Abstract
BACKGROUND: Homelessness is a pressing public health issue that is associated with adverse physical and mental health outcomes. Negative perceptions of individuals experiencing homelessness, including stereotyping and stigma, exacerbate health inequalities and impede access to care. Calls to address these issues include the incorporation of culturally competent education for future healthcare providers. This study explored the use of Tracy Kidder's Rough Sleepers as a teaching tool in an undergraduate health sciences course to deepen students' understanding of homelessness as a multifaceted public health issue. METHODS: A qualitative, thematic analysis, using a pre- and post-test study design was conducted to assess undergraduate students’ knowledge and perceptions of homelessness, including its relationship to public health. Thirty first-year undergraduate students enrolled in a required health sciences course consented and participated. Participants were asked to complete a baseline questionnaire before being assigned to read Rough Sleepers and engage in weekly discussions with the instructor as part of the six-week course. They completed the same questionnaire post-intervention. Thematic analysis was conducted to assess changes in students' perceptions, understanding, and attitudes toward homelessness, focusing on key domains such as stigma, healthcare access, and systemic factors. RESULTS: Baseline responses revealed surface-level understandings of homelessness, with students emphasizing basic needs and emotional impacts but demonstrating limited awareness of systemic barriers. Post-intervention, students demonstrated a more nuanced understanding of homelessness as a public health issue, with greater attention to its social and structural determinants, including economic instability, healthcare access, and stigma. Our thematic analysis of the qualitative data collected at baseline and post-intervention yielded three overall themes: 1) Acknowledgement of Homelessness as a Public Health Issue, 2) Awareness of Systemic and Structural Factors, and 3) More Empathy, Less Stigma: A Call for Action. CONCLUSION: The integration of Rough Sleepers as a teaching tool significantly enhanced students’ understanding of homelessness, fostering empathy, reducing stigma, and promoting awareness of systemic barriers. These findings support the use of popular media in health sciences education to challenge stereotypes and prepare future providers to address public health inequities. Further research is warranted to explore the long-term impacts of such interventions. TRIAL REGISTRATION: Not applicable. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12909-026-08597-x.