The document describes a project using photovoice methodology to assess the health care needs of homeless families. National guidelines addressed access to health care, basic needs, and social support. Participants took photographs related to these areas and their health. The intended outcomes were to empower participants, increase community awareness of homeless health needs, promote awareness of the guidelines, and stimulate dialogue to improve services. The assessment found themes aligned with the guidelines around food, shelter, and safety. Non-guideline themes involved control, strengths, and emotions.

1. National Guidelines for Care of the Homeless
The National Guideline ‘Adapting Your Practice: General Recommendations for the Care of
Homeless Patients’ ([Guideline] Bonin et al., 2010) was developed and supported by the Bureau
of Primary Health Care, Health Resources and Services Administration, and the U.S. Department
of Health and Human Services. These guidelines were developed by clinicians and providers
from across the United States who have extensive experience delivering care and services to the
homeless population within the primary care setting. This project addressed three main areas of
the Guideline most appropriate for community health care providers.
Access and continuity of health care (including barriers and services)
Basic needs (food, shelter, and safety)
Social support systems
Information on the Guideline can be found at: http://www.guideline.gov/content.aspx?id=16325
Photovoice Assessment
Photovoice enables individuals to self­select issues of greatest importance to them and
communicate these concerns or realities through photographs to policy makers, healthcare
providers, and influential advocates who might, unlike them, have a “voice” or be in a position to
make changes for their benefit. Photographs, as visual images, along with an analysis of the
descriptions of the meanings attached to these photographs is a powerful method to explore and
address the realities and perspective of vulnerable populations regarding their health and health
care needs. The participants for this project were asked to take photographs of:
The three areas identified in the Guideline
o Health care access
o Basic needs
o Social support
Anything they felt that affects their health both positively or negatively
Information on Photovoice methodology can be found at:
http://heb.sagepub.com/content/24/3/369.short
Outcomes of Project
The intended outcomes of this project include:
Empowerment of the participants
Increased awareness of health care needs of homeless families within the community
Awareness of National Guideline
Promotion of dialogue; involving local leaders, policy makers and the community that
may lead to improvement of delivery of services to the homeless
*On the other side of this page are some of the results of the assessment and comparison to the Guideline.
Table 1. GuidelineThemes

2. Guideline foci Themes identified Number of Participants who
identified themes through
photographs, stories and interviews
Nutrition/Food Access to food (at least 2 meals/day) 13
Lack of food choices/nutritional food 9
Statements about being hungry 4
Shelter/Housing Shelter/Housing (nights on street) 13
(1 night for one family)
Lack of permanency 12
Communal living concerns/lack of privacy 10
Hygiene concerns 9
Housed during project 2
Safety/Security Concern about personal belongings 7
Generally feels safe 5
Concern about personal safety 2
Support/Resources Initial family/friend support 12
Lack of job resources/concerns 11
Transportation 11
Financial concerns 11
‘Spend Down’ concerns 10
Faith 7
Healthcare Access and
Concerns
Health insurance 11
Health issues/illness 7
Medications 6
Emergency room visits (over last 6 months) 6
Self­reported Mental Health issues 5
Primary Physician 4
Co­pays 4
Table 2. Non­Guideline Themes
Theme Theme description Number of Participants
who identified themes
through photographs,
stories or interviews
Control Parenting issues/concerns 13
Choices/Lack of control 13
Rules 11
Strengths Resilience/Hope/Determination 12
Coping and Survival Strategies 9
Emotions Desire for a Sense of Normalcy 11
Dehumanizing feelings/frustrations 11
Perceptions of others towards self 11
Thankfulness/Appreciation 6