The Experiences of Adults Experiencing Homelessness When Accessing and Using Psychosocial Interventions: A Systematic Review and Qualitative Evidence Synthesis

Abstract

Background

Adults experiencing homelessness in high-income countries are more likely to have mental ill-health and engage in problematic substance use. They are also more likely to experience challenges when accessing services. Psychosocial interventions are increasingly used with this group. Most of the evidence around these interventions is not specific to their use with adults experiencing homelessness.

Objectives

To summarise the best available evidence of the views and experiences of adults experiencing homelessness in high-income countries about psychosocial interventions.

Search Methods

This review is based on evidence identified in an Evidence and Gap Map (EGM) on interventions for people experiencing homelessness. The EGM searches were conducted in September 2021. Additionally, we undertook a call for evidence and hand searches of key journals.

Selection Criteria

We included qualitative data from studies of psychosocial interventions. Participants were adults aged 18+ experiencing homelessness in high-income countries. Only studies that reported the views, opinions, perceptions, and experiences of participants were included.

Data Collection and Analysis

Of the 468 studies originally screened, 17 were eligible for full-text review, which was undertaken independently by two reviewers. Ten were excluded at this stage, and seven were identified as meeting the inclusion criteria. Analysis was undertaken using thematic synthesis in three stages: (1) findings data were extracted from studies. Two reviewers independently extracted findings from included studies. These were compared and agreed on which findings to include for analysis; (2) two reviewers gave each line of extracted data a descriptive code (a short descriptive summary). These were compared and a set of codes for inclusion in the next stage of analysis was agreed; (3) the reviewers iteratively examined the descriptive themes, inferring from these themes the experiences of participants and their perceptions of how the intervention worked for them. These analytical themes were discussed with a panel of people with experience of homelessness.

Main Results

Seven studies were included in this review, covering several intervention types. A total of 84 adults experiencing homelessness were included in these studies. Three studies were conducted in Canada, three in the United States, and one in Scotland. All were published after 2009. The studies used various qualitative methods of data collection and analysis. None of the included studies were assessed as high quality. The most significant area of concern across the included studies concerned relationships between researchers and research participants, where five included studies were assessed as low quality. Areas of higher quality were clarity of research questions and methods. Overall, 368 lines of findings were extracted and coded under 118 descriptive codes. Of these, 55 related to direct quotes of participants' views and experiences. The remainder were the study authors' interpretations of the research participants' experiences. The 118 descriptive codes were grouped into 14 descriptive themes. The themes are descriptions of patterns in the data (the findings extracted from the included studies). These 14 descriptive themes (and the 118 descriptive codes underpinning them) summarise data from the primary studies. The final analysis stage was interpretation of the descriptive themes and development of analytical themes to answer the review questions. The reviewers were able to answer two of the four review questions: the experiences of participants when using psychosocial interventions, and whether they felt the interventions worked for them. The question concerning underlying theories of how the interventions are intended to work was addressed through a separate analysis. The question of differences between interventions could not be answered because of the small number of included studies. The final analysis stage identified three analytical themes. These are: (1) the individual plays a pivotal role in their recovery and change journey; (2) accessibility is a key component of intervention success; and (3) relationships are an important intervention ingredient.

Author's Conclusions

The reviewers draw two broad conclusions from this analysis: (1) it is important to place adults experiencing homelessness at the centre of the design of psychosocial interventions; and (2) it is important to treat adults experiencing homelessness as individuals.