CORE Posters Fall 2025

"Long Term Effects of Housing Instability on the Body, Mind, and Spirit Complex and Avenues to New Models of Holistic Care" Gunn, Matthew B.S., Hanratty, Brielle B.S, Kress, Nicolas B.S, M.S., Miller, Elizabeth B.S., Moses, Justin B.S., Virk, Ranjit B.S., Vu, Anh B.A., Anandakrishnan, Ramu PhD, Nicholson, Jess MAT, Kadio, Bernard MD, MPH, PhD Edward Via College of Medicine, Preventive Medicine, Blacksburg, VA

Group K

Abstract

Results

Conclusions

References This preliminary study highlights important multifaceted health challenges faced by individuals who are experiencing housing insecurity in the New River Valley of Virginia. After observing the residents of the Linden Green Apartments through direct interactions via monthly community events, it was evident that their physical, social, and emotional needs were not being entirely fulfilled. However; after analyzing the results of the administered surveys, there was no statistically significant difference in the extent to which participants felt each domain of health was being satisfied. The additional, if not greater goal of this research, is to directly address medical mistrust present in the New River Valley community by facilitating direct engagement with future osteopathic physicians and underserved members of said community. Qualitatively, the members of this research observed that the community members they engaged with were far more comfortable interacting with and accepting towards them by the end of this study. Through these efforts we are contributing to the goal of overcoming medical mistrust of underserved communities while increasing future osteopathic physicians’ understanding of their patient populations. The next steps for this study are to expand the survey instrument to more effectively capture domains of spiritual wellbeing and medical literacy, to re-administer the revised survey to a larger sample of participants from Linden Green Apartments, and to utilize the resulting dataset to develop an actionable framework that informs patient care within communities experiencing housing insecurity and associated social determinants of health 1. Lathrop B. Moving Toward Health Equity by Addressing Social Determinants of Health. Nursing for Women’s Health. 2020;24(1):36-44. doi:https://doi.org/10.1016/j.nwh.2019.11.003 2. Andermann A. Taking action on the social determinants of health in clinical practice: A framework for health professionals. Canadian Medical Association Journal. 2016;188(17-18):474-483. doi:https://doi.org/10.1503/cmaj.160177 3. Daniel H, Bornstein SS, Kane GC. Addressing Social Determinants to Improve Patient Care and Promote Health Equity: An American College of Physicians Position Paper. Annals of Internal Medicine. 2018;168(8):577. doi:https://doi.org/10.7326/m17-2441 4. Geronimus AT, Pearson JASteptoe A. The role of psychobiological pathways in socio-economic inequalities in cardiovascular disease risk. European Heart Journal. 2002;23(1):13-25. doi:https://doi.org/10.1053/euhj.2001.2611 5. , Linnenbringer E, et al. Race-Ethnicity, Poverty, Urban Stressors, and Telomere Length in a Detroit Community based Sample. Journal of Health and Social Behavior. 2015;56(2):199-224. doi:https://doi.org/10.1177/0022146515582100 6. Hwang SW, Burns T. Health interventions for people who are homeless. The Lancet. 2014;384(9953):1541-1547. doi:https://doi.org/10.1016/s0140-6736(14)61133-8 7. Baggett TP, Hwang SW, O’Connell JJ, et al. Mortality Among Homeless Adults in Boston. JAMA Internal Medicine. 2013;173(3):189. doi:https://doi.org/10.1001/jamainternmed.2013.1604 8. Woods P, Gapp R, King MA. Generating or developing grounded theory: methods to understand health and illness. International journal of clinical pharmacy. 2016;38(3):663-670. doi:10.1007/s11096-016-0260-2 9. Johnson MP. Community-Based Operations Research: Introduction, Theory, and Applications. International Series in Operations Research & Management Science. Published online August 21, 2011:3-36. doi:https://doi.org/10.1007/978-1-4614-0806-2_1 10.Arumugam A, Phillips LR, Moore A, et al. Patient and public involvement in research: a review of practical resources for young investigators. BMC Rheumatol. 2023;7(1):2. Published 2023 Mar 9. doi:10.1186/s41927-023 00327-w 11. Wallenhorst, Lois. “Cardinal News Op Ed: Affordable Housing Crisis in Southwest and Southern Virginia Impacts Everyone.” Virginia Housing Alliance, 29 July 2024, vahousingalliance.org/cardinal-news-op ed/#:~:text=However%2C%20this%20is%20both%20an,affordable%20for%20the%20long%20term. 12. The Virginia Department of Housing and Community Development and Virginia Housing. “Chapter 17 Housing Instability and Homelessness: HB854 Statewide Housing Study.” Chapter 17 Housing Instability and Homelessness | HB854 Statewide Housing Study, dmz1.dhcd.virginia.gov/HB854/part-3 instability.html#:~:text=Homeowners%20in%20Virginia%20have%20fared,17.1%20Impact%20of%20COVID%2D19.

Housing insecurity is associated with significant physical, emotional, and social health challenges , particularly in the New River Valley of Virginia, where supportive housing needs remain high. Traditional interventions often focus on removing barriers, but less attention has been given to how healthcare systems can provide holistic, whole-person care to this population. This preliminary study aimed to develop an osteopathic framework for holistic healthcare delivery tailored to individuals experiencing housing insecurity, with the long-term goal of disseminating this framework to physicians within hospital systems to improve education and patient care approaches. We conducted a qualitative study among adults residing in Linden Green Apartments, a rent controlled housing community in Christiansburg, VA. Physical, emotional, and social health domains were assessed using a modified survey derived from the NIH All of Us Overall Health survey, NIH All of Us Social Factors of Health survey, and Standardized Screening for Health Related Social Needs in Clinical Settings. Surveys were administered anonymously following monthly community engagement events designed to build rapport with residents. Surveys evaluated the perceived level of unmet need in areas of Financial Wellbeing, Emotional Wellbeing, Physical Wellbeing, Medical Literacy, and Spiritual Wellbeing. Responses from subjects were compiled into a dataset which showed that there was no statistical difference between the level of need across the five categories.These findings suggest that individuals experiencing housing insecurity face challenges across multiple wellbeing domains, underscoring the importance of an integrative, whole-person care model. Future research may expand this framework to larger populations and test its feasibility for implementation in healthcare systems, with the goal of improving physician training and care delivery for vulnerable communities. Background: • Housing insecurity is associated with significant physical, emotional, and social health challenges, compounded by limited healthcare access. • In Virginia, ~1 million individuals struggle with basic needs due to housing costs; Southside Virginia/New River Valley has one of the highest rates in the state. • Current supportive housing and community-based interventions exist, but healthcare access for families without stable housing remains limited. Rationale • The osteopathic philosophy emphasizes holistic care that integrates body, mind, and spirit. • Addressing health needs of individuals experiencing housing insecurity requires understanding their lived experiences to provide meaningful, whole-person care. Objective • Engage with a community nourishment program and respective housing residents to create opportunities for medical students to learn from this population. • To develop a framework for holistic healthcare delivery tailored to individuals facing housing insecurity. The goal of this pilot study is to disseminate the framework to physicians within hospital systems, equipping them with strategies to better understand and approach patients facing housing insecurity. Methods; Design • Qualitative study assessing perceived health disparities in residents of low-income housing in Christiansburg, VA. Population • Adults living in Linden Green Apartments (rent-controlled housing) in Christiansburg, VA. • Children <18 years were excluded. Measures • Physical, emotional, and social health domains. • Data collected through a modified survey combining: ○ NIH All of Us Overall Health survey ○ NIH All of Us Social Factors of Health survey ○ Standardized Screening for Health-Related Social Needs in Clinical Settings • Questions standardized to Likert scale; non-relevant items removed. • Likert scale responses given a value of 1-5, with 1 indicating low levels of unmet need and 5 indicating high levels of unmet need. Procedures • Consent obtained and surveys administered anonymously. • Scores compiled into a dataset to visualize perceived needs across health domains. • Community engagement included monthly food and craft events to build rapport and trust prior to survey administration. Introduction and Methods

Fig. 1: Average Likert score per question answered by survey-takers. Values are mean +/- standard error. (N=16 for each question).

• 19 participants returned a survey. 3 surveys were omitted from the final analysis due to lack of completion. 16 surveys were included in the final data analysis. • Respondents indicated a moderate amount of need across all categories . By mean category response scores, there was the lowest level of unmet need for financial wellbeing (mean score 2.28) and the highest level of unmet need for emotional wellbeing (mean score 2.89). • A Kruskal-Wallis analysis showed no statistically significant difference between the mean scores of any of the five categories. • The highest average score for an individual question was 3.75 for “In the past 7 days, have you been bothered by an emotional problem such as feeling anxious, depressed, or irritable?”, corresponding to a qualitative answer between "Somewhat" and "Quite a bit". • The lowest average score for an individual question was 2.0 for “Are you able to easily carry out daily tasks, like climbing stairs, carrying groceries, or moving a chair ?”, corresponding to a qualitative answer of "A little bit". Fig. 1: Average score for each domain captured by survey questions scored through a Likert scale. Values are mean +/- standard error. (Four survey questions comprise categories: Financial Wellbeing, Emotional Wellbeing, Physical Wellbeing). (Two survey questions comprise categories: Medical Literacy, Spiritual Wellbeing).

Acknowledgements

We would like to sincerely thank the VCOM Institutional Review Board (IRB) for their guidance and support throughout this project. Special thanks to Dr. Bernard Kadio for his mentorship, Jessica Nicholson for her contributions, and Dr. Ramu Anandakrishnan for his expertise in statistical analysis. We are also grateful to Wendy Welch, who served as coordinator for the Community Health Project (CHP) collaboration at Linden Green Apartments, and to the residents of Linden Green for their participation. Finally, we acknowledge our sister research group for their collaboration and valuable insights, which greatly enhanced the success of this study.