Date Presented 04/04/19
A number of studies have emerged in the OT, occupational science, and interdisciplinary literature that explore the occupational and time use experiences of homeless persons. Since these studies have begun to accumulate, it is advantageous to provide a summary of their findings to direct future occupation-based research in the area of homelessness. Using JBI guidelines, we conducted a systematic review and performed a meta-aggregation of included studies.
Primary Author and Speaker: Carrie Anne Marshall
Additional Authors and Speakers: Lee Westover
Contributing Authors: Leonie Boland, Rebecca Gewurtz, Bonnie Kirsh, Laurence Roy, Jenni Mace, Sarah Wickett
PURPOSE: To identify the scope of literature exploring the occupational experiences of homeless persons, and to conduct a meta-aggregation of the collective findings of this body of literature. We sought to answer the research question: What is the nature of occupational experiences for homeless persons as identified in existing interdisciplinary research?
DESIGN: Using guidelines provided by the Joanna Briggs Institute (JBI), we conducted a systematic review, including critical appraisal and meta-aggregation of included studies.
METHODS: A search strategy was developed in collaboration with an academic research librarian, and deployed. The search strategy was optimized specifically for each database. Databases searched included EMBASE, CINAHL, PsychINFO, Medline, Sociological Abstracts, PubMed, OT Seeker, and Proquest Dissertations and Theses. Using 2 independent raters, we conducted a title/abstract screen and full text review using Covidence. We evaluated eligibility for inclusion based on a variety of inclusion and exclusion criteria that were established among our research team. Only qualitative studies were selected to correspond to our research question. Data from these studies was extracted using a standardized form.
CRITICAL APPRAISAL: Following data extraction, we conducted a critical appraisal using the JBI Critical Appraisal Checklist for Qualitative Studies. We assigned a score of 1 to each rating of ‘yes’ for each of the 10 criteria resulting in a score ranging from 1-10.
META-AGGREGATION: Following our critical appraisal, we conducted an inductive meta-aggregation of the themes that were presented in included studies using the process identified by the JBI. We carefully selected only themes related to occupation from each of these studies. Only primary themes were selected. If a secondary theme was deemed to be a more relevant theme by two independent reviewers, we elected to include only that theme in our meta-aggregation. Three articles were deemed unsuitable to include in the meta-aggregation due to the absence of themes, and the consequent need for interpretation of data by our research team.
RESULTS: A total of 4645 unique records were identified following the removal of duplicates. All were subjected to a title/abstract review by two independent raters. 66 studies were included in our full-text review. Conflicts that emerged at the title/abstract and full-text phases were resolved by discussion and consensus. 15 articles remained. We extracted data from each article including demographic and cultural characteristics, country of publication, and discipline.
CRITICAL APPRAISAL: Our quality ratings of included studies ranged from 5-10 on the JBI Checklist.
META-AGGREGATION: We identified 59 themes from 12 studies representing 331 participants. These were aggregated into 9 distinct themes in order to characterize the occupational experiences of homeless persons.
CONCLUSION: This study provides evidence of several studies exploring the occupational experiences of homeless persons. A number of common themes emerge from this body of literature that emphasize the role of the environment in determining the occupations of this population. These findings provide evidence that supports the importance of occupation in the lives of homeless persons, and provides a foundation for understanding meaning that homeless persons attribute to their occupations. Future research should explore the specific impacts of the occupational experiences of homeless persons on health and well-being, and the occupational experiences of homeless persons during the transition to being housed. The potential for collaborative efforts, including an international network will help to focus future research and practice efforts.
References
Marshall, C. A., Lysaght, R., & Krupa, T. (2017). The experience of occupational engagement of chronically homeless persons in a mid-sized urban context. Journal of Occupational Science, 24(2), 165-180.
Illman, S. C., Spence, S., O’Campo, P. J., & Kirsh, B. H. (2013). Exploring the occupations of homeless adults living with mental illnesses in toronto/explorer les occupations d’adultes sans-abri atteints de maladies mentales vivant à toronto. Canadian Journal of Occupational Therapy, 80(4), 215-223.
Lockwood C, Munn Z, Porritt K. (2015). Qualitative research synthesis: methodological guidance for systematic reviewers utilizing meta-aggregation. Int J Evid Based Healthcare,13(3), 179–187.
Cunningham, M. J., & Slade, A. (2017). Exploring the lived experience of homelessness from an occupational perspective. Scandinavian journal of occupational therapy, 1-14.
