Addressing housing insecurity as a social determinant of health: A systematic review of interventions in healthcare settings

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine Pub Date : 2025-09-05 DOI:10.1016/j.socscimed.2025.118557

Han Yan , Allyson J. Gallant , Alannah Delahunty-Pike , Jodi E. Langley , Alexander Zsager , Eunice Abaga , Carolyn Ziegler , Jeff Karabanow , Stephen W. Hwang , Andrew D. Pinto

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引用次数: 0

Abstract

Background

Stable housing is a key social determinant of health. Those experiencing homelessness or housing insecurity are known to have increased healthcare utilization and yet worse healthcare outcomes compared to securely housed individuals. Housing interventions offered via healthcare settings provide an opportunity to reach this population. We conducted a systematic review to 1) identify interventions which address housing insecurity and engage healthcare settings; 2) determine effectiveness of these interventions; and 3) ascertain common characteristics of effective interventions to inform new ways to address housing insecurity within healthcare.

Methods

Twelve databases were searched for relevant studies published from January 1, 1990–January 3, 2025. We included intervention studies aimed at meeting patients’ housing needs as a primary or secondary outcome and initiated by referrals from within the healthcare system. Titles, abstracts and full-text articles were reviewed by two independent reviewers. Data were extracted relevant to study design, population, and intervention details. Quality appraisals were conducted using JBI critical appraisal tools. Discrepancies at each stage were resolved through reviewer or team discussions.

Results

We identified 19 studies from 12,483 unique citations. Most were randomized controlled trials and of moderate quality. Studies primarily addressed the housing needs of adults with mental health or substance use issues (n = 9; 47 %). We identified three common characteristics of housing interventions with positively-associated outcomes active community referrals (i.e. connection to a professional social worker or case manager instead of sharing passive information), incorporating multi-component interventions to address housing and additional health needs, and utilizing case management or assertive community treatment approaches.

Conclusions

Interventions to address housing insecurity can be successfully situated within healthcare settings, although more research is required to examine the cost-effectiveness of such interventions. The characteristics of the interventions identified can be used to inform new housing interventions in healthcare settings to address this critical social determinant of health.

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解决住房不安全作为健康的社会决定因素：对医疗保健机构干预措施的系统审查

背景稳定的住房是健康的关键社会决定因素。众所周知，与有安全住所的人相比，无家可归或住房不安全的人对医疗保健的利用率更高，但医疗保健结果更差。通过卫生保健机构提供的住房干预措施为接触这一人群提供了机会。我们进行了一项系统回顾，以1)确定解决住房不安全问题和参与医疗保健机构的干预措施；2)确定这些干预措施的有效性；3)确定有效干预措施的共同特征，以告知解决医疗保健内住房不安全问题的新方法。方法检索1990年1月1日- 2025年1月3日发表的相关文献。我们纳入了旨在满足患者住房需求的干预研究，作为主要或次要结果，并由医疗保健系统内的转诊发起。题目、摘要和全文均由两名独立审稿人审阅。提取与研究设计、人群和干预细节相关的数据。使用JBI关键评估工具进行质量评估。每个阶段的差异通过审稿人或团队讨论来解决。结果我们从12483次独特引用中确定了19项研究。大多数是随机对照试验，质量中等。研究主要针对有精神健康或药物使用问题的成年人的住房需求（n = 9; 47%）。我们确定了住房干预措施的三个共同特征，这些特征与积极的结果相关：积极的社区转诊（即与专业社会工作者或病例管理人员联系，而不是分享被动的信息），结合多成分干预措施来解决住房和额外的健康需求，以及利用病例管理或自信的社区治疗方法。结论：解决住房不安全问题的干预措施可以在医疗机构中成功实施，尽管需要更多的研究来检查此类干预措施的成本效益。所确定的干预措施的特点可用于为卫生保健环境中的新的住房干预措施提供信息，以解决健康的这一关键社会决定因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Social Science & Medicine PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

9.10

自引率

5.60%

发文量

762

审稿时长

38 days

期刊介绍： Social Science & Medicine provides an international and interdisciplinary forum for the dissemination of social science research on health. We publish original research articles (both empirical and theoretical), reviews, position papers and commentaries on health issues, to inform current research, policy and practice in all areas of common interest to social scientists, health practitioners, and policy makers. The journal publishes material relevant to any aspect of health from a wide range of social science disciplines (anthropology, economics, epidemiology, geography, policy, psychology, and sociology), and material relevant to the social sciences from any of the professions concerned with physical and mental health, health care, clinical practice, and health policy and organization. We encourage material which is of general interest to an international readership.