The study, published in Frontiers in Global Women’s Health, used a narrative inquiry design embedded within a larger participatory action research project. Each of the eleven participants took part in two in-depth interviews lasting up to two and a half hours, followed by three sequential focus groups held between February and May 2025. Rather than fragmenting the women’s accounts into codes and categories, the team applied Riessman’s thematic and structural narrative analysis, treating the stories as wholes. They paid attention not only to what was said but to how it was told: the sequencing, repetitions, interruptions, and omissions that revealed how the women made sense of their lives. The researchers then wove the material into composite narratives, first-person accounts built from multiple participants’ verbatim words, a strategy chosen to protect anonymity for women escaping abusive partners or hiding their housing insecurity from their own families.

The health burden the women carried was staggering. Every single participant met the criteria for multimorbidity, meaning two or more co-existing chronic conditions, a profile associated with reduced function, increased health service use, and premature death. Their conditions spanned diabetes, heart failure, cancer, chronic pain, arthritis, memory problems, depression, anxiety, and post-traumatic stress disorder, with many health problems attributed to or worsened by past intimate partner violence, which ten of the eleven women reported. Long-term homelessness is known to accelerate aging, with people experiencing homelessness presenting health profiles comparable to housed individuals ten to twenty years older. That is why age 50 is widely accepted as the threshold for older in homelessness research, and why women aged 55 and older now constitute the majority of visibly homeless women in Canada.

From the analysis, two storylines emerged. The first, which the researchers named Hurry up and Wait, captures the cruel rhythm of bureaucratic systems that appear to offer help while simultaneously disempowering the people they serve. Women described shelters as unsafe and unstable yet nearly impossible to exit. One woman recounted bed bugs, lice, and the risk of being barred from the shelter entirely if staff suspected she was photographing conditions on her phone. Another described how a case manager required her to phone every two weeks to keep her place on a waitlist for accessible subsidized housing, and how a full voice mailbox could cost her that spot. Mandatory workshops on resume writing and nutrition were repeated regardless of need, and one facilitator’s joking tone during a session on intimate partner violence left participants distressed.

The composite narrative of Marilyn, assembled from several women’s experiences, illustrates how these constraints compound. After a stroke at 54 ended her work and driving, she cycled through an emergency shelter, a hostile relative’s home, and her daughter’s apartment, all while facing rents above $1,200 against income support of less than $1,000 a month. A missing credit history, destroyed by an ex-partner’s fraudulent cards, and mobility limitations that ruled out staircases closed off even the cheapest options. Full disability benefits, which might have changed the math, required yet more medical documentation, expensive taxi rides, and waits of more than a year to see a neurologist. Seniors housing with elevators and lower rents sat just out of reach behind an age-65 eligibility threshold. Her summary was blunt: stuck everywhere.

The second storyline, Making lemonade, documents what the women did inside these constraints. They formed bonds in shelters that outlasted re-housing, talking daily and providing emotional support across the city. They searched for housing together, attended each other’s medical appointments, and exchanged tips on navigating resources. One participant, a recognized artist, offered to teach craftwork in the shelter; another used her computer skills to file housing applications not only for herself but for other residents. Women advocated at building meetings in transitional housing, set boundaries against drug smoke and violence, and used humor strategically, greeting shelter staff behind the glass with a cheerful line that, as one woman recalled, made her smile for the first time.

It is this relational labor that the researchers propose as a previously unrecognized form of social capital. Social capital, in the sociological sense, refers to the resources people derive from their networks and relationships, and it has been mapped in homelessness research across three domains: interpersonal relationships, access to formalized services, and the exchange of emotional, practical, and informational support. The Calgary women built bonding relationships with socially similar peers and bridging relationships with service providers who treated them with dignity. They worked to repair family ties, maintained fierce identities as mothers and grandmothers, and drew on cultural teachings about looking out for one another. In the language of urban geography, they functioned as people as infrastructure, informal networks of cooperation that patched over the fragmentation and under-resourcing of formal systems.

The researchers are careful to note the limits of this finding. Mutual aid, however productive, cannot substitute for housing and healthcare, and other scholars have cautioned that homelessness itself undermines the reciprocity and autonomy that sustain social capital. The structural barriers the study documents are formidable: affordable housing stock that has declined since federal withdrawal from housing provision in the 1980s and 1990s, income supports so low that some women continued working low-wage jobs despite serious illness, and specialist care waits that rippled outward, blocking disability income, transportation passes, and housing waitlists that all demanded medical proof. Age-based eligibility criteria excluding adults under 65 from seniors’ housing left a gap that the study’s participants, most aged 57 to 64, fell straight through.

The study’s methods deserve attention in their own right. The work grew out of the Exchange, a collective of older adults with lived experience of late-life homelessness who co-direct research aimed at improving services. Recruitment used snowball sampling through shelters, transitional housing, and an elder abuse shelter, and the team employed a trauma-informed approach throughout, providing transportation, food, honoraria, and process consent revisited at every encounter. The authors acknowledge limitations: the sample was intentionally small, and Black, Indigenous, and people of color, as well as LGBTQ and Two-Spirit participants, were underrepresented relative to their prevalence in the homeless population, a gap the researchers attribute partly to recruitment pathways that reproduce the same structural barriers the study examines.

The implications reach from clinic to legislature. For health providers, the findings underscore the gendered nature of late-life homelessness and the value of trusting, person-centered primary care relationships, which ten of the eleven women had established. For homelessness organizations, the study argues for relational continuity and manageable caseloads to counter the burnout and turnover that erode the few supportive connections women found. For policymakers, the message is that older women’s lived expertise must inform system design, and that trauma-informed, age- and ability-specific services are likely to yield high returns while preventing the institutionalization the women themselves identified as their greatest fear. Behind the policy language, though, is the study’s central, quietly radical observation: the women it followed were never simply waiting to be helped. They were helping, every day, in ways no system counted.

Subject of Research: Experiences of aging, health, and homelessness among older women and their mutual support networks

Article Title: Help me, and I'll help myself (and others). A narrative inquiry into older women's experiences of health and homelessness

Article References: Help me, and I'll help myself (and others). A narrative inquiry into older women's experiences of health and homelessness. (n.d.). https://doi.org/10.3389/fgwh.2026.1740814

Image Credits: AI Generated

DOI: 10.3389/fgwh.2026.1740814

Keywords: homelessness, older women, aging, social capital, narrative inquiry, health equity, shelters, housing policy, caregiving, structural stigma, participatory research, Canada

The study was carried out between September 2025 and January 2026 in government-run shelters located in a low-resource region of eastern Iran. Researchers recruited thirteen homeless women through a combination of convenience and purposive sampling, a strategy that allowed them to capture both readily accessible participants and women with particular experiences relevant to the research question. Each participant took part in a semi-structured, in-depth interview that was audio-recorded and later transcribed verbatim. The interviews explored how the women perceived the conditions, circumstances, and structural forces that influenced their day-to-day health, from the availability of food and shelter to their interactions with health services and the communities around them.

To analyze the transcripts, the team applied a manual thematic analysis following Boyatzis’s methodological approach, a well-established technique in qualitative health research that involves systematically coding data and clustering codes into themes. The researchers used the Healthy People 2030 framework, developed by the United States Department of Health and Human Services, as their conceptual guide. This framework organizes social determinants of health, sometimes called social drivers of health, into five domains: Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context. Anchoring the analysis in this framework allowed the Iranian findings to be compared with a global body of research on how social conditions shape health outcomes.

The analysis revealed twenty-four social determinants of health distributed across the five framework themes. Two domains stood out for their weight in the women’s lives: Economic Stability and Social and Community Context. These two themes encompassed the highest number of determinants, underscoring, the authors argue, their influential role in the ultimate health outcomes of homeless women. In practical terms, this means that the women’s health was shaped less by individual clinical risk factors alone and more by the grinding arithmetic of poverty, income insecurity, and the presence or absence of supportive relationships and community ties. For a population with no stable housing, economic shocks translate directly into skipped meals, untreated illness, and exposure to unsafe environments.

The emphasis on Economic Stability reflects conditions specific to the border region studied. Eastern Iran’s provinces adjacent to Afghanistan are characterized by pronounced socioeconomic and healthcare disparities, and they host communities affected by migration flows, unemployment, and limited public infrastructure. Homeless women in this setting face a compounding set of disadvantages: they are women in a context of gendered economic exclusion, they are homeless in a region with thin social services, and many are affected by the broader instability associated with the Afghan border. The study’s findings suggest that any intervention aimed at improving these women’s health must begin with economic levers, including income support, employment pathways, and reliable access to basic material needs.

The second dominant domain, Social and Community Context, points to the relational side of health that is often overlooked in clinical settings. For homeless women, social isolation, stigma, family breakdown, and the absence of trusted support networks can be as damaging to health as any pathogen. The interviews captured how the women navigated relationships with shelter staff, other residents, family members, and the wider community, and how the quality of those relationships influenced their willingness to seek care, their mental wellbeing, and their sense of dignity. The researchers note that these findings hold particular value for low-resource settings, where formal health systems cannot alone compensate for the absence of social support structures.

The remaining three themes of the Healthy People 2030 framework also yielded concrete determinants. Education Access and Quality captured how limited literacy and schooling constrained the women’s ability to find work, understand health information, and advocate for themselves. Health Care Access and Quality encompassed barriers such as cost, distance, documentation status, and experiences of discrimination when seeking treatment. Neighborhood and Built Environment covered the physical conditions of shelters and streets, including safety, sanitation, and exposure to environmental hazards. Together, the twenty-four determinants form what the authors describe as a comprehensive list of social determinants of health for homeless women, one of the most granular portraits assembled for this population in the region.

Methodologically, the study demonstrates the value of qualitative inquiry in settings where quantitative data on homeless populations are scarce or unreliable. Homeless women are frequently missed by censuses, surveys, and routine health information systems, meaning their needs remain statistically invisible even as their suffering accumulates. By sitting down with thirteen women and systematically coding their accounts, the research team surfaced determinants that would never appear in administrative datasets. The use of a recognized international framework strengthens the study’s utility, allowing local findings to inform global conversations about housing, health equity, and the social drivers of disease, while remaining grounded in the specific realities of Iran’s eastern borderlands.

The authors conclude that the study highlights the pivotal role of governments in addressing the health of homeless women. Because the determinants identified span income, education, healthcare, housing, and community life, no single ministry or program can tackle them in isolation. Effective responses, the findings imply, require coordinated policy action: social protection schemes that reach women without fixed addresses, shelters that connect residents to healthcare and education, anti-discrimination measures in health facilities, and investment in the infrastructure of neglected border regions. The research was funded by Birjand University of Medical Sciences and approved by the university’s ethics committee, with informed consent obtained from all participants and their anonymity strictly protected throughout collection and analysis.

Beyond its immediate regional significance, the study offers a template for understanding homelessness as a public health issue rather than merely a social welfare problem. The twenty-four determinants mapped by the researchers illustrate how health is produced, or eroded, long before a patient reaches a clinic, in the labor market, the classroom, the neighborhood, and the family. For the homeless women of Iran’s Afghan border regions, the path to better health runs through economic security and human connection as much as through medicine. The study’s comprehensive inventory gives policymakers, clinicians, and advocates a concrete starting point, and it gives a long-invisible population something it has rarely been granted: a documented, systematic account of the forces shaping their lives.

Subject of Research: Social determinants of health among homeless women in Iran's border regions with Afghanistan

Article Title: Social determinants of health among homeless women in border regions of Iran with Afghanistan: a qualitative study

Article References: Khosravi, M., Khosravi, F., Mohammadi, F., Rezaei Qazravan, Z., & Hajiaghaye, Z. (2026). Social determinants of health among homeless women in border regions of Iran with Afghanistan: a qualitative study. Discover Social Science and Health. https://doi.org/10.1007/s44155-026-00470-y

Image Credits: AI Generated

DOI: 10.1007/s44155-026-00470-y

Keywords: social determinants of health, homeless women, Iran, Afghanistan border, qualitative study, Healthy People 2030, economic stability, healthcare access, shelters, health equity, Birjand University of Medical Sciences, public health