Approvals were obtained from the Western Sydney University Human Research Ethics Committee, the Ghanaian Department of Social Development, and four community organisations that serve people experiencing homelessness in Accra. Respondents were recruited by trained research assistants experienced in public health research with vulnerable populations and fluent in local languages. For potential respondents in the streets and slums, their community leaders were contacted in advance to facilitate data collection. Respondents were recruited day and night during pre-existing outreach, health screening, and free meal programmes. The research team was introduced to the potential respondents, research information and consent were discussed, and consenting individuals were invited to pre-arranged community centres or playing grounds for participation. At the shelters, staff members introduced the research team to clients for information dissemination, consent, and participation.
To prevent exploitation, individuals with serious cognitive impairment, intellectual disability, and mental illness were excluded if the conditions limited capacity to consent. For such individuals, the capacity to provide consent was determined by social workers and shelter staff based on the seriousness of the health condition and prior experience of serious distress. Intoxicated individuals were only engaged when they had the ability to give informed consent. Three people judged as incapable to provide consent were excluded. To prevent coercion, community leaders, social workers, and shelter staff members were not involved in the consent process except when a person’s capacity to consent was questionable. Respondents had the opportunity to confirm or re-negotiate consent over time. That is participants who had already agreed to participate were asked of permission again prior to the start of the survey. Participants could change their decision to participate or withdraw their participation altogether based on changes in personal lives or availability of new information about the research.
Activities were conducted in either the local Ghanaian language (66%, n = 201) or English (34%, n = 104). The research assistants read the questions to respondents, recorded answers in electronic format, and then synchronised to the online software platform CANVAS (https://canvass.acspri.org.au ) using android tablets. The survey lasted for 50 to 60 minutes, and respondents were reimbursed with mosquito repellent (valued at AU$5). All respondents could also check-in to any of the two partner alcohol and drug rehabilitation centres with the help of social workers free of charge. Community organisations provided timely referrals for mental health support for respondents who may experience psychological harm and distress. Two respondents experienced mild discomfort answering questions on discrimination and violence which led to a temporary pause of the survey.
To prevent exploitation, individuals with serious cognitive impairment, intellectual disability, and mental illness were excluded if the conditions limited capacity to consent. For such individuals, the capacity to provide consent was determined by social workers and shelter staff based on the seriousness of the health condition and prior experience of serious distress. Intoxicated individuals were only engaged when they had the ability to give informed consent. Three people judged as incapable to provide consent were excluded. To prevent coercion, community leaders, social workers, and shelter staff members were not involved in the consent process except when a person’s capacity to consent was questionable. Respondents had the opportunity to confirm or re-negotiate consent over time. That is participants who had already agreed to participate were asked of permission again prior to the start of the survey. Participants could change their decision to participate or withdraw their participation altogether based on changes in personal lives or availability of new information about the research.
Activities were conducted in either the local Ghanaian language (66%, n = 201) or English (34%, n = 104). The research assistants read the questions to respondents, recorded answers in electronic format, and then synchronised to the online software platform CANVAS (
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