@Article{info:doi/10.2196/63898,
author="Adams, Emily
and Donaghy, Eddie
and Sanders, Caroline
and Wolters, Klara Maria
and Ng, Lauren
and St-Jean, Christa
and Galan, Ryan
and Mercer, William Stewart",
title="Digital Interventions for Older People Experiencing Homelessness: Systematic Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="21",
volume="27",
pages="e63898",
keywords="homeless",
keywords="technology",
keywords="digital exclusion",
keywords="elderly",
keywords="rough sleeping",
keywords="digital intervention",
keywords="older people",
keywords="homelessness",
keywords="systematic scoping review",
keywords="aging",
keywords="premature mortality",
keywords="indicators",
keywords="scoping review",
keywords="databases",
keywords="thematic analysis",
keywords="telehealth",
keywords="mhealth",
keywords="ehealth",
abstract="Background: older people experiencing homelessness can have mental and physical indicators of aging several decades earlier than the general population and experience premature mortality due to age-related chronic conditions. Digital interventions could positively impact the health and well-being of homeless people. However, increased reliance on digital delivery may also perpetuate digital inequalities for socially excluded groups. The potential triple disadvantage of being older, homeless, and digitally excluded creates a uniquely problematic situation warranting further research. Few studies have synthesized available literature on digital interventions for older people experiencing homelessness. Objective: This scoping review examined the use, range, and nature of digital interventions available to older people experiencing homelessness and organizations supporting them. Methods: The scoping review followed Arksey and O'Malley's proposed methodology, PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, and recent Joanna Briggs Institute guidelines. We searched 14 databases. Gray literature sources were searched to supplement the electronic database search. A narrative synthesis approach was conducted on the included articles, and common themes were identified inductively through thematic analysis. Results: A total of 19,915 records were identified through database and gray literature searching. We identified 10 articles reporting on digital interventions that had a clearly defined a participant age group of >50 years or a mean participant age of >50 years. A total of 9 of 10 studies were published in the United States. The study design included descriptive studies, uncontrolled pilot studies, and pilot randomized controlled trials. No studies aimed to deliver an intervention exclusively to older people experiencing homelessness or organizations that supported them. Four types of intervention were identified: telecare for people experiencing homelessness, distributing technology to enable digital inclusion, text message reminders, and interventions delivered digitally. Interventions delivered digitally included smoking cessation support, vocational training, physical activity promotion, and cognitive behavioral therapy. Overall, the included studies demonstrated evidence for the acceptability and feasibility of digital interventions for older people experiencing homelessness, and all 10 studies reported some improvements in digital inclusion or enhanced engagement among participants. However, several barriers to digital interventions were identified, particularly aspects related to digital inclusion, such as infrastructure, digital literacy, and age. Proposed facilitators for digital interventions included organizational and peer support. Conclusions: Our findings highlight a paucity of evaluated digital interventions targeted at older people experiencing homelessness. However, the included studies demonstrated evidence of the acceptability and feasibility of digital interventions for older people experiencing homelessness. Further research on digital interventions that provide services and support older people experiencing homelessness is required. Future interventions must address the barriers older people experiencing homelessness face when accessing digital technology with the input of those with lived experience of homelessness. Trial Registration: OSF Registries OSF.IO/7QGTY; https://doi.org/10.17605/OSF.IO/7QGTY ",
doi="10.2196/63898",
url="https://www.jmir.org/2025/1/e63898"
}


@Article{info:doi/10.2196/58546,
author="Buetti, David
and Larche, Cynthia
and Fitzgerald, Michael
and Bourgeois, Isabelle
and Cameron, Erin
and Carr, Kady
and Aubry, Tim
and Persaud, Sydney
and Kendall, E. Claire",
title="Evaluating the Impacts of Community-Campus Engagement on Population Health in Ottawa and Thunder Bay, Canada: Protocol for a Mixed Methods Contribution Analysis",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="17",
volume="14",
pages="e58546",
keywords="community-campus engagement",
keywords="population health",
keywords="contribution analysis",
keywords="mixed methods",
keywords="health determinants",
keywords="community health",
keywords="CityStudio",
keywords="theory of change",
keywords="impact evaluation",
abstract="Background: Municipalities play a crucial role in population health due to their community connections and influence on health determinants. Community-campus engagement (CCE), that is, collaboration between academic institutions and communities, is a promising approach to addressing community health priorities. However, evidence of CCE's impact on population health remains limited. Measuring the impacts of CCE is inherently complex due to factors such as diverse stakeholders, context-specific variables, and dynamic interactions within a community. Objective: This study aims to develop robust evidence on the impacts of CCE on population health outcomes in Ottawa and Thunder Bay, Ontario, Canada, focusing on 5 shared health priorities: housing, discrimination, poverty, violence, and mental health. Methods: We will use a proven CCE model called CityStudio, which has been implemented in both cities. We will use Mayne's mixed methods contribution analysis in three stages: (1) formulating a theory of change that outlines the expected contributions of CCE to population health outcomes; (2) gathering qualitative and quantitative data in line with the established Theory of Change; the data will be collected from various sources, including case studies of existing CityStudio projects, a web-based CCE stakeholder survey, a literature review, and population and community health data; and (3) reviewing the gathered evidence to determine the extent of CCE impacts on population health. Results: Ethical approval for this project was granted in May 2023. We have since initiated stage 1 by reviewing the literature to inform the development of the theory of change. We expect to complete this study by May 2026. Conclusions: This study will address two critical gaps about how improving health outcomes depends on CCE: (1) how academic institutions can best engage with their communities to improve population health outcomes, and (2) how municipalities can engage with academic institutions to address their community health priorities. Conducting our work in differing contexts will allow us to consider a broader range of other influences on outcomes, thus making our work applicable to various settings and outcomes. International Registered Report Identifier (IRRID): PRR1-10.2196/58546 ",
doi="10.2196/58546",
url="https://www.researchprotocols.org/2025/1/e58546"
}


@Article{info:doi/10.2196/63445,
author="Ralevski, Alexandra
and Taiyab, Nadaa
and Nossal, Michael
and Mico, Lindsay
and Piekos, Samantha
and Hadlock, Jennifer",
title="Using Large Language Models to Abstract Complex Social Determinants of Health From Original and Deidentified Medical Notes: Development and Validation Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="19",
volume="26",
pages="e63445",
keywords="housing instability",
keywords="housing insecurity",
keywords="housing",
keywords="machine learning",
keywords="artificial intelligence",
keywords="AI",
keywords="large language model",
keywords="LLM",
keywords="natural language processing",
keywords="NLP",
keywords="electronic health record",
keywords="EHR",
keywords="electronic medical record",
keywords="EMR",
keywords="social determinants of health",
keywords="exposome",
keywords="pregnancy",
keywords="obstetric",
keywords="deidentification",
abstract="Background: Social determinants of health (SDoH) such as housing insecurity are known to be intricately linked to patients' health status. More efficient methods for abstracting structured data on SDoH can help accelerate the inclusion of exposome variables in biomedical research and support health care systems in identifying patients who could benefit from proactive outreach. Large language models (LLMs) developed from Generative Pre-trained Transformers (GPTs) have shown potential for performing complex abstraction tasks on unstructured clinical notes. Objective: Here, we assess the performance of GPTs on identifying temporal aspects of housing insecurity and compare results between both original and deidentified notes. Methods: We compared the ability of GPT-3.5 and GPT-4 to identify instances of both current and past housing instability, as well as general housing status, from 25,217 notes from 795 pregnant women. Results were compared with manual abstraction, a named entity recognition model, and regular expressions. Results: Compared with GPT-3.5 and the named entity recognition model, GPT-4 had the highest performance and had a much higher recall (0.924) than human abstractors (0.702) in identifying patients experiencing current or past housing instability, although precision was lower (0.850) compared with human abstractors (0.971). GPT-4's precision improved slightly (0.936 original, 0.939 deidentified) on deidentified versions of the same notes, while recall dropped (0.781 original, 0.704 deidentified). Conclusions: This work demonstrates that while manual abstraction is likely to yield slightly more accurate results overall, LLMs can provide a scalable, cost-effective solution with the advantage of greater recall. This could support semiautomated abstraction, but given the potential risk for harm, human review would be essential before using results for any patient engagement or care decisions. Furthermore, recall was lower when notes were deidentified prior to LLM abstraction. ",
doi="10.2196/63445",
url="https://www.jmir.org/2024/1/e63445"
}


@Article{info:doi/10.2196/53488,
author="Deng, Tianjie
and Urbaczewski, Andrew
and Lee, Jin Young
and Barman-Adhikari, Anamika
and Dewri, Rinku",
title="Identifying Marijuana Use Behaviors Among Youth Experiencing Homelessness Using a Machine Learning--Based Framework: Development and Evaluation Study",
journal="JMIR AI",
year="2024",
month="Oct",
day="17",
volume="3",
pages="e53488",
keywords="machine learning",
keywords="youth experiencing homelessness",
keywords="natural language processing",
keywords="infodemiology",
keywords="social good",
keywords="digital intervention",
abstract="Background: Youth experiencing homelessness face substance use problems disproportionately compared to other youth. A study found that 69\% of youth experiencing homelessness meet the criteria for dependence on at least 1 substance, compared to 1.8\% for all US adolescents. In addition, they experience major structural and social inequalities, which further undermine their ability to receive the care they need. Objective: The goal of this study was to develop a machine learning--based framework that uses the social media content (posts and interactions) of youth experiencing homelessness to predict their substance use behaviors (ie, the probability of using marijuana). With this framework, social workers and care providers can identify and reach out to youth experiencing homelessness who are at a higher risk of substance use. Methods: We recruited 133 young people experiencing homelessness at a nonprofit organization located in a city in the western United States. After obtaining their consent, we collected the participants' social media conversations for the past year before they were recruited, and we asked the participants to complete a survey on their demographic information, health conditions, sexual behaviors, and substance use behaviors. Building on the social sharing of emotions theory and social support theory, we identified important features that can potentially predict substance use. Then, we used natural language processing techniques to extract such features from social media conversations and reactions and built a series of machine learning models to predict participants' marijuana use. Results: We evaluated our models based on their predictive performance as well as their conformity with measures of fairness. Without predictive features from survey information, which may introduce sex and racial biases, our machine learning models can reach an area under the curve of 0.72 and an accuracy of 0.81 using only social media data when predicting marijuana use. We also evaluated the false-positive rate for each sex and age segment. Conclusions: We showed that textual interactions among youth experiencing homelessness and their friends on social media can serve as a powerful resource to predict their substance use. The framework we developed allows care providers to allocate resources efficiently to youth experiencing homelessness in the greatest need while costing minimal overhead. It can be extended to analyze and predict other health-related behaviors and conditions observed in this vulnerable community. ",
doi="10.2196/53488",
url="https://ai.jmir.org/2024/1/e53488"
}


@Article{info:doi/10.2196/53022,
author="Foster, Marva
and Fix, M. Gemmae
and Hyde, Justeen
and Dunlap, Shawn
and Byrne, H. Thomas
and Sugie, F. Naomi
and Kuhn, Randall
and Gabrielian, Sonya
and Roncarati, S. Jill
and Zhao, Shibei
and McInnes, Keith D.",
title="Capturing the Dynamics of Homelessness Through Ethnography and Mobile Technology: Protocol for the Development and Testing of a Smartphone Technology--Supported Intervention",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="22",
volume="13",
pages="e53022",
keywords="ethnography",
keywords="homelessness",
keywords="housing transitions",
keywords="longitudinal data",
keywords="military",
keywords="mobile technology",
keywords="smartphone",
keywords="social support",
keywords="veterans",
abstract="Background: US military veterans who have experienced homelessness often have high rates of housing transition. Disruptions caused by these transitions likely exacerbate this population's health problems and interfere with access to care and treatment engagement. Individuals experiencing homelessness increasingly use smartphones, contributing to improved access to medical and social services. Few studies have used smartphones as a data collection tool to systematically collect information about the daily life events that precede and contribute to housing transitions, in-the-moment emotions, behaviors, geographic movements, and perceived social support. Objective: The study aims to develop and test a smartphone app to collect longitudinal data from veterans experiencing homelessness (VEH) and to evaluate the feasibility and acceptability of using the app in a population that is unstably housed or homeless. Methods: This study's design had 3 phases. Phase 1 used ethnographic methods to capture detailed data on day-to-day lived experiences of up to 30 VEH on topics such as housing stability, health, and health behaviors. Phase 2 involved focus groups and usability testing to develop and refine mobile phone data collection methods. Phase 3 piloted the smartphone mobile data collection with 30 VEH. We included mobile ethnography, real-time surveys through an app, and the collection of GPS data in phase 3. Results: The project was launched in June 2020, and at this point, some data collection and analysis for phases 1 and 2 are complete. This project is currently in progress. Conclusions: This multiphase study will provide rich data on the context and immediate events leading to housing transitions among VEH. This study will ensure the development of a smartphone app that will match the actual needs of VEH by involving them in the design process from the beginning. Finally, this study will offer important insights into how best to develop a smartphone app that can help intervene among VEH to reduce housing transitions. International Registered Report Identifier (IRRID): DERR1-10.2196/53022 ",
doi="10.2196/53022",
url="https://www.researchprotocols.org/2024/1/e53022",
url="http://www.ncbi.nlm.nih.gov/pubmed/38648101"
}


@Article{info:doi/10.2196/46690,
author="Gaetz, Stephen
and Bonakdar, Ahmad
and Ecker, John
and MacDonald, Cora
and Ilyniak, Sophia
and Ward, Ashley
and Kimura, Lauren
and Vijayaratnam, Aranie
and Banchani, Emmanuel",
title="Evaluating the Effectiveness of the Housing First for Youth Intervention for Youth Experiencing Homelessness in Canada: Protocol for a Multisite, Mixed Methods Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Sep",
day="19",
volume="12",
pages="e46690",
keywords="youth homelessness",
keywords="Housing First for Youth",
keywords="Canada",
keywords="randomized controlled trial",
keywords="RCT",
keywords="Making the Shift",
abstract="Background: Emerging evidence at the international level suggests that the Housing First approach could improve the housing stability of young people experiencing homelessness. However, there is a dearth of literature in Canada on whether the Housing First intervention for young people experiencing homelessness can improve outcomes including housing stability, health and well-being, and access to complementary supports. Adapted from the original Housing First model, Housing First for Youth (HF4Y) was developed in Canada as a rights-based approach tailored specifically for young people aged 16 to 24 years who are experiencing or are at risk of homelessness. Objective: The Making the Shift Youth Homelessness Social Innovation Lab is testing the effectiveness of the HF4Y intervention in Canada. The objective of this study is to determine whether the HF4Y model results in better participant-level outcomes than treatment-as-usual services for young people experiencing homelessness in 2 urban settings: Ottawa and Toronto, Ontario. Primary outcomes include housing stability, health and well-being, and complementary supports, and secondary outcomes include employment and educational attainment and social inclusion. Methods: The HF4Y study used a multisite, mixed methods, randomized controlled trial research approach for data collection and analysis. Eligible participants included young people aged 16 to 24 years who were experiencing homelessness or housing precarity. The participants were randomly assigned to either the treatment-as-usual group or the housing first intervention group. Survey and interview data in Ottawa and Toronto, Ontario are being collected at multiple time points (3-6 months) over 4 years to capture a range of outcomes. Analytic strategies for quantitative data will include mixed-effects modeling for repeated measures and logistic models. A thematic analysis will be used to analyze qualitative data based on participants' narratives and life journeys through homelessness. Furthermore, program fidelity evaluations are conducted within each HF4Y program. These evaluations assess how well the intervention aligns with the HF4Y model and identify any areas that may require adjustments or additional support. Results: The HF4Y study has received human participant research ethics approval from the Office of Research Ethics at York University. Recruitment was conducted between February 2018 and March 2020. Data collection is expected to be completed at both sites by March 2024. A preliminary analysis of the quantitative and qualitative data collected between baseline and 24 months is underway. Conclusions: This pilot randomized controlled trial is the first to test the effectiveness of the HF4Y intervention in Canada. The findings of this study will enhance our understanding of how to effectively deliver and scale up the HF4Y intervention, with the aim of continually improving the HF4Y model to promote better outcomes for youth. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) ISRCTN10505930; https://www.isrctn.com/ISRCTN10505930 International Registered Report Identifier (IRRID): DERR1-10.2196/46690 ",
doi="10.2196/46690",
url="https://www.researchprotocols.org/2023/1/e46690",
url="http://www.ncbi.nlm.nih.gov/pubmed/37725430"
}


@Article{info:doi/10.2196/42404,
author="Mitchell, Eileen
and O'Reilly, Dermot
and O'Donovan, Diarmuid
and Bradley, Declan",
title="Predictors and Consequences of Homelessness: Protocol for a Cohort Study Design Using Linked Routine Data",
journal="JMIR Res Protoc",
year="2023",
month="Jul",
day="27",
volume="12",
pages="e42404",
keywords="administrative data",
keywords="data linkage",
keywords="health care use",
keywords="homelessness",
keywords="housing",
keywords="mortality",
abstract="Background: Homelessness is a global burden, estimated to impact more than 100 million people worldwide. Individuals and families experiencing homelessness are more likely to have poorer physical and mental health than the general population. Administrative data is being increasingly used in homelessness research. Objective: The objective of this study is to combine administrative health care data and social housing data to better understand the consequences and predictors associated with being homeless. Methods: We will be linking health and social care administrative databases from Northern Ireland, United Kingdom. We will conduct descriptive analyses to examine trends in homelessness and investigate risk factors for key outcomes. Results: The results of our analyses will be shared with stakeholders, reported at conferences and in academic journals, and summarized in policy briefing notes for policymakers. Conclusions: This study will aim to identify predictors and consequences of homelessness in Northern Ireland using linked housing, health, and social care data. The findings of this study will examine trends and outcomes in this vulnerable population using routinely collected health and social care administrative data. International Registered Report Identifier (IRRID): DERR1-10.2196/42404 ",
doi="10.2196/42404",
url="https://www.researchprotocols.org/2023/1/e42404",
url="http://www.ncbi.nlm.nih.gov/pubmed/37498664"
}


@Article{info:doi/10.2196/43511,
author="Liyanage, Ravihari Chandreen
and Mago, Vijay
and Schiff, Rebecca
and Ranta, Ken
and Park, Aaron
and Lovato-Day, Kristyn
and Agnor, Elise
and Gokani, Ravi",
title="Understanding Why Many People Experiencing Homelessness Reported Migrating to a Small Canadian City: Machine Learning Approach With Augmented Data",
journal="JMIR Form Res",
year="2023",
month="May",
day="2",
volume="7",
pages="e43511",
keywords="data augmentation",
keywords="feature selection",
keywords="homelessness",
keywords="machine learning",
keywords="migrants",
abstract="Background: Over the past years, homelessness has become a substantial issue around the globe. The largest social services organization in Thunder Bay, Ontario, Canada, has observed that a majority of the people experiencing homelessness in the city were from outside of the city or province. Thus, to improve programming and resource allocation for people experiencing homelessness in the city, including shelter use, it was important to investigate the trends associated with homelessness and migration. Objective: This study aimed to address 3 research questions related to homelessness and migration in Thunder Bay: What factors predict whether a person who migrated to the city and is experiencing homelessness stays or leaves shelters? If an individual stays, how long are they likely to stay? What factors predict stay duration? Methods: We collected the required data from 2 sources: a survey conducted with people experiencing homelessness at 3 homeless shelters in Thunder Bay and the database of a homeless information management system. The records of 110 migrants were used for the analysis. Two feature selection techniques were used to address the first and third research questions, and 8 machine learning models were used to address the second research question. In addition, data augmentation was performed to improve the size of the data set and to resolve the class imbalance problem. The area under the receiver operating characteristic curve value and cross-validation accuracy were used to measure the models' performances while avoiding possible model overfitting. Results: Factors predicting an individual's stay duration included home or previous district, highest educational qualification, recent receipt of mental health support, migrating to visit family or friends, and finding employment upon arrival. For research question 2, among the classification models developed for predicting the stay duration of migrants, the random forest and gradient boosting tree models presented better results with area under the receiver operating characteristic curve values of 0.91 and 0.93, respectively. Finally, home district, band membership, status card, previous district, and recent support for drug and/or alcohol use were recognized as the factors predicting stay duration. Conclusions: Applying machine learning enables researchers to make predictions related to migrants' homelessness and investigate how various factors become determinants of the predictions. We hope that the findings of this study will aid future policy making and resource allocation to better serve people experiencing homelessness. However, further improvements in the data set size and interpretation of the identified factors in decision-making are required. ",
doi="10.2196/43511",
url="https://formative.jmir.org/2023/1/e43511",
url="http://www.ncbi.nlm.nih.gov/pubmed/37129936"
}


@Article{info:doi/10.2196/46782,
author="Henwood, F. Benjamin
and Kuhn, Randall
and Padwa, Howard
and Ijadi-Maghsoodi, Roya
and Corletto, Gisele
and Lawton, Alex
and Chien, Jessie
and Bluthenthal, Ricky
and Cousineau, R. Michael
and Chinchilla, Melissa
and Tran Smith, Bikki
and Vickery, D. Katherine
and Harris, Taylor
and Patanwala, Maria
and Akabike, Whitney
and Gelberg, Lillian",
title="Investigating the Comparative Effectiveness of Place-Based and Scatter-Site Permanent Supportive Housing for People Experiencing Homelessness During the COVID-19 Pandemic: Protocols for a Mixed Methods, Prospective Longitudinal Study",
journal="JMIR Res Protoc",
year="2023",
month="Apr",
day="28",
volume="12",
pages="e46782",
keywords="homelessness",
keywords="housing first",
keywords="permanent supportive housing",
keywords="COVID-19",
keywords="homeless",
keywords="housing",
keywords="health outcome",
keywords="patient-centered",
keywords="person-centered",
keywords="photo-elicitation",
abstract="Background: Permanent supportive housing (PSH) is an evidence-based practice to address homelessness that is implemented using 2 distinct approaches. The first approach is place-based PSH (PB-PSH), or single-site housing placement, in which an entire building with on-site services is designated for people experiencing homelessness. The second approach is scatter-site PSH (SS-PSH), which uses apartments rented from a private landlord while providing mobile case management services. Objective: This paper describes the protocols for a mixed methods comparative effectiveness study of 2 distinct approaches to implementing PSH and the patient-centered quality of life, health care use, and health behaviors that reduce COVID-19 risk. Methods: People experiencing homelessness who are placed in either PB-PSH or SS-PSH completed 6 monthly surveys after move-in using smartphones provided by the study team. A subsample of participants completed 3 qualitative interviews at baseline, 3 months, and 6 months that included photo elicitation interviewing. Two stakeholder advisory groups, including one featuring people with lived experience of homelessness, helped guide study decisions and interpretations of findings. Results: Study recruitment was supposed to occur over 6 months starting in January 2021 but was extended due to delays in recruitment. These delays included COVID-19 delays (eg, recruitment sites shut down due to outbreaks and study team members testing positive) and delays that may have been indirectly related to the COVID-19 pandemic, including high staff turnover or recruitment sites having competing priorities. In end-July 2022, in total, 641 people experiencing homelessness had been referred from 26 partnering recruitment sites, and 563 people experiencing homelessness had enrolled in the study and completed a baseline demographic survey. Of the 563 participants in the study, 452 had recently moved into the housing when they enrolled, with 272 placed in PB-PSH and 180 placed in SS-PSH. Another 111 participants were approved but are still waiting for housing placement. To date, 49 participants have been lost to follow-up, and 12\% of phones (70 of the initial 563 distributed) were reported lost by participants. Conclusions: Recruitment during the pandemic, while successful, was challenging given that in-person contact was not permitted at times either by program sites or the research institutions during COVID-19 surges and high community transmission, which particularly affected homelessness programs in Los Angeles County. To overcome recruitment challenges, flexible strategies were used, which included extending the recruitment period and the distribution of cell phones with paid data plans. Given current recruitment numbers and retention rates that are over 90\%, the study will be able to address a gap in the literature by considering the comparative effectiveness of PB-PSH versus SS-PSH on patient-centered quality of life, health care use, and health behaviors that reduce COVID-19 risk, which can influence future public health approaches to homelessness and infectious diseases. Trial Registration: ClinicalTrials.gov NCT04769349; https://clinicaltrials.gov/ct2/show/NCT04769349 International Registered Report Identifier (IRRID): DERR1-10.2196/46782 ",
doi="10.2196/46782",
url="https://www.researchprotocols.org/2023/1/e46782",
url="http://www.ncbi.nlm.nih.gov/pubmed/37115590"
}


@Article{info:doi/10.2196/45309,
author="Ilyas, Yousaf
and Hassanbeigi Daryani, Shahrzad
and Kiriella, Dona
and Pachwicewicz, Paul
and Boley, A. Randy
and Reyes, M. Karen
and Smith, L. Dale
and Zalta, K. Alyson
and Schueller, M. Stephen
and Karnik, S. Niranjan
and Stiles-Shields, Colleen",
title="Geolocation Patterns, Wi-Fi Connectivity Rates, and Psychiatric Symptoms Among Urban Homeless Youth: Mixed Methods Study Using Self-report and Smartphone Data",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="18",
volume="7",
pages="e45309",
keywords="mHealth",
keywords="mobile health",
keywords="smartphones",
keywords="geolocation",
keywords="Wi-Fi",
keywords="youth experiencing homelessness",
keywords="mobile phone",
keywords="homelessness",
keywords="youth",
abstract="Background: Despite significant research done on youth experiencing homelessness, few studies have examined movement patterns and digital habits in this population. Examining these digital behaviors may provide useful data to design new digital health intervention models for youth experiencing homelessness. Specifically, passive data collection (data collected without extra steps for a user) may provide insights into lived experience and user needs without putting an additional burden on youth experiencing homelessness to inform digital health intervention design. Objective: The objective of this study was to explore patterns of mobile phone Wi-Fi usage and GPS location movement among youth experiencing homelessness. Additionally, we further examined the relationship between usage and location as correlated with depression and posttraumatic stress disorder (PTSD) symptoms. Methods: A total of 35 adolescent and young adult participants were recruited from the general community of youth experiencing homelessness for a mobile intervention study that included installing a sensor data acquisition app (Purple Robot) for up to 6 months. Of these participants, 19 had sufficient passive data to conduct analyses. At baseline, participants completed self-reported measures for depression (Patient Health Questionnaire-9 [PHQ-9]) and PTSD (PTSD Checklist for DSM-5 [PCL-5]). Behavioral features were developed and extracted from phone location and usage data. Results: Almost all participants (18/19, 95\%) used private networks for most of their noncellular connectivity. Greater Wi-Fi usage was associated with a higher PCL-5 score (P=.006). Greater location entropy, representing the amount of variability in time spent across identified clusters, was also associated with higher severity in both PCL-5 (P=.007) and PHQ-9 (P=.045) scores. Conclusions: Location and Wi-Fi usage both demonstrated associations with PTSD symptoms, while only location was associated with depression symptom severity. While further research needs to be conducted to establish the consistency of these findings, they suggest that the digital patterns of youth experiencing homelessness offer insights that could be used to tailor digital interventions. ",
doi="10.2196/45309",
url="https://formative.jmir.org/2023/1/e45309",
url="http://www.ncbi.nlm.nih.gov/pubmed/37071457"
}


@Article{info:doi/10.2196/41939,
author="Lal, Shalini
and Elias, Sarah
and Sieu, Vida
and Peredo, Rossana",
title="The Use of Technology to Provide Mental Health Services to Youth Experiencing Homelessness: Scoping Review",
journal="J Med Internet Res",
year="2023",
month="Jan",
day="16",
volume="25",
pages="e41939",
keywords="digital equity",
keywords="homelessness",
keywords="telemedicine",
keywords="telehealth",
keywords="cellular phone",
keywords="internet",
keywords="e-mental health",
keywords="digital health",
keywords="mobile health",
keywords="mHealth",
keywords="literature review",
keywords="mobile phone",
abstract="Background: There is growing interest in using information and communication technologies (ICTs) to improve access to mental health services for youth experiencing homelessness (YEH); however, limited efforts have been made to synthesize this literature. Objective: This study aimed to review the research on the use of ICTs to provide mental health services and interventions for YEH. Methods: We used a scoping review methodology following the Arksey and O'Malley framework and guidelines from the Joanna Briggs Institute Manual for Evidence Synthesis. The results are reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A systematic search was conducted from 2005 to 2021 in MEDLINE, Embase, CINAHL, PsycInfo, Cochrane, Web of Science, and Maestro and in ProQuest Thesis and Dissertations, Papyrus, Homeless Hub, and Google Scholar for gray literature. Studies were included if participants' mean age was between 13 and 29 years, youth with mental health issues were experiencing homelessness or living in a shelter, ICTs were used as a means of intervention, and the study provided a description of the technology. The exclusion criteria were technology that did not allow for interaction (eg, television) and languages other than French or English. The data were analyzed using descriptive statistics and qualitative approaches. Two reviewers were involved in the screening and data extraction process in consultation with a third reviewer. The data were summarized in tables and by narrative synthesis. Results: From the 2153 abstracts and titles screened, 12 were included in the analysis. The most common types of ICTs used were communication technologies (eg, phone, video, and SMS text messages) and mobile apps. The intervention goals varied widely across studies; the most common goal was reducing risky behaviors, followed by addressing cognitive functioning, providing emotional support, providing vital resources, and reducing anxiety. Most studies (9/11, 82\%) focused on the feasibility of interventions. Almost all studies reported high levels of acceptability (8/9, 89\%) and moderate to high frequency of use (5/6, 83\%). The principal challenges were related to technical problems such as the need to replace phones, issues with data services, and phone charging. Conclusions: Our results indicate the emerging role of ICTs in the delivery of mental health services to YEH and that there is a high level of acceptability based on early feasibility studies. However, our results should be interpreted cautiously, considering the limited number of studies included in the analysis and the elevated levels of dropout. There is a need to advance efficacy and effectiveness research in this area with larger and longer studies. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2022-061313 ",
doi="10.2196/41939",
url="https://www.jmir.org/2023/1/e41939",
url="http://www.ncbi.nlm.nih.gov/pubmed/36645703"
}


@Article{info:doi/10.2196/42113,
author="Eachus, Emily
and Rasul, Taha
and Henderson, Armen",
title="Melanoma Identification and Management in an Unsheltered Male Using Teledermatology: Street Medicine Perspective",
journal="JMIR Dermatol",
year="2022",
month="Nov",
day="4",
volume="5",
number="4",
pages="e42113",
keywords="skin cancer",
keywords="REDCap",
keywords="homelessness",
keywords="melanoma",
keywords="teledermatology",
keywords="street medicine",
keywords="dermatology",
keywords="homeless",
keywords="case report",
keywords="case study",
keywords="skin lesion",
keywords="biopsy",
keywords="dermatologist",
keywords="insurance",
keywords="low income",
keywords="health coverage",
keywords="skin",
keywords="cancer",
doi="10.2196/42113",
url="https://derma.jmir.org/2022/4/e42113",
url="http://www.ncbi.nlm.nih.gov/pubmed/37632907"
}


@Article{info:doi/10.2196/38729,
author="Rad{\'o}, N{\'o}ra
and Girasek, Edmond
and B{\'e}k{\'a}si, S{\'a}ndor
and Gy?rffy, Zsuzsa",
title="Digital Technology Access and Health-Related Internet Use Among People Experiencing Homelessness in Hungary: Quantitative Survey",
journal="J Med Internet Res",
year="2022",
month="Oct",
day="19",
volume="24",
number="10",
pages="e38729",
keywords="homelessness",
keywords="digital technology",
keywords="internet",
keywords="access",
keywords="internet use",
keywords="homeless shelter",
keywords="digital equity",
keywords="mobile phone",
abstract="Background: In recent years, there has been an increase in the use of digital technology for personal health and well-being. Previous research has revealed that these technologies might provide vulnerable populations, including those who are homeless, better access to health services and thus a greater chance of more personalized care. Objective: However, little is known about the relationship between technology and health among people experiencing homelessness in Central and Eastern Europe. This study is part of a series of studies by the Digital Health Research Group at Semmelweis University (Budapest, Hungary) in cooperation with the Hungarian Charity Service of the Order of Malta; it aims to assess the existing technological resources available for the homeless population and their health-related internet use characteristics to set the ground for potential health policy interventions, enabling better access to health services by strengthening the digital components of the existing health care system. Methods: Between April 19, 2021, and August 11, 2021, a total of 662 people from 28 institutions providing social services for people experiencing homelessness in Budapest, Hungary, were surveyed about their access to digital tools and internet use patterns. For selected questions, the responses of a representative sample of the Hungarian population were used for comparison as the reference group. Chi-square tests and logistic regression analyses were performed to identify variables affecting internet use for health-related reasons. Results: The results demonstrated a considerable level of internet use in the homeless population; 52.9\% (350/662) of the respondents used the internet frequently compared with 81.3\% (1220/1500) of the respondents in the reference group. Among the homeless group, 69.6\% (461/662) of the respondents reported mobile phone ownership, and 39.9\% (264/662) of the respondents added that it had a smartphone function. Moreover, 11.2\% (70/662) of the respondents had already used a health mobile app, and 34.6\% (229/662) of the respondents had used the internet for medical purposes. On the basis of these characteristics, we were able to identify a broadly defined, digitally engaged group among people experiencing homelessness (129/662, 19.5\%). This subpopulation was inclined to benefit from digitalization related to their personal health. Multivariate analysis demonstrated that internet use for health reasons was more significant for younger respondents, women, those with higher levels of education, and those with no chronic conditions. Conclusions: Although compared with the general population, health-related internet use statistics are lower, our results show that the idea of involving homeless populations in the digital health ecosystem is viable, especially if barriers to access are systematically reduced. The results show that digital health services have great promise as another tool in the hands of community shelters for keeping homeless populations well ingrained in the social infrastructure as well as for disease prevention purposes. ",
doi="10.2196/38729",
url="https://www.jmir.org/2022/10/e38729",
url="http://www.ncbi.nlm.nih.gov/pubmed/36260379"
}


@Article{info:doi/10.2196/33387,
author="Semborski, Sara
and Henwood, Benjamin
and Redline, Brian
and Dzubur, Eldin
and Mason, Tyler
and Intille, Stephen",
title="Feasibility and Acceptability of Ecological Momentary Assessment With Young Adults Who Are Currently or Were Formerly Homeless: Mixed Methods Study",
journal="JMIR Form Res",
year="2022",
month="Mar",
day="25",
volume="6",
number="3",
pages="e33387",
keywords="ecological momentary assessment",
keywords="homelessness",
keywords="young adults",
keywords="reactivity",
keywords="compliance",
keywords="mobile phone",
abstract="Background: Ecological momentary assessment (EMA) has been used with young people experiencing homelessness to gather information on contexts associated with homelessness and risk behavior in real time and has proven feasible in this population. However, the extent to which EMA may affect the attitudes or behaviors of young adults who are currently or were formerly homeless and are residing in supportive housing has not been well investigated. Objective: This study aims to describe the feedback regarding EMA study participation from young adults who are currently or were formerly homeless and examine the reactivity to EMA participation and compliance. Methods: This mixed methods study used cross-sectional data collected before and after EMA, intensive longitudinal data from a 7-day EMA prompting period, and focus groups of young adults who are currently or were formerly homeless in Los Angeles, California, between 2017 and 2019. Results: Qualitative data confirmed the quantitative findings. Differences in the experience of EMA between young adults who are currently or were formerly homeless were found to be related to stress or anxiety, interference with daily life, difficulty charging, behavior change, and honesty in responses. Anxiety and depression symptomatology decreased from before to after EMA; however, compliance was not significantly associated with this decrease. Conclusions: The results point to special considerations when administering EMA to young adults who are currently or were formerly homeless. EMA appears to be slightly more burdensome for young adults who are currently homeless than for those residing in supportive housing, which are nuances to consider in the study design. The lack of a relationship between study compliance and symptomatology suggests low levels of reactivity. ",
doi="10.2196/33387",
url="https://formative.jmir.org/2022/3/e33387",
url="http://www.ncbi.nlm.nih.gov/pubmed/35333187"
}


@Article{info:doi/10.2196/25553,
author="Moczygemba, R. Leticia
and Thurman, Whitney
and Tormey, Kyler
and Hudzik, Anthony
and Welton-Arndt, Lauren
and Kim, Elizabeth",
title="GPS Mobile Health Intervention Among People Experiencing Homelessness: Pre-Post Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Nov",
day="3",
volume="9",
number="11",
pages="e25553",
keywords="GPS",
keywords="mHealth",
keywords="care coordination",
keywords="people experiencing homelessness",
keywords="homelessness",
keywords="emergency department",
keywords="health outcomes",
keywords="health care costs",
keywords="mobile phone",
abstract="Background: People experiencing homelessness are at risk for gaps in care after an emergency department (ED) or hospital visit, which leads to increased use, poor health outcomes, and high health care costs. Most people experiencing homelessness have a mobile phone of some type, which makes mobile health (mHealth) interventions a feasible way to connect a person experiencing homelessness with providers. Objective: This study aims to investigate the accuracy, acceptability, and preliminary outcomes of a GPS-enabled mHealth (GPS-mHealth) intervention designed to alert community health paramedics when people experiencing homelessness are in the ED or hospital. Methods: This study was a pre-post design with baseline and 4-month postenrollment assessments. People experiencing homelessness, taking at least 2 medications for chronic conditions, scoring at least 10 on the Patient Health Questionnaire-9, and having at least 2 ED or hospital visits in the previous 6 months were eligible. Participants were issued a study smartphone with a GPS app programmed to alert a community health paramedic when a participant entered an ED or hospital. For each alert, community health paramedics followed up via telephone to assess care coordination needs. Participants also received a daily email to assess medication adherence. GPS alerts were compared with ED and hospital data from the local health information exchange (HIE) to assess accuracy. Paired t tests compared scores on the Patient Health Questionnaire-9, Medical Outcomes Study Social Support Survey, and Adherence Starts with Knowledge-12 adherence survey at baseline and exit. Semistructured exit interviews examined the perceptions and benefits of the intervention. Results: In total, 30 participants were enrolled; the mean age was 44.1 (SD 9.7) years. Most participants were male (20/30, 67\%), White (17/30, 57\%), and not working (19/30, 63\%). Only 19\% (3/16) of the ED or hospital visit alerts aligned with HIE data, mainly because of patients not having the smartphone with them during the visit, the smartphone being off, and gaps in GPS technology. There was a significant difference in depressive symptoms between baseline (mean 16.9, SD 5.8) and exit (mean 12.7, SD 8.2; t19=2.9; P=.009) and a significant difference in adherence barriers between baseline (mean 2.4, SD 1.4) and exit (mean 1.5, SD 1.5; t17=2.47; P=.03). Participants agreed that the app was easy to use (mean 4.4/5, SD 1.0, with 5=strongly agree), and the email helped them remember to take their medications (mean 4.6/5, SD 0.6). Qualitative data indicated that unlimited smartphone access allowed participants to meet social needs and maintain contact with case managers, health care providers, family, and friends. Conclusions: mHealth interventions are acceptable to people experiencing homelessness. HIE data provided more accurate ED and hospital visit information; however, unlimited access to reliable communication provided benefits to participants beyond the study purpose of improving care coordination. ",
doi="10.2196/25553",
url="https://mhealth.jmir.org/2021/11/e25553",
url="http://www.ncbi.nlm.nih.gov/pubmed/34730550"
}


@Article{info:doi/10.2196/27787,
author="Thurman, Whitney
and Semwal, Monika
and Moczygemba, R. Leticia
and Hilbelink, Mark",
title="Smartphone Technology to Empower People Experiencing Homelessness: Secondary Analysis        ",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="29",
volume="23",
number="9",
pages="e27787",
keywords="homelessness",
keywords="self-management",
keywords="smartphone technology",
keywords="social needs",
keywords="mobile phone",
abstract="Background: In the United States, the number of people experiencing homelessness has continually increased over the last 3 years. Homelessness is associated with poor health, and people experiencing homelessness are often burdened with high rates of chronic and mental health conditions, functional limitations, and cognitive impairment. Despite the high burden of chronic illness and functional limitations, there is limited literature exploring self-management among homeless populations. Objective: This study aims to investigate how access to smartphone technology facilitates self-management, including the attainment of social needs within the context of homelessness. Methods: A secondary analysis of 33 exit interviews from 2 feasibility studies related to mobile health interventions among people experiencing homelessness was conducted. Iterative thematic analysis was used to identify themes representative of participants' experiences using smartphone technology. Results: Collectively, participants revealed not only how the context of homelessness constrained their ability to engage in activities necessary to self-manage health and meet social needs but also how consistent and predictable access to the tools available through a smartphone changed their behaviors and outlook. The global theme of empowered by technology was identified and defined as how having a smartphone with a plan for unlimited text, calling, data, and transportation allowed participants to navigate homelessness and facilitated self-management. Conclusions: People experiencing homelessness used the tools on a smartphone to make decisions, take action, solve problems, and use the resources---skills necessary for fulfilling tasks required for effective self-management. Further, consistent access to smartphone technology and transportation empowered participants to meet the requirements for the attainment of social needs. ",
doi="10.2196/27787",
url="https://www.jmir.org/2021/9/e27787",
url="http://www.ncbi.nlm.nih.gov/pubmed/34586073"
}


@Article{info:doi/10.2196/26704,
author="Santa Maria, Diane
and Padhye, Nikhil
and Businelle, Michael
and Yang, Yijiong
and Jones, Jennifer
and Sims, Alexis
and Lightfoot, Marguerita",
title="Efficacy of a Just-in-Time Adaptive Intervention to Promote HIV Risk Reduction Behaviors Among Young Adults Experiencing Homelessness: Pilot Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="6",
volume="23",
number="7",
pages="e26704",
keywords="youth",
keywords="homelessness",
keywords="HIV",
keywords="prevention",
keywords="just-in-time adaptive interventions",
keywords="mHealth",
keywords="ecological momentary assessments",
keywords="drug use",
keywords="stress",
keywords="intervention",
keywords="smartphone",
keywords="mobile phone",
keywords="drug",
keywords="efficacy",
keywords="pilot",
keywords="feasibility",
keywords="predictor",
keywords="risk",
keywords="behavior",
abstract="Background: People experiencing homelessness have higher rates of HIV than those who are stably housed. Mental health needs, substance use problems, and issues unique to homelessness such as lack of shelter and transiency need to be considered with regard to HIV prevention. To date, HIV prevention interventions for young adults experiencing homelessness have not specifically addressed modifiable real-time factors such as stress, sexual or drug use urge, or substance use, or been delivered at the time of heightened risk. Real-time, personalized HIV prevention messages may reduce HIV risk behaviors. Objective: This pilot study tested the initial efficacy of an innovative, smartphone-based, just-in-time adaptive intervention that assessed predictors of HIV risk behaviors in real time and automatically provided behavioral feedback and goal attainment information. Methods: A randomized attention control design was used among young adults experiencing homelessness, aged 18-25 years, recruited from shelters and drop-in centers in May 2019. Participants were randomized to either a control or an intervention group. The intervention (called MY-RID [Motivating Youth to Reduce Infection and Disconnection]) consisted of brief messages delivered via smartphone over 6 weeks in response to preidentified predictors that were assessed using ecological momentary assessments. Bayesian hierarchical regression models were used to assess intervention effects on sexual activity, drug use, alcohol use, and their corresponding urges. Results: Participants (N=97) were predominantly youth (mean age 21.2, SD 2.1 years) who identified as heterosexual (n=51, 52\%), male (n=56, 57\%), and African American (n=56, 57\%). Reports of sexual activity, drug use, alcohol use, stress, and all urges (ie, sexual, drug, alcohol) reduced over time in both groups. Daily drug use reduced by a factor of 13.8 times over 6 weeks in the intervention group relative to the control group (Multimedia Appendix 4). Lower urges for sex were found in the intervention group relative to the control group over the duration of the study. Finally, there was a statistically significant reduction in reports of feeling stressed the day before between the intervention and control conditions (P=.03). Conclusions: Findings indicate promising intervention effects on drug use, stress, and urges for sex in a hard-to-reach, high-risk population. The MY-RID intervention should be further tested in a larger randomized controlled trial to further investigate its efficacy and impact on sexual risk behaviors. Trial Registration: ClinicalTrials.gov NCT03911024; https://clinicaltrials.gov/ct2/show/NCT03911024 ",
doi="10.2196/26704",
url="https://www.jmir.org/2021/7/e26704",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255679"
}


@Article{info:doi/10.2196/26716,
author="Santa Maria, Diane
and Lightfoot, Marguerita
and Nyamathi, Adey
and Businelle, Michael
and Paul, Mary
and Quadri, Yasmeen
and Padhye, Nikhil
and Jones, Jennifer
and Calvo Armijo, Margarita",
title="A Nurse Case Management HIV Prevention Intervention (Come As You Are) for Youth Experiencing Homelessness: Protocol for a Randomized Wait-list Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="21",
volume="10",
number="5",
pages="e26716",
keywords="HIV prevention",
keywords="nurse case management",
keywords="motivational interviewing",
keywords="homelessness",
keywords="youth",
keywords="just-in-time-adaptive intervention",
keywords="ecological momentary assessment",
abstract="Background: Youth experiencing homelessness are more likely than housed youth to experience premature death, suicide, drug overdose, pregnancy, substance use, and mental illness. Yet while youth experiencing homelessness are 6 to 12 times more likely to become infected with HIV than housed youth, with HIV prevalence as high as 16\%, many do not access the prevention services they need. Despite adversities, youth experiencing homelessness are interested in health promotion programs, can be recruited and retained in interventions and research studies, and demonstrate improved outcomes when programs are tailored and relevant to them. Objective: The study aims to compare the efficacy of a nurse case management HIV prevention and care intervention, titled Come As You Are, with that of usual care among youth experiencing homelessness aged 16 to 25 years. Methods: The study is designed as a 2-armed randomized wait-list controlled trial. Participants (n=450) will be recruited and followed up for 9 months after the intervention for a total study period of 12 months. Come As You Are combines nurse case management with a smartphone-based daily ecological momentary assessment to develop participant-driven HIV prevention behavioral goals that can be monitored in real-time. Youth in the city of Houston, Texas will be recruited from drop-in centers, shelters, street outreach programs, youth-serving organizations, and clinics. Results: Institutional review board approval (Committee for the Protection of Human Subjects, University of Texas Health Science Center at Houston) was obtained in November 2018. The first participant was enrolled in November 2019. Data collection is ongoing. To date, 123 participants have consented to participate in the study, 89 have been enrolled, and 15 have completed their final follow-up. Conclusions: There is a paucity of HIV prevention research regarding youth experiencing homelessness. Novel and scalable interventions that address the full continuum of behavioral and biomedical HIV prevention are needed. This study will determine whether a personalized and mobile HIV prevention approach can reduce HIV risk among a hard-to-reach, transient population of youth at high risk. International Registered Report Identifier (IRRID): DERR1-10.2196/26716 ",
doi="10.2196/26716",
url="https://www.researchprotocols.org/2021/5/e26716",
url="http://www.ncbi.nlm.nih.gov/pubmed/34018967"
}


@Article{info:doi/10.2196/21638,
author="Acorda, Darlene
and Businelle, Michael
and Santa Maria, Diane",
title="Perceived Impacts, Acceptability, and Recommendations for Ecological Momentary Assessment Among Youth Experiencing Homelessness: Qualitative Study",
journal="JMIR Form Res",
year="2021",
month="Apr",
day="6",
volume="5",
number="4",
pages="e21638",
keywords="youth experiencing homelessness",
keywords="ecological momentary assessment",
keywords="mobile apps",
keywords="behavior change",
abstract="Background: The use of ecological momentary assessment (EMA) to study youth experiencing homelessness (YEH) behaviors is an emerging area of research. Despite high rates of participation and potential clinical utility, few studies have investigated the acceptability and recommendations for EMA from the YEH perspective. Objective: This study aimed to describe the perceived benefits, usability, acceptability, and barriers to the use of EMA from the homeless youth perspective. Methods: YEH were recruited from a larger EMA study. Semistructured exit interviews were performed using an interview guide that focused on the YEH experience with the EMA app, and included perceived barriers and recommendations for future studies. Data analyses used an inductive approach with thematic analysis to identify major themes and subthemes. Results: A total of 18 YEH aged 19-24 years participated in individual and group exit interviews. The EMA was highly acceptable to YEH and they found the app and EMA surveys easy to navigate. Perceived benefits included increased behavioral and emotional awareness with some YEH reporting a decrease in their high-risk behaviors as a result of participation. Another significant perceived benefit was the ability to use the phones for social support and make connections to family, friends, and potential employers. Barriers were primarily survey and technology related. Survey-related barriers included the redundancy of questions, the lack of customizable responses, and the timing of survey prompts. Technology-related barriers included the ``freezing'' of the app, battery charge, and connectivity issues. Recommendations for future studies included the need to provide real-time mental health support for symptomatic youth, to create individually customized questions, and to test the use of personalized motivational messages that respond to the EMA data in real time. Conclusions: YEH are highly receptive to the use of EMA in studies. Further studies are warranted to understand the impact of EMA on YEH behaviors. Incorporating the YEH perspective into the design and implementation of EMA studies may help minimize barriers, increase acceptability, and improve participation rates in this hard-to-reach, disconnected population. ",
doi="10.2196/21638",
url="https://formative.jmir.org/2021/4/e21638",
url="http://www.ncbi.nlm.nih.gov/pubmed/33821805"
}


@Article{info:doi/10.2196/24122,
author="Rizvi, Rubina
and VanHouten, Courtney
and Bright, J. Tiffani
and McKillop, M. Mollie
and Alevy, Shira
and Brotman, David
and Sands-Lincoln, Megan
and Snowdon, Jane
and Robinson, J. Barbie
and Staats, Carolyn
and Jackson, P. Gretchen
and Kassler, J. William",
title="The Perceived Impact and Usability of a Care Management and Coordination System in Delivering Services to Vulnerable Populations: Mixed Methods Study",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="12",
volume="23",
number="3",
pages="e24122",
keywords="vulnerable population",
keywords="managed care",
keywords="data integration",
keywords="advanced technologies",
keywords="usability",
keywords="mixed methods study",
abstract="Background: People with complex needs, such as those experiencing homelessness, require concurrent, seamless support from multiple social service agencies. Sonoma County, California has one of the nation's largest homeless populations among largely suburban communities. To support client-centered care, the county deployed a Care Management and Coordination System (CMCS). This system comprised the Watson Care Manager (WCM), a front-end system, and Connect 360, which is an integrated data hub that aggregates information from various systems into a single client record. Objective: The aim of this study is to evaluate the perceived impact and usability of WCM in delivering services to the homeless population in Sonoma County. Methods: A mixed methods study was conducted to identify ways in which WCM helps to coordinate care. Interviews, observations, and surveys were conducted, and transcripts and field notes were thematically analyzed and directed by a grounded theory approach. Responses to the Technology Acceptance Model survey were analyzed. Results: A total of 16 participants were interviewed, including WCM users (n=8) and department leadership members (n=8). In total, 3 interdisciplinary team meetings were observed, and 8 WCM users were surveyed. WCM provided a central shared platform where client-related, up-to-date, comprehensive, and reliable information from participating agencies was consolidated. Factors that facilitated WCM use were users' enthusiasm regarding the tool functionalities, scalability, and agency collaboration. Constraining factors included the suboptimal awareness of care delivery goals and functionality of the system among the community, sensitivities about data sharing and legal requirements, and constrained funding from government and nongovernment organizations. Overall, users found WCM to be a useful tool that was easy to use and helped to enhance performance. Conclusions: WCM supports the delivery of care to individuals with complex needs. Integration of data and information in a CMCS can facilitate coordinated care. Future research should examine WCM and similar CMCSs in diverse populations and settings. ",
doi="10.2196/24122",
url="https://www.jmir.org/2021/3/e24122",
url="http://www.ncbi.nlm.nih.gov/pubmed/33709928"
}


@Article{info:doi/10.2196/18244,
author="Chavez, Johnson Laura
and Kelleher, Kelly
and Slesnick, Natasha
and Holowacz, Eugene
and Luthy, Ellison
and Moore, Laura
and Ford, Jodi",
title="Virtual Reality Meditation Among Youth Experiencing Homelessness: Pilot Randomized Controlled Trial of Feasibility",
journal="JMIR Ment Health",
year="2020",
month="Sep",
day="24",
volume="7",
number="9",
pages="e18244",
keywords="virtual reality",
keywords="meditation",
keywords="homelessness",
keywords="stress",
abstract="Background: Homelessness among youth is devastating, with high rates of substance use disorders and mental health comorbidity. Mindfulness-based interventions that include meditation and mindfulness skills training reduce stress and symptoms of anxiety or depression. However, engaging high-risk youth in interventions is challenging. Virtual reality is a more flexible platform for delivering meditation and may be appealing to youth. Objective: The study objectives were to evaluate the feasibility of delivering virtual reality meditation and of collecting outcome measures, including anxiety and physiologic stress. Methods: A sample of 30 youth experiencing homelessness was enrolled in the study. Youth were randomized to receive 10 minutes of one of three interventions: (1) virtual reality meditation, (2) audio meditation (through a web-based platform), or (3) virtual reality imagery of historical pictures and text. Subjects who consented to the study attended two research visits. The first visit collected survey measures of demographics, mental health, and substance use, and oriented subjects to the intervention platforms. The second visit (1-3 days later) delivered the intervention and collected pre and post outcome measures of anxiety and physiologic stress (salivary cortisol). Changes in anxiety and cortisol at the second visit were compared across groups using a linear regression model in which the primary analysis compared virtual reality meditation to audio meditation and secondary analyses compared virtual reality meditation to virtual reality imagery. Results: Anxiety scores decreased in all groups, with a larger reduction among the virtual reality meditation group (difference=10.8) compared to the web-based meditation or virtual reality images groups (difference=5.8 and 5.0, respectively). After controlling for baseline values, there were no significant group differences in changes in anxiety scores or cortisol levels. In comparing virtual reality meditation and audio meditation, the effect size for anxiety was moderate (Cohen d=0.58) while the effect size for cortisol was small (Cohen d=0.08). Conclusions: Preliminary results suggest that virtual reality meditation has a moderate benefit for anxiety but not physiologic stress. Future research is needed to confirm these results in a larger sample and to investigate whether the effects are sustained or increase with repeated use of virtual reality mediation. Virtual reality meditation appears feasible to deliver among homeless youth and merits further study. Trial Registration: ClinicalTrials.gov NCT04004520; https://clinicaltrials.gov/ct2/show/NCT04004520 ",
doi="10.2196/18244",
url="http://mental.jmir.org/2020/9/e18244/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32969834"
}


@Article{info:doi/10.2196/16401,
author="Hill, J. Brandon
and Motley, N. Darnell
and Rosentel, Kris
and VandeVusse, Alicia
and Garofalo, Robert
and Schneider, A. John
and Kuhns, M. Lisa
and Kipke, D. Michele
and Reisner, Sari
and Rupp, M. Betty
and Sanchez, Maria
and McCumber, Micah
and Renshaw, Laura
and West Goolsby, Rachel
and Loop, Shane Matthew",
title="An Employment Intervention Program (Work2Prevent) for Young Men Who Have Sex With Men and Transgender Youth of Color (Phase 2): Protocol for a Single-Arm Mixed Methods Pilot Test to Assess Feasibility and Acceptability",
journal="JMIR Res Protoc",
year="2020",
month="Aug",
day="10",
volume="9",
number="8",
pages="e16401",
keywords="HIV/AIDS",
keywords="YMSM",
keywords="YTW",
keywords="GNC youth",
keywords="LGBTQ",
keywords="unemployment",
keywords="homelessness",
keywords="sex work",
abstract="Background: Young cisgender men who have sex with men (YMSM), young transgender women (YTW), and gender nonconforming (GNC) youth of color face substantial economic and health disparities. In particular, HIV risk and infection among these groups remains a significant public health issue. In 2017, 17\% of all new HIV diagnoses were attributed to male-to-male sexual contact among adolescents and young adults aged 13 to 24 years. However, such disparities cannot be attributed to individual-level factors alone but rather are situated within larger social and structural contexts that marginalize and predispose YMSM, YTW, and GNC youth of color to increased HIV exposure. Addressing social and structural risk factors requires intervention on distal drivers of HIV risk, including employment and economic stability. The Work2Prevent (W2P) study aims to target economic stability through job readiness and employment as a structural-level intervention for preventing adolescent and young adult HIV among black and Latinx YMSM, YTW, and GNC youth. This study seeks to assess intervention feasibility and acceptability in the target populations and determine preliminary efficacy of the intervention to increase employment and reduce sexual risk behaviors. Objective: The goal of the research is to pilot-test a tailored, theoretically informed employment intervention program among YMSM, YTW, and GNC youth of color. This intervention was adapted from Increased Individual Income and Independence, an existing evidence-based employment program for HIV-positive adults during phase 1 of the W2P study. Methods: The employment intervention will be pilot-tested among vulnerable YMSM, YTW, and GNC youth of color in a single-arm pre-post trial to assess feasibility, acceptability, and preliminary estimates of efficacy. Results: Research activities began in March 2018 and were completed in November 2019. Overall, 5 participants were enrolled in the pretest and 51 participants were enrolled in the pilot. Conclusions: Interventions that address the social and structural drivers of HIV exposure and infection are sorely needed in order to successfully bend the curve in the adolescent and young adult HIV epidemic. Employment as prevention has the potential to be a scalable intervention that can be deployed among this group. Trial Registration: ClinicalTrials.gov NCT03313310; https://clinicaltrials.gov/ct2/show/NCT03313310 International Registered Report Identifier (IRRID): DERR1-10.2196/16401 ",
doi="10.2196/16401",
url="https://www.researchprotocols.org/2020/8/e16401",
url="http://www.ncbi.nlm.nih.gov/pubmed/32773376"
}


@Article{info:doi/10.2196/16384,
author="Hill, J. Brandon
and Motley, N. Darnell
and Rosentel, Kris
and VandeVusse, Alicia
and Garofalo, Robert
and Schneider, A. John
and Kuhns, M. Lisa
and Kipke, D. Michele
and Reisner, Sari
and Rupp, M. Betty
and Sanchez, Maria
and McCumber, Micah
and Renshaw, Laura
and Loop, Shane Matthew",
title="An Employment Intervention Program (Work2Prevent) for Young Men Who Have Sex With Men and Transgender Youth of Color (Phase 1): Protocol for Determining Essential Intervention Components Using Qualitative Interviews and Focus Groups",
journal="JMIR Res Protoc",
year="2020",
month="Aug",
day="10",
volume="9",
number="8",
pages="e16384",
keywords="HIV/AIDS",
keywords="YMSM",
keywords="YTW",
keywords="GNC youth",
keywords="LGBTQ",
keywords="unemployment",
keywords="homelessness",
keywords="sex work",
abstract="Background: HIV continues to have a disparate impact on young cisgender men who have sex with men (YMSM), young trans women (YTW), and gender-nonconforming (GNC) youth who are assigned male at birth. Outcomes are generally worse among youth of color. Experiences of discrimination and marginalization often limit educational attainment and may even more directly limit access to gainful employment. Though seemingly distal, these experiences influence young people's proximity to HIV risk by limiting their access to health care and potentially moving them toward sex work as a means of income as well as increased substance use. Work2Prevent (W2P) aims to achieve economic stability through employment as a structural-level intervention for preventing adolescent and young adult HIV infection. The study will pilot-test an effective, theoretically driven employment program (increased individual income and independence [iFOUR]), for HIV-positive adults, and adapt it to the needs of black and Latinx YMSM, YTW, and GNC youth aged 16 to 24 years who are vulnerable to HIV exposure. Objective: This paper aimed to describe the protocol for the exploratory phase of W2P. The purpose of this phase was to determine the essential components needed for a structural-level employment intervention aimed at increasing job-seeking self-efficacy and career readiness among black and Latinx YMSM, YTW, and GNC youth aged 16 to 24 years. Methods: The exploratory phase of the W2P study consisted of in-depth interviews and focus groups with members of the target community as well as brief interviews with lesbian, gay, bisexual, transgender, and queer (LGBTQ)--inclusive employers. The study team will conduct in-depth interviews with up to 12 YMSM and 12 YTW and GNC youth, up to 10 focus groups with a maximum of 40 YMSM and 40 YTW and GNC youth, and up to 40 brief interviews with LGBTQ-inclusive employers. Participants will be recruited through a community-based recruiter, passive recruitment in community spaces and on social media, and active recruitment by research staff in community spaces serving LGBTQ youth. Results: In-depth interviews were conducted with 21 participants, and 7 focus groups were conducted with 46 participants in total. In addition, 19 brief interviews with LGBTQ-inclusive employers were conducted. The analysis of the data is underway. Conclusions: Preliminary findings from the formative phase of the study will be used to inform the tailoring and refinement of the iFOUR adult-based intervention into the youth-focused W2P intervention curriculum. Perspectives from YMSM, YTW, GNC youth, and LGBTQ-inclusive employers offer a multidimensional view of the barriers and facilitators to adolescent and young adult LGBTQ employment. This information is critical to the development of a culturally appropriate and relevant youth-focused intervention. Trial Registration: ClinicalTrials.gov NCT03313310; https://clinicaltrials.gov/ct2/show/NCT03313310 International Registered Report Identifier (IRRID): DERR1-10.2196/16384 ",
doi="10.2196/16384",
url="https://www.researchprotocols.org/2020/8/e16384",
url="http://www.ncbi.nlm.nih.gov/pubmed/32773383"
}


@Article{info:doi/10.2196/14833,
author="Jennings Mayo-Wilson, Larissa
and Glass, E. Nancy
and Labrique, Alain
and Davoust, Melissa
and Ssewamala, M. Fred
and Linnemayr, Sebastian
and Johnson, W. Matthew",
title="Feasibility of Assessing Economic and Sexual Risk Behaviors Using Text Message Surveys in African-American Young Adults Experiencing Homelessness and Unemployment: Single-Group Study",
journal="JMIR Form Res",
year="2020",
month="Jul",
day="17",
volume="4",
number="7",
pages="e14833",
keywords="HIV",
keywords="sexual risk behaviors",
keywords="homelessness",
keywords="text messages",
keywords="young adults",
keywords="economic",
keywords="mobile phones",
abstract="Background: Text messages offer the potential to better evaluate HIV behavioral interventions using repeated longitudinal measures at a lower cost and research burden. However, they have been underused in US minority settings. Objective: This study aims to examine the feasibility of assessing economic and sexual risk behaviors using text message surveys. Methods: We conducted a single-group study with 17 African-American young adults, aged 18-24 years, who were economically disadvantaged and reported prior unprotected sex. Participants received a text message survey once each week for 5 weeks. The survey contained 14 questions with yes-no and numeric responses on sexual risk behaviors (ie, condomless sex, sex while high or drunk, and sex exchange) and economic behaviors (ie, income, employment, and money spent on HIV services or products). Feasibility measures were the number of participants who responded to the survey in a given week, the number of questions to which a participant responded in each survey, and the number of hours spent from sending a survey to participants to receiving their response in a given week. One discussion group was used to obtain feedback. Results: Overall, 65\% (n=11/17) of the participants responded to at least one text message survey compared with 35\% (n=6/17) of the participants who did not respond. The majority (n=7/11, 64\%) of the responders were women. The majority (n=4/6, 67\%) of nonresponders were men. An average of 7.6 participants (69\%) responded in a given week. Response rates among ever responders ranged from 64\% to 82\% across the study period. The mean number of questions answered each week was 12.6 (SD 2.7; 90\% of all questions), ranging from 72\% to 100\%. An average of 6.4 participants (84\%) answered all 14 text message questions in a given week, ranging from 57\% to 100\%. Participants responded approximately 8.7 hours (SD 10.3) after receiving the survey. Participants were more likely to answer questions related to employment, condomless sex, and discussions with sex partners. Nonresponse or skip was more often used for questions at the end of the survey relating to sex exchange and money spent on HIV prevention services or products. Strengths of the text message survey were convenience, readability, short completion time, having repeated measures over time, and having incentives. Conclusions: Longitudinal text message surveys may be a valuable tool for assessing HIV-related economic and sexual risk behaviors. Trial Registration: ClinicalTrials.gov NCT03237871; https://clinicaltrials.gov/ct2/show/NCT03237871 ",
doi="10.2196/14833",
url="https://formative.jmir.org/2020/7/e14833",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706656"
}


@Article{info:doi/10.2196/15610,
author="Businelle, S. Michael
and Walters, T. Scott
and Mun, Eun-Young
and Kirchner, R. Thomas
and H{\'e}bert, T. Emily
and Li, Xiaoyin",
title="Reducing Drinking Among People Experiencing Homelessness: Protocol for the Development and Testing of a Just-in-Time Adaptive Intervention",
journal="JMIR Res Protoc",
year="2020",
month="Apr",
day="16",
volume="9",
number="4",
pages="e15610",
keywords="alcohol use disorder",
keywords="mobile health",
keywords="smartphone",
keywords="ecological momentary assessment",
keywords="homeless persons",
abstract="Background: Adults who are homeless are more likely to have alcohol use disorders (AUDs) compared with domiciled adults. Although AUD treatments are commonly available, many factors (eg, transportation limitations and inability to schedule appointments) contribute to low treatment completion rates and low success rates of these interventions among adults experiencing homelessness. Most adults who are homeless own mobile phones; however, no interventions have been developed that use mobile devices to deliver and support AUD interventions for this population. Mobile phone--based AUD interventions may reduce barriers that have limited the use and utility of traditional interventions. Objective: The aim of this study is to (1) identify variables (eg, affect, stress, geolocation, and cravings) that predict drinking among homeless adults (phase I), (2) develop a mobile intervention that utilizes an algorithm to identify moments of risk for drinking and deliver treatment messages that are tailored to the individual's current needs in real time (phase II), and (3) pilot test the intervention app (phase III). Methods: In phase I, adults experiencing homelessness with an AUD (N=80) will complete baseline, equipment, 2-week, and 4-week follow-up visits in person. Participants will be prompted to complete five daily ecological momentary assessments on a study-provided smartphone for 28 days. The smartphone app will collect GPS coordinates every 5 min for the entire 28-day study period. Participants will wear a transdermal alcohol sensor that will objectively measure alcohol use. In phase II, we will use phase I data to develop an algorithm that identifies moments of heightened risk for drinking and develop treatment messages that address risk factors for drinking. Phase III will pilot test the intervention in 40 adults experiencing homelessness with AUD. Results: This project was funded in June 2018. IRB approval was obtained in October 2018, and data collection for phase I began in February 2019. Phase III data collection is expected to conclude in 2020. To date, 80 participants have consented to the study, and data analysis for phase I will begin in early 2020. Conclusions: This research will highlight intervention targets and develop a novel intervention for understudied and underserved adults experiencing homelessness with AUD. International Registered Report Identifier (IRRID): DERR1-10.2196/15610 ",
doi="10.2196/15610",
url="http://www.researchprotocols.org/2020/4/e15610/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32297874"
}


@Article{info:doi/10.2196/14584,
author="Greenwood, Michelle Ronni
and Manning, M. Rachel
and O'Shaughnessy, R. Branagh
and Cross, Oisin
and Vargas-Moniz, J. Maria
and Auquier, Pascal
and Santinello, Massimo
and Wolf, R. Judith
and Bokszczanin, Anna
and Bernad, Roberto
and K{\"a}llm{\'e}n, H{\aa}kan
and Spinnewijn, Frederik
and Ornelas, Jos{\'e}
and ",
title="Comparison of Housing First and Traditional Homeless Service Users in Eight European Countries: Protocol for a Mixed Methods, Multi-Site Study",
journal="JMIR Res Protoc",
year="2020",
month="Feb",
day="5",
volume="9",
number="2",
pages="e14584",
keywords="homeless services",
keywords="Housing First",
keywords="recovery",
keywords="capabilities",
abstract="Background: Homeless services expend considerable resources to provide for service users' most basic needs, such as food and shelter, but their track record for ending homelessness is disappointing. An alternative model, Housing First, reversed the order of services so that homeless individuals are offered immediate access to independent housing, with wraparound supports but no treatment or abstinence requirements. Although the evidence base for Housing First's effectiveness in ending homelessness is robust, less is known about its effectiveness in promoting recovery. Objective: The objective of this research is to compare rehabilitation- and recovery-related outcomes of homeless services users who are engaged in either Housing First or traditional staircase services in eight European countries: France, Ireland, Italy, the Netherlands, Poland, Portugal, Spain, and Sweden. Methods: A mixed methods, multi-site investigation of Housing First and traditional services will compare quantitative outcomes at two time points. Key rehabilitation outcomes include stable housing and psychiatric symptoms. Key growth outcomes include community integration and acquired capabilities. Semistructured interviews will be used to examine service users' experiences of environmental constraints and affordances on acquired capabilities to identify features of homeless services that enhance service users' capabilities sets. Multi-level modelling will be used to test for group differences---Housing First versus traditional services---on key outcome variables. Thematic analysis will be used to understand the ways in which service users make sense of internal and external affordances and constraints on capabilities. Results: The study is registered with the European Commission (registration number: H2020-SC6-REVINEQUAL-2016/ GA726997). Two press releases, a research report to the funding body, two peer-reviewed articles, and an e-book chapter are planned for dissemination of the final results. The project was funded from September 2016 through September 2019. Expected results will be disseminated in 2019 and 2020. Conclusions: We will use the findings from this research to formulate recommendations for European social policy on the configuration of homeless services and the scaling up and scaling out of Housing First programs. From our findings, we will draw conclusions about the setting features that promote individuals' exits from homelessness, rehabilitation, and recovery. International Registered Report Identifier (IRRID): RR1-10.2196/14584 ",
doi="10.2196/14584",
url="https://www.researchprotocols.org/2020/2/e14584",
url="http://www.ncbi.nlm.nih.gov/pubmed/32022696"
}


@Article{info:doi/10.2196/15144,
author="Glover, C. Angela
and Schueller, M. Stephen
and Winiarski, A. Dominika
and Smith, L. Dale
and Karnik, S. Niranjan
and Zalta, K. Alyson",
title="Automated Mobile Phone--Based Mental Health Resource for Homeless Youth: Pilot Study Assessing Feasibility and Acceptability",
journal="JMIR Ment Health",
year="2019",
month="Oct",
day="11",
volume="6",
number="10",
pages="e15144",
keywords="mental health",
keywords="young adult",
keywords="homelessness",
keywords="telemedicine",
keywords="treatment",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: Youth experiencing housing instability have higher rates of mental health problems than their housed peers. Few studies have evaluated technological resources for homeless youth to determine how to effectively engage and reach them. Objective: The primary aims of this pilot study were to establish the feasibility (as measured by phone retention rates) and acceptability (ie, participant ratings of resources) of delivering automated mental health resources via smartphone technology. Methods: Youth aged 16 to 25 years (N=100) were recruited through homeless shelter agencies in the Chicago metropolitan area. Eligible participants completed a baseline assessment and received a smartphone with a 3-month data plan. The phone was preloaded with several apps designed to promote mental health wellness and provide real-time resources. One app specifically designed for this study, Pocket Helper 2.0, sent participants daily surveys and tips via push notification. The tips focused on coping and motivation, and the surveys assessed mood. This app also included an automated self-help system with brief cognitive behavioral interventions (5-10 min) and access to several interactive mobile tools, including a crisis text line, a telephone hotline, a crowd-based emotional support tool, and an app providing up-to-date information on social service and mental health resources for homeless youth in Chicago. Participants completed assessments at 3 and 6 months. Results: Some individuals (23\%, 23/100) experienced problems with the phones (eg, theft, loss, and technological issues) throughout the study. Participant retention at the midpoint was moderate, with 48\% (48/100) of youth responding to the 3-month surveys. At 6 months, only 19\% (19/100) of the total sample responded to the end point survey. Overall, 63\% (30/48) to 68\% (13/19) of respondents at both time points reported benefiting from the intervention; however, participant usage and satisfaction varied with the different features. At both time points, participants reported receiving the most benefit from the daily tips and daily surveys. Daily tips that were most preferred by participants involved motivational tips related to overcoming struggles and making progress in life. Aside from the tips and surveys, the most used features were the app providing up-to-date resources and the automated self-help system. Interactive features, including the telephone hotline and crowd-based emotional support tool, were the least used features and were rated as the least beneficial. Conclusions: Automated mental health interventions seem to be an acceptable way to engage homeless youth in mental health support. The participants preferred fully automated features and brief interventions over features requiring interaction with others or more engagement. Future research should explore ways to retain homeless youth in interventions and evaluate the clinical impact of automated technology-based interventions for improving mental health. Trial Registration: ClinicalTrials.gov NCT03776422; https://clinicaltrials.gov/ct2/show/NCT03776422 ",
doi="10.2196/15144",
url="http://mental.jmir.org/2019/10/e15144/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31605516"
}


@Article{info:doi/10.2196/12347,
author="Schueller, M. Stephen
and Glover, C. Angela
and Rufa, K. Anne
and Dowdle, L. Claire
and Gross, D. Gregory
and Karnik, S. Niranjan
and Zalta, K. Alyson",
title="A Mobile Phone--Based Intervention to Improve Mental Health Among Homeless Young Adults: Pilot Feasibility Trial",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jul",
day="02",
volume="7",
number="7",
pages="e12347",
keywords="mental health",
keywords="homelessness",
keywords="telemedicine",
keywords="treatment",
abstract="Background: Youth homelessness is a substantial issue, and many youths experiencing homelessness have mental health issues as both a cause and consequence of homelessness. These youths face many barriers to receiving traditional mental health services, and as a result, only a few youths experiencing homelessness receive any form of mental health care. Objective: This project aimed to develop and determine the feasibility and acceptability of engaging young adults (ie, individuals aged 18-24 years) experiencing homelessness in a remotely delivered mental health intervention. This intervention provided brief emotional support and coping skills, drawing from cognitive behavioral principles as an introduction into psychosocial support. The intervention was piloted in a homeless shelter network. Methods: A total of 35 young adults experiencing homelessness participated in a single-arm feasibility pilot trial. Participants received a mobile phone, a service and data plan, and 1 month of support from a coach consisting of up to 3 brief phone sessions, text messaging, and mobile mental health apps. We evaluated feasibility by looking at completion of sessions as well as the overall program and acceptability with satisfaction ratings. We also collected clinical symptoms at baseline and the end of the 1-month support period. We used validity items to identify participants who might be responding inappropriately and thus only report satisfaction ratings and clinical outcomes from valid responses. Results: Most participants (20/35, 57\%) completed all 3 of their phone sessions, with an average of 2.09 sessions (SD 1.22) completed by each participant. Participants sent an average of 15.06 text messages (SD 12.62) and received an average of 19.34 messages (SD 12.70). We found higher rates of satisfaction among the participants with valid responses, with 100\% (23/23) of such participants indicating that they would recommend participation to someone else and 52\% (12/23) reporting that they were very or extremely satisfied with their participation. We found very little change from pre- to posttreatment on measures of depression (d=0.27), post-traumatic stress disorder (d=0.17), and emotion regulation (d=0.10). Conclusions: This study demonstrated that it was feasible to engage homeless young adults in mental health services in this technology-based intervention with high rates of satisfaction. We did not find changes in clinical outcomes; however, we had a small sample size and a brief intervention. Technology might be an important avenue to reach young adults experiencing homelessness, but additional work could explore proper interventions to deliver with such a platform. Trial Registration: ClinicalTrials.gov NCT03620682; https://clinicaltrials.gov/ct2/show/NCT03620682 ",
doi="10.2196/12347",
url="https://mhealth.jmir.org/2019/7/e12347/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31267980"
}


@Article{info:doi/10.2196/13162,
author="Baggett, P. Travis
and McGlave, Claire
and Kruse, R. Gina
and Yaqubi, Awesta
and Chang, Yuchiao
and Rigotti, A. Nancy",
title="SmokefreeTXT for Homeless Smokers: Pilot Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jun",
day="04",
volume="7",
number="6",
pages="e13162",
keywords="homeless persons",
keywords="cigarette smoking",
keywords="smoking cessation",
keywords="text messaging",
abstract="Background: Homeless smokers want to quit smoking but face numerous barriers to doing so, including pervasive smoking among peers and a lack of social support for quitting. An SMS (short message service)  text messaging intervention could address these challenges by providing virtual daily support for homeless smokers who are trying to quit but coping with multiple triggers to smoke. Objective: This study aimed to assess whether a free SMS text messaging program, added to evidence-based pharmacotherapy and counseling, improved smoking abstinence among homeless adult smokers. Methods: From October 2015 to June 2016, we conducted an 8-week pilot randomized controlled trial (RCT) of nicotine patch therapy and weekly in-person counseling with (n=25) or without (n=25) SmokefreeTXT, a free SMS text messaging service administered by the National Cancer Institute (NCI) at Boston Health Care for the Homeless Program. All participants were provided with a mobile phone and a 2-month prepaid voice and text plan at no cost. SmokefreeTXT enrollees were sent 1 to 5 automated SMS text messages daily for up to 8 weeks and could receive on-demand tips for managing cravings, mood symptoms, and smoking lapses. The primary outcome was smoking abstinence, defined as an exhaled carbon monoxide count of <8 parts per million, assessed 14 times over 8 weeks of follow-up, and analyzed using repeated-measures logistic regression with generalized estimating equations. Other outcomes were use of SmokefreeTXT, assessed by data obtained from NCI; perceptions of SmokefreeTXT, assessed by surveys and qualitative interviews; and mobile phone retention, assessed by self-report. Results: Of the SmokefreeTXT arm participants (n=25), 88\% (22) enrolled in the program, but only 56\% (14) had confirmed enrollment for ?2 weeks. Among 2-week enrollees, the median response rate to interactive messages from SmokefreeTXT was 2.1\% (interquartile range 0-10.5\%). Across all time points, smoking abstinence did not differ significantly between SmokefreeTXT and control arm participants (odds ratio 0.92, 95\% CI 0.30-2.84). Of SmokefreeTXT enrollees who completed exit surveys (n=15), two-thirds were very or extremely satisfied with the program. However, qualitative interviews (n=14) revealed that many participants preferred in-person intervention formats over phone-based, found the SMS text messages impersonal and robotic, and felt that the messages were too frequent and repetitive. Only 40\% (10/25) of SmokefreeTXT arm participants retained their study-supplied mobile phone for the 8-week duration of the trial, with phone theft being common. Storing and charging phones were cited as challenges. Conclusions: SmokefreeTXT, added to nicotine patch therapy and in-person counseling, did not significantly improve smoking abstinence in this 8-week pilot RCT for homeless smokers. SMS text messaging interventions for this population should be better tuned to the unique circumstances of homelessness and coupled with efforts to promote mobile phone retention over time. Trial Registration: ClinicalTrials.gov NCT02565381; https://clinicaltrials.gov/ct2/show/NCT02565381 (Archived by WebCite at http://www.webcitation.org/78PLpDptZ) ",
doi="10.2196/13162",
url="https://mhealth.jmir.org/2019/6/e13162/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31165717"
}


@Article{info:doi/10.2196/12378,
author="Buitenweg, C. David
and Bongers, L. Ilja
and van de Mheen, Dike
and van Oers, AM Hans
and van Nieuwenhuizen, Chijs",
title="Cocreative Development of the QoL-ME: A Visual and Personalized Quality of Life Assessment App for People With Severe Mental Health Problems",
journal="JMIR Ment Health",
year="2019",
month="Mar",
day="28",
volume="6",
number="3",
pages="e12378",
keywords="mobile app",
keywords="quality of life",
keywords="mental health",
keywords="homeless persons",
keywords="medical informatics",
abstract="Background: Quality of life (QoL) is a prominent outcome measure in mental health. However, conventional methods for QoL assessment rely heavily on language?based communication and therefore may not be optimal for all individuals with severe mental health problems. In addition, QoL assessment is usually based on a fixed number of life domains. This approach conflicts with the notion that QoL is influenced by individual values and preferences. A digital assessment app facilitates both the accessibility and personalization of QoL assessment and may, therefore, help to further advance QoL assessment among individuals with severe mental health problems. Objective: This study focused on the development of an innovative, visual, and personalized QoL assessment app for people with severe mental health problems: the QoL-ME. Methods: This study targeted 3 groups of individuals with severe mental health problems: (1) people with psychiatric problems, (2) people treated in forensic psychiatry, and (3) people who are homeless. A group of 59 participants contributed to the 6 iterations of the cocreative development of the QoL-ME. In the brainstorming stage, consisting of the first iteration, participants' previous experiences with questionnaires and mobile apps were explored. Participants gave their feedback on initial designs and wireframes in the second to fourth iterations that made up the design stage. In the usability stage that comprised the final 2 iterations, the usability of the QoL-ME was evaluated. Results: In the brainstorming stage, participants stressed the importance of privacy and data security and of receiving feedback when answering questionnaires. Participants in the design stage indicated a preference for paging over scrolling, linear navigation, a clean and minimalist layout, the use of touchscreen functionality in various modes of interaction, and the use of visual analog scales. The usability evaluation in the usability stage revealed good to excellent usability. Conclusions: The cocreative development of the QoL-ME resulted in an app that corresponds to the preferences of participants and has strong usability. Further research is needed to evaluate the psychometric quality of the QoL-ME and to investigate its usefulness in practice. ",
doi="10.2196/12378",
url="http://mental.jmir.org/2019/3/e12378/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30920381"
}


@Article{info:doi/10.2196/10186,
author="Nandy, R. Rajesh
and Nandy, Karabi
and H{\'e}bert, T. Emily
and Businelle, S. Michael
and Walters, T. Scott",
title="Identifying Behaviors Predicting Early Morning Emotions by Observing Permanent Supportive Housing Residents: An Ecological Momentary Assessment",
journal="JMIR Ment Health",
year="2019",
month="Feb",
day="07",
volume="6",
number="2",
pages="e10186",
keywords="permanent supportive housing",
keywords="circumplex model of affect",
keywords="ecological momentary assessment",
keywords="emotion",
keywords="valence",
keywords="arousal",
keywords="hierarchical mixed effects model",
keywords="mobile phone",
abstract="Background: Behavior and emotions are closely intertwined. The relationship between behavior and emotions might be particularly important in populations of underserved people, such as people with physical or mental health issues. We used ecological momentary assessment (EMA) to examine the relationship between emotional state and other characteristics among people with a history of chronic homelessness who were participating in a health coaching program. Objective: The goal of this study was to identify relationships between daily emotional states (valence and arousal) shortly after waking and behavioral variables such as physical activity, diet, social interaction, medication compliance, and tobacco usage the prior day, controlling for demographic characteristics. Methods: Participants in m.chat, a technology-assisted health coaching program, were recruited from housing agencies in Fort Worth, Texas, United States. All participants had a history of chronic homelessness and reported at least one mental health condition. We asked a subset of participants to complete daily EMAs of emotions and other behaviors. From the circumplex model of affect, the EMA included 9 questions related to the current emotional state of the participant (happy, frustrated, sad, worried, restless, excited, calm, bored, and sluggish). The responses were used to calculate two composite scores for valence and arousal. Results: Nonwhites reported higher scores for both valence and arousal, but not at a statistically significant level after correcting for multiple testing. Among momentary predictors, greater time spent in one-on-one interactions, greater time spent in physical activities, a greater number of servings of fruits and vegetables, greater time spent interacting in a one-on-one setting as well as adherence to prescribed medication the previous day were generally associated with higher scores for both valence and arousal, and statistical significance was achieved in most cases. Number of cigarettes smoked the previous day was generally associated with lower scores on both valence and arousal, although statistical significance was achieved for valence only when correcting for multiple testing. Conclusions: This study provides an important glimpse into factors that predict morning emotions among people with mental health issues and a history of chronic homelessness. Behaviors considered to be positive (eg, physical activity and consumption of fruits and vegetables) generally enhanced positive affect and restrained negative affect the following morning. The opposite was true for behaviors such as smoking, which are considered to be negative. ",
doi="10.2196/10186",
url="http://mental.jmir.org/2019/2/e10186/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30730296"
}


@Article{info:doi/10.2196/10049,
author="Raven, C. Maria
and Kaplan, M. Lauren
and Rosenberg, Marina
and Tieu, Lina
and Guzman, David
and Kushel, Margot",
title="Mobile Phone, Computer, and Internet Use Among Older Homeless Adults: Results from the HOPE HOME Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Dec",
day="10",
volume="6",
number="12",
pages="e10049",
keywords="homelessness",
keywords="internet",
keywords="cell phone",
keywords="smartphone",
keywords="aged and middle aged",
abstract="Background: The median age of single homeless adults is approximately 50 years. Older homeless adults have poor social support and experience a high prevalence of chronic disease, depression, and substance use disorders. Access to mobile phones and the internet could help lower the barriers to social support, social services, and medical care; however, little is known about access to and use of these by older homeless adults. Objective: This study aimed to describe the access to and use of mobile phones, computers, and internet among a cohort of 350 homeless adults over the age of 50 years. Methods: We recruited 350 participants who were homeless and older than 50 years in Oakland, California. We interviewed participants at 6-month intervals about their health status, residential history, social support, substance use, depressive symptomology, and activities of daily living (ADLs) using validated tools. We performed clinical assessments of cognitive function. During the 6-month follow-up interview, study staff administered questions about internet and mobile technology use. We assessed participants' comfort with and use of multiple functions associated with these technologies. Results: Of the 343 participants alive at the 6-month follow-up, 87.5\% (300/343) completed the mobile phone and internet questionnaire. The median age of participants was 57.5 years (interquartile range 54-61). Of these, 74.7\% (224/300) were male, and 81.0\% (243/300) were black. Approximately one-fourth (24.3\%, 73/300) of the participants had cognitive impairment and slightly over one-third (33.6\%, 100/300) had impairments in executive function. Most (72.3\%, 217/300) participants currently owned or had access to a mobile phone. Of those, most had feature phones, rather than smartphones (89, 32.1\%), and did not hold annual contracts (261, 94.2\%). Just over half (164, 55\%) had ever accessed the internet. Participants used phones and internet to communicate with medical personnel (179, 64.6\%), search for housing and employment (85, 30.7\%), and to contact their families (228, 82.3\%). Those who regained housing were significantly more likely to have mobile phone access (adjusted odds ratio [AOR] 3.81, 95\% CI 1.77-8.21). Those with ADL (AOR 0.53, 95\% CI 0.31-0.92) and executive function impairment (AOR 0.49; 95\% CI 0.28-0.86) were significantly less likely to have mobile phones. Moderate to high risk amphetamine use was associated with reduced access to mobile phones (AOR 0.27, 95\% CI 0.10-0.72). Conclusions: Older homeless adults could benefit from portable internet and phone access. However, participants had a lower prevalence of smartphone and internet access than adults aged over 65 years in the general public or low-income adults. Participants faced barriers to mobile phone and internet use, including financial barriers and functional and cognitive impairments. Expanding access to these basic technologies could result in improved outcomes. ",
doi="10.2196/10049",
url="http://mhealth.jmir.org/2018/12/e10049/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30530464"
}


@Article{info:doi/10.2196/mental.9814,
author="Calvo, Fran
and Carbonell, Xavier",
title="Using Facebook for Improving the Psychological Well-Being of Individuals Experiencing Homelessness: Experimental and Longitudinal Study",
journal="JMIR Ment Health",
year="2018",
month="Oct",
day="10",
volume="5",
number="4",
pages="e59",
keywords="homelessness",
keywords="individuals experiencing homelessness",
keywords="health",
keywords="satisfaction with life",
keywords="self-esteem",
keywords="self-efficacy",
keywords="social networking sites",
keywords="social skills",
abstract="Background: Web-based social networks are a powerful communicative element and their use is increasingly widespread. Persons living in extreme social exclusion such as individuals experiencing homelessness can benefit from the positive elements of communication and relationship associated with social networking sites. Objective: This study aimed to suggest the comparison of a Facebook training course and an office software course and their effect on psychological well-being in a group of individuals experiencing homelessness. Methods: An experimental and longitudinal study was designed. Individuals experiencing homelessness were randomly assigned to either the Facebook group or the office software group, and their social skills, self-esteem, self-efficacy, and satisfaction with life were measured on 4 occasions: pretest, at the end of the training course, 1 month later, and 3 months later. A mixed analysis of variance of repeated measures (2{\texttimes}4) was performed. Results: A total of 92 individuals experiencing homelessness participated in the study. The number of cases in which the 4 measurements were completed was 71 (35 in the intervention group and 36 in the control group). The mixed analysis of variance of repeated measures and the multiple regression analysis indicated a significant increase of the 4 analyzed parameters, with greater significance in the areas of social skills and self-esteem. The critical levels associated to the interaction Time{\texttimes}Program were significant in all variables and levels. Therefore, the scores in the 4 analyzed constructs were not equal according to the program carried out throughout the work. The effect size associated to the interaction Time{\texttimes}Program in the social skills scores was large ($\eta$2=0.32); in the self-esteem and self-efficacy scores, it was medium, ($\eta$2=0.13); and in the satisfaction with life scores, it was small ($\eta$2=0.09). The results of the adjustment of the different models of multiple linear regression indicate that the number of hours devoted weekly to the use of Facebook was a predictor of the increase in the scores of social skills (B=3.43, r2=.405) and self-esteem (B=.382). Age (B=.175) and self-efficacy (B=.09) were also variables, which with independence and in equal conditions, predicted self-esteem (r2=.29). Finally, self-esteem (B=.69) was also a predictor variable of the increase of satisfaction with life (r2=.195). Conclusions: These findings suggest that Facebook could be a key element in homeless psychological well-being and socialization. ",
doi="10.2196/mental.9814",
url="http://mental.jmir.org/2018/4/e59/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30305262"
}