Street Medicine as Service Learning: Lessons from a Needs Assessment Conducted by Medical Students

Abstract

Background The homeless population is growing across the United States, particularly in urban areas. Oftentimes, there is a disconnect between existing community services and actual needs of individuals experiencing homelessness. These services gaps are frequently identified by needs assessments and utilized by community agencies to inform outreach efforts and program development. Community outreach by medical students through participation in community-based service learning projects is critically important for the preparation of future physicians to care for underserved and vulnerable populations. This study describes the stepwise approach taken by medical students to design and administer a needs assessment for the purpose of informing the development of a new street medicine program. This study is intended to serve as a guide to students who aspire to launch a new street medicine program but is generalizable to other student-led service learning outreaches. Methods We conducted a needs assessment from April-June 2018 of 144 unsheltered homeless individuals in metro Phoenix, Arizona. The 16-question survey investigated perceptions of priority needs, sources of medical care, health literacy, and health status. Survey results were analyzed using Wilcoxon Rank Sum Test, chi-squared analysis, and multivariable logistic regression. Results Most respondents (91.6%) identified food as a top need. The majority (64.1%) utilized Emergency Departments as their primary source of care, and 40.1% reported suboptimal health. Suboptimal health was more likely to be reported in those who expressed transportation (OR 3.03, 95% CI: 1.30-7.07) as a top priority need. Health illiteracy (OR 3.68, 95% CI: 0.76-17.9) was associated with suboptimal health, as was obtaining care at an Emergency Department (OR 2.05, 95% CI: 0.81-5.25). Conclusions Pairing health care with meals and other primary needs may be an effective strategy to increase service utilization by this population. Needs assessments provide an opportunity for health professional students to learn about social needs and more effectively connect patients with services from community agencies and health care organizations.