Experiences of Community Violence Among Adults with Chronic Conditions: Qualitative Findings from Chicago.

BACKGROUND: Community violence is an important social determinant of health in many high-poverty, urban communities.

OBJECTIVE: The purpose of this study was to explore and characterize self-described experiences of community violence among adults with chronic health conditions.

DESIGN: Qualitative study design was implemented in 2017 using in-depth, semi-structured focus groups and interviews; data were collected from two clinical sites located in geographic epicenters of high violent crime in Chicago.

PARTICIPANTS: Adult patients, ages 35 years and older, who had at least one chronic condition.

APPROACH: Data were analyzed using grounded theory and the constant comparison method.

KEY RESULTS: The overall sample (N = 51) was predominantly female (67%) and black non-Hispanic (75%); a large proportion had hypertension (65%), arthritis (55%), obesity (53%), and/or diabetes (45%). The majority reported that a close friend or family member was seriously injured or killed due to community violence (71%); a similar proportion had never discussed their experiences of community violence with a healthcare provider (73%). Several major themes emerged: (1) perceived risk of being targeted, (2) chronic stress and worry, (3) hypervigilance, (4) social breakdown, (5) chronic isolation, (6) constrained choice (loss of freedom), (7) limited access to material resources, and (8) inadequate healthcare responses.

CONCLUSIONS: Patients often struggled to balance the challenges imposed by community violence with the demands of living with and managing their chronic conditions. Emergent themes may inform practical targets for addressing community violence as a social determinant of health in vulnerable populations.