Abstract
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.
| Original language | English |
|---|---|
| Pages (from-to) | 1-128 |
| Number of pages | 128 |
| Journal | Health technology assessment (Winchester, England) |
| Volume | 26 |
| Issue number | 14 |
| DOIs | |
| Publication status | Published - 1 Feb 2022 |
Bibliographical note
AcknowledgementsWe would first like to acknowledge the intervention participants for taking part in this study and sharing their views and experiences on being involved. Second, we would like to thank our wonderful PNs, Josh Dumbrell, Rebecca Jones, Michael Roy and Wez Steele, for their compassion, commitment, vision for the project, honesty, integrity and hard work throughout.
The SHARPS study would not have been possible without the support and contribution of a wide range of individuals who offered their expertise and support at different stages of the study.
We would like to thank our SSG members, led by Professor Stewart Mercer: our supportive and wise chairperson, Professor Carol Emslie; Mr Stan Burridge; Professor Alex McConnachie; Dr Saket Priyadarshi; Professor Sarah Johnsen; Ms Rachel Beaton; Ms Susanne Millar; Mr Lee Ball; Dr Neil Hamlet, Dr Ruth McGovern and Dr Ruth Freeman; and Mr Jason Wallace and Professor Graeme MacLennan
as study team representatives.
We would like to thank our TSA partners: Mitch Menagh, Malcolm Page, Susan Grant, Iain Wilson, Jeanette Lees, Steph Phillips, Andy Parkinson, Andrew McCall, Helen Murdoch, Laura Mitchell, Pam Knuckey, Nick Redmore, Tony Thornton, Gillian Coates, Amber Sylvester, Laura Logan and Sarah Lapido.
We would like to thank our Cyrenians/Change Grow Live partners: Tess Hamilton, John Arthur, Mike Wright and Amy Hutton.
We would like to thank our Streetwork/Simon Community Scotland partners: Rankin Barr, Jan Williamson, Cindy Pritchard and Hugh Hill.
We would like to thank our SDF partners and peer researchers who supported the data collection: Alex Murray, Emma Hamilton, Matthew McCue, Tammie Brown, Sylvia Fox and David Logan.
We would like to thank our EbyE group members: Joanne Denton, Philip Foley, Alex Dunedin, Stan Burridge, Tracy Polson and Leslie Norris.
We would like to thank the current and former members of our university team who supported the data entry and analysis: Ms Tracey Price, Mr Joe Schofield, Dr Mary Cobbett Ondiek, Ms Janette Clark, Dr Joanna Miler, Ms Wendy Masterton and Mr Marcus Cusack.
Finally, we would like to thank Renzo Cardozi and Jan Hay, who supported the study in valuable ways.
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.
Data Availability Statement
Data-sharing statementOwing to the sample size, known geographical locations, and personal and organisational sensitivities, the qualitative and quantitative data sets will not be available for sharing. All requests for data should be sent to the corresponding author.
Keywords
- FEASIBILITY STUDIES
- HARM REDUCTION
- HOMELESS PERSONS
- MENTAL HEALTH
- OUTCOME ASSESSMENTS
- PATIENT HEALTH QUESTIONNAIRE
- PEER GROUP
- QUALITY OF LIFE
- SUBSTANCE-RELATED DISORDERS
Access to Document
- Parkes_et_al__A_Peer_delivered_NIHR_vor
Copyright © 2022 Parkes et al. This work was produced by Parkes et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaption in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/. For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited.