Perceptions, needs and preferences of chronic disease self-management support among men experiencing homelessness in Montreal

Objective This study explored the perceptions, needs and preferences for chronic disease self- management (SM) and SM support among men experiencing homelessness. Design A qualitative interpretive approach was used. Eighteen semi-structured interviews were conducted with 18 homeless men with a chronic disease at an emergency overnight shelter of Welcome Hall Mission (WHM) in Montreal, Quebec. Interviews were audio-recorded, transcribed verbatim and thematically analysed. Results The majority of participants perceived SM as important, described confidence to perform medical SM behaviours, and creatively adapted their SM behaviours to homelessness. Emotional SM was described as most challenging, as it was intertwined with the experience of homelessness. Three vulnerable groups were identified: (a) those with no social networks, (b) severe physical symptoms and/or (c) co-morbid mental illness. The preferred mode of delivery for SM support was through consistent contacts with health-care providers (HCPs) and peer-support initiatives. Discussion and Conclusions Despite competing demands to fulfill basic needs, participants valued chronic disease SM and SM support. However, SM support must address complex challenges relating to homelessness including emotional SM, multiple vulnerabilities and barriers to forming relationships with HCPs.