Abstract
OBJECTIVE: To advance patient-centered care for high-need homeless-experienced patients, we identified the rates of various personal health goals, the broader domains that underlie these goals, and associations between these domains and the health-related needs of this population. METHOD: The sample consisted of 176 veterans from 3 VA Medical Centers who were enrolled in primary care, on VA's Homeless Registry, and high utilizers of acute care. An interview was conducted with each participant to collect information on their personal health goals and health-related needs. Exploratory factor analysis was used to identify broad domains underlying endorsement of personal health goals. Associations between these broad goal domains and health-related needs (substance use, mental and physical health, treatment engagement, and psychosocial) were examined using an exploratory structural equation modeling-within-confirmatory factor analysis approach. RESULTS: Three broad domains were found to underlie the personal health goals of the sample: social functioning, health promotion, and substance use. Social functioning and health promotion were highly correlated, whereas substance use was weakly correlated with both social functioning and health promotion. All substance use-related needs were positively associated with substance use goals. Mental and physical health needs were primarily associated with health promotion goals. Treatment engagement and psychosocial needs demonstrated associations across all 3 goal domains. CONCLUSIONS: Findings highlight the high value that many high-need homeless-experienced patients place on their social well-being and the potential benefits to measuring both deficiency and growth needs in this population. Clinical implications and future directions for research are discussed.