Targeting Diet and Physical Activity: Reaching Homeless Adults through Customized Interventions

Abstract

Over six percent of the American population experience homelessness in their lifetime, and poor health is commonplace among individuals experiencing this condition. Homelessness is a risk factor for both acute and chronic diseases; homeless populations experience an age-adjusted mortality rate 3-4 times greater than the general population. In fact, despite the high prevalence of poor health behaviors and the well-documented disparities in health care outcomes among homeless adults, interventions for this population are scarce, likely due to the fact that they are challenging to implement. Consequently, there are few published interventions on diet/physical activity interventions targeting this population to date. Health-e-Strides, a novel randomized pilot lifestyle intervention for 32 transitional shelter residents, took place at The Bridge in Dallas, Texas. This paper reports on the lessons learned and approaches for intervening in this vulnerable population. Participants were randomized into either the experimental arm or control arm of the study. The experimental arm included a 4-week shelter-based diet, physical activity intervention, tailored educational newsletters, and supplemental fruits and vegetables; the control arm was not given any additional resources and compensated for completing assessments at the conclusion of the study. 71% of participants reported that the intervention was "extremely/very helpful" for both increasing daily intake of fruits and vegetables and for increasing physical activity. Based on this intervention, this paper discusses barriers and facilitators for lifestyle improvements among homeless adults. This intervention demonstrated the effectiveness of customized lifestyle interventions in improving health care outcomes for homeless adults and affirms the need for more research and innovation on this vulnerable population, especially in terms of long-term and sustainable solutions. Key Points About What is Known: • Homelessness is a risk factor for both acute and chronic disease; homeless populations experience an age-adjusted mortality rate 3-4 times greater than the general population. • Poor diet and insufficient physical activity are linked with cancer and cardiovascular disease; these conditions are associated with high homelessness mortality rates. • Improving both physical activity and vegetable and fruit consumption has substantial beneficial effects on overall health, including the prevention of cancer, cardiovascular disease, and premature death. • No published research exists on diet/physical activity interventions in homeless adults to date. Key Points about What is Not Known: • There are few studies looking at behavioral health interventions in homeless adults; therefore, there are no best practices available for this population. • Additional research is required to assess the effectiveness of technology (relative to other services shelters provide) in eliminating homelessness. • It is critical to develop operational and process-driven improvements that would enable and empower homeless adults both to have access to and to save food. • Future research should assess health literacy and identify the best mediums by which to transmit information and empower homeless adults to lead healthier lives.