Health and well-being of homeless youth in Ghana.

Abstract

Background: Homeless youth have been described as being resilient, and vulnerable to poor mental and behavioural health. However, literature on factors promoting resilience of these homeless youth in an African context, especially in Ghana, is scarce. The main aim of the present study was to examine the mental and behavioural health and well-being of homeless youth and the protective factors that could be strengthened to promote their mental health and reduce risky health related behaviours. Specifically this doctoral thesis investigated: 1) factors fostering resilience among homeless youth, 2) the experiences of homeless youth in relation to their health and well-being, 3) the validation of the factor structure of Connor-Davidson Resilience Scale (CD-RISC), 4) the prevalence of health risk behaviours and status of psychological well-being, and 5) the relationship between resilience and health risk behaviours among homeless youth in Ghana. Method: An exploratory mixed method approach was adopted in which qualitative data was first collected followed by a quantitative survey. For the qualitative study a purposive sample of 16 homeless youth from the Central Business District of Accra were interviewed using a semi-structured interview schedule. A cross-sectional study with an interviewer-administered questionnaire was used to assess the mental health variables from a relatively large sample of 227 conveniently selected homeless youth. The participants were between the ages of 9-19 years, and had lived on the street for a period of between 6 months to 8 years. Interpretive Phenomenological Analysis (IPA) was used to analyse the interview transcripts in the qualitative study whilst exploratory factor analysis, One-Way ANOVA, independent samples t-tests, Chi-Square tests for independence, Pearson- moment correlation coefficient, standard multiple regression and logistic regression models were used to analyse the quantitative data. Data collection lasted for 8 and 12 weeks for the qualitative and quantitative phases of the study respectively. Results: The qualitative results showed that strong religious beliefs, engagement in meaningful activities, peer group support, adherence to cultural norms and support from community-based organizations were important factors that promote resilience among participants. The quantitative results showed that participants exhibited poor mental health with high levels of psychological distress, substance use and suicidal ideation. Clustering of health risk behaviours was found in this study among homeless youth who were using substances and engaging in unprotected sex with multiple sexual partners. Some evidence for the engagement in survival sex was also found. Overall poor psychological functioning was predicted by experiences of perceived stigmatization and discrimination, self-stigma, suicidal ideation and exposure to violence. The results also showed that perceived resilience served as a protective factor for suicidal ideation and having multiple sexual lifetime partners, suggesting that youth with higher perceived resilience were less likely to engage in health risk behaviours. Conclusion: These findings seem to suggest that homeless youth are resilient, but nevertheless are susceptible to various mental health problems, with substance use acting as a gateway for sexual risk behaviours. Development of multilevel prevention interventions are recommended to build resilience in youth through access to psychological counselling and to develop better coping strategies at the individual level; facilitate health enhancing social networks that provide homeless youth with an alternative network to that of gains in social support at the interpersonal level and to address the social determinants of poor mental health at community and societal levels.