The benefits of information communication technology use by the ...

journal of social distress and the homeless, Vol. 23 No. 1, March, 2014, 51–67

The benefits of information communication technology use by the homeless: a narrative synthesis review Adrien Sala and Javier Mignone University of Manitoba, Winnipeg, Canada Recent studies have suggested that technologies are becoming an increasingly ubiquitous element in the lives of individuals experiencing homelessness. With both Canadian and US researchers reporting staggering levels of homelessness on both sides of the border, an understanding and synthesis of the current literature exploring how technologies are being utilized by homeless individuals and how it may impact their well-being is of relevance to policy makers and social service organizations. The study explored and synthesized literature to examine the ways in which individuals experiencing homelessness utilize information and communication technologies (ICTs), and how the use of ICTs influences the health and social outcomes of individuals experiencing homelessness. The study examined 16 peer reviewed articles using a narrative synthesis systematic review, following three elements of the narrative synthesis approach: preliminary synthesis of findings; exploration of relationships between studies; and assessment of the robustness of the synthesis. In relation to what ICTs are used for by homeless individuals, three major themes emerged: social connectedness, identity management, and instrumental purposes. Furthermore, there was some tentative evidence about a positive relationship between ICT use among individuals experiencing homelessness and health outcomes. The paper discussed limitations, future areas of research, as well as some policy directions. keywords homeless, information communication technologies, social media, internet

Introduction Recent studies have suggested that technologies are becoming an increasingly ubiquitous element in the lives of individuals experiencing homelessness, leading some researchers to question the existence of a “digital divide” (Eyrich-Garg, 2011; Guadagno, Muscanell, & Pollio, 2013; Pollio, Batey, Bender, Ferguson, & Thompson,

© W. S. Maney & Son Ltd 2014

DOI 10.1179/1573658X14Y.0000000006

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ADRIEN SALA and JAVIER MIGNONE

2013). Other research has underlined the potential for social media, mobile phones, and the internet in general to improve mental health, addiction issues, and sexual health outcomes of individuals experiencing homelessness (Freedman, Lester, McNamara, Milby, & Schumacher, 2006; Rice, Kurzban, & Ray, 2012). Furthermore, it seems to promise new frontiers for HIV prevention, as well as opportunities for intervention among individuals grappling with debilitating mental health and addictions issues, that often lead to further disenfranchisement and entrenchment in life on the street (Rice, 2010; Rice, Milburn, & Monro, 2011; Rice, Munro, Barman-Adhikari, & Young, 2010; Young & Rice, 2011). Common wisdom would suggest that greater access to information and social connectedness, which is supposedly gained through information and communication technologies (ICTs), may improve the health and social outcomes of individuals experiencing homelessness. Nonetheless, the evidence remains inconclusive and little is known about the ways in which these populations utilize or leverage ICTs for their own benefit (Hwang, Kirst, & Chiu, 2009). As the internet, mobile phones, and various forms of social media have become increasingly ubiquitous mechanisms for maintaining and building social relationships, and for instrumental purposes, the relevance of ICTs and the benefits or potential harms of their use is a subject area of mounting interest (Boyd, 2007; Dvorak, 2009; Rice et al., 2012). While many would assume that individuals experiencing homelessness are not among those becoming increasingly reliant upon technologies, recent studies are suggesting otherwise (Guadagno et al., 2013; Pollio et al., 2013; Rice, Lee, & Taitt, 2011; Woelfer & Hendry, 2012). Academics from diverse fields have begun to take note, spawning a literature related to homelessness within journals outside of the expected fields of health and social work. Journals from areas such as human–computer interaction, occupational therapy, and library and information sciences, have in recent years published a spate of articles exploring the question of homelessness and the relevance of ICTs to improving the health and social outcomes of this population. With both Canadian and US researchers reporting staggering levels of homelessness on both sides of the border, an understanding and synthesis of the current literature exploring how technologies are being utilized by homeless individuals and how it may impact their wellbeing is of relevance to policy makers and social service organizations.

Purpose of the study The study explored and synthesized literature to examine: (1) the ways in which individuals experiencing homelessness utilize ICTs; and (2) how the use of ICTs influences the health and social outcomes of individuals experiencing homelessness.

Methodology General considerations The approach utilized in conducting this systematic review differs from approaches that explore a more homogeneous range of study designs aimed at conducting

NARRATIVE SYNTHESIS REVIEW OF ICT USE BY THE HOMELESS

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meta-analyses. The study utilized an explicit set of protocols for locating and selecting the various articles included in this study. However, the breadth of perspectives, fields, and methodologies of the studies discovered in our exploratory search suggested that a more inclusive approach would be necessary. Furthermore, there were too few articles from any one particular discipline to allow for a more focused review of a particular aspect of technology use by individuals experiencing homelessness. No specific typologies of homelessness were examined in this study for two main reasons. Firstly, limiting the search strategy to studies related to one particular category of homelessness would have severely limited the number of examinable studies, as this is a relatively novel area of exploration with few papers specifically researching technology use among homeless populations. Secondly, our exploratory search revealed that many of the articles examining technology use by the homeless failed to specifically identify the type of homeless population they studied. While some articles did indeed differentiate for instance between youth homelessness and adult homelessness, the vast majority did not specify sub-categories of homelessness. Although potential differences are to be expected in the ways in which technologies are accessed and utilized by homeless youth relative to homeless adults for example, we assessed that these differences could be identified within the narrative synthesis. The use of a broader notion of homelessness led to the use of a wide range of search terms during our journal and database searches, all of which are summarized in Appendix A. While we faced some challenges in determining which terms would capture the scope of technology use to be examined in the review, the use of a pearl growing method (EPPI Centre, 2010) was of great assistance in helping to identify thesaurus terms for use in the search process. Though we sought to understand the ways in which technologies such as cell phones and the internet were used by the homeless, we were also interested in the ways in which they utilized social media applications and email. While it may be argued that the use of each of these technologies deserves independent study, our initial search revealed that many of the articles exploring technology use by the homeless simply referred to the use of cell phones, the internet, email, and social media under the larger umbrella of “technology use”. It was therefore determined that the search protocol would include numerous terms describing various technologies of interest, including the specific names of social media applications such as Facebook and Twitter. Outcomes related to the use of specific forms of technology are identified within the synthesis section of the paper. The approach used in our study, narrative synthesis, has been defined by Popay et al. (2006) as “an approach to the systematic review and synthesis of findings from multiple studies that relies primarily on the use of words and text to summarize and explain the findings.” Although it is being increasingly used in systematic reviews (EPPI Centre, 2010; Higgins & Green, 2005; Petticrew & Roberts, 2006) it has been criticized for the lack of agreement on its constituent

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elements. Responding to this, Popay et al. (2006) developed a guidance tool which aimed “to make the process of narrative synthesis more systematic and to minimize bias”. The use of this approach was especially appropriate for our study because it allows for the inclusion of a wide range of research designs, and because no authoritative body of knowledge is known to exist within this field. Popay et al. (2006) suggest including four elements within narrative synthesis focused systematic reviews. We chose to omit the first suggested element, theory development, as no pre-existing body of knowledge was found to exist within this area. The three narrative synthesis elements used in our study were (1) preliminary synthesis of findings; (2) exploration of relationships between studies; and (3) assessment of the robustness of the synthesis. As mentioned earlier, our exploratory search was valuable in offering insight into the breadth of free text and thesaurus terms used in articles exploring homelessness and technology use. This allowed us to “widen our net” and ensure that we captured the greatest number of articles for review during our systematic search. Our exploratory search had also provided valuable insight into the types of journals and databases where articles or studies were likely to be found, allowing us to make informed decisions about which journals to hand search and which databases to examine. We determined that articles developed prior to the year 2000 would likely be irrelevant to the review because technological access for the homeless was far less prevalent prior to that year (Pew Internet and American Life Project, 2009; Wagner, Bundorf, & Singer, 2005) and social media platforms did not become widely available until early 2000.

Search strategy Electronic searches were conducted on Academic Search Complete, Google Scholar, Sociological Abstracts, Sociology: SAGE full text collection, Social Work Abstracts, PSYC Info, Family and Society Studies Worldwide, Child Development and Adolescent studies, Homeless Hub, PubMed. Journals electronically and hand searched included Journal of Substance Abuse Treatment, AIDS Behaviour, Journal of Adolescent Health, Preventative Science, Community Mental Health Journal, Health Education Research, Canadian Journal of Information and Library Science, American Journal of Occupational Therapy, Journal of Community Informatics, Cyberpsychology and Behaviour, CHI, Computer Supported Cooperative Work, Personal Ubiquitous Computing, Journal of Urban Health, Computers in Human Behaviour, Social Work, Advances in Social Work, Journal of Documentation, Human Computer Interaction, Advances in Human Computer Interaction, International Journal of Human Computer Interaction, American Journal of Sociology, Canadian Journal of Sociology, Advances in Applied Sociology, Children and Youth Services Review, Community Mental Health Sciences Journal, Journal of the American Academy of Child and Adolescent Psychiatry.


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Bibliographies of articles which met the inclusion criteria were finger searched. Search terms used alone or in combination included homeless*, technolog*, and a number of variants are listed in Appendix A. Our inclusion criteria identified that qualitative, quantitative, and mixed methods studies would all be considered within this review. Additional criteria included primary research focused on the ways in which ICTs are utilized by individuals experiencing homelessness; primary research focused on the impact of ICT use on the health and social outcomes of individuals experiencing homelessness; primary research exploring the degree of technology use by homeless populations; peer-reviewed studies, case reports, conference studies, and grey literature exploring the ways in which ICTs are utilized by individuals experiencing homelessness, the impact of ICT use on their health and social outcomes, as well as the degree of technology use by homeless populations; published in English between the years 2000 and 2013. The exclusion criteria were studies that failed to explicitly focus on the use of technologies by the homeless; studies that explored technology use by marginalized groups who were not explicitly identified as homeless. The electronic searches of databases and journals identified a total of 21 articles that met the inclusion criteria. Hand searches of journals listed above produced an additional 4 articles, and finger searches within the bibliographies of these 25 articles produced another 3 articles meriting further review. After careful scrutiny utilizing the inclusion and exclusion criteria, a total of 16 (10 quantitative, 3 qualitative, 3 mixed-methods) articles were selected for the review. Ten studies were excluded from the review on the basis that they failed to meet the inclusion criteria (Bure, 2005; Hersberger, 2003; LeDantec et al., 2011; Miller, BunchHarrison, Brumbaugh, Kutty, & Fitzgerald, 2005; Muggleton & Ruthven, 2011; Rice, Tulbert, Cedarbaum, Barman-Adhikari, & Milburn, 2012; Taylor, 2011; Woelfer & Hendry, 2010a, 2010b, 2011), and two other articles were excluded as they were identified as duplicates (LeDantec, 2008; Rice et al., 2010). The non-duplicate studies which met initial screening criteria but did not end up being included in the review were excluded for the following reasons: focused on the potential of technological design to improve the lives of the homeless; focused on exploring information poverty among the homeless and the existence of the “digital divide”; focused too broadly on the meaning of computers for a very small sample of homeless men; were theoretical in their study of the potential for social inclusion through digital inclusion and included no empirical data. Of the 16 articles included in the review, 5 focused on the potential health and social benefits of technology use by individuals experiencing homelessness, and the remaining 11 focused on the ways in which ICTs are utilized by these populations (Table 1).

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Results Preliminary synthesis of findings and exploration of relationships between studies Degree of ICT usage among the homeless All of the articles confirmed the widespread use of ICTs among homeless populations, with the exception of one. Redpath et al. (2006) found that only 55% of the 265 homeless individuals they interviewed reported ever having used a computer, and that only 24% of interviewees reported having an email account. As this study was one of the earliest to examine ICT use by homeless populations, it is possible that these figures reflect a lack of technological access at that time. Nevertheless, as one of the earliest and most robust examinations of ICT use by homeless individuals to date, this article is valuable in that it may reflect a “turning point” in ICT use by individuals experiencing homelessness. In fact, many of the articles included in this review refer to the Redpath study as a counterpoint to more recent studies, which seems to suggest ever increasing levels of ICT usage among the homeless. Three of the studies reported high levels of mobile phone usage by homeless populations. In a study published in 2008, 61.5% of homeless adults who were interviewed reported owning a mobile phone, and that it was an essential tool for remaining in contact with their family and friends (LeDantec & Edwards, 2008). Eyrich-Garg (2010) found that out of the 100 homeless youth they surveyed, 44% mentioned owning a mobile phone, and that 20% of those individuals reported using their mobile phones to access the internet at least once per month. A more recent study (Rice et al., 2011) reported that out of 150 homeless youth interviewed 62% owned a mobile phone, and these youth indicated that the phone was an essential part of maintaining contact with home-based peers. This factor has been linked to improved social outcomes for individuals experiencing homelessness (Rice et al., 2011; Uchino, Cacioppo, Kiecolt-Glaser, 1996). Relating to the wide use of ICTs by the homeless, Bender, Ferguson, Pollio, Thompson, and McClendon (2009) stated that 92% of homeless youth interviewed reported using technology at least once per week, and that the majority of this technology use was geared towards connecting with friends and family. This same study suggested that those interviewed used email and social media sites 3.8 days per week on average, and that social media in particular allowed for increased contact with pro-social connections. A study by Pollio et al. (2013) found evidence of even greater technology use by homeless youth, indicating that out of the 100 individuals they interviewed in Los Angeles and Denver, 93% reported used technology on a daily basis. While it is true that these studies account for a very small proportion of the overall urban homeless population country-wide, the data seem to suggest widespread use of ICTs. Consequently, the notion of the digital divide should be re-examined. As well, it suggests the relevance of further examining the ways in which ICTs may be used to improve the health and social outcomes of individuals experiencing homelessness.


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The ways in which ICTs are utilized by the homeless Studies in this review suggested that the nature of ICT utilization by individuals experiencing homelessness is often highly dependent on individual factors such as mental health, addictions histories, pre-existing social factors, and time spent living on the street (LeDantec & Edwards, 2008; Woelfer & Hendry, 2010a). We identified three broad categories among the studies reviewed which can be said to characterize ICT use by individuals experiencing homelessness. These categories are social connectedness, identity management, and instrumental purposes (i.e. housing, employment, access to social resources). Social connectedness Many of the articles identified that ICTs play an important role in helping homeless individuals stay connected to family and friends by bridging physical and social gaps (Eyrich-Garg, 2010, 2011; LeDantec & Edwards, 2008; Rice et al., 2011; Roberson & Nardi, 2010; Yost, 2012). As many homeless individuals live in places other than the communities in which they were born and raised, keeping in touch over long distances is greatly facilitated by the use of ICTs. This allows them to stay connected to family and friends who may be able to help them with social support and access to resources when needed (LeDantec & Edwards, 2008). Additionally, ICTs allow individuals experiencing homelessness to develop ties to individuals outside their socioeconomic sphere, and can assist in the maintenance of relationships which may otherwise be untenable within a strictly physical environment (Roberson & Nardi, 2010). Relating to this, one study reported that some of the homeless individuals they interviewed had utilized Facebook as a means of locating groups or causes to which they were sympathetic, such as animal rights or environmental advocacy groups, allowing them to feel a sense of validation and acceptance within social spheres they might otherwise be unable to access (Yost, 2012). At a broader level, several of the studies found that homeless individuals relied heavily on ICTs as a means of staying connected to family members and close friends from back home (Bender et al., 2009; Eyrich-Garg, 2010, 2011; LeDantec & Edwards, 2008; Pollio et al., 2013; Rice et al., 2011; Woelfer & Hendry, 2012; Yost, 2012). Given that studies have demonstrated that having access to social supports can vastly improve behavioral and physical health outcomes for the general population (Uchino et al., 1996), further research is merited to have a better understanding of how increased social connectivity through ICT use can benefit individuals experiencing homelessness. Identity management Reviewed articles suggested that ICTs play an important role in allowing homeless individuals to manage their presentation of self, and have even been instrumental in fostering the conditions for some individuals to get off the street (Eyrich-Garg, 2011; LeDantec & Edwards, 2008; Woelfer & Hendry, 2012). By being able to create and manage multiple profiles online, homeless individuals are able to simultaneously

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present themselves to family members in one light, while at the same time being able to present a different image of themselves to their street-based peers. This ability to achieve “pseudonymity” through the management of multiple online profiles was reported to have many advantages for some homeless individuals (LeDantec & Edwards, 2008; Woelfer & Hendry, 2012). Among the advantages are the ability to avoid the undesirable convergence of distinct social groups which may result in further alienation or disenfranchisement from pro-social support systems; and the ability to isolate a particular presentation of self which may facilitate obtaining employment or housing that may be inaccessible to those perceived as being street entrenched. Some studies identified the capacity for social media sites to act as “virtual/physical” tools that can offer homeless individuals a non-confrontational way of creating space between themselves and other street-based peers that they may identify as having a negative influence on their life (Woelfer & Hendry, 2012). The difficulty of breaking off street-based ties has been shown to be a major factor in preventing homeless youth from escaping the street. Consequently, ICTs may play a useful role in allowing homeless individuals to distance themselves from their street-based peers in a non-confrontational manner (Woelfer & Hendry, 2012). From a less instrumental perspective, ICTs were also shown to foster healthy forms of self-exploration, and to allow individuals who are largely excluded from society to feel validated through what they perceive to be a normative use of technology, even though their use of ICTs may differ from that of other populations (Eyrich-Garg, 2010; LeDantec & Edwards, 2008; Woelfer & Hendry, 2012).

Instrumental purposes Six of the reviewed studies reported that ICTs may play an important role in helping homeless individuals to access critical support infrastructures, as well as employment resources (Eyrich-Garg, 2010, 2011; LeDantec & Edwards, 2008; Rice et al., 2011; Yost, 2012). Eyrich-Garg (2011) found that half of the 100 homeless individuals interviewed reported using the internet for business purposes, and that 25 of those interviewed used the internet to search for employment. Interviews conducted by LeDantec and Edwards (2008) found that a number of interviewees used the internet to identify free drug programs when they were unable to afford pharmaceuticals, and others identified the need to have an online presence in order to find employment. Another study focusing on homeless youth indicated that the majority of individuals they interviewed used cell phones for instrumental purposes such as contacting their case workers or searching for employment (Rice et al., 2011). Unsurprisingly, considering the challenges of obtaining housing or employment without access to a telephone, mobile phones are identified within three of the studies as a relatively low cost means of enabling homeless youth to access higher level resources (LeDantec & Edwards, 2008; Rice et al., 2011; Yost, 2012).


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The impact of ICT use on the health and social outcomes of individuals experiencing homelessness Five of the studies reviewed specifically explored the ways in which ICT use impacted sexual health, addictions, and mental health outcomes. Overall, ICT usage by homeless populations was found to act as a protective factor in reducing the likelihood of sexual risk behaviors, depression, as well as substance abuse among interviewees (Freedman et al., 2006; Rice, 2010; Rice et al., 2011, 2012; Young & Rice, 2011). Freedman et al. (2006) found that cell phones could help reduce the incidence of crack cocaine use by homeless individuals undergoing drug treatment. The study suggested that cell phones could be used to reliably deliver online surveys, and that through the use of ecological momentary assessments, participants became more aware of their craving and use episodes, permitting them to identify those times of day during which they were most vulnerable to relapse. Rice et al. (2010) analyzed social network composition data among 136 homeless adolescents and found that increased connectivity to non-substance-using home-based ties was strongly associated with decreases in alcohol use among this population. As peerbased prevention programs are becoming increasingly prevalent, and deviancy training is a major problem with the peer-based prevention model, the results of this study suggest that ICTs may be valuable in delivering peer-based addictions programming to homeless youth who are at heightened risk of deviancy training (Rice et al., 2010). Relating to the impact of ICT usage on the sexual health of the homeless, two articles suggested a correlation between ICT access and increase in condom use and sexual health knowledge. Given 2010 data showing that there are 1.6 million runaway youth in the USA each year, and that homeless youth are 2–10 times more at risk than their peers of contracting HIV, this is an area which seems vastly underexplored (Young & Rice, 2011). In relation to condom use, one study found that respondents who reported having a home-based, condom-using peer with whom they communicated through social networking technology was associated with a 90% reduction in risky sexual behavior and a 3.5 times increase in safer sex behaviors (Rice, 2010). Another larger study from the same year revealed that while social network site usage was indeed correlated to increased HIV knowledge, it was also found to be associated with increased levels of exchange sex (Young & Rice, 2011). More data are therefore needed in order to assess how online sexual health services or interventions may be designed to help reduce sexual risk behaviors among the homeless. As two-thirds of homeless adolescents have at least one psychiatric disorder meeting DSM-IV criteria (Pollio et al., 2013), it was striking to find only one article exploring the ways in which ICTs may be utilized to improve mental health outcomes for the homeless (Rice et al., 2012). This study identified the strong correlation between the lack of social connection and incidences of depression among the homeless. It suggested that social organizations and public institutions should

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strongly consider increasing internet access for the homeless as it allows for increased levels of connectivity to home-based peers, a factor which is shown to reduce incidences of depression. This same study recommended that a probability sample should be taken to examine technology use by the homeless and how social networking technology is used to maintain connections to pro-social relationships that support mental health (Rice et al., 2012). Additionally, the authors recommended that researchers should seek to more thoroughly understand the process of how connecting to pro-social home-based peers is associated with improved mental health, as little data have been produced in this area.

Robustness of the synthesis All the articles that met the inclusion criteria for the review were from the USA. Consequently, there appears to be a need for more studies exploring digital technology use by those experiencing homelessness in other English-speaking countries (since the review did not include non-English language papers we cannot comment on all countries). A more comprehensive understanding of the relationship between geographies and the use of digital technologies by individuals experiencing homelessness is essential as technological access may be very limited in some parts of North America, but ubiquitous in others (e.g. rural vs. urban). As Canadian-based researchers, it was perplexing to learn that there were no studies to be found which examined access to digital technologies and their potential benefit among individuals experiencing homelessness in Canada. Highlighting the lack of exploration on this topic, Taylor (2011) points out that in an 800 page e-book titled Finding Home: Policy Options for Addressing Homelessness in Canada, which was authored by some of Canada’s leading experts on homelessness, the issue of internet access is not mentioned even once. Though a number of the articles included within this systematic review suggested a positive relationship between health outcomes for homeless individuals and their ability to connect with home-based pro-social peers through the use of digital technologies, there is a need for studies specifically designed to examine the degree of causality between access to digital technologies and positive outcomes. This applies especially to those papers authored by Rice (Freedman et al., 2006; Rice et al., 2011, 2012; Young & Rice, 2011), all of which indicated that online connectivity to a pro-social peers can act as a protective factor in reducing incidences of substance use, depression, and HIV infection. While these studies provided promising evidence of the potential for better health outcomes for homeless individuals who utilize ICTs, the studies were not designed to provide causal empirical evidence that ICTs played a role in improving health outcomes. It is possible that those individuals who reported better health outcomes would have found some way of keeping in touch with home-based pro-social supports regardless of their ability to access ICTs. Nonetheless, as greater access to ICTs has expanded the ability of homeless individuals to remain connected to friends and family, more research


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needs to be done in this area to elucidate the relationship between ICT use and the improvement of health and social outcomes.

Conclusions and discussion The study systematically explored and synthesized the literature about how individuals experiencing homelessness utilize ICTs and how the use of ICTs influences their health and social outcomes. In relation to what ICTs are used for by homeless individuals, three major themes emerged: social connectedness, identity management, and instrumental purposes. Furthermore, there was some tentative evidence about a positive relationship between ICT use among individuals experiencing homelessness and health outcomes. Before discussing these findings, a few issues merit attention. The study purposely used a broad notion of homelessness, benefitting the review because it provided insights into the similarities and differences in ICT among various homeless populations. As has been suggested by several scholars (Snow & Anderson, 1987; Spradley, 1970), narratives and language used to describe the nature of homelessness often reflect social constructions which exemplify particular modes of thought. As researchers, we recognize that homelessness can be constructed both as a legitimate and temporary way of being, as well as a problem in urgent need of correction. We were therefore mindful of the unique set of social and economic circumstances faced by every individual who is categorized as being homeless and did not seek to suggest that technologies can be used to fix or remedy the “problem” of homelessness. Instead we sought to develop an understanding of the conditions which underlie the use of technology by homeless populations, the relevance of digital technologies to their well-being, and those policy opportunities which may provide mechanisms for helping people to get off the streets should they desire to do so. The themes that emerged from the review, social connectedness, identity management, and instrumental purposes suggested that homeless populations, young and old, are becoming increasingly reliant on ICTs in order to remain connected to family and social peers; that access to social connectivity among the homeless is of importance for their psychological and social well-being; that ICTs facilitate the cultivation of various representations of self which can then be used for both social and instrumental purposes; and that ICTs provide an invaluable tool kit for the homeless that can be used to gain access to employment opportunities, housing, as well as support infrastructures. In theory, increased access to ICTs can have both positive and negative impacts on the lives of homeless individuals. However, the studies reviewed for the most part focused on improvement in health and social outcomes for homeless individuals, and had little to say about potential negative effects. The review provided evidence of the potential for mobile phone and social networking technologies to reduce the

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incidence of HIV infections, incidences of depression, and levels of addiction among homeless populations. However, despite the suggested positive relationship between health and social outcomes for homeless individuals, there is still a need for studies specifically designed to examine the direction and degree of causality between access to digital technologies and health and social outcomes. The results of this review seemed to confirm, as other scholars have indicated, that the existence of a digital divide should be reconsidered. An interesting area of inquiry in this regard would be to better understand differences in how digital technologies are utilized by the homeless relative to other populations. As is stated by Roberson and Nardi (2010), the use of ICTs among the homeless is unique from other populations in that it is linked to “collaborative practices ensuring survival and inclusion in social worlds beyond their immediate communities”. While further research is certainly needed to develop a clearer sense of the impact of ICT use on the health and social outcomes of individuals experiencing homelessness, the results of this review suggested that access to ICTs should no longer be seen as a privilege for the homeless, but a right. As Canadian researchers, it was perplexing to find no articles exploring the question of technological access among the homeless in Canada, especially considering the rising importance of these technologies for normative societal participation, and recent data suggesting that as many as 30 000 people are homeless on any given night in Canada (Gaetz, Donaldson, Richter, & Gulliver, 2012). Further data from the Canadian Homelessness Research Network suggest that while single adult males make up approximately half of this homeless population, homeless youth are thought to constitute approximately 20% of the homeless population. With an estimated 200 000 individuals utilizing shelters across Canada per year and an estimated 380 000 Canadian households who are in severe housing need and therefore at risk of becoming homeless, the magnitude of this social issue in Canada is apparent (Gaetz, et al., 2012). While it is clear that policy and programmatic interventions are key to improving the lives of individuals facing homelessness, a failure to deepen our understanding of the instrumental utility of technology use by the homeless is negligent, especially in light of recent US studies suggesting that as many as 93% of a relatively large sample of homeless youth attending shelters in Los Angeles and Denver were found to be using ICTs on a daily basis (Pollio et al., 2013). Taken into consideration with recent data reporting that 1.5 million youth experienced homelessness in the USA in 2009, and that as many as 1.6 million youth runaway in the USA each year, the relevance of studying data within this area is highlighted further (National Center for Family Homelessness, 1999). In addition to providing more social housing, employment and training programs, as well as addictions and mental health assistance, we must examine this critical issue as ICTs take on an increasingly predominant role in facilitating normative participation in contemporary Canadian and US society. While there is a risk in overstating the potential of ICTs to improve health and social outcomes within this population, a failure to understand the relevance of


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these technologies for individuals experiencing homelessness could be a missed opportunity for policy makers and social organizations seeking to improve health and social outcomes.

Appendix A: Search terms #1: KW = (homeless) #2: KW = (homelessness) #3: KW = (homeless youth) #4: KW = (homeless adults) #5: KW = (homeless families) #6: KW = (homeless adolescents) #7: KW = (emergent adult homeless) #8: KW = (unsheltered) #9: KW = (unsheltered youth) #10: KW = (street youth) #11: KW = (emergency sheltered) #12: KW = (provisionally sheltered) #13: KW = (provisionally accommodated) #14: KW = (indigent) #15: KW = (hidden homeless) #16: KW = (at-risk youth) #17: KW = (at-risk population*) #18: #1 OR #2 OR #3 OR #4 OR #5 OR # 6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 #19: (de = (homeless)) #20: (de = (homelessness)) #21: (de = (homeless youth)) #22: (de = (homeless adults)) #23: (de = (homeless families)) #24: (de = (at-risk youth)) #25: #19 OR #20 OR #21 OR #22 OR #23 OR #24 #26: #18 OR #25 #27: KW = (technology) #28: KW = (technologies) #29: KW = (information communication technolog*) #30: KW = (digital technolog*) #31: KW = (digital media) #32: KW = (digital divide) #33: KW = (computer*) #34: KW = (internet) #35: KW = (email) #36: KW = (social media) #37: KW = (social network*) #38: KW = (social networking sites) #39: KW = (social networking technolog*) #40: KW = (online social networking technolog*) #41: KW = (urban computing) #42: KW = (social computing) #43: KW = (web) #44: KW = (web 2.0)

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#45: KW = (mobile phone*) #46: KW = (cell phone*) #47: KW = (cellular phone*) #48: KW = (facebook) #49: KW = (myspace) #50: KW = (twitter) #51: KW = (youtube) #52: #27 OR #28 OR #29 OR #30 OR #31 OR #32 OR #33 OR #34 OR #35 OR #36 OR #37 OR #38 OR #39 OR #40 OR #41 OR #42 OR #43 OR #44 OR #45 OR #46 OR #47 OR #48 OR #49 OR #50 OR #51 #53: (de = (technology)) #54: (de = (technologies)) #55: (de = (digital technology)) #56: (de = (digital technologies)) #57: (de = (digital divide)) #58: (de = (internet)) #59: (de = (social media)) #60: (de = (social network)) #61: (de = (social networking)) #62: (de = (social networking technologies)) #63: (de = (urban computing)) #64: (de = (social computing)) #65: (de = (web 2.0)) #66: #53 OR #54 OR #55 OR #56 OR #57 OR #58 OR #59 OR #60 OR #61 OR #62 OR #63 OR #64 OR #65 #67: #52 OR #66 #68: #26 OR #67

Appendix B Articles exploring the potential health and social benefits of ICT use among individuals experiencing homelessness

Author (year)

Country

Study design

Number of participants (women)

Age mean/ range (years)

Focus of study

Freedman et al. USA (2006)

NRC

30 (19)

38 ± 6.19

Utility of cell phones in conducting EMAs with addicted homeless adults

Rice (2010)

USA

NRC

103 (43)

20.9

Examined the impact of social network use on condom-using behaviors of homeless youth

Young and Rice USA (2011)

NRC

201 (62)

21.07 ± 2.09

Examines the relationship between sexual health and internet use

Rice et al. (2010) USA

NRC

136 (53)

16–25

Examines relationships between social network technologies, substance abuse, and homeless youth

Rice et al. (2012) USA

NRC

136 (53)

20.8 ± 2.1

Examines relationship between use of social networking technology by homeless youth and mental health


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Appendix C Articles exploring the ways in which ICTs are utilized by individuals experiencing homelessness

Author (year)

Country

Study design

Redpath et al. (2006)

USA

NRC

LeDantec and Edwards (2008)

USA

Bender et al. (2009) Roberson and Nardi (2010)

Number of participants (women)

Age mean/ range (years)

Focus of study

265 (68)

43.28 ± 8.25

Seeks to describe internet access and use among a population of homeless individuals with HIV

QUAL

28 (2)

46–55

How technology affects the daily lives of the homeless

USA

MM

100

18–24

Explores how technology connects homeless youth to resources

USA

QUAL

39

NS

Ethnographic examination of the ways in which digital technologies affect the lives of the homeless

Eyrich-Garg (2010) USA

MM

44 (27)

45 ± 10.02

Examines mobile phone use and possession among the homeless

Rice et al. (2011)

USA

NRC

169 (58)

20.91 ± 2.1

Examines levels of cell phone ownership among homeless youth and the ways in which they are used by this population

Eyrich-Garg (2011) USA

NRC

100 (27)

45 ± 10.02

Examines computer use among the unsheltered street homeless

Woelfer and Hendry (2012)

USA

NRC

24 (12)

21.7

Explores the use of social network sites by homeless young people

Yost (2012)

USA

QUAL

15

36

Examines how people experiencing homelessness utilize social media technologies

Guadagno et al. (2013)

USA

RCT

303 (146)

19.4 ± 1.09

Compares technology use between homeless young adults and college students

Pollio et al. (2013) USA

MM

100

20.4 ± 1.8

Explores the purpose and frequency of technology use among emergent adult homeless and which risk factors predict its use

Disclaimer statements Contributors AS was the lead author and JM was the supporting author. Funding None. Conflicts of interest None. Ethics approval Not required.

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