A peer-delivered intervention to reduce harm and improve the well-being of homeless people with problem substance use: the SHARPS feasibility mixed-methods study
Background: For people experiencing homelessness and problem substance use, access to appropriate services can be challenging. There is evidence that development of trusting relationships with non-judgemental staff can facilitate service engagement. Peer-delivered approaches show particular promise,...
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| Format: | Article |
| Language: | English |
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NIHR Journals Library
2022-02-01
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| Series: | Health Technology Assessment |
| Subjects: | |
| Online Access: | https://doi.org/10.3310/WVVL4786 |
| _version_ | 1818982107370749952 |
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| author | Tessa Parkes Catriona Matheson Hannah Carver Rebecca Foster John Budd Dave Liddell Jason Wallace Bernie Pauly Maria Fotopoulou Adam Burley Isobel Anderson Graeme MacLennan |
| author_facet | Tessa Parkes Catriona Matheson Hannah Carver Rebecca Foster John Budd Dave Liddell Jason Wallace Bernie Pauly Maria Fotopoulou Adam Burley Isobel Anderson Graeme MacLennan |
| author_sort | Tessa Parkes |
| collection | DOAJ |
| description | Background: For people experiencing homelessness and problem substance use, access to appropriate services can be challenging. There is evidence that development of trusting relationships with non-judgemental staff can facilitate service engagement. Peer-delivered approaches show particular promise, but the evidence base is still developing. This study tested the feasibility and acceptability of a peer-delivered intervention, through ‘Peer Navigators’, to support people who are homeless with problem substance use to address a range of health and social issues. Objectives: The study objectives were to design and implement a peer-delivered, relational intervention to reduce harms and improve health/well-being, quality of life and social functioning for people experiencing homelessness and problem substance use, and to conduct a concurrent process evaluation to inform a future randomised controlled trial. Design: A mixed-methods feasibility study with concurrent process evaluation was conducted, involving qualitative interviews [staff interviews (one time point), n = 12; Peer Navigator interviews (three or four time points), n = 15; intervention participant interviews: first time point, n = 24, and second time point, n = 10], observations and quantitative outcome measures. Setting: The intervention was delivered in three outreach services for people who are homeless in Scotland, and three Salvation Army hostels in England; there were two standard care settings: an outreach service in Scotland and a hostel in England. Participants: Participants were people experiencing homelessness and problem substance use (n = 68) (intervention). Intervention: This was a peer-delivered, relational intervention drawing on principles of psychologically informed environments, with Peer Navigators providing practical and emotional support. Main outcome measures: Outcomes relating to participants’ substance use, participants’ physical and mental health needs, and the quality of Peer Navigator relationships were measured via a ‘holistic health check’, with six questionnaires completed at two time points: a specially created sociodemographic, health and housing status questionnaire; the Patient Health Questionnaire-9 items plus the Generalised Anxiety Disorder-7; the Maudsley Addiction Profile; the Substance Use Recovery Evaluator; the RAND Corporation Short Form survey-36 items; and the Consultation and Relational Empathy Measure. Results: The Supporting Harm Reduction through Peer Support (SHARPS) study was found to be acceptable to, and feasible for, intervention participants, staff and Peer Navigators. Among participants, there was reduced drug use and an increase in the number of prescriptions for opioid substitution therapy. There were reductions in risky injecting practice and risky sexual behaviour. Participants reported improvements to service engagement and felt more equipped to access services on their own. The lived experience of the Peer Navigators was highlighted as particularly helpful, enabling the development of trusting, authentic and meaningful relationships. The relationship with the Peer Navigator was measured as excellent at baseline and follow-up. Some challenges were experienced in relation to the ‘fit’ of the intervention within some settings and will inform future studies. Limitations: Some participants did not complete the outcome measures, or did not complete both sets, meaning that we do not have baseline and/or follow-up data for all. The standard care data sample sizes make comparison between settings limited. Conclusions: A randomised controlled trial is recommended to assess the effectiveness of the Peer Navigator intervention. Future work: A definitive cluster randomised controlled trial should particularly consider setting selection, outcomes and quantitative data collection instruments. Trial registration: This trial is registered as ISRCTN15900054. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 14. See the NIHR Journals Library website for further project information. |
| first_indexed | 2024-12-20T17:41:57Z |
| format | Article |
| id | doaj.art-54bbdea73b2844a98fb7c7fabdaee295 |
| institution | Directory Open Access Journal |
| issn | 1366-5278 2046-4924 |
| language | English |
| last_indexed | 2024-12-20T17:41:57Z |
| publishDate | 2022-02-01 |
| publisher | NIHR Journals Library |
| record_format | Article |
| series | Health Technology Assessment |
| spelling | doaj.art-54bbdea73b2844a98fb7c7fabdaee2952022-12-21T19:31:05ZengNIHR Journals LibraryHealth Technology Assessment1366-52782046-49242022-02-01261410.3310/WVVL478616/153/14A peer-delivered intervention to reduce harm and improve the well-being of homeless people with problem substance use: the SHARPS feasibility mixed-methods studyTessa Parkes0Catriona Matheson1Hannah Carver2Rebecca Foster3John Budd4Dave Liddell5Jason Wallace6Bernie Pauly7Maria Fotopoulou8Adam Burley9Isobel Anderson10Graeme MacLennan11Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UKSalvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UKSalvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UKSalvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UKFaculty of Medicine, University of Edinburgh, Edinburgh, UKThe Scottish Drugs Forum, Glasgow, UKThe Scottish Drugs Forum, Glasgow, UKThe Canadian Institute for Substance Use Research, University of Victoria, Greater Victoria, BC, CanadaFaculty of Social Sciences, University of Stirling, Stirling, UKFaculty of Medicine, University of Edinburgh, Edinburgh, UKFaculty of Social Sciences, University of Stirling, Stirling, UKThe Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UKBackground: For people experiencing homelessness and problem substance use, access to appropriate services can be challenging. There is evidence that development of trusting relationships with non-judgemental staff can facilitate service engagement. Peer-delivered approaches show particular promise, but the evidence base is still developing. This study tested the feasibility and acceptability of a peer-delivered intervention, through ‘Peer Navigators’, to support people who are homeless with problem substance use to address a range of health and social issues. Objectives: The study objectives were to design and implement a peer-delivered, relational intervention to reduce harms and improve health/well-being, quality of life and social functioning for people experiencing homelessness and problem substance use, and to conduct a concurrent process evaluation to inform a future randomised controlled trial. Design: A mixed-methods feasibility study with concurrent process evaluation was conducted, involving qualitative interviews [staff interviews (one time point), n = 12; Peer Navigator interviews (three or four time points), n = 15; intervention participant interviews: first time point, n = 24, and second time point, n = 10], observations and quantitative outcome measures. Setting: The intervention was delivered in three outreach services for people who are homeless in Scotland, and three Salvation Army hostels in England; there were two standard care settings: an outreach service in Scotland and a hostel in England. Participants: Participants were people experiencing homelessness and problem substance use (n = 68) (intervention). Intervention: This was a peer-delivered, relational intervention drawing on principles of psychologically informed environments, with Peer Navigators providing practical and emotional support. Main outcome measures: Outcomes relating to participants’ substance use, participants’ physical and mental health needs, and the quality of Peer Navigator relationships were measured via a ‘holistic health check’, with six questionnaires completed at two time points: a specially created sociodemographic, health and housing status questionnaire; the Patient Health Questionnaire-9 items plus the Generalised Anxiety Disorder-7; the Maudsley Addiction Profile; the Substance Use Recovery Evaluator; the RAND Corporation Short Form survey-36 items; and the Consultation and Relational Empathy Measure. Results: The Supporting Harm Reduction through Peer Support (SHARPS) study was found to be acceptable to, and feasible for, intervention participants, staff and Peer Navigators. Among participants, there was reduced drug use and an increase in the number of prescriptions for opioid substitution therapy. There were reductions in risky injecting practice and risky sexual behaviour. Participants reported improvements to service engagement and felt more equipped to access services on their own. The lived experience of the Peer Navigators was highlighted as particularly helpful, enabling the development of trusting, authentic and meaningful relationships. The relationship with the Peer Navigator was measured as excellent at baseline and follow-up. Some challenges were experienced in relation to the ‘fit’ of the intervention within some settings and will inform future studies. Limitations: Some participants did not complete the outcome measures, or did not complete both sets, meaning that we do not have baseline and/or follow-up data for all. The standard care data sample sizes make comparison between settings limited. Conclusions: A randomised controlled trial is recommended to assess the effectiveness of the Peer Navigator intervention. Future work: A definitive cluster randomised controlled trial should particularly consider setting selection, outcomes and quantitative data collection instruments. Trial registration: This trial is registered as ISRCTN15900054. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 14. See the NIHR Journals Library website for further project information.https://doi.org/10.3310/WVVL4786harm reductionsubstance-related disordersmental healthpeer grouphomeless personsquality of lifefeasibility studiespatient health questionnaireoutcome assessments |
| spellingShingle | Tessa Parkes Catriona Matheson Hannah Carver Rebecca Foster John Budd Dave Liddell Jason Wallace Bernie Pauly Maria Fotopoulou Adam Burley Isobel Anderson Graeme MacLennan A peer-delivered intervention to reduce harm and improve the well-being of homeless people with problem substance use: the SHARPS feasibility mixed-methods study Health Technology Assessment harm reduction substance-related disorders mental health peer group homeless persons quality of life feasibility studies patient health questionnaire outcome assessments |
| title | A peer-delivered intervention to reduce harm and improve the well-being of homeless people with problem substance use: the SHARPS feasibility mixed-methods study |
| title_full | A peer-delivered intervention to reduce harm and improve the well-being of homeless people with problem substance use: the SHARPS feasibility mixed-methods study |
| title_fullStr | A peer-delivered intervention to reduce harm and improve the well-being of homeless people with problem substance use: the SHARPS feasibility mixed-methods study |
| title_full_unstemmed | A peer-delivered intervention to reduce harm and improve the well-being of homeless people with problem substance use: the SHARPS feasibility mixed-methods study |
| title_short | A peer-delivered intervention to reduce harm and improve the well-being of homeless people with problem substance use: the SHARPS feasibility mixed-methods study |
| title_sort | peer delivered intervention to reduce harm and improve the well being of homeless people with problem substance use the sharps feasibility mixed methods study |
| topic | harm reduction substance-related disorders mental health peer group homeless persons quality of life feasibility studies patient health questionnaire outcome assessments |
| url | https://doi.org/10.3310/WVVL4786 |
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