Design and Development of an Integrated Nursing Care Framework for Homeless Youth Experiencing Substance Use Disorders in Community-Based Shelters
Authors
Taif University, Al Mutamarat Rd, Al Mathnah, At Taif, 26521, Saudi Arabia|University of Perpetual Help System – DALTA, Alabang–Zapote Rd, Las Piñas, 1740 Metro Manila, Philippines (Saudi Arabia)
University of Perpetual Help System – DALTA, Alabang–Zapote Rd, Las Piñas, 1740 Metro Manila, Philippines (Saudi Arabia)
Article Information
DOI: 10.51583/IJLTEMAS.2026.150900045
Subject Category: Community Nursing
Volume/Issue: 15/9 | Page No: 575-597
Publication Timeline
Submitted: 2026-09-18
Accepted: 2026-09-23
Published: 2026-10-05
Abstract
This study, entitled “Design and Development of an Integrated Nursing Care Framework for Homeless Youth Experiencing Substance Use Disorders in Community-Based Shelters,” aimed to develop a nursing-oriented framework responsive to the complex healthcare needs of homeless youth aged 16 to 25 years in selected community-based shelters in Kitchener, Ontario, Canada. This study used a developmental mixed-methods research design with an exploratory sequential approach. The qualitative phase involved 12 purposively selected participants, while the quantitative phase included 112 respondents from an accessible population of 128 homeless youth. Data were gathered using a researcher-developed questionnaire assessing healthcare needs and the extent of nursing care delivery, together with semi-structured interviews exploring healthcare experiences, service gaps, barriers, and facilitators. Findings revealed an overall High Need for healthcare (M = 3.25, SD = 0.44), with Mental Health Needs (M = 3.42) and Substance Use Management Needs (M = 3.38) receiving the highest ratings. Nursing care was generally delivered to a High Extent (M = 2.82, SD = 0.52), with Comprehensive Assessment ranking highest and Substance Use Management and Harm Reduction ranking lowest. A significant moderate negative relationship was found between nursing care delivery and healthcare needs (ρ = −0.46, p < .001). Healthcare needs significantly differed according to duration of homelessness, primary substance used, duration of substance use, and previous treatment or rehabilitation history, but not according to age, sex, or gender identity. Qualitative findings identified four major experiences: inconsistent healthcare access, the need for respectful and nonjudgmental care, interconnected health concerns, and gaps in continuity of care. Barriers included fragmented services, limited accessibility, stigma and mistrust, and complex co-occurring needs, while facilitators included therapeutic nursing relationships, accessible shelter-based support, coordinated care, and individualized approaches. Integration of the findings resulted in a seven-component Integrated Nursing Care Framework encompassing Comprehensive and Continuous Assessment; Mental Health and Psychosocial Support; Substance Use Management and Harm Reduction; Health Promotion and Self-Management Support; Healthcare Access, Referral, and Care Coordination; Person-Centered and Trauma-Informed Therapeutic Engagement; and Interprofessional Collaboration and Continuity of Care. Anchored in the Roy Adaptation Model, the framework provides a structured basis for holistic, trauma-informed, recovery-oriented, coordinated, and continuous nursing care for homeless youth experiencing substance use disorders.
Keywords
Homeless Youth, Substance Use Disorders, Integrated Nursing Care, Community-Based Shelters, Harm Reduction
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References
1. Beck, K., Pallot, K., & Amri, M. (2024). A scoping review on barriers and facilitators to harm reduction care among youth in British Columbia, Canada. Harm Reduction Journal, 21, Article 189. https://doi.org/10.1186/s12954-024-01063-1 [Google Scholar] [Crossref]
2. D’Amico, F., Marmiere, M., Fonti, M., Battaglia, M., & Belletti, A. (2025). Association does not mean causation, when observational data were misinterpreted as causal: The observational interpretation fallacy. Journal of Evaluation in Clinical Practice, 31(1), Article e14288. https://doi.org/10.1111/jep.14288 [Google Scholar] [Crossref]
3. Gaetz, S., Buchnea, A., Fournier, C., Dej, E., & Schwan, K. (2024). Towards the prevention of youth homelessness. Youth, 4(4), 1694–1725. https://doi.org/10.3390/youth4040108 [Google Scholar] [Crossref]
4. Garcia, C., Doran, K., & Kushel, M. (2024). Homelessness and health: Factors, evidence, innovations that work, and policy recommendations. Health Affairs, 43(2), 164–171. https://doi.org/10.1377/hlthaff.2023.01049 [Google Scholar] [Crossref]
5. Goodyear, T., Jenkins, E., Oliffe, J. L., Fast, D., Kia, H., & Knight, R. (2024). 2S/LGBTQ+ youth substance use and pathways to homelessness: A photovoice study. International Journal of Drug Policy, 133, Article 104621. https://doi.org/10.1016/j.drugpo.2024.104621 [Google Scholar] [Crossref]
6. Goodyear, T., Barborini, C., Gilmore, R., Collin-Gray, A., Jensen, M., Young, L., Hossain, A., He, E., & Other Members of the Substance Use Beyond the Binary Youth Action Committee. (2025). Harm reduction in photovoice knowledge mobilization with 2S/LGBTQ+ youth who use(d) drugs: A community showcase. Harm Reduction Journal, 22, Article 109. https://doi.org/10.1186/s12954-025-01263-3 [Google Scholar] [Crossref]
7. Grand-Guillaume-Perrenoud, J. A., Geese, F., Uhlmann, K., Blasimann, A., Wagner, F. L., Neubauer, F. B., Huwendiek, S., Hahn, S., & Schmitt, K.-U. (2023). Mixed methods instrument validation: Evaluation procedures for practitioners developed from the validation of the Swiss Instrument for Evaluating Interprofessional Collaboration. BMC Health Services Research, 23, Article 83. https://doi.org/10.1186/s12913-023-09040-3 [Google Scholar] [Crossref]
8. Health Canada. (2024). Substance use among street-involved youth in Canada: Pan-Canadian findings from the People with Lived and Living Experience Survey. Government of Canada. https://www.canada.ca/en/health-canada/services/publications/healthy-living/substance-use-street-involved-youth-canada.html [Google Scholar] [Crossref]
9. Hennink, M., & Kaiser, B. N. (2022). Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Social Science & Medicine, 292, Article 114523. https://doi.org/10.1016/j.socscimed.2021.114523 [Google Scholar] [Crossref]
10. Housing, Infrastructure and Communities Canada. (2024). Homelessness data snapshot: Mental health, substance use, and homelessness in Canada. Government of Canada. https://housing-infrastructure.canada.ca/homelessness-sans-abri/reports-rapports/mental-health-substance-use-sante-mentale-consom-substances-eng.html [Google Scholar] [Crossref]
11. Kumar, M., Padgett, D., Louie, K., & Narendorf, S. C. (2026). Crossing the divides: Integrated services for youth at risk of homelessness. The Lancet Regional Health—Americas, 62, Article 101556. https://doi.org/10.1016/j.lana.2026.101556 [Google Scholar] [Crossref]
12. Meda, F., Oprea, N., & Buongiorno Sottoriva, C. (2025). Improving access to healthcare services for people experiencing homelessness: Evidence from a scoping review of interventions. Health & Justice, 13, Article 77. https://doi.org/10.1186/s40352-025-00384-y [Google Scholar] [Crossref]
13. Polit, D. F., & Beck, C. T. (2006). The content validity index: Are you sure you know what’s being reported? Critique and recommendations. Research in Nursing & Health, 29(5), 489–497. https://doi.org/10.1002/nur.20147 [Google Scholar] [Crossref]
14. Schober, P., Boer, C., & Schwarte, L. A. (2018). Correlation coefficients: Appropriate use and interpretation. Anesthesia & Analgesia, 126(5), 1763–1768. https://doi.org/10.1213/ANE.0000000000002864 [Google Scholar] [Crossref]
15. Simkhada, B., Singh, D., Sah, R. K., Barclay, H., Duke, M., & Brown, P. (2025). Health promotion efforts for people experiencing homelessness in England: A scoping review. Journal of Social Distress and Homelessness, 34(2), 296–311. https://doi.org/10.1080/10530789.2024.2395163 [Google Scholar] [Crossref]
16. Taber, K. S. (2018). The use of Cronbach’s alpha when developing and reporting research instruments in science education. Research in Science Education, 48(6), 1273–1296. https://doi.org/10.1007/s11165-016-9602-2 [Google Scholar] [Crossref]
17. United Nations Department of Economic and Social Affairs. (2024). The Sustainable Development Goals report 2024. United Nations. https://unstats.un.org/sdgs/report/2024/ [Google Scholar] [Crossref]
18. Wadge, S., Lethby, M., Stobbe, K., Gardner, P., & Michaelson, V. (2024). Gender matters: Exploring the mental health of youth experiencing homelessness in Canada. International Journal on Homelessness, 4(2), 200–221. https://doi.org/10.5206/ijoh.2023.3.16751 [Google Scholar] [Crossref]
19. Wasti, S. P., Simkhada, P., van Teijlingen, E. R., Sathian, B., & Banerjee, I. (2022). The growing importance of mixed-methods research in health. Nepal Journal of Epidemiology, 12(1), 1175–1178. https://doi.org/10.3126/nje.v12i1.43633 [Google Scholar] [Crossref]
20. Yeo, E. J., Hausman, E., Noyes, E., & Chatterjee, A. (2024). Evaluating mobile harm reduction services for youth and young adults. Frontiers in Public Health, 12, Article 1375323. https://doi.org/10.3389/fpubh.2024.1375323 [Google Scholar] [Crossref]
21. Yusoff, M. S. B. (2019). ABC of content validation and content validity index calculation. Education in Medicine Journal, 11(2), 49–54. https://doi.org/10.21315/eimj2019.11.2.6 [Google Scholar] [Crossref]