Learning Objective #1: Describe health behaviors of homeless persons with serious mental illness within a cultural context

Learning Objective #2: Describe behaviors that characterize three subgroups found within the subculture

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The aim of this study was to describe the subculture of homeless persons with serious mental illness in order to determine cultural influences on health and health behaviors. The design of this exploratory qualitative study was ethnography. An interpretive perspective or worldview underpinned the study. Methods used to gather data during this eight month study were participant observation and interviewing. The informants ranged in age from 35 to 79 years. All self-reported as having either schizophrenia or bipolar disorder, experienced one or more symptoms commonly associated with serious mental disorders, and were or had been homeless at time of interview. From the data, five major domains emerged and became the primary focus of the study: (a) Being Homeless, (b) Identity, (c) Social Network, (d) Victimization, and (e) Health. The domains and their associated pattern categories and themes were formulated into a theoretical model that served to describe the subculture. Examples of themes ncluded: (a) subgroups, (b) isolation, (c) separateness, (d) lack of permanence, (e) bodily distress, (f) different from others, (g) on the alert, and (h) seeking remedy. Study findings indicate that homeless persons with serious mental illness have unique cultural needs. The day-to-day focus on surviving is important for nurses and other health care providers to consider. Specifically, nurses need to assess the individual's perception regarding the importance of prescribed therapeutic regimes. The practically of the instructions need to be evaluated in relation to the environment in which they are to be implemented. In addition, knowledge of the diversity of the subculture can be used when conducting community assessments of healthcare needs. Recommendations for further research include using the study domains and corresponding pattern categories and themes as a guiding framework to further abstract the concepts and thereby, help to develop it into a theory.