Introduction: People experiencing homelessness (PEH) represent an underserved population that is highly stigmatized, due to stereotypes and negative perceptions from society at large and by health professionals (HPs). This stigma can impact access to and quality of care and risk for morbidity and mortality. To understand the magnitude of interprofessional HPs’ bias toward PEH in clinical and educational settings and to assess outcomes of interventions, attitudinal assessments are needed. However, evidence suggests that existing instruments measuring HPs’ attitudes toward homelessness may inadvertently foster bias and stereotyping by oversimplifying how homelessness is experienced.
This Lightning talk addresses the theme “Interprofessional Collaboration and Advocacy to Address Health Equity, Racism and Bias in Practice” by addressing bias in measurement of attitudes toward PEH. The presentation focuses on the validity of the Health Professionals' Attitudes Toward the Homeless Inventory (HPATHI). We describe a cognitive interviewing (CI) study which aimed to explore how interprofessional HPs in training interpreted and responded to HPATHI items, including the potential impact of dated and stereotypical terminology used in item phrasing.
Method: The CI study used an interpretive approach to examine validity of the 35 HPATHI questions. Participants were 11 HP students from Medicine, Nursing, Occupational Therapy, Physical Therapy, and Public Health. In-depth cognitive interviews were conducted to elicit participant descriptions of their response methods and interpretation of the questions as they responded to each item sequentially. Audio recordings of the cognitive interviews were transcribed. A five-step analysis consisting of conducting, summarizing, comparing across respondents, comparing across groups, and concluding was used to evaluate each question’s performance within the context of respondents’ varied experiences and world views.
Results: Several themes that could threaten the validity of the HPATHI were identified: 1) use of outdated and/or pejorative language that could promote bias and stereotyping; 2) confusion due to inappropriate word choice (e.g., students preferred the phrase “interested in” instead of “enjoy” learning about the lives of PEH); and 3) overgeneralizing the question to the profession of medicine when the inventory purports to measure attitudes of health professionals including other disciplines.
Conclusions: Revising the problematic language and other issues could enable use of the updated HPATHI to aid in validation of the amended instrument. This in turn may enable a more relevant and culturally sensitive tool to measure attitudes of health professions towards PEH, potentially leading to better education of these health professions and care for people experiencing homelessness.
In support of improving patient care, this activity is planned and implemented by The National Center for Interprofessional Practice and Education Office of Interprofessional Continuing Professional Development (National Center OICPD). The National Center OICPD is accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.
As a Jointly Accredited Provider, the National Center is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. The National Center maintains responsibility for this course. Social workers completing this course receive continuing education credits.
The National Center OICPD (JA#: 4008105) is approved by the Board of Certification, Inc. to provide continuing education to Athletic Trainers (ATs).
This activity was planned by and for the healthcare team, and learners will receive Interprofessional Continuing Education (IPCE) credit for learning and change.
Physicians: The National Center for Interprofessional Practice and Education designates this live activity for AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with their participation.
Physician Assistants: The American Academy of Physician Assistants (AAPA) accepts credit from organizations accredited by the ACCME.
Nurses: Participants will be awarded contact hours of credit for attendance at this workshop.
Nurse Practitioners: The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts credit from organizations accredited by the ACCME and ANCC.
Pharmacists and Pharmacy Technicians: This activity is approved for contact hours.
Athletic Trainers: This program is eligible for Category A hours/CEUs. ATs should claim only those hours actually spent in the educational program.
Social Workers: As a Jointly Accredited Organization, the National Center is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. The National Center maintains responsibility for this course. Social workers completing this course receive continuing education credits.
IPCE: This activity was planned by and for the healthcare team, and learners will receive Interprofessional Continuing Education (IPCE) credits for learning and change.
Learners can claim CE credit by completing the Daily Evaluation.
