Exploring the health and healthcare needs of adults experiencing homelessness linked with primary care and addiction services in Dublin, Ireland: A community-based participatory research approach

The aim of this PhD was to conduct the first stage of Community-Based Participatory Research (CBPR) with people experiencing homelessness (PEH) linked with primary care and addiction services in Dublin city centre in partnership with a community health clinic. The chosen methodology for the CHNA was Rapid Participatory Appraisal (RPA) grounded in a social constructivist research paradigm which involved reviewing secondary data in the form of a systematic review and meta-analysis, conducting community expert interviews with professionals working with PEH in Dublin, and ethnographic fieldwork involving active participant observations and informal interviews with PEH attending the partner community health clinic. The methods used / findings stemming from each of the research components are reported separately within the thesis in the form of academic publications. Triangulated findings from the three RPA components revealed a set of priority concerns and research questions relating to recovery from illicit drugs and alcohol addiction, mental health, chronic-physical health conditions, parenting, social support, safety, ethnic disparities in health, and access to housing. The final component of the PhD used a pragmatic approach to explore one of these concerns – illicit drugs and alcohol addiction – in depth in order to refine a research question for subsequent stages of CBPR. A secondary data analysis of CE interviews and ethnographic field notes was conducted to identify barriers and enablers of addiction recovery within the target population using an existing framework, the Recovery Capital Assessment and Planning Tool (REC-CAP). This analysis resulted in a fourth academic publication and the identification of key factors enabling recovery within the target community (e.g., self-esteem and sense of purpose, physiological stability, meaningful employment, long-term housing). One of the foremost recovery enablers mentioned by PEH was the willingness of GPs to facilitate clients’ entry into residential stabilisation and addiction treatment facilities. However, community partners and experts explained their hesitation to promote non-medicalised treatment options for clients experiencing homelessness due to inadequate aftercare, and concerns about pushing clients too early or creating false hope. Thesis findings revealed uncertainty about this issue and whether GPs can / should promote recovery while a client is still in homelessness. A refined research question thus emerged relating to the co-design and implementation of care guidelines for GPs on holding recovery-oriented conversations with patients experiencing co-occurring homelessness and addiction.