Interventions that could mitigate the adverse effects of household overcrowding: A rapid realist review with stakeholder participation from urban contexts in England

Abstract

Household overcrowding has increased in England. However, there is limited synthesis of evidence about what can be done to reduce the impact of overcrowding on health/well-being. We undertook a rapid realist review of English language peer-reviewed and grey literature of interventions from comparable settings to urban contexts in England that addressed household overcrowding/health outcomes. A search was conducted (01.06.23) in MEDLINE, EMBASE, Web of Science, SCOPUS. Two expert panels informed the review. The first comprised individuals with lived experience of overcrowding in London; the second local and regional government representatives from London, Salford and Doncaster (England). Both panels contributed at two stages to guide the scope/literature identification and test/refine programme theories. Final full-text screening and quality appraisal were completed by two independent researchers. Thirty-one peer-reviewed papers and 27 documents from participating local authorities were included. The peer-reviewed literature, emanating from multiple geographical contexts and of variable study designs and quality, contained 15 evaluated interventions across three categories: Rehousing (n=7 interventions); Home improvements, e.g. renovations/retrofitting (n=6); Co-ordination with healthcare and wider services (combined with home improvements) (n=2). A synthesis of the peer-reviewed literature with expert panel comments and grey literature, identified contexts and mechanisms that could facilitate or hinder achievement of positive health outcomes. There was reluctance to be rehoused elsewhere, with residents fearing the loss of social networks in available properties often located far away from their current homes. Home improvements may alleviate the worst impacts of overcrowding, and residents living in unhealthy conditions can benefit from better healthcare co-ordination.