Establishing need and population priorities to improve the health of homeless and vulnerably housed women, youth, and men: A Delphi consensus study

• Published in: PLOS ONE
• Main Authors: Shoemaker, Esther S., Kendall, Claire E., Mathew, Christine, Crispo, Sarah, Welch, Vivian, Andermann, Anne, Mott, Sebastian, Lalonde, Christine, Bloch, Gary, Mayhew, Alain, Aubry, Tim, Tugwell, Peter, Stergiopoulos, Vicky, Pottie, Kevin
• Format: Text
• Language: English
• Published: Public Library of Science 2020
• Subjects: Research Article; Canada; First Nations; inuit
• Online Access: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162520/; http://www.ncbi.nlm.nih.gov/pubmed/32298388; https://doi.org/10.1371/journal.pone.0231758

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.