used as data for determining the lived experiences of homeless people during the spike of

the COVID-19 pandemic. 

 Based on the study conducted in the United States in 2013, it showed that

demographic profiles play a significant role in determining the outcome of the lifestyle and

characteristics of each homeless person, for this creates a different level of living

perspective and coping mechanism (Fargo, 2013). Furthermore, intervening variables aids

in making the type of connection between both the independent and dependent variables

more concise that will further result in a clear research (Crossman, 2019).

In line with this, the study is anchored on the Self-Care Deficit Theory by Dorothea

Orem, Theory of System Model by Betty Neuman and Sister Callista Roy’s Adaptation

Model whereas these models will help demonstrate the connections between the concepts to

the study and would act as a basis in correlating the literatures in the said study. The Self-

Care Deficit Theory by Dorothea Orem highlights each person's capacity to practice self-

care whereas this will determine how a homeless person deals with their coping

management and health status. Roy suggests that adaptation affects how a person identifies

their external and internal stimuli, in relation to this the coping mechanisms and health-

seeking behaviors of the homeless people must be determined further to understand their

experiences and their healthcare service utilization to determine what factors affect their

stimuli. Lastly, Betty Neuman highlighted in the Neuman systems model that the state of

the environment that people live in is associated with people's health and well-being. This

will determine how a homeless person’s health status is affected in the kind of environment

the person is or located. 

These theories contribute to the key variables that influence the said phenomenon of interest

and this has been thoroughly discussed in the theoretical framework. 

A diagram is presented in Figure 1 to illustrate the hypothesized relationship between the

theories and variables in the study.

 Figure 1. Schematic diagram showing the conceptual framework of the study.

Figure 1 presents a diagram demonstrating the connection between the theories and

the study's variables. The first box on the left is the starting profile of the participants

categorized based on age, sex, number of people in the family, location, and vaccination

status. Factors that affect the lived experiences of homeless people in healthcare service

utilization amidst COVID-19 pandemic include: coping mechanisms, health status, health

seeking behavior among homeless people, and healthcare services utilization/availability.

The primary focus of this study is to identify the lived experiences of homeless persons in

healthcare service utilization in COVID-19 pandemic. 

Scope and Limitation

This study is qualitative research. It will explore the health experiences in the

utilization of healthcare services of homeless persons in Bacolod City. This study will

involve six (6) family heads, preferably mothers, all of whom will be interviewed. Each

participant will be given a consent form to prove that they are not being forced to

participate in this study. A month will be set aside for data collection. Data collection will

begin in the last week of January 2023.

 This research, however, is subject to several limitations. First, this includes the place

and area where the researchers will conduct the interview. This will encourage the

researchers to utilize safe areas to conduct the study. Next, the limited resources, whereas

the researchers have limited amounts of resources such as the materials needed for

conducting the study, and the transportation going back and forth to the designated place.

Lastly, the ethical consideration, whereas a private room is needed to conduct the study.

This is one of the limitations where the researchers do not have a private room to conduct

the interview and if needed to rent a space, it would be a heavy financial load. 

Significance of the Study

This study may be beneficial to the following: 

                Local Government Units. Local government units are in charge of enacting laws

and implementing programs that benefit society. There are no programs that provide health

care services to homeless persons. Thus, this study may increase the local government

units’ knowledge of health care and health habits of homeless people, prompting them to

develop programs to benefit homeless people. 

Non-Governmental and Healthcare organizations. There have been community-

led actions that helped in providing assistance to homeless persons. These activities and

programs are led by different non-governmental organizations such as Homeless People’s

Federation of the Philippines.  This study may serve as their additional basis in making

programs and creating medical missions related to providing health services to different

vulnerable groups especially homeless persons. 

Medical Professionals.  People who work in the healthcare industry offer medical

treatment and assistance based on professional training and practical experience to sustain
human health via the use of evidence-based medicine and humanistic approaches. In line

with this, this study can be used by medical professionals in enhancing their care to a wider

scope of people.

Nurses. Nurses are medical professionals who deliver and ensure quality care to all

kinds of clients. They play a big role in health maintenance and promotion. Nurses use a

nursing process that serves as a guide in giving care for clients. This study may serve as a

guide on creating plans on how to approach a wide range of healthcare concerns.

Barangay Health Workers.  The first line of medical workers that provides the

medical available needs and resources to the people in the community. This may serve as a

basis to formulate different ways to address the basic health care needs for vulnerable

groups of people in a much inclusive way.

Academe. This study may be beneficial to the college and to the institution as this

can act as a guide, and basis for students to read and to further harness and widen their

knowledge in the perspective of homeless people. 

Student Nurses. Aspiring future nurses by studying in institutions. Whereas this

study may be beneficial because it will serve as a reference for student  nurses to identify

the underlying themes in this phenomenon to help them comprehend why this is happening. 

Future Researchers. This may serve as a useful guide and reference for the future

researchers who had a plan to make similar Studies.

Definition of Terms

Experiences. It ceases to be the source of justification, not the authoritative proof

that supports what is known because it can be seen or felt (Crosby, 2013).  In this study this

term is used to perceive the real-life events that were undergone by a group of people. 
 Health  Experiences. A person's interaction with the healthcare industry, patients,

and the medical personnel who care for them (Goodwin, 2021). In this study, this term

refers to the information gathered about a group of people's overall well-being during a

pandemic.

  Lived Experience. Defined as an ongoing process which is known “from within”

by individuals. Derives from the phenomenological tradition and is rooted in the enactive

approach of cognition. As such, lived experience appears to be active and passive, holistic,

situated in a complex temporality, and partly pre-reflective.

Homeless Persons.  People who are unfortunate in having access to minimally

adequate housing. (Keenan & MccGreevy, 2019) In this study, this term refers to people

who are part of the vulnerable group, specifically those who live on the streets. 

COVID-19. This term refers to an infectious illness caused by the SARS-CoV-2

virus that arose in 2019, having killed over five million people worldwide (Burgan, 2019).

In this study this term is used to refer to the pandemic that has aroused since 2019 until and

is still a major problem.

Review of Related Literature

The following review of literature is related to the research problem presented in a

thematic approach.

Coping throughout the pandemic as a homeless person

A study conducted in Canada showed individuals suffering homelessness are more

likely to contract severe acute respiratory syndrome coronavirus 2 due to a lack of secure

housing, and therefore also have a greater likelihood to contract COVID19 because of the

high incidence of risk factors in homeless communities (Mellisa Pherri, 2020).  Due to

restricted access to health care and social services, the spread of SARS-CoV-2 is often fast,
and disease treatments are being delayed. People who are homeless are more prone to have

their daily lives stigmatized. Until today, the homeless people have stayed on the city's

streets, safeguarding their families in the midst of the protocols (Wang, 2020). Though there

are measures implemented in the US and Canada to increase capacity to allow safe physical

distancing for homeless people, the unique needs of categories of persons experiencing

homelessness must be acknowledged (Wang, 2020). In relation to the previous study, the

statistics show that homeless persons seem to be more likely to have previous health

difficulties, poor mental health, high rates of drug use, and low health literacy, all of which

contribute to inadequate adherence to COVID-19 safety measures like mask wearing and

social distance. (Cromer, 2022). People opt to handle their own health needs instead of

going to the hospital because of the stigma and even experiences that made them feel harsh,

disrespectful, and dismissive. Homeless individuals do not trust medical practitioners

because they have never been welcomed in the hospital, which has resulted in Pandemic-

related difficulties that are limited to this population (Martinez, 2022).

On the contrary, the homeless people also felt loneliness especially during the first

wave of COVID19. This study conducted in Harmburg, Germany showed during the initial

wave of the COVID-19 epidemic, the general populace saw an upsurge in loneliness

(Bertam, 2021). Increased loneliness was connected with male gender, being single, being

originally from Germany, a high frequency of sharing a sleeping area with more than three

persons, and a high self-perceived risk of developing COVID-19, according to regression

analysis. Furthermore, this affected the emotional health of the homeless persons living in

the streets during the first stage of COVID19 pandemic with decreased hope and feeling of

being left out (Heinrich, 2021). 

 Furthermore, during COVID-19, homeless persons acknowledged sentiments of

depression and sadness, and many stated that consuming drugs was a common coping

mechanism they used to deal with their emotions. Their street experience during COVID-19

increases drug usage because it serves as a coping strategy in which individuals tend to

forget that COVID is present and that they have easy access to street drug dealers. (Salem,

2022). The belief that alcohol could be more safely secured during COVID-19 than

narcotics, or that alcohol killed the COVID-19 virus also governed the perspective of adult

persons living on the streets. This led to actions that resulted in too much alcohol intake as a

coping mechanism (Nyamathi, 2022). There are also homeless people who have an eye

view and caution  when it comes to protecting themselves during COVID19. Some made

use of social distance by not being too close with their fellow homeless folks and limited

their trash-digging for the look of food. Though their resources when it comes to disease

prevention such as public bathrooms and water fountains are restricted, they still made use

of their life-tactics (Gelberg, 2022).

In addition to that, from 2018 to 2019, the number of people suffering homelessness in

Denver, Colorado, grew by approximately 15%, this tendency, paired with the 2020 SARS-

CoV-2 (COVID-19) pandemic, has created a significant issue for unhoused populations

(Briggs, 2022).  Unhoused people tend to gather together as a group to help each other and

this led to the big groups domination. The unavailability of public restrooms and shelter

spaces dominated Denver Colorado from the start of the pandemic. This also led to people

sleeping in piles of sweeps because of the displacement of outdoor tent encampments where

the coping method of homeless people is to survive despite being left out and the scarcity of

the resources (Briggs, 2022).

 In regards to the previous aforesaid, the results of this study that was conducted in

some of the poorest cities of France indicated that the experience of being homeless put risk

among numerous others. (Mosnier, 2021). Different forms of protection were discovered

depending on the type of living environment, such as emergency shelters but this put them

into high-risk of infection because the number of homeless people were huge. Despite the

negative impact on the homeless people, they still have hope to live and survive the

pandemic through thriving their best to support their daily needs such as food (Allaria,

2021).

Health status of homeless people in COVID -19

Due to their particular difficulties, it has been hypothesized that COVID-19 will

disproportionately affect vulnerable groups including the homeless. People who are

homeless frequently have no access to healthcare and may reside in unclean or congested

conditions. These obstacles make it challenging for homeless people to follow suggestions

for frequent hygiene, social isolation, and self-quarantining (Matthew, et al. 2022).

Additionally, homelessness refers to the state where people live under the minimum

standard or lack of secure tenure. Humans under this social category inhabit the streets,

moving between temporary shelters, living in private boarding houses without a private

bathroom, and/or marginal caravan park residents who are renting (Pacaol, 2021). In

comparison to younger homeless people, older homeless adults appear to use more hospital-

based medical care and less non-acute, preventative healthcare. Shelter-based or community

outreach programs that proactively offer interdisciplinary healthcare services may be

beneficial for this vulnerable population (Dongen, et al. 2019). Since the start of the

pandemic, homeless people have had somewhat higher infection prevalence rates than those

with housing, which may be explained by the different homeless sample, which also
included people without shelter. While cleanliness practices, appropriate sleeping and

separation arrangements, daily symptom monitoring, they could not be assured for people

living on the streets (Massimo, et al. 2021). 

Each and every one specifically urges rigorous community-based homelessness care

providers to share their personal, observant, and attitude-based knowledge to help us gain a

deeper grasp of how the pandemic is affecting homeless populations across the nation. The

voices of vulnerable populations and the frontline professionals who are best equipped to

comprehend their unique needs (Rodriguez, et al. 2022). 

Health seeking behavior among homeless people 

Homeless persons are most likely to experience health problems. Based on the

survey that was conducted, at least 75% of homeless people are suffering from mental

illness and the rest having cardiovascular disease, injury, and intoxication which requires

treatment. This concludes that more health care services and resources should be available

to homeless people other than basic health care services (Kaduszkiewicz, 2017). In line with

the previous study , this study discussed that having primary health care programs that are

specified with homeless people might be much more effective in standard primary health,

government and medical professionals should make sure to know and address risk factors

that result in homeless (Hwang & Burns, 2014). Homeless people frequently lack access to

vaccine information, may view vaccination as a low priority, People who are homeless have

lower immunization rates than the overall population. Hence there is no data to guide

practice in this area. Given that COVID-19 is the subject of the greatest vaccine campaign

in history, this is problematic (Cosker, et al.2022).   When social workers and medical

professionals encounter homeless people in encampments, beneath overpasses, or on the

streets, they can offer them treatments including wound care, medications for infections,
and management of chronic illnesses. Homelessness is associated with increased rates of

mental and physical health issues, such as HIV infection, alcohol and drug misuse, and TB,

according to the Centers for Disease Control and Prevention (Ginger. 2022).

In contrast, health problems and health care services are recognized by homeless

people, and one of the main reasons why some of them don't avail such services is because

of their experiences and encounters with these healthcare services. Homeless people feel

that they were insulted because of the prejudice that was given and some substandard care.

This goes to show that healthcare encounters can greatly affect the client's perspective in

healthcare especially homeless persons (Rae and Rees, 2015). In relation to that, this study

suggests that homeless people have different barriers that keep them from obtaining

healthcare. These barriers are predisposing: chronic/severe Homelessness, deficiency in

knowledge, financial instability, mental illness, and psychological stress. With good

healthcare policies, programs, and interventions can help in overcoming these barriers

(White and Newman, 2014).  Whereas, in this study, it suggests that The Affordable Care

Act provides a guide in forming and improving the healthcare system for homeless or

vulnerable people. However, with the programs and services that were given, improving

healthcare coverage can't alone be the solution in improving it. Healthcare improvements 

must be implemented and integrated with different resources circulating the target

population to address the different challenges and barriers caused by inadequate shelter,

hunger, and dangerous environment (Bharel, 2013). 

Also, another study offers a detailed account of homeless people experiences and

attitudes. Healthcare for the homeless, indicating generally positive opinions toward this

demographic while having mixed attitudes toward healthcare for these people. It will be

beneficial to understand the viewpoint of those whose occupations involve helping this
group as many sectors, including healthcare, evaluate and address the needs of people who

are experiencing homelessness (Qian & Hauser 2022).  The relationship between helping in

homelessness prevention. Utilizing health services, being in good or fair health, insurance

reduced the likelihood of home instability. regardless of citizenship, have access to health

insurance Housing insecurity may be thwarted by status and the application of preventative

healthcare to keep one's health (Chinchilla et al.2021). The key to aiding the homeless

population is educating the medical community. Medical contact, which most frequently

occurs through emergency rooms, offers the chance to direct patients toward crucial

resources. When it comes to education on this subject, we must improve (Watts, I. V.

(2022). 

Healthcare services utilization of homeless persons

The COVID-19 pandemic has presented many challenges to most people, especially

health care professionals. A healthcare team in Brazil, along with other organizations,

arranged an activity to promote health measures to prevent the spread of the virus. This was

done with the intention of investigating the experiences of homeless people during the

pandemic through the experience reports of professionals working with them. This study

revealed that when dealing with COVID-19 and working with homeless people, it is critical

to share difficulties and use empathetic methods to mitigate effects (Schettino et al., 2021).

Another study shows that homeless people have poorer health compared to others which

can be addressed through creating programs and services. These programs can be done

through collaborative, multidisciplinary, and integrated systems where physical and mental

health care are addressed (Jego, Abcaya, Stefan, et al., 2018). In light of the COVID-19

pandemic, vaccination completion for homeless people have been studied about. According

to a study done in Minnesota, USA, homeless people have lower completion rates of
COVID-19 vaccination compared to the general population at the end of 2021 (Shearer et

al., 2022).  There is a significant difference in completed vaccination rates between the

general population and the homeless population. In a similar study, homeless people in

Ontario, Canada have lower vaccination rates than the general population (Stead et al.,

2022). The rate is influenced negatively by homeless people's negative attitudes toward

vaccination and their lack of trust. Stead et al. (2022) proposed methods for increasing the

vaccination status of homeless people. On the other hand, there are a significant number of

homeless people, both past and present, who are willing to receive vaccination and return to

their normal daily lives (Knight et al., 2021).

Another literature pertaining to this theme is a study conducted in Africa where it

determined that due to multiple accessibility and socio-economic limitations, homeless

people are not able to utilize healthcare services in Africa (Osei Asibey et al., 2020). The

hospital and clinic services, complementary services, and modern contraceptives are

underutilized by homeless people. It was suggested that non-governmental organizations

can provide stigma-free health care and social assistance for these people.  In contrast to

this, a study conducted in Rome, Italy revealed that healthcare service utilization was well

utilized by homeless migrants due to the improvement of  accessibility to healthcare

facilities. The study determined that compared to the Italian-born homeless population,

migrants utilize the ambulatory clinic more, hence the implementation of a series of

migrant-oriented practices may effectively increase the utilization of health care services by

these people (Silverstrini, 2017). Similarly, homeless children in Dublin, Ireland utilized

healthcare services especially the pediatric emergency department more than non-homeless

children but are less likely to receive primary health care (O’brien et al., 2022). It has been
indicated that they are less likely to be fully vaccinated and are more likely to be partially or

completely unvaccinated.

Synthesis

In the first wave of the pandemic, the emotions filled the hearts of the homeless

people were loneliness and sadness, where they felt as a left-out. Studies showed that the

coping mechanisms of homeless people vary depending on the place and environment they

are living in. This includes alcohol intake, substance and nicotine use for these mechanisms

to help them forget that COVID is present. Factors that contribute to this is the lockdown of

public services where homeless people thrive to survive this pandemic despite having very

limited resources.  In line with this, homeless people are prone to catch COVID19 and that

their health are in risk especially having no resources and unavailability of grasping health

needs. Furthermore, most studies reveal that there is a prevalence of underutilized

healthcare services for homeless people due to multiple factors. The stigma against them

that hinders them from seeking health care. Understanding them on a personal level and

approaching them with compassion are essential to help them seek health care more often.

Their perception of the COVID-19 vaccine also influences their use of healthcare services

such as vaccination. The homeless persons’ demographic profile contributes to this

underutilization of healthcare services. Among this pool of literature, there are no studies

that have been conducted in the Philippines, nor are there any available healthcare services

by governmental organizations that could start one. There are also suggestions for

additional research because there is a lack of knowledge about the relationship between

healthcare services and the homeless population. In addition to that, the need of attention

and emphasis to homeless people here in the Philippines is a must, also to make more

activities where the goal is to render services for those kind of people. Those people who
are considered to be homeless are ones who are more vulnerable to the pandemic we are

facing today. Being aware of the fact, our medical professionals are being urged to pay heed

to the needs of the people who are in need of healthcare the most. Being able to effectively

provide care to the homeless will educate them to seek the help from the professionals

rather than brace the diseases themselves. Having accessible healthcare facilities not only

promote inclusiveness but also health education to the homeless and reliability towards the

health care providers. 

References 

World Health Organization. (2022). Weekly epidemiological update on COVID-19 - 28

September 2022. https://www.who.int/publications/m/item/weekly-epidemiological-update-

on-covid-19---28-september-2022

Philippines: WHO Coronavirus Disease (COVID-19) Dashboard With Vaccination Data.

(n.d.). WHO Coronavirus (COVID-19) Dashboard With Vaccination Data. Retrieved

October 2, 2022, from https://covid19.who.int/region/wpro/country/ph/

Department of Health Philippines. (2022) National COVID-19 Vaccination Dashboard

https://doh.gov.ph/covid19-vaccination-dashboard

Jadloc, M. (2021). UPD, WHO Philippines vaccinate at-risk population. University of the

Philippines Diliman. https://upd.edu.ph/upd-who-philippines-vaccinate-at-risk-population/

Dieumegard, G., Nogry, S., Ollagnier-Beldame, M., & Perrin, N. (2021, December). Lived

experience as a unit of analysis for the study of learning. Learning, Culture and Social

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