Health Problems, Healthcare Service Utilisation and its Associated Factors Among the Homeless in Malaysia: A Systematic Review

Abstract

Background: Homelessness is a growing concern since it affects many individuals worldwide. Homeless people are vulnerable to health problems but tend to underutilise health services. Despite being a worldwide concern, there is little research on health issues and healthcare utilisation among homeless people in Malaysia. Methodology: Three databases were used to search for relevant articles: Scopus, Web of Science, and PubMed. Studies published between 2011 and 2021 that examined the health problems and health service utilisation among homeless adults in Malaysia were considered. Manual searches in reference lists and grey literature were also performed to add reports. Data were extracted manually. The authors conducted a descriptive analysis and narrative synthesis. Results: A total of seven articles fulfilled the pre-determined inclusion and exclusion criteria. Three themes emerged from the studies: health problems, healthcare service utilisation, and associated factors of healthcare services utilisation. Of the seven articles, reported health problems included drug abuse, alcohol abuse, HIV-positive status, mental health problems, oral health, and other chronic diseases. All included articles reported none to under-utilised health care services. The associated factors of health care utilisations were financial issues, low levels of self-care awareness, feeling embarrassed, low health literacy, and poor social support. Conclusion: Evidence shows that the homeless suffer from a range of health problems. Poor health care utilisations among the homeless are a significant issue, with several associated factors contributing to that worrying scenario. Future studies among homeless people are needed to provide more information, especially about their health care utilisations. In addition, effective multi-agency interventions are required to address health vulnerabilities.