Health Education and Mindfulness for Homeless Persons Diagnosed with Hypertension, Diabetes Mellitus and/or Obesity

Abstract

Background

There has been a national increase in homelessness since COVID-19, despite federal, state, and local efforts to end homelessness, accompanied by an increase in chronic diseases such as hypertension (HTN), diabetes mellitus (DM), obesity, and other stress related conditions. The cost of goods, services, housing, healthy foods, medicine, and medical supplies have faced an inflationary squeeze, further increasing the homeless population and decreased access to health resources. Research has shown that chronic medical conditions worsened by stress are major risk factors for myocardial infarctions, stroke, and kidney failure.

Researchers consisting of physicians, nurse practitioners, and medical students conducted a face-to-face pilot study in one local homeless shelter over a 4-week period that showed high rates of HTN, DM, obesity, and overall stress among the sheltered residents. Researchers performed similar work using a virtual platform during COVID-19 Pandemic with a group of sheltered homeless residents. The virtual HTN, DM, and obesity education program showed an increase in knowledge of chronic diseases and improvements in blood pressure, blood glucose, and weight management.

The purpose of this paper is to report the impact of a pilot health education and clinical intervention program for sheltered homeless residents to become knowledgeable and empowered to recognize signs and symptoms of worsening disease, expected effects of pharmacotherapy, weight management through diet and exercise, and to decrease levels of stress through mindfulness (meditation) training.

Significance

As seen in America, homeless and underserved populations in South Florida are faced with medically complex needs that are minimally met by onsite clinics and have increased in severity since COVID 19. Homeless persons have limited access to onsite clinics and hospital outpatient services, and due to limited resources when scheduling appointments, face longer wait timesthat lead to gaps in care, resulting in worsening of disease progression. Initial, follow up care, and recovery support are minimal and negatively impact homeless persons, resulting in a cost burden to the healthcare system.

Methods

Homeless residents identified with a co-morbid condition from a medical records’ review were invited to participate in the pilot study and to sign a consent agreeing to participate. Persons agreeing to participate were provided weekly one-hour health education, aerobic exercises, and mindfulness (meditation) sessions. Weekly blood pressure (BP), blood glucose (BG), and weight measurements were collected from participants. Thirty-minute aerobic exercises were performed by participants following each lecture series. A pre- and post-test was given at the start of the Pilot program and at the end of the fourth week to determine knowledge of diseases and prescribed medications, importance of exercise, proper dietary adherence, and levels of stress precipitating depression.

Interventions

Sheltered residents were provided with weekly 20-minute lecture series on HTN, DM, nutrition, exercise, and mindfulness. Individual medications have been reviewed with each participant for adherence and patient response. Those participants identified with additional medical concerns were accompanied tothe clinic for a medical encounter with a provider.

Results

Data were collected utilizing the mood questionnaire, BP measures, weight, BMI, and BG for each week the individuals participated in the project. Data was analyzed using sample paired t test and the repeated measure ANOVA based on data completeness; analyses were conducted on the data generated by the participants. SPSS Statistics V. 28.0 was used for data analysis. Descriptive statistics, correlation and group comparison analyses were conducted to answer the research questions; the sample was described using descriptive statistics, while histograms and the Kolmogorov-Smirnov statistic tests were used to assess the distribution of systolic, diastolic, BMI, and mood variables.

BP percent changes were calculated for the sample for each week after week 1. Overall, the BP measures were as follow for each week consecutively, Systolic/Diastolic (M= 130.86/83.86, SD= 20.03/12.07), (M= 126.64.0/83.36, SD= 7.05/7.06), (M= 126.0/86.78, SD= 20.4/12.14), (M= 128.31/83.69, SD= 16.59/9.22).BMI and weight measurements over the 4-week period showed a slight decrease from baseline. Participants mean weight at the beginning of the Pilot study was 220.9 and at the end of the Pilot study, the mean weight was 218.43. There were also minimal changes in the BMI showing pre-BMI 34.9 and post-BMI 34.7. The questions given to the participants on knowledge of hypertension, diabetes, and nutrition and weight are under review because majority of participants demonstrated difficulties in health literacy when completing the surveys and many questions were left blank, creating an intervening variable impacting the reliability of the results. The results of the questionnaires are being analyzed and rescreened for health literacy measures.

Conclusion

This pilot study demonstrated that effective lifestyle changes supported by weekly health educational programs, dietary adjustments, and pharmacological management, can have a positive impact on HTN, DM, obesity, and stress management among sheltered homeless persons. A reevaluation of written surveys are being analyzed improved health literacy. An extended approach to this program can lead to a decrease in the incidence and burden of chronic diseases among sheltered homeless persons.