Document Type



Doctor of Philosophy



Date of Defense


Graduate Advisor

Kamila White


Zoe Peterson

Gary Morse

Brian Vandenberg


The physical and mental health care needs of homeless adults are extensive. However, these needs regularly go unmet. Healthcare use behavior is complex and involves a range of obstacles. As such, self-efficacy, an individual’s belief in his or her ability to perform a given behavior, appears to be a relevant factor in healthcare use. While current theory supports this notion and research has confirmed the role of self-efficacy in health behavior generally, a validated measure of healthcare use self-efficacy has not previously existed. The aim of this study was to develop and validate the Healthcare Use Self-Efficacy List (HUSEL) in a sample of homeless adults. Qualitative data collected from homeless adults (N = 10) and case managers (N = 7) were used to ensure that questionnaire items meaningfully reflect the challenges faced in healthcare utilization. A series of analyses involving a larger sample of homeless of adults (N = 131) demonstrated that the HUSEL has sound validity and reliability properties. Results also indicated that healthcare use self-efficacy is associated with number of non-urgent, ambulatory care visits in the past year, presence of unmet medical/surgical need in the past year, and perceived mental health status. The findings are reviewed in light of the existing literature. Clinical implications and future directions are also discussed.

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