'You can change your life through sports'-physical activity interventions to improve the health and well-being of adults experiencing homelessness: a mixed-methods systematic review.

OBJECTIVES: Systematically synthesise evidence of physical activity interventions for people experiencing homelessness (PEH). DESIGN: Mixed-methods systematic review. DATA SOURCES: EMBASE, Web of Science, CINAHL, PubMed (MEDLINE), PsycINFO, SPORTDiscus and Cochrane Library, searched from inception to October 2022. ELIGIBILITY CRITERIA: PICO framework: population (quantitative/qualitative studies of PEH from high-income countries); intervention (physical activity); comparison (with/without comparator) and outcome (any health/well-being-related outcome). The risk of bias was assessed using Joanna Briggs Institute critical appraisal tools. RESULTS: 3615 records were screened, generating 18 reports (17 studies, 11 qualitative and 6 quantitative (1 randomised controlled trial, 4 quasi-experimental, 1 analytical cross-sectional)) from the UK, USA, Denmark and Australia, including 554 participants (516 PEH, 38 staff). Interventions included soccer (n=7), group exercise (indoor (n=3), outdoor (n=5)) and individual activities (n=2). The risk of bias assessment found study quality to vary; with 6 being high, 6 moderate, 4 low and 1 very low. A mixed-methods synthesis identified physical and mental health benefits. Qualitative evidence highlighted benefits carried into wider life, the challenges of participating and the positive impact of physical activity on addiction. Qualitative and quantitative evidence was aligned demonstrating the mental health benefits of outdoor exercise and increased physical activity from indoor group exercise. Quantitative evidence also suggests improved musculoskeletal health, cardiovascular fitness, postural balance and blood lipid markers (p<0.05). CONCLUSION: Qualitative evidence suggests that physical activity interventions for PEH can benefit health and well-being with positive translation to wider life. There was limited positive quantitative evidence, although most was inconclusive. Although the evidence suggests a potential recommendation for physical activity interventions for PEH, results may not be transferable outside high-income countries. Further research is required to determine the effectiveness and optimal programme design.

The impact of the COVID-19 pandemic on people experiencing homelessness: a qualitative interview study in the UK.

BACKGROUND: People experiencing homelessness faced unique challenges during the COVID-19 pandemic, including changes to accommodation availability, societal restrictions impacting access to essentials like food, and services moving to remote access. There is a paucity of in-depth qualitative research exploring how the pandemic affected this population, which this research aims to address. METHODS: 33 semi-structured qualitative interviews (22 with people who experienced homelessness during the pandemic and 11 with homelessness sector service providers) were done in the UK between April 26, 2021, and Jan, 25, 2022. Ethical approval was granted by the University College London research ethics committee (Project ID: 14895/005) and all participants provided informed consent. Interviews were audio-recorded, transcribed, and analysed using reflexive thematic analysis utilising NVivo software. Four interviews were coded by two researchers for consistency of codes. FINDINGS: In our sample of people experiencing homelessness, 11 (50%) were female, 13 (59%) White British, all were aged between 24 and 59 years, and all had lived in hostels or hotels, with friends or family, or on the streets during the pandemic. Providers interviewed worked for varied services, including support charities, housing, and addiction services. Four key themes were identified: understanding of and adherence to COVID guidelines; changes to accommodation and experiences of "Everyone In" (a government initiative in which people sleeping on the street or in accommodation where it was difficult to self-isolate were provided emergency accommodation); living through a pandemic while navigating homelessness; and, adaptations to service provision for people experiencing homelessness. INTERPRETATION: Policy makers and public health communicators must learn from people experiencing homelessness to maximise effectiveness of future public health strategies. Housing providers and support services should recognise the implications of imposing a scarcity of choice on people who need accommodation during a public health emergency. The loss of usual support was destabilising for people experiencing homelessness, triggering a need to adopt survival tactics which negatively influence their health. Although this research was limited by the possibility that views expressed might differ from those unwilling or unable to participate, it does highlight successes and difficulties in supporting people experiencing homelessness during the COVID-19 pandemic and informs planning for similar public health events. FUNDING: Nuffield Foundation, Wellcome Trust.

Capturing learning from public involvement with people experiencing homelessness to help shape new physiotherapy research: Utilizing a reflective model with an under-served, vulnerable population.

INTRODUCTION: People experiencing homelessness (PEH) have poorer health than housed people but face barriers accessing care and being involved in research. As an often-ignored group, their contribution to help shape research that is for and about them is essential, as it can strengthen the research proposal, in turn facilitating research and outcomes that are relevant to this vulnerable group. METHODS: Six people with experience of homelessness attended a PPI consultation aided by Pathway, a UK homeless peer advocacy charity, which coordinates an 'Experts by Experience' group. We present reflections on conducting PPI with PEH that informed the development of a physiotherapy research proposal. Kolb's Experiential Learning Cycle guided reflections across four stages: (1) describing the PPI experience; (2) reviewing and reflecting on the PPI experience; (3) learning from the PPI experience; and (4) planning and trying out learning. RESULTS: Reflections highlighted the importance of: working closely with an advocacy organisation and leader to reach under-served people; the diversity of experiences; using familiar venues, contingency and budget planning; flexibility and 'allowing time; talking less; listening more'; planning for early and ongoing PPI, and the potential of mobile 'one-off' PPI outreach models to reach vulnerable groups. CONCLUSION: Kolb's Experiential Learning Cycle aided team reflection on feedback from PEH, which helped refine and strengthen a physiotherapy research proposal. The project was unfunded. However, a reflective model helped maximize learning and impact including for future PPI and research. The novel application of Kolb's Experiential Learning Cycle provided structure, facilitated reflection and enhanced individual and collective learning and may benefit capturing learning from PPI with other vulnerable populations. PATIENT OR PUBLIC CONTRIBUTION: We highlight how a PPI consultation with people with experience of homelessness helped shape a funding proposal. Additionally, the reflections of the experts by experience team leader are included.

A qualitative study exploring the impact of the COVID-19 pandemic on People Who Inject Drugs (PWID) and drug service provision in the UK: PWID and service provider perspectives.

BACKGROUND: People Who Inject Drugs (PWID) are subject to distinct socio-structural inequalities that can expose them to high risks of COVID-19 transmission and related health and social complications. In response to COVID-19 mitigation strategies, these vulnerabilities are being experienced in the context of adapted drug treatment service provision, including reduced in-person support and increased regulatory flexibility in opioid substitution therapy (OST) guidelines. This study aimed to explore the longer-term impact of the pandemic on the health and wellbeing of PWID in the UK, including provider and client experiences of treatment changes. METHODS: Interviews were conducted with 19 PWID and 17 drug treatment providers between May and September 2021, recruited from drug and homelessness charities providing treatment services and healthcare in the UK. Data were analysed using reflexive thematic analysis. RESULTS: Most participants expressed ongoing fears of COVID-19 transmission, although socio-structural inequalities limited the contexts in which physical distancing could be practised. In addition, virus mitigation strategies altered the risk environment for PWID, resulting in ongoing physical (e.g. changing drug use patterns, including transitions to crack cocaine, benzodiazepine and pregabalin use) and socio-economic harms (e.g. limited opportunities for sex work engagement and income generation). Finally, whilst clients reported some favourable experiences from service adaptations prompted by COVID-19, including increased regulatory flexibility in OST guidelines, there was continued scepticism and caution among providers toward sustaining any treatment changes beyond the pandemic period. CONCLUSIONS: Whilst our findings emphasize the importance of accessible harm reduction measures attending to changing indices of drug-related harm during this period, there is a need for additional structural supports to ensure pre-existing disparities and harms impacting PWID are not exacerbated further by the conditions of the pandemic. In addition, any sustained policy and service delivery adaptations prompted by COVID-19 will require further attention if they are to be acceptable to both service users and providers.

The Impact of the COVID-19 Pandemic and Associated Societal Restrictions on People Experiencing Homelessness (PEH): A Qualitative Interview Study with PEH and Service Providers in the UK.

People experiencing homelessness (PEH) faced unique challenges during the COVID-19 pandemic, including changes to accommodation availability, societal restrictions impacting access to essentials like food, and services moving to online and remote access. This in-depth qualitative research aims to add to the existing, but limited research exploring how the pandemic affected PEH. 33 semi-structured qualitative interviews (22 with PEH during the pandemic and 11 with homelessness sector service providers) were undertaken in the United Kingdom between April 2021 and January 2022. Interviews were audio-recorded, transcribed and analysed using reflexive thematic analysis. To ensure consistency of coding, 10% of interviews were coded by two researchers. The PEH sample was 50% female, aged 24-59 years, 59% white British, and included people who had lived in hostels/hotels, with friends/family, and on the streets during the COVID-19 pandemic. Providers came from varied services, including support charities, housing, and addiction services. Five key themes were identified: (i) the understanding of and adherence to public health guidance and restrictions; (ii) the experience of people accommodated by the 'Everyone In' initiative; (iii) the impact of social distancing guidelines on PEH experiences in public spaces; (iv) the importance of social support and connections to others; and (v) how homelessness services adapted their provision. Policy makers and public health communicators must learn from PEH to maximize the effectiveness of future public health strategies. Housing providers and support services should recognize the implications of imposing a lack of choice on people who need accommodation during a public health emergency. The loss of usual support for PEH triggered a loss of ability to rely on usual 'survival strategies', which negatively influenced their health. This research highlights successes and difficulties in supporting PEH during the COVID-19 pandemic and informs planning for similar public health events.

'You're just there, alone in your room with your thoughts': a qualitative study about the psychosocial impact of the COVID-19 pandemic among young people living in the UK.

OBJECTIVES: Adolescents and young adults have been greatly affected by quarantine measures during the COVID-19 pandemic, but little is understood about how restrictions have affected their well-being, mental health, and social life. We therefore aimed to learn more about how UK quarantine measures affected the social lives, mental health and well-being of adolescents and young adults. DESIGN: Qualitative interview study. The data were analysed using reflexive thematic analysis, with particular attention paid to contextual factors (such as age, gender, ethnicity and health status) when analysing each individual transcript. SETTING: Data collection took place remotely across the UK via audio or video call, between June 2020 and January 2021. PARTICIPANTS: We conducted semi-structured interviews with 37 participants (aged 13-24 years) to elicit their views. RESULTS: Authors generated four themes during the qualitative analysis: (a) concerns about disruption to education, (b) missing social contact during lockdown, (c) changes to social relationships and (d) improved well-being during lockdown. Many participants said they struggled with a decline in mental health during the pandemic, lack of support and concern about socialising after the pandemic. However, some participants described experiences and changes brought on by the pandemic as helpful, including an increased awareness of mental health and feeling more at ease when talking about it, as well as stronger relationship ties with family members. CONCLUSIONS: Findings suggest that young people may have felt more comfortable when talking about their mental health compared with prepandemic, in part facilitated by initiatives through schools, universities and employers. However, many were worried about how the pandemic has affected their education and social connections, and support for young people should be tailored accordingly around some of these concerns.

Impact of the COVID-19 pandemic on the mental health and wellbeing of parents with young children: a qualitative interview study.

BACKGROUND: Parents have faced unique challenges during the coronavirus disease 2019 (COVID-19) pandemic, including mobility constraints, isolation measures, working from home, and the closure of schools and childcare facilities. There is presently a lack of in-depth qualitative research exploring how these changes have affected parents' mental health and wellbeing. METHODS: Semi-structured qualitative interviews with 29 parents of young children. Interviews were analysed using reflexive thematic analysis. RESULTS: We identified five superordinate themes affecting participant mental health and wellbeing: (1) navigation of multiple responsibilities and change inside the home; (2) disruption to home life; (3) changes to usual support networks; (4) changes in personal relationships; and (5) use of coping strategies. Participants described stress and exhaustion from navigating multiple pressures and conflicting responsibilities with home, schooling, and work, without their usual support networks and in the context of disrupted routines. Family roles and relationships were sometimes tested, however, many parents identified coping strategies that protected their wellbeing including access to outdoor space, spending time away from family, and avoiding conflict and pandemic-related media coverage. CONCLUSIONS: Employers must be cognisant of the challenges that the pandemic has placed on parents, particularly women and lone parents. Flexible working arrangements and support might therefore relieve stress and increase productivity. Coping strategies identified by parents in this study could be harnessed and encouraged by employers and policymakers to promote positive wellbeing during times of stress throughout the pandemic and beyond.

"A Mile in Her Shoes": A qualitative exploration of the perceived benefits of volunteer led running groups for homeless women.

"A Mile in Her Shoes" is a volunteer-led charity which provides running groups for homeless women. The objective of this study was to explore the experiences of homeless women attending these running groups and to establish how participation in a supported running group impacted their lives. This exploratory qualitative study was carried out across two sites in London UK during February and April 2017. All regular attenders of the running groups were invited to participate in the study; subsequently, a self-selected sample of 11 women consented to being interviewed. Data were collected by female interviewers on a one-to-one basis, steered by a semi-structured topic guide. All interviews were digitally recorded, transcribed verbatim, and analysed using thematic analysis. Themes were cross-referenced by the research team and findings were supported by direct quotes. Five main themes emerged from the findings: the positive impact of the charity; homeless women's motivations and barriers to participating in running groups; the benefits of participating on physical and mental health; the importance and value of social support from the group; and the value of being provided with quality running kit. This study concludes that volunteer-led running groups are valued by homeless women by helping them take control of their health. It provides insight into their engagement in physical activity, thus potentially helping prevent injury or illness, and aiding recovery and rehabilitation. One implication of this study is that gathering homeless women's views helps to steer how community-based physical activity programmes can benefit their wellbeing. However, this small-scale study may have limited generalisability, with the topic warranting further research.

Homeless people's access to primary care physiotherapy services: an exploratory, mixed-method investigation using a follow-up qualitative extension to core quantitative research.

OBJECTIVES: The purpose of this study was to appraise referrals of homeless patients to physiotherapy services and explore perceptions of barriers to access. DESIGN: This exploratory mixed-method study used a follow-up qualitative extension to core quantitative research design. Over 9 months, quantitative data were gathered from the healthcare records of homeless patients referred to physiotherapy by a general practitioner (GP) practice, including the number of referrals and demographic data of all homeless patients referred. Corresponding physiotherapy records of those people referred to physiotherapy were searched for the outcome of their care. Qualitative semi-structured telephone interviews, based on the quantitative findings, were carried out with staff involved with patient care from the referring GP practice and were used to expand insight into the quantitative findings. SETTING: Two primary care sites provided data for this study: a GP practice dedicated exclusively to homeless people and the physiotherapy department receiving their referrals. PARTICIPANTS: Quantitative data from the healthcare records of 34 homeless patient referrals to physiotherapy were collected and analysed. In addition, five staff involved in patient care were interviewed. RESULTS: 34 referrals of homeless people were made to physiotherapy in a 9-month period. It was possible to match 25 of these to records from the physiotherapy department. Nine (36%) patients did not attend their first appointment; seven (28%) attended an initial appointment, but did not attend a subsequent appointment and were discharged from the service; five (20%) completed treatment and four patients (16%) had ongoing treatment. Semi-structured interviews revealed potential barriers preventing homeless people from accessing physiotherapy services, the complex factors being faced by those making referrals and possible ways to improve physiotherapy access. CONCLUSIONS: Homeless people with musculoskeletal problems may fail to access physiotherapy treatment, but opportunities exist to make access to physiotherapy easier.

Practice educators' experiences of supervising two students on allied health practice-based placements.

UNLABELLED: Literature suggests that supervising two students together on clinical placement (2:1 model) has a place in practice-based education, helping to increase placement capacity, improve the learning experience for the students, and possibly improve departmental productivity. The aim of this study was to explore the experiences of allied health professional practice educators in using the 2:1 model. METHODS: This qualitative study used an interpretive, phenomenological approach to data collection and interpretation. Thirteen educators with experience of practice education were recruited and either interviewed alone or involved in a focus group. Data were recorded, transcribed verbatim, and analysed using NVivo 7 computer-based software. RESULTS: The practice educators reported mixed views regarding the 2:1 model. Emergent themes suggested success of supervising two students may depend more on the attitude and philosophy of the practice educator than on the profession or clinical setting, that many practice educators had initially used the 2:1 model in response to a short notice request from the universities to accommodate more students, and that practice educators were unclear as to whether the 2:1 model affected their ability to get through their workload. DISCUSSION: The findings suggest that the unplanned nature of the 2:1 model's initial use may have tempered views on its success. Also, success of this model appears to depend more on the attitude and approach of the practice educator and the support from colleagues to manage students and other workplace duties than it did to profession or clinical setting.