Factors That Influence Quality of Life in People Experiencing Homelessness: A Systematic Mixed Studies Review

Abstract

Background: An emerging category of morbidity in research among people experiencing homelessness (PEH) is quality of life (QoL). Conceptual Framework: The Commission on Social Determinants of Health (CSDH) framework was used to explain the relationship between the resulting factors and their impact on QoL among PEH. Purpose: The purpose of this systematic mixed studies review was to explore the factors that are associated with QoL among homeless individuals. Method: A systematic mixed studies review was conducted using CINAHL, Medline, PubMed, and SocIndex databases. Quantitative, qualitative, and mixed methods studies were included and synthesized employing results-based convergent synthesis design. Results: The initial search resulted in 757 studies with 55 studies meeting the inclusion criteria. Thematic analysis revealed themes influencing QoL among PEH categorized by the CSDH determinants of structural, social cohesion and social capital, and intermediary determinants. Among these themes, higher social status, strong relationships, better reported physical and mental health, and a positive life outlook were associated with increased QoL. Social isolation, substance use, poorer life outlook, increased years spent homeless, and perceived quality of housing were associated with decreased QoL. Age, sex, and housing programs revealed inconsistent results on QoL. Implications: While the factors presented in this review indicate some consistent relationships with QoL in PEH, this review has shown QoL among this population is complex and multifactorial. Future research should focus on relationships between the CSDH determinants, particularly the psychosocial factors and the QoL priorities defined by PEH, and how they may influence QoL among PEH.

The impact of patient‐centred care on the relationship between access to care and subjective health outcomes amongst people experiencing homelessness: A mediation analysis

“…Previous qualitative studies have revealed the relationship between components of PCC and the willingness of PEH to seek healthcare (Flike & Aronowitz, 2021), these results add to the current body of research because no studies were located that quantitatively examined the impact of PCC on the relationship between access to care and subjective health outcomes. Future research should continue to examine how PCC impacts health outcomes where PEH have been shown to have pronounced disparities such as preventive care and cancer screenings (Asgary, 2018) and chronic illnesses such as cardiovascular disease (Baggett, Berkowitz, et al, 2018).…”

“…PCC was predicted to be the mediator for both models. Covariates were selected based on a systematic review (Flike & Aronowitz, 2021).…”

“…Health‐related quality of life amongst people experiencing homelessness (PEH) has increasingly been identified as an outcome of interest in research publications over the last decade (Flike & Aronowitz, 2021). The lower health‐related quality of life reported by PEH (Lewer et al, 2019) has been shown to be influenced by poor access to healthcare (Fazel et al, 2014) and the desire for more choices and respect from society (Palepu et al, 2012).…”

Association of sexual orientation with substance use in Colombian adults experiencing homelessness

“…Colombia is a country with upper middle income, high inequality, and poverty (Chacón & Ramírez, 2020), Christian religious beliefs, and, therefore, high heteronormativity (Palacio, 2017). These characteristics are related to the attitude toward sexual orientations and, consequently, are confounding variables in the association between sexual orientation and substance use, even among people experiencing homelessness (Ecker et al, 2019;Flike & Aronowitz, 2021). This information may be relevant to the Colombian healthcare system, which favors differential care in all contexts to guarantee the full enjoyment of the right to health for all citizens (García-Balaguera, 2018).…”

“…People experiencing homelessness show a high frequency of health risk behaviors (Ecker et al, 2019; Oppenheimer et al, 2016). Substance use is highly prevalent in people experiencing homelessness and is associated with proximal (demographic characteristics) and distal (political, legal, or cultural) factors or determinants (Ecker et al, 2019; Flike & Aronowitz, 2021).…”