{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T08:54:39Z","timestamp":1769504079275,"version":"3.49.0"},"reference-count":43,"publisher":"CMA Impact Inc.","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["cmajo"],"published-print":{"date-parts":[[2022,7]]},"DOI":"10.9778\/cmajo.20210334","type":"journal-article","created":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T12:17:11Z","timestamp":1658233031000},"page":"E685-E691","source":"Crossref","is-referenced-by-count":12,"title":["Challenges faced by people experiencing homelessness and their providers during the COVID-19 pandemic: a qualitative study"],"prefix":"10.9778","volume":"10","author":[{"given":"Kathryn","family":"Hodwitz","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janet","family":"Parsons","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clara","family":"Juando-Prats","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esther","family":"Rosenthal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Craig-Neil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen W.","family":"Hwang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joel","family":"Lockwood","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Das","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tara","family":"Kiran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"382","published-online":{"date-parts":[[2022,7,19]]},"reference":[{"key":"2022072107100440000_10.3.E685.1","unstructured":"Gaetz S Dej E Richter T (2016) The state of homelessness in Canada 2016 (Canadian Observatory on Homelessness Press, Toronto) Available: https:\/\/www.homelesshub.ca\/SOHC2016 . accessed 2021 Sept. 20."},{"key":"2022072107100440000_10.3.E685.2","unstructured":"(2020) 2019 AHAR: Part 1 - PIT estimates of homelessness in the U.S (US Department of Housing and Urban Development, Washington (DC)) Available: https:\/\/www.hudexchange.info\/resource\/5948\/2019-ahar-part-1-pit-estimates-of-homelessness-in-the-us\/ . accessed 2021 Sept. 20."},{"key":"2022072107100440000_10.3.E685.3","doi-asserted-by":"crossref","first-page":"e186","DOI":"10.1016\/S2468-2667(20)30053-0","article-title":"COVID-19: a potential public health problem for homeless populations","volume":"5","author":"Tsai","year":"2020","journal-title":"Lancet Public Health"},{"key":"2022072107100440000_10.3.E685.4","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.200834"},{"key":"2022072107100440000_10.3.E685.5","unstructured":"National Academies of Sciences, Engineering and Medicine (2018) in accessed 2021 Dec. 19 Permanent supportive housing: evaluating the evidence for improving health outcomes among people experiencing chronic homelessness (The National Academies Press, Washington (DC)) Availablehttps:\/\/www.ncbi.nlm.nih.gov\/books\/NBK519594\/pdf\/Bookshelf_NBK519594.pdf ."},{"key":"2022072107100440000_10.3.E685.6","doi-asserted-by":"publisher","DOI":"10.9778\/cmajo.20200253"},{"key":"2022072107100440000_10.3.E685.7","doi-asserted-by":"crossref","first-page":"2191","DOI":"10.1001\/jama.2020.6887","article-title":"Prevalence of SARS-CoV-2 infection in residents of a large homeless shelter in Boston","volume":"323","author":"Baggett","year":"2020","journal-title":"JAMA"},{"key":"2022072107100440000_10.3.E685.8","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6917e1"},{"key":"2022072107100440000_10.3.E685.9","unstructured":"Nielsen K (June 14, 2021) Global News, 76 COVID-19 cases now connected to outbreak in Waterloo Region congregate setting. Available: https:\/\/globalnews.ca\/news\/7948916\/covid-19-outbreak-waterloo-region-congregate-setting\/ . accessed 2021 Dec. 19."},{"key":"2022072107100440000_10.3.E685.10","doi-asserted-by":"publisher","DOI":"10.9778\/cmajo.20200287"},{"key":"2022072107100440000_10.3.E685.11","doi-asserted-by":"crossref","unstructured":"Teti M Schatz E Liebenberg L (2020) Methods in the time of COVID-19: the vital role of qualitative inquiries. Int J Qual Methods, 19.","DOI":"10.1177\/1609406920920962"},{"key":"2022072107100440000_10.3.E685.12","doi-asserted-by":"crossref","first-page":"2441","DOI":"10.1002\/jcop.22583","article-title":"Hand hygiene during the COVID-19 pandemic among people experiencing homelessness: Atlanta, Georgia, 2020","volume":"49","author":"Montgomery","year":"2021","journal-title":"J Community Psychol"},{"key":"2022072107100440000_10.3.E685.13","doi-asserted-by":"crossref","first-page":"100829","DOI":"10.1016\/j.ssmph.2021.100829","article-title":"\u201cLocked down outside\u201d: perception of hazard and health resources in COVID-19 epidemic context among homeless people\u201d","volume":"15","author":"Allaria","year":"2021","journal-title":"SSM Popul Health"},{"key":"2022072107100440000_10.3.E685.14","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s12939-020-01364-4","article-title":"Exploring the experiences of changes to support access to primary health care services and the impact on the quality and safety of care for homeless people during the COVID-19 pandemic: a study protocol for a qualitative mixed methods approach","volume":"20","author":"Howells","year":"2021","journal-title":"Int J Equity Health"},{"issue":"Suppl 2","key":"2022072107100440000_10.3.E685.15","doi-asserted-by":"crossref","first-page":"e20200489","DOI":"10.1590\/0034-7167-2020-0489","article-title":"No place to shelter: ethnography of the homeless population in the COVID-19 pandemic [article in Portuguese]","volume":"73","author":"de Paula","year":"2020","journal-title":"Rev Bras Enferm"},{"key":"2022072107100440000_10.3.E685.16","doi-asserted-by":"crossref","first-page":"635715","DOI":"10.3389\/fpsyt.2021.635715","article-title":"Social injustice in the neoliberal pandemic era for homeless persons with mental illness: a qualitative inquiry from India","volume":"12","author":"Bhattacharya","year":"2021","journal-title":"Front Psychiatry"},{"key":"2022072107100440000_10.3.E685.17","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2006.03740.x"},{"key":"2022072107100440000_10.3.E685.18","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1080\/2159676X.2019.1628806","article-title":"Reflecting on reflexive thematic analysis","volume":"11","author":"Braun","year":"2019","journal-title":"Qual Res Sport Exerc Health"},{"key":"2022072107100440000_10.3.E685.19","unstructured":"Fox C Toronto and Peel placed under \u201clockdown,\u201d all non-essential retail will be limited to curbside pickup only, CP24 updated 2020 Nov. 20. Available: https:\/\/www.cp24.com\/news\/toronto-and-peel-placed-under-lockdown-all-non-essential-retail-will-be-limited-to-curbside-pickup-only-1.5197335 . accessed 2022 Mar. 28."},{"key":"2022072107100440000_10.3.E685.20","unstructured":"Davidson S CTV News Toronto, Stay-at-home order extended in Toronto, Peel and North Bay until March 8, restrictions to ease in York. updated 2021 Feb. 19. Available: https:\/\/toronto.ctvnews.ca\/stay-at-home-order-extended-in-toronto-peel-and-north-bay-until-march-8-restrictions-to-ease-in-york-1.5315544 . accessed 2022 Mar. 28."},{"key":"2022072107100440000_10.3.E685.21","unstructured":"The Canadian Press (Apr 3, 2021) Global News, COVID-19: Ontario now under provincewide \u2018shutdown\u2019 to control spread of virus. updated 2021 Apr. 4. Available: https:\/\/globalnews.ca\/news\/7736868\/covid-ontario-provincewide-shutdown\/ . accessed 2022 Mar. 28."},{"key":"2022072107100440000_10.3.E685.22","unstructured":"City of Toronto (2018) Toronto street needs assessment 2018 results report (Canadian Observatory on Homelessness\/Homeless Hub, Toronto) Available: www.homelesshub.ca\/resource\/toronto-street-needs-assessment-2018-results-report . accessed 2021 Dec. 19."},{"key":"2022072107100440000_10.3.E685.23","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"2022072107100440000_10.3.E685.24","unstructured":"Green J Thorogood N (2014) Qualitative methods for health research (SAGE, Los Angeles)."},{"key":"2022072107100440000_10.3.E685.25","doi-asserted-by":"publisher","DOI":"10.1080\/17439760.2016.1262613"},{"key":"2022072107100440000_10.3.E685.26","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"2022072107100440000_10.3.E685.27","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1080\/2159676X.2019.1704846","article-title":"To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales","volume":"13","author":"Braun","year":"2021","journal-title":"Qual Res Sport Exerc Health"},{"key":"2022072107100440000_10.3.E685.28","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2020.566212"},{"key":"2022072107100440000_10.3.E685.29","doi-asserted-by":"publisher","DOI":"10.1186\/s12954-021-00472-w"},{"key":"2022072107100440000_10.3.E685.30","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1139\/facets-2021-0004","article-title":"Seeking shelter: homelessness and COVID-19","volume":"6","author":"Baral","year":"2021","journal-title":"Facets"},{"key":"2022072107100440000_10.3.E685.31","doi-asserted-by":"publisher","DOI":"10.1159\/000507639"},{"key":"2022072107100440000_10.3.E685.32","doi-asserted-by":"publisher","DOI":"10.1056\/nejmp2008017"},{"key":"2022072107100440000_10.3.E685.33","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2020.05.026"},{"key":"2022072107100440000_10.3.E685.34","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1007\/s00420-021-01695-x","article-title":"Burnout among healthcare professionals during COVID-19 pandemic: a cross-sectional study","volume":"94","author":"Jalili","year":"2021","journal-title":"Int Arch Occup Environ Health"},{"key":"2022072107100440000_10.3.E685.35","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1007\/s11469-020-00367-0","article-title":"The mental health impact of the COVID-19 pandemic across different cohorts","volume":"20","author":"Khan","year":"2022","journal-title":"Int J Ment Health Addict"},{"key":"2022072107100440000_10.3.E685.36","doi-asserted-by":"crossref","unstructured":"Sheather J Fidler H (2021) COVID-19 has amplified moral distress in medicine. BMJ, 372.","DOI":"10.1136\/bmj.n28"},{"key":"2022072107100440000_10.3.E685.37","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1177\/1359105315595120","article-title":"When healthcare professionals cannot do the right thing: a systematic review of moral distress and its correlates","volume":"22","author":"Lamiani","year":"2017","journal-title":"J Health Psychol"},{"key":"2022072107100440000_10.3.E685.38","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18020488"},{"key":"2022072107100440000_10.3.E685.39","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1080\/23294515.2019.1586008","article-title":"Enhancing understanding of moral distress: the measure of moral distress for health care professionals","volume":"10","author":"Epstein","year":"2019","journal-title":"AJOB Empir Bioeth"},{"key":"2022072107100440000_10.3.E685.40","unstructured":"Couto Zuber M (Aug 18, 2021) CTV News Toronto, Nearly 75 per cent of Ontario doctors experienced burnout during pandemic, survey finds. Available: https:\/\/toronto.ctvnews.ca\/nearly-75-per-cent-of-ontario-doctors-experienced-burnout-during-pandemic-survey-finds-1.5552218 . accessed 2021 Sept. 20."},{"key":"2022072107100440000_10.3.E685.41","unstructured":"Etz R Green LA (July 27, 2021) (2021) Quick COVID-19 primary care survey, Series 29 (University of Michigan Library, Ann Arbor (MI)) Availablehttps:\/\/deepblue.lib.umich.edu\/handle\/2027.42\/168418 . accessed 2021 Aug. 23."},{"key":"2022072107100440000_10.3.E685.42","unstructured":"(2020) City of Toronto COVID-19 response for people experiencing homelessness (City of Toronto, Toronto) Available: https:\/\/www.toronto.ca\/news\/city-of-toronto-covid-19-response-for-people-experiencing-homelessness\/ . accessed 2021 Dec. 19."},{"key":"2022072107100440000_10.3.E685.43","unstructured":"Hwang S (Sept 28, 2020) Globe and Mail, It is possible to end chronic homelessness if we act now. Available: https:\/\/www.theglobeandmail.com\/opinion\/article-it-is-possible-to-end-chronic-homelessness-if-we-act-now\/ . accessed 2021 Sept. 20."}],"container-title":["CMAJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.9778\/cmajo.20210334","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,21]],"date-time":"2022-07-21T14:10:36Z","timestamp":1658412636000},"score":1,"resource":{"primary":{"URL":"http:\/\/cmajopen.ca\/lookup\/doi\/10.9778\/cmajo.20210334"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7]]},"references-count":43,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,7,19]]},"published-print":{"date-parts":[[2022,7]]}},"alternative-id":["10.9778\/cmajo.20210334"],"URL":"https:\/\/doi.org\/10.9778\/cmajo.20210334","relation":{},"ISSN":["2291-0026"],"issn-type":[{"value":"2291-0026","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7]]}}}