An Intersectional Perspective on Digital Health: Longitudinal Narratives and Observations With Older and Middle-Aged Women Experiencing Homelessness.

Background and objectives: People experiencing homelessness and older people encounter barriers as health and social care services are increasingly delivered online, however, there is limited knowledge about how this relates to older and middle-aged women experiencing homelessness, especially those from minoritized and/or migrant communities. We aimed to explore how technology, including digital health, can help or hinder older and middle-aged women to navigate paths through and out of homelessness.

Research design and methods: This 16-month qualitative longitudinal study utilized narrative interviews and participant observations with seven older and two middle-aged women experiencing homelessness, in London, England. Additionally, we observed interactions between the women experiencing homelessness and 2 information and communications technology class facilitators. We collected and analyzed data using a narrative, interpretative approach. An advisory board of women with lived experiences of homelessness supported the interpretation of findings and development of practice and policy recommendations.

Results: We present our findings as 3 composite narrative vignettes co-constructed with the participants: (1) "No, I'm not taking this telephone appointment"; (2) "Technology doesn't judge you"; and (3) "You have to be a digital person now." The findings illuminate determinants of digital health equity related to aging, gender, and migration status among older and middle-aged women experiencing homelessness.

Discussion and implications: Using an intersectional lens, we provide recommendations about how to better align digital health to the needs of older and middle-aged women experiencing homelessness. The findings will inform intervention development.