Journal of Community Health

, Volume 45, Issue 1, pp 73–80 | Cite as

The Effect of Place of Service on Diabetic Screening Adherence in the Homeless Population

  • Mary Katherine Wainwright
  • Melinda Earle
  • Kari Kosog
  • Mary Kay Gilbert
  • Christopher Nolan
  • Ed Stellon
  • Olivia Vitolo
  • William Jeffrey CanarEmail author
Original Paper


This study examined the association between place of service and adherence to select diabetes screening measures in a homeless population. At a Midwestern metropolitan federally qualified health center (FQHC), 508 participants with diabetes and also experiencing homelessness were studied throughout calendar year 2018. Diabetes measures included controlled blood pressure, diabetic foot exam and hemoglobin A1C screening. Patients were seen at one of three locations: FQHC only, shelter only and both shelter and FQHC. After controlling for primary insurance, insurance status, homeless status, age group, ethnicity, primary language, race, sex and poverty level, a stepwise binary logistic regression demonstrated significant model improvement in A1c screening (p ≤ 0.001) and controlled blood pressure (p = 0.009) when place of service was added as a predictor. Specifically, results showed significant negative associations in screening adherence for shelter as compared to FQHC for both controlled blood pressure (OR = 0.40; 95% CI = 0.20–0.79; p = 0.009) and A1c screening (OR = 0.06; 95% CI = 0.03–0.16; p ≤ 0.001). Our results support the hypothesis that FQHC care results in higher rates of adherence than shelter only or FQHC and shelter combined care. The study addresses the gap in literature surrounding place of service and patient adherence. Recommendations for future research are included.


Homelessness FQHC Diabetes Adherence 



  1. 1.
    Changes in the HUD Definition of “Homeless”. (n.d.). Retrieved from
  2. 2.
    Pribish, A., Khalil, N., Mhaskar, R., Woodard, L., & Mirza, A. (2018). Chronic disease burden of the homeless: A descriptive study of student-run free clinics in Tampa, Florida. Journal of Community Health. Scholar
  3. 3.
    HCH Clinicians’ Network. (2013). Adapting your practice: Treatment and recommendations for patients who are homeless with diabetes mellitus. Retrieved from
  4. 4.
    Asgary, R., Naderi, R., & Wisnivesky, J. (2017). Opt-out patient navigation to improve breast and cervical cancer screening among homeless women. Journal of Womens Health,26(9), 999–1003.CrossRefGoogle Scholar
  5. 5.
    Kaplan-Weisman, L., Waltermaurer, E., & Crump, C. (2018). Assessing and improving Zoster Vaccine uptake in a homeless population. Journal of Community Health. Scholar
  6. 6.
    Davachi, S., & Ferrari, I. (2012). Homelessness and diabetes: Reducing disparities in diabetes care through innovations and partnerships. Canadian Journal of Diabetes,36(2), 75–82.CrossRefGoogle Scholar
  7. 7.
    Zazworsky, D., & Johnson, N. (2014). It takes a village: A community partnership model in caring for the homeless. Nursing Administration Quarterly,38(2), 179–185.CrossRefGoogle Scholar
  8. 8.
    Wilk, T., Mora, P. F., Chaney, S., & Shaw, K. (2002). Use of an insulin pen by homeless patients with diabetes mellitus. Journal of the American Academy of Nurse Practitioners,14(8), 372–380.CrossRefGoogle Scholar
  9. 9.
    Baty, P. J., Viviano, S. K., Schiller, M., & Wendling, A. L. (2010). A systematic approach to diabetes mellitus care in underserved populations: Improving care of minority and homeless persons. Family Medicine,42(9), 623–627.PubMedGoogle Scholar
  10. 10.
    To, M. J., Brothers, T. D., & Zoost, C. V. (2016). Foot conditions among homeless persons: A systematic review. PLoS ONE,11(12), e0167463.CrossRefGoogle Scholar
  11. 11.
    Uniform Data System Reporting Instructions for 2018 Health Center Data (p. 45, 2018 UDS Manual). (2018). Rockville, MD: Bureau of Primary Health.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Rush University Medical CenterChicagoUSA
  2. 2.College of Nursing and College of Health SciencesRush University Medical CenterChicagoUSA
  3. 3.GenevaUSA
  4. 4.Heartland Alliance HealthChicagoUSA
  5. 5.Rush University Medical CenterChicagoUSA
  6. 6.Heartland Alliance HealthChicagoUSA
  7. 7.Department of Health Systems Management (126 TOB)Rush University Medical CenterChicagoUSA

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