标题：Opportunities for Engaging Low-Income, Vulnerable Populations in Health Care: A Systematic Review of Homeless Persons’ Access to and Use of Information Technologies
摘要：We systematically reviewed the health and social science literature on access to and use of information technologies by homeless persons by searching 5 bibliographic databases. Articles were included if they were in English, represented original research, appeared in peer-reviewed publications, and addressed our research questions. Sixteen articles met our inclusion criteria. We found that mobile phone ownership ranged from 44% to 62%; computer ownership, from 24% to 40%; computer access and use, from 47% to 55%; and Internet use, from 19% to 84%. Homeless persons used technologies for a range of purposes, some of which were health related. Many homeless persons had access to information technologies, suggesting possible health benefits to developing programs that link homeless persons to health care through mobile phones and the Internet. The health of homeless persons is among the worst of any vulnerable group. Homeless persons experience high morbidity, and age-adjusted death rates are 2 to 4 times as high as those of the general US population. 1 Compared with the general population, emergency department use and hospitalization rates are higher and use of outpatient care is lower 2 among homeless persons, adding to inefficiencies in resource use. 3–5 Those who are homeless are also less likely to report having a regular source of health care and are more likely to have forgone needed care. 6 Despite their needs, access to and use of appropriate health care services by homeless persons is challenging. Previous studies have identified social and psychological barriers to care, including feeling suspicious of medical providers, 7,8 feeling stigmatized or unwelcome, 9,10 and having multiple competing needs such as shelter and food, 6 as well as systemic barriers such as limited insurance coverage. 11 Moreover, lack of a permanent address and traditional communication infrastructure (e.g., landline phones) can impede the ability of homeless persons and health care providers to communicate consistently and reliably. These challenges suggest a potential role for information technologies to facilitate access to health care and to improve disease self-management in the homeless population. Perhaps most notable, the rapid proliferation of mobile phones in the United States presents opportunities for health care systems to improve communication with homeless persons and to increase both their retention in care and the continuity of care that they receive. According to the Pew Research Center, 85% of American adults own a mobile phone. 12 A number of studies have shown that mobile phone technologies improve communication between health care providers and traditionally vulnerable populations, such as persons of lower socioeconomic status and those with stigmatized health conditions. 13–17 In light of these points, now may be an opportune time to develop and assess information technology–based outreach efforts for homeless populations in an effort to improve retention in, and continuity of, health care. As a first step toward this goal, we conducted a systematic review of the existing health and social sciences literature. Our overarching objective was to synthesize what is known about access to and use of information technologies in homeless populations. Our review was guided by 3 research questions: What is the prevalence of access to and use of information technologies (Internet, mobile phones, texting, etc.) by homeless populations? What are homeless persons’ purposes for using information technologies? What are the barriers to and facilitators of access to and use of information technologies by homeless populations?
