Common trust and personal safety issues: A systematic review on the acceptability of health and social interventions for persons with lived experience of homelessness

Autoři: Olivia Magwood aff001;  Vanessa Ymele Leki aff002;  Victoire Kpade aff003;  Ammar Saad aff001;  Qasem Alkhateeb aff001;  Akalewold Gebremeskel aff001;  Asia Rehman aff001;  Terry Hannigan aff001;  Nicole Pinto aff005;  Annie Huiru Sun aff001;  Claire Kendall aff001;  Nicole Kozloff aff009;  Emily J. Tweed aff010;  David Ponka aff011;  Kevin Pottie aff001
Působiště autorů: C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada aff001;  PET/CT Department, MyHealth Centre, Mississauga, ON, Canada aff002;  Faculty of Medicine, McGill University Montreal, QC, Canada aff003;  School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada aff004;  Department of Population Medicine, University of Guelph, Guelph, ON, Canada aff005;  Department of Family Medicine & School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada aff006;  Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada aff007;  Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada aff008;  Centre for Addiction and Mental Health and Department of Psychiatry and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada aff009;  MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland, United Kingdom aff010;  Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada aff011
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
prolekare.web.journal.doi_sk: 10.1371/journal.pone.0226306



Persons experiencing homelessness and vulnerable housing or those with lived experience of homelessness have worse health outcomes than individuals who are stably housed. Structural violence can dramatically affect their acceptance of interventions. We carried out a systematic review to understand the factors that influence the acceptability of social and health interventions among persons with lived experience of homelessness.


We searched through eight bibliographic databases and selected grey literature sources for articles that were published between 1994 and 2019. We selected primary studies that reported on the experiences of homeless populations interacting with practitioners and service providers working in permanent supportive housing, case management, interventions for substance use, income assistance, and women- and youth-specific interventions. Each study was independently assessed for its methodological quality. We used a framework analysis to identify key findings and used the GRADE-CERQual approach to assess confidence in the key findings.


Our search identified 11,017 citations of which 35 primary studies met our inclusion criteria. Our synthesis highlighted that individuals were marginalized, dehumanized and excluded by their lived homelessness experience. As a result, trust and personal safety were highly valued within human interactions. Lived experience of homelessness influenced attitudes toward health and social service professionals and sometimes led to reluctance to accept interventions. Physical and structural violence intersected with low self-esteem, depression and homeless-related stigma. Positive self-identity facilitated links to long-term and integrated services, peer support, and patient-centred engagement.


Individuals with lived experience of homelessness face considerable marginalization, dehumanization and structural violence. Practitioners and social service providers should consider anti-oppressive approaches and provide, refer to, or advocate for health and structural interventions using the principles of trauma-informed care. Accepting and respecting others as they are, without judgment, may help practitioners navigate barriers to inclusiveness, equitability, and effectiveness for primary care that targets this marginalized population.

Klíčová slova:

Behavioral and social aspects of health – Housing – Human families – Mental health and psychiatry – Primary care – Qualitative studies – Socioeconomic aspects of health – Systematic reviews


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