COVID-19 response and the unhoused communities in Sacramento: a mixed methods study with policy implications

In an emergency response to the COVID-19 pandemic, cross-sector public health collaborations facilitated emergency hotel room placements for people experiencing homelessness (PEH). To inform a Health-in-All-Policies approach to future disasters, the study objective was to assess the impact of the disaster response on the unhoused communities surrounding Sacramento.

Our interdisciplinary team-based convergent parallel mixed methods study included quantitative and qualitative data collection and analysis, followed by integrated analyses. The quantitative primary outcome was number of self-reported primary care physician visits. Semi-structured in-person interviews focused on perspectives of the COVID-19 pandemic and public health interventions, experiences with healthcare access and preventative measures, and personal priorities. Interviews were recorded, transcribed, and coded using thematic analysis. Integration was guided by the "following a thread" approach.

We surveyed 100 people living outdoors ("outside PEH") and 100 people in temporary hotel room placements ("hotel PEH"), and we conducted and transcribed interviews with 19 outside PEH and 16 hotel PEH for qualitative thematic analysis. Hotel PEH reported significantly more primary care physician visits compared to outside PEH (p < 0.05). Mobile health clinics were viewed favorably by both outside PEH (93%) and hotel PEH (85%). Four qualitative themes emerged: (1) Access to resources; (2) Social connection as empowerment; (3) Exacerbation of pre-existing conditions; and (4) Impact of systems and policy on safety. Integrated comparison demonstrated that hotel placements improved access to information, healthcare, resources, hygiene, hope, and safety. This informed four disaster response guidelines: (1) Prioritize housing; (2) Maintain safe and healthy living environments; (3) Improve health and access to integrated healthcare services; and (4) Promote social and emotional well-being.

Comprehensive disaster responses require understanding vulnerable populations' experiences, perspectives, and priorities. Student-led team science addresses complex questions, revealing pandemic response lessons and informing Health-in-All-Policies approaches to ongoing and future disasters.