Reflecting mixed method research on drinking water, sanitation and hygiene among unhoused people. Insights into a case study from Germany

Abstract

Introduction

People experiencing homelessness and the drinking water, sanitation and hygiene (WASH) challenges that they are facing are neither well-represented in academic literature, nor in national and international statistics. This dynamic and often invisible vulnerable group is commonly undercounted in national surveys and official statistics are often based on household units, thus, not accounting for unsheltered individuals. Living at the margins, they are often out of reach to be involved in outreach efforts and interventions, and these systemic inequities increase their exposure to risks, while decreasing access to assistance to mitigate and reduce them.

Methods

Using a mixed method case study carried out in Germany in 2023, we involved 45 persons experiencing homelessness. We first provide an overview of our study design capturing spatial and non-spatial, individual and collective information through research methods such as in-depth interviews, walking interviews, focus group discussions, collaborative mapping (digital versus on paper), arts-based research, mental mapping, photovoice and shadowing. We then reflect on their feasibility and usefulness.

Results

In-depth interviews were most feasible to implement, captured individual, cross-sectional, information and lead to the best results. Participatory methods, collaborative mapping and group discussions were more difficult to implement, yet lead to highly relevant findings. Longitudinal approaches and mental mapping methods were most difficult to realize. Photovoice could not be implemented at all. Shadowing resulted in findings that were only of medium relevance, yet, were very helpful in establishing an improved relationship with the target population, and building trust.

Conclusions and recommendations

The multifaceted challenges of unhoused individuals require awareness of their lived realities, great flexibility, time, trust, relationships, openness and adaptations, and research designs tailored to their life realities. Our insights can enable decision-makers to design targeted interventions and have broader applicability among other populations and contexts.