Establishing need and population priorities to improve the health of homeless and vulnerably housed women, youth, and men: A Delphi consensus study.
Adult
Canada
/ epidemiology
Consensus
Delphi Technique
Demography
Disabled Persons
/ statistics & numerical data
Female
Health Personnel
Health Services Accessibility
/ statistics & numerical data
Ill-Housed Persons
/ statistics & numerical data
Housing
/ statistics & numerical data
Humans
Indigenous Peoples
/ psychology
Male
Mental Health
/ statistics & numerical data
Middle Aged
Refugees
/ statistics & numerical data
Risk Factors
Social Problems
/ psychology
Substance-Related Disorders
/ diagnosis
Surveys and Questionnaires
Transients and Migrants
/ statistics & numerical data
Young Adult
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2020
2020
Historique:
received:
15
07
2019
accepted:
01
04
2020
entrez:
17
4
2020
pubmed:
17
4
2020
medline:
4
8
2020
Statut:
epublish
Résumé
Homelessness is one of the most disabling and precarious living conditions. The objective of this Delphi consensus study was to identify priority needs and at-risk population subgroups among homeless and vulnerably housed people to guide the development of a more responsive and person-centred clinical practice guideline. We used a literature review and expert working group to produce an initial list of needs and at-risk subgroups of homeless and vulnerably housed populations. We then followed a modified Delphi consensus method, asking expert health professionals, using electronic surveys, and persons with lived experience of homelessness, using oral surveys, to prioritize needs and at-risk sub-populations across Canada. Criteria for ranking included potential for impact, extent of inequities and burden of illness. We set ratings of ≥ 60% to determine consensus over three rounds of surveys. Eighty four health professionals and 76 persons with lived experience of homelessness participated from across Canada, achieving an overall 73% response rate. The participants identified priority needs including mental health and addiction care, facilitating access to permanent housing, facilitating access to income support and case management/care coordination. Participants also ranked specific homeless sub-populations in need of additional research including: Indigenous Peoples (First Nations, Métis, and Inuit); youth, women and families; people with acquired brain injury, intellectual or physical disabilities; and refugees and other migrants. The inclusion of the perspectives of both expert health professionals and people with lived experience of homelessness provided validity in identifying real-world needs to guide systematic reviews in four key areas according to priority needs, as well as launch a number of working groups to explore how to adapt interventions for specific at-risk populations, to create evidence-based guidelines.
Sections du résumé
BACKGROUND
Homelessness is one of the most disabling and precarious living conditions. The objective of this Delphi consensus study was to identify priority needs and at-risk population subgroups among homeless and vulnerably housed people to guide the development of a more responsive and person-centred clinical practice guideline.
METHODS
We used a literature review and expert working group to produce an initial list of needs and at-risk subgroups of homeless and vulnerably housed populations. We then followed a modified Delphi consensus method, asking expert health professionals, using electronic surveys, and persons with lived experience of homelessness, using oral surveys, to prioritize needs and at-risk sub-populations across Canada. Criteria for ranking included potential for impact, extent of inequities and burden of illness. We set ratings of ≥ 60% to determine consensus over three rounds of surveys.
FINDINGS
Eighty four health professionals and 76 persons with lived experience of homelessness participated from across Canada, achieving an overall 73% response rate. The participants identified priority needs including mental health and addiction care, facilitating access to permanent housing, facilitating access to income support and case management/care coordination. Participants also ranked specific homeless sub-populations in need of additional research including: Indigenous Peoples (First Nations, Métis, and Inuit); youth, women and families; people with acquired brain injury, intellectual or physical disabilities; and refugees and other migrants.
INTERPRETATION
The inclusion of the perspectives of both expert health professionals and people with lived experience of homelessness provided validity in identifying real-world needs to guide systematic reviews in four key areas according to priority needs, as well as launch a number of working groups to explore how to adapt interventions for specific at-risk populations, to create evidence-based guidelines.
Identifiants
pubmed: 32298388
doi: 10.1371/journal.pone.0231758
pii: PONE-D-19-19733
pmc: PMC7162520
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0231758Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Health Place. 2015 May;33:118-24
pubmed: 25817940
Lancet. 2014 Oct 25;384(9953):1541-7
pubmed: 25390579
BMJ Open. 2011 Nov 14;1(2):e000323
pubmed: 22102645
Cochrane Database Syst Rev. 2017 Jan 06;1:CD007906
pubmed: 28067944
Can J Psychiatry. 2003 Jul;48(6):374-80
pubmed: 12894611
PLoS One. 2015 Apr 07;10(4):e0122246
pubmed: 25849568
Syst Rev. 2020 Feb 1;9(1):21
pubmed: 32007104
Am J Orthopsychiatry. 2007 Jul;77(3):350-61
pubmed: 17696663
Am J Prev Med. 2000 Jan;18(1 Suppl):35-43
pubmed: 10806978
JAMA. 2014 Oct 15;312(15):1513-4
pubmed: 25167382
J Prim Care Community Health. 2015 Apr;6(2):77-87
pubmed: 25389222
BMC Public Health. 2009 Jun 03;9:171
pubmed: 19493353
Psychiatr Serv. 2014 Mar 1;65(3):287-94
pubmed: 24343350
J Adolesc. 1998 Jun;21(3):241-52
pubmed: 9657892
Am J Community Psychol. 2005 Dec;36(3-4):223-38
pubmed: 16389497
J Interpers Violence. 2006 Jun;21(6):820-39
pubmed: 16672743
New Dir Ment Health Serv. 1992 Spring;(53):43-54
pubmed: 1579118
Implement Sci. 2013 Oct 02;8:117
pubmed: 24088228
CMAJ. 2008 Oct 7;179(8):779-84
pubmed: 18838453
PLoS One. 2013 Oct 04;8(10):e75133
pubmed: 24124470
JAMA. 2015 Mar 3;313(9):905-15
pubmed: 25734732
PLoS Med. 2008 Dec 2;5(12):e225
pubmed: 19053169
J Health Care Poor Underserved. 2010 Aug;21(3):1031-45
pubmed: 20693742
BMJ. 2006 Jan 28;332(7535):220-2
pubmed: 16439401
PLoS Med. 2010 Feb 16;7(2):e1000217
pubmed: 20169112
Am J Public Health. 2013 Dec;103 Suppl 2:S206-9
pubmed: 24148038
Am J Public Health. 2013 Dec;103 Suppl 2:S269-74
pubmed: 24148063
Psychiatr Serv. 2016 Mar;67(3):275-81
pubmed: 26620289
J Urban Health. 2009 Sep;86(5):791-803
pubmed: 19629703
CMAJ. 2001 Jan 23;164(2):229-33
pubmed: 11332321
BMC Health Serv Res. 2014 Apr 13;14:167
pubmed: 24725374
CMAJ. 2011 Sep 6;183(12):E928-32
pubmed: 20547714
BMC Public Health. 2006 Mar 29;6:81
pubmed: 16571122
Can Fam Physician. 2014 Jan;60(1):e32-40
pubmed: 24452576
Am J Prev Med. 2005 Nov;29(4):311-9
pubmed: 16242595
Am J Public Health. 2004 Apr;94(4):651-6
pubmed: 15054020
CMAJ. 1999 Sep 21;161(6):689-93
pubmed: 10513274