Stigma and the role of oral appearance in homeless people

Objectives: To explore the perception of stigma, self disgust and the relationship with oral appearance in single homeless people (SHP) living in south London. Methods: A qualitative study was conducted using in-depth semi-structured interviews with a purposive sample of 21 SHP. Data were analysed using framework analysis. Results: Attributions about homeless people were made at three levels; attributions made about one-self, attributions made by non-homeless people, and attributions made by homeless people about the characteristics of other homeless people. All these attributes were related to physical characteristics around appearance and smell and perceived character flaws which included substance use, being a failure and ‘down on your luck'. No person had perceived stigma in relation to mental health. By far the greatest characteristic eliciting stigma was being homeless, though no distinction was drawn between rough sleeping and hostel dwelling. Maintaining good appearance which included oral appearance was identified as means of safeguarding individuals from being perceived as devalued and discredited. Homeless people stigmatised other homeless people who did not comply with their perception of desirable attributes. Those who did not maintain a clean and tidy appearance also incurred the attribution of other undesirable devaluing characteristics such as mental health problems and substance use. Conclusions: The consequences of stigma were shame, embarrassment and denial of housing status amongst homeless people which lead to disability in terms of accessing health and support need services.