Using a Photovoice Intervention to Teach Nursing Students About Living Homeless
Abstract
Background: Over 582,000 people live homeless in the United States daily. They have more health problems and are more likely to receive inadequate health care than people with adequate housing. They also report that nurses treat them uncivilly when they seek health care. Nurse educators teach students to care and advocate for those who are unhoused. Photovoice has been used as a strategy to teach nursing students, but we found no studies using this technique to teach about homelessness. The purpose of this study was to develop and test a photovoice intervention to teach nursing students what it is like to live with unstable living conditions.
Method: The convenience sample for this mixed methods design consisted of 88 undergraduate nursing students in a health assessment course.
Results: Scores for the intervention group improved, with a significant difference between groups in attitudes toward poverty. Students expressed a better understanding of the experience of living homeless, gained awareness of the challenges faced by those who live homeless, and stated this awareness will impact their future nursing practice. They further identified the importance of knowing what resources unhoused individuals may need to support their overall health and well-being.
Conclusion: Photovoice is an effective method to teach students about homelessness.
1. Introduction
After a multiyear decline, the United States Department of Housing and Urban Development [1] reported a more than 5% increase in the number of people with unstable housing conditions from 2018 to 2022. Black, Indigenous, and people of color in the United States are more likely to experience homelessness than white people [2]. Those who live homeless have more health problems [3, 4] and report having received inadequate health care, including experiencing incivility, disrespect, and rushed care from nurses [5]. When they are treated uncivilly, they may be reluctant to seek care in the future [5, 6]. Therefore, the behavior of nurses toward those who live homeless is critically important in meeting their healthcare needs.
While nurses are charged with providing fair and unbiased care, we know that most, if not all, humans have biases of which they are not aware. Implicit bias is “a form of bias that occurs automatically and unintentionally, that nevertheless affects judgments, decisions, and behaviors” [7]. The healthcare literature primarily addresses implicit bias toward certain racial groups, such as Black or Latine patients [8–10], but providers also exhibit bias toward the poor and those who live homeless [5, 11, 12]. Several authors have investigated the experiences and perspectives of people living homeless regarding their interactions with the healthcare system [5, 13–15] and nurses specifically [5]. Woith et al. interviewed unhoused individuals. Their participants felt judged, shamed, and disrespected by nurses. They believed nurses rushed through their care and did not give them the attention other patients received. They asserted their experiences with nurses prevented them from seeking future health care. Helping healthcare providers take the point of view of people who live homeless may diminish bias and increase empathy for them, ultimately resulting in better nursing care [5].
Nurse educators are instrumental in conveying to their students the need for respectful advocacy for the unhoused. To be effective advocates, students must understand homelessness and the hurdles those who live homeless face each day [5, 16]. Nurse educators must provide specific education, focused on homelessness, to give students an opportunity to understand and empathize with this marginalized population [17, 18]. Few such teaching strategies have been developed and empirically tested.
In photovoice, members of the community of interest are provided with cameras and asked to take photographs that illustrate their lived experiences [19]. The photography and narrative are combined into a poster to tell their story [20]. The visual imagery and related narrative can help us understand “wider cultural perceptions … and provide us with views of how things are or should be” ([20], p. 857). This technique has been effectively used in public health initiatives to empower individuals who may not otherwise have a voice [21–23]. In a participatory action research study, photovoice was shown to empower a small group of marginalized single mothers in Canada [22]. In a qualitative review of 31 photovoice studies, the authors strongly advocated for the use of photovoice as a vehicle for community change [24]. Other scholars have studied the impact of photovoice on target behavior. In one study, photovoice was used to improve attitudes and change behavior of children struggling with obesity [25].
Photovoice has been used in education. Schell et al. [26] successfully used a photovoice intervention to enhance critical thinking. Wilson et al. [27] used photovoice to help children in low-income families identify issues at their school and develop actions plans to manage them. Doyumgac, Tanhan, and Kiymaz [28] used online photovoice to allow college students and academics to express facilitators and barriers to the shift to online education during the COVID-19 pandemic. Online photovoice, in which participants submit their photographs and accompanied narratives electronically, has also been used to give a voice to marginalized communities. Tanhan and Strack explored the experiences of Muslims teaching at and attending colleges in the United States [29].
Researchers have also used photovoice to educate students in health-related fields [30–34], including nursing [35–38], but we found no studies in which this technique was used to teach nursing students about homelessness. Photovoice is an effective tool for giving a voice to marginalized people whose voice is often not heard or not given appropriate weight [29]. In our study, photovoice also provided a safe way for people living homeless to tell their own story.
2. Theoretical Framework
Leininger’s [39] Culture Care Diversity and Universality Theory guided this study. Leininger’s theory encourages us to view the person holistically within the context of their culture. We chose this model because our perceptions of others are framed by our own cultural backgrounds. To provide the best care, we need to understand the needs of others through their perspectives and experiences. The model influenced development of the photovoice intervention, in which people who were living homeless described their experiences both verbally and visually, thus allowing students the opportunity to better understand their unique experiences and perspectives.
In accordance with Leininger’s [39] theory, the authors have broad experience in working with the unhoused community and are equipped to consider their perspectives. The authors are nursing faculty who are experienced in the conduct of qualitative and quantitative research with those who live homeless. They have developed and utilized interventions to teach nursing students about the lives of those without adequate housing and are engaged in service work to better the lives and health care of those who live homeless.
3. Statement of the Problem
Few strategies that promote understanding the needs of those who live homeless have been developed and tested. Photovoice has been used as an education strategy for nursing students, but only in studies where students described their own experiences [35, 38]. Photovoice has not been used to help students understand the lived experience of others. Our strategy combined photography and narrative to present a story about the experiences of those who live homeless.
The purpose of this study was to develop and test a photovoice intervention to help undergraduate nursing students better understand what it is like to live homeless, thereby enhancing empathy and broadening attitudes toward this vulnerable population. Additionally, we conducted focus groups with participants in the intervention group to further explore students’ attitudes and elicit their feedback concerning the effectiveness of the intervention. We hypothesized students in the treatment group would demonstrate increased empathy for those who live homeless and develop more positive attitudes toward them. Our research questions were: Does a photovoice teaching intervention affect students’: (1) Empathy for those who live homeless? (2) Attitudes toward those who live homeless? (3) Attitudes towards poverty for those who live homeless? (4) Understanding of the lived experience of those who are homeless?
This innovative education strategy was tested in a course in which nursing students begin to learn to identify health needs. Students are taught to assess people from diverse cultural backgrounds. This is the first course where content about caring for people who live homeless is introduced. We randomized students into a control group, who received standard content, and a treatment group, who received the photovoice intervention in addition to standard content. Several students in the intervention group participated in focus group discussions. At the completion of data collection, students in the control group were also given the opportunity to participate in the photovoice intervention.
4. Methods
4.1. Design, Setting, and Sample
This mixed methods study was conducted in two phases. Phase one was conducted at a shelter for the unhoused. Phase two was conducted at a college of nursing in the Midwestern United States.
4.2. Phase 1: Development of the Intervention
A convenience sample of 20 adults was recruited from a homeless shelter in a small midwestern city. Participants provided informed consent and demographic data, including age, gender, and race/ethnicity. They were given disposable cameras and asked to take photographs that depicted their experience of living homeless. Participants were asked not to take photographs of people, and no photographs of people were used in the study. Forty-eight hours later, researchers met with the 13 participants who returned their cameras. We collected the cameras and processed the film. One participant’s film was not useable; the remaining 12 participants met with researchers to select their two favorite photographs and tell the story of what those pictures meant to them. Their narrative responses were audio recorded and transcribed. Each participant was given a $10 gift card as an expression of thanks for their time and effort. The researchers then developed 19 posters from 12 participants’ favorite photographs and their associated narratives.
4.3. Phase 2: The Research Study
Phase 2 occurred over three sessions and two focus groups. We used a two-group pretest/posttest randomized control test design and focus group discussions. A convenience sample of 120 undergraduate nursing students in their first semester was recruited from their health assessment course. Eighty-eight of these completed both the pretest and the posttest and were used in the final statistical analysis. Ten students self-selected into the two focus groups.
4.3.1. Pretest/Posttest
Participants were randomly assigned to the control (n = 60) or intervention group (n = 60). During the first session, a recruiter visited the students’ health assessment class and those who wished to participate signed informed consent. They completed the pretest, which consisted of the Toronto Empathy Questionnaire (TEQ) [40], Attitudes Toward Homelessness Inventory (ATHI) [41], and the Attitudes Toward Poverty Scale-Short Form (ATP-SF) [42]. Immediately after the first session, researchers randomly assigned participants to either the control (n = 60) or intervention (n = 60) groups, using a random number generator.
Approximately 48 h after the first session, the intervention group proceeded to a nearby classroom to participate in the second session—the intervention—which consisted of a 30-minute poster discussion in which they viewed the photovoice posters and a 30-minute presentation on homelessness led by a local expert with 20 years of experience working with the local homeless community. They then completed the posttest which was identical to the pretest. The control group and those who opted not to participate remained in the original classroom and completed the posttest. Because we anticipated the photovoice intervention to be a valuable learning experience, we made it available to all students in a final session after the posttest.
4.3.2. Focus Groups
Following the final session, 10 students in the intervention group opted to participate in one of two, one-hour focus groups with five participants assigned to each group. Focus groups were held at a private location on campus; two researchers moderated the discussion with each group. They began the conversation with three open-ended questions: (1) What did you learn through this photovoice activity? (2) How will you use this information, especially in your future nursing practice? (3) What ideas do you have to improve teaching nurses about those who live homeless?
4.4. Measures
We assessed the impact of the intervention using three valid and reliable questionnaires: the TEQ [40], the ATHI [41], and the ATP-SF [42]. The TEQ [40] consists of 16 items that measure empathy. The items are scored on a 5-point Likert-type scale ranging from 1 = “never” to 5 = “always” and then summed to provide a single score, with higher scores reflecting greater empathy. The TEQ [40] demonstrates “strong convergent validity, correlating positively with behavioral measures of social decoding, self-report measures of empathy, and negatively with a measure of autism symptomatology; furthermore, it exhibited good internal consistency (Cronbach’s alpha = 0.85) and high test–retest reliability” [40, p. 62].
The ATHI [41] captures four dimensions of attitudes people hold about causes of and solutions for homelessness. It consists of 27 items scored on a 6-point Likert-type scale where 1 = “strongly agree” and 6 = “strongly disagree.” Higher scores reflect greater levels of the attitude being measured. Initial validation showed a four-factor structure when used with college students. The ATHI was shown to have a Pearson test–retest reliability correlation coefficient of 0.80 and a Cronbach’s alpha coefficient of 0.74 [41].
The ATP-SF [42] contains 21 items defining attitudes toward poverty and is scored on a 5-point Likert-type scale where 1 = “strongly agree” and 5 = “strongly disagree.” While our purpose was not to explore poverty directly, poverty is a predictor of homelessness [43, 44]. Higher scores reflect greater levels of the attitude measured in each dimension. Validity and reliability have previously been established on the original ATP scale and the subsequent ATP-SF. Cronbach’s alpha was used to determine internal consistency of the 37-item ATP scale (0.93), and split half reliability (odd vs. even) demonstrated reliability [44]. The ATP-SF [42], which contains 21 of the original 37 items, reflects convergent validity (r = 0.83; p < 0.05) and high internal consistency (Cronbach’s alpha = 0.87). Subscales of personal deficiency, stigma, and structural perspective reported on the ATP-SF [42] also revealed internal consistency (Cronbach’s alpha = 0.50–0.70).
In addition to the quantitative measures, we conducted two focus groups. Adding focus group discussions to the intervention allowed for deeper discourse and encouraged reflection; students were able to build on the thoughts and ideas of their peers. From the focus groups, we identified themes that gave richness and deeper meaning to the survey findings, including how students’ perceptions of homelessness and the health care needs of those living homeless changed following the intervention.
5. Data Collection Procedure
After obtaining Institutional Review Board approval from the university, we began data collection in two phases.
5.1. Phase 1: Development of the Intervention
A convenience sample of 20 adults was recruited from a shelter for unhoused people in a small midwestern city. Participants provided informed consent and demographic data, including age, gender, and race/ethnicity. They were given disposable cameras and asked to take photographs that depicted their experience of living homeless. Participants were asked not to take photographs of people, and no photographs of people were used in the study. Forty-eight hours later, researchers met with the 13 participants who returned their cameras. Seven did not return their cameras. We collected the cameras and processed the film. One participant’s film was not useable; the remaining 12 participants met with researchers to select their two favorite photographs and tell the story of what those pictures meant to them. Their narrative responses were audio recorded and transcribed. Each participant was given a $10 gift card as an expression of thanks for their time and effort. The researchers then developed 19 posters from the 12 participants’ favorite photographs and their associated narratives.
5.2. Phase 2: The Research Study
A convenience sample of 120 beginning undergraduate nursing students was recruited from their first semester health assessment course. Participants were randomly assigned to the control (n = 60) or intervention group (n = 60). Phase 2 occurred over three sessions and two focus groups. During the first session, a recruiter visited the students’ health assessment class and those who wished to participate signed informed consent. They completed the pretest, which consisted of the TEQ [40], ATHI [41], and ATP-SF [42] questionnaires. Immediately after the first session, researchers randomly assigned participants to either the control (n = 60) or intervention (n = 60) groups, using a random number generator.
Approximately 48 h after the first session, the intervention group proceeded to a nearby classroom to participate in the second session—the intervention—which consisted of a 30-minute poster discussion in which they viewed the photovoice posters and a 30-minute presentation on homelessness led by a local expert. This expert has worked closely with unhoused individuals in both service and research for over 20 years. Students then completed the posttest, which was identical to the pretest. The control group and those who opted not to participate remained in the original classroom and completed the posttest. Because we anticipated the photovoice intervention to be a valuable learning experience, we made it available to all students in a final session after the posttest.
Following the final session, 10 students in the intervention group opted to participate in one of two one-hour focus groups with five participants assigned to each group. Focus groups were held at a private location on campus with two researchers in attendance. One primarily led the discussion while the other took field notes. The discussion was audio-recorded with a digital MP3 player for voice clarity. They began the conversation with three open-ended questions: (1) What did you learn through this photovoice activity? (2) How will you use this information, especially in your future nursing practice? (3) What ideas do you have to improve teaching nurses about those who live homeless? Researchers enhanced trustworthiness by member-checking during and after the focus groups to ensure they understood students’ meaning.
5.3. Data Analysis
We used IBM SPSS Statistics (Version 28.01) [45] to conduct statistical analysis. The general linear model (GLM) was run to identify differences within and between groups. Inductive qualitative content analysis, as described by Elo and Kyngas [46], was used to analyze the focus group data. Analysis of the data began as they were collected. Audio recordings of focus group sessions were transcribed verbatim by the two researchers who attended the focus groups. During data preparation, the research team, each of whom had expertise in homelessness and nursing education, immersed themselves in the data by listening to the recordings and reading the transcripts multiple times. Data were prepared through an iterative process. During primary coding, each researcher worked independently to identify and constantly compare major themes. Researchers then met to compare and discuss their analyses until consensus was reached. The process was repeated during secondary coding, as researchers worked to reduce the coding categories and develop final themes.
6. Results
6.1. Quantitative Results
Of the 120 students who enrolled in the study, 88 (73%) completed both the pretest and the posttest surveys, with 44 in the intervention group and 44 in the control group. The majority of participants were female (85%). To maintain confidentiality, other demographics were not collected due to the limited diversity of the students.
The main effect for time on the TEQ [40] showed a significant change between the pretest and posttest scores, but the effect size was small (Wilks’ Λ = 0.950, F(1, 86) = 4.55, p = 0.036, = 0.05). There was no significant main effect for group (F(1, 86) = 2.086, p = 0.152, = 0.024). The lack of a significant interaction suggests the effect over time was not different between the groups (Wilks’ Λ = 0.970, F(1, 86) = 2.616, p = 0.109, = 0.030).
The main effect for time on the ATHI [41] demonstrated a significant change over time with a moderate effect size (Wilks’ Λ = 0.891, F(1, 86) = 10.487, p = 0.002, = 0.102). There was no significant main effect of group (F(1, 86) = 0.084, p = 0.773, ηp2 = 0.001). The lack of a significant interaction suggests the effect over time was not different between the groups (Wilks’ Λ = 0.999, F(1, 86) = 0.111, p = 0.740, = 0.001).
The main effects for time on the ATP-SF [42] showed a significant change with a moderate to large effect size (Wilks’ Λ = 0.825, F(1, 86) = 18.203, p < 0.000, = 0.18). The interaction between groups over time was also significant, with a moderate effect size (Wilks’ Λ = 0.888, F(1, 86) = 10.867, p = 0.001, = 0.112). The intervention group’s average pretest score was lower by almost 3 points than the control group’s average, but their posttest average was 2 points higher than the control group’s average, indicating that the intervention was highly successful at improving students’ attitudes toward those living in poverty. The main effect of group was not significant (F(1, 86) = 0.040, p = 0.842, < 0.000) (Table 1).
| Variable | Group (n) | Time | |
|---|---|---|---|
| Pretest mean (SD) | Posttest mean (SD) | ||
| ATP-SF | Control (44) | 79.66 (11.36) | 80.38 (11.86) |
| Intervention (44) | 76.7159 (11.75) | 82.3864 (11.48) | |
| TEQ | Control (44) | 50.34 (5.85) | 50.59 (5.74) |
| Intervention (44) | 51.11 (4.79) | 52.93 (5.74) | |
| ATHI | Control (44) | 47.09 (6.72) | 48.48 (6.20) |
| Invention (44) | 46.55 (6.85) | 48.25 (6.81) | |
- Abbreviations: ATHI = Attitudes Toward Homelessness Inventory, ATP-SF = Attitudes Toward Poverty-Short Form, and TEQ = Toronto Empathy Questionnaire.
6.2. Qualitative Results
We identified three main themes when we analyzed the qualitative data. The first theme revealed that students not only learned about homelessness, but that they also gained awareness of the challenges faced by those who live homeless. The second theme revealed that this new, deeper understanding of homelessness will impact students’ future nursing practice. The third theme revealed that the students identified the importance of knowing what resources people who live homeless may need to support their overall health and well-being.
6.3. Gained Awareness
Students asserted that the photovoice intervention opened their eyes to different ways of living. They were aware that they had been insulated from the realities of poverty and homelessness. One said, “You forget there’s another whole world out there,” while another stated, “I understand their world better. It motivates me to go learn more and work with homeless [individuals].” The group believed that the intervention had given them “a better understanding of what the day-to-day life of a homeless person looks like.” One student said, “Way more goes into living homeless than I thought. It’s way more involved and difficult.” Another added, “They have so much more stress just trying to be safe. They have to think about safety in addition to everything else they have to worry about.”
Our students explained that their perceptions about people who live homeless changed following the intervention. One said, “Homeless people are not what I thought. These are smart people.” They discussed one of the photovoice posters in which the homeless individual quoted President Eisenhower. The group was surprised at the level of intelligence demonstrated by the people quoted in the posters. They realized that they held misconceptions about those who live homeless. One asserted, “They don’t fit the stereotype.” The group had not been aware of the skill and resourcefulness required to live homeless. “They have to work so hard to survive. They have to do so much. They have these strategies to survive.” Another noted that “they have to take so much into consideration just to get by.” One student summed up the experience by acknowledging, “This was very eye-opening. I had no idea!”
The students believed that their involvement in the intervention increased their empathy. “Usually, we learn about homelessness as statistics. This [intervention] was stories. You can empathize.” Several students explained that the experience allowed them to see things from the point of view of those living homeless. One said, “I put myself in their [place].” Another explained, “Usually, I don’t see myself in their shoes, but this helped me to empathize.” Students mentioned two specific posters that had moved them. In one, a man photographed a park he often visited, pretending it was his home. “You work hard to own your own home. I can’t imagine not having a place indoors that’s my own space and safe. I can take a nap. I can escape.” In the other, a mother photographed her child’s stroller, loaded with all she and her two children might need for the day, while the shelter was closed to them. In her narrative, she explained that they had to be prepared for any eventuality, because they may have to spend the entire day outdoors. “What about the woman who had a kid and it’s raining? How do you keep your child warm and dry?” The students asserted that the intervention changed them. One said, “This hit me a lot harder than I thought.”
6.4. Impact on Future Practice
Students asserted that in the future, they would treat all patients with respect, fairness, and empathy. Our participants recognized their own potential for bias toward those who live homeless. One asserted, “You have to treat all patients alike. Doesn’t matter who they are, what they look like, what their hygiene is like.” Another maintained that nurses should not allow their biases to impact care. “As nurses we need to set our personal feelings aside. Put yourself in their shoes. Like someone who uses street marijuana to control pain. If they have decreased access and no insurance, then marijuana is cheaper than pain meds. I saw this in one of my clinical patients. It’s heartbreaking.”
The students were able to envision a future practice transformed by their deeper understanding of those who live homeless. One asserted, “I will help them no matter who they are… in the most respectful, non-judgmental way possible.” A second student realized, “As a nurse, I have to understand that you must individualize care. Think about what is right for that patient.” Other students said, “You need to remember that some people don’t have the same opportunities you have. Put yourself in their shoes,” and, “I have more empathy now that I can apply in my clinicals.”
6.5. Know Your Resources
Some students had already witnessed the special challenges nurses face when planning the care of patients who live homeless. “Be sure you know their special circumstances. I had a patient who was really quiet when asked about his family. Turns out, he had been living homeless and lost his family connection. He lost access to a lot of things. He seemed embarrassed [about his situation].” Another student shared, “I had a homeless person in clinical. My nurse was very involved in caring for her. She had to get her a cab. Her meds were too expensive. She had to stay another night to get meds and transportation worked out.” A student who worked in the Emergency Department told us, “When it’s really cold, [we] let them sleep in unused rooms. You can’t just send them out into the cold with no place to get warm.”
Our participants better understood what questions needed to be asked. They wondered, “What resources do [homeless individuals] need to heal and get well?” “Where will they go when they leave the hospital?” “If they don’t have shoes, will you discharge them?” One student was concerned that, “[If] they get a menstrual cup, but no one teaches them how to clean it if they are living outdoors, do they have resources to clean it? They get infections.”
7. Discussion
Our quantitative and qualitative findings demonstrated that the photovoice intervention was successful in raising awareness and increasing understanding of the experiences of those who live homeless. These findings are similar to results of studies using different approaches such as simulation [47], service learning [48], and clinical experiences [49] to expose students to the reality of homelessness, including the complexity of contributing factors and stereotypes. Our participants realized that those who live homeless are “smart” people who must employ complex strategies daily to survive; this has not been reported in the literature. Consistent with Allen and Vottero [13], our participants came away from the intervention with an awareness of the special needs of those who live homeless. They understood that care for this population is necessarily more complicated and requires more resources than care for those who are housed.
Nursing tends to attract empathetic people [50]. Still, our intervention increased empathy for those who live homeless. Our participants described being personally changed following the intervention. This depth of feeling is not typically mentioned in the literature. Our participants described seeing poor nursing care directed at patients who live homeless; this was also described by Astroth et al. [51]. They asserted that their nursing care will be different. In fact, they were motivated to work with those experiencing homelessness. While students have been reported as determined to give respectful, non-judgmental care for all patients, we found no reports of an intervention that motivated students to work with those who live homeless.
7.1. Limitations
In developing the intervention, seven participants did not return their cameras, and one camera’s film was not useable. Some of the richness of what it means to live homeless may have been missed as a result. In the research study, student participants self-selected into the focus groups. It may be that the groups were made up of students who were more interested in the topic. Finally, generalizability of this study is limited by its small sample size and its use of beginning students in an undergraduate nursing program.
8. Conclusion
Our study has important implications for nursing education and research. Nursing students learn to use evidence-based interventions to provide individualized patient-centered care to diverse populations. While historically minoritized populations are more likely to experience homelessness, most students in registered nurse programs in the United States are white [52]. The evidence gained from this study will give students better understanding of those who live homeless and help them interact with greater sensitivity and professionalism toward this population who have unique and varied health and social challenges, especially at the intersection of race and homelessness. Our goal as educators is to prepare nurses who are better informed and more empathetic toward all clients. The photovoice intervention could be a powerful antiracist education strategy for not only amplifying the voices of minoritized patients but also raising nursing students’ awareness, broadening their understanding of the complexities of homelessness, and providing a safe space for them to explore and challenge their own biases. Educators may use photovoice to teach about homelessness in a variety of nursing classes and clinical experiences. Other disciplines, including health-related professions, social work, and criminal justice, may also find photovoice an effective teaching modality.
While we used photovoice as an education intervention, it may also be used as a research methodology. Researchers typically experience much more prestige and financial stability than those who live homeless. Their perspectives are likely to vary substantially. Photovoice allows marginalized groups to directly express themselves without the need for interpretation by researchers. Future research should focus on studies comparing photovoice with more traditional methods of teaching students about homelessness. This study could be expanded to a variety of settings, including large urban centers or underserved rural areas. Online photovoice may be useful for accessing those unhoused individuals who have reliable access to the Internet and to a computer. Photovoice may ultimately improve care, and outcomes, for those who live homeless.
Conflicts of Interest
The authors declare no conflicts of interest.
Funding
The authors received no funding for this research.
Acknowledgments
We would like to acknowledge the important contributions Dr. Kim Schafer Astroth (deceased) and Dr. Cynthia Kerber made to the conduct of this research.
Open Research
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
