Food Insecurity among Unsheltered Homeless People in Fresno, California, with an Emphasis on the Role of Drugs and Other Substances, Disease/Illness, Sleeping Patterns, and Food Consumption. II. A Qualitative Study

The objective of this study is to examine the role of substance use, disease and illness, inadequate sleep, and 24-hour dietary patterns in food insecurity in Fresno’s unsheltered homeless population. We conducted 201 semi-structured interviews and 32 in-depth interviews, and made direct observations of people’s behavior and circumstances. Triangulation of the information from these three methods ensured its reliability and credibility. We employed an inductive thematic analysis, which enabled us to identify, analyze, and report complex data. The data were coded and sub-coded around emerging themes and analyzed. The five themes that emerged from the analysis were the cumulative impact of disease/illness, substance use, 24-hour sleeping patterns, multiple substance use, coping behavior, and food security. Whereas the former three themes describe the downward trajectory of food insecurity that is strongly influenced by mental disease, substance use, and personal safety measures, the coping behavior theme identifies both positive and negative behavioral traits and safety-linked factors, and the food security theme describes the beneficial impacts of good health, non-use of substances, self-efficacy, eating at least two meals a day, and sleeping six or more hours. We conclude that the triad of semi-structured interviews, in-depth interviews, and direct observation is a comprehensive information source and inductive thematic analysis is a powerful tool for examining complex food insecurity data, and that the actionable results can inform the development of policies and integrative social and health services aimed at improving the food security of unsheltered homeless people in Fresno.

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