What is known about women's experiences of homelessness in high income contexts? Evidence from a systematic review

Introduction: Homelessness is a significant public policy and health service challenge globally. Globally, prevalence of homelessness is underreported and is poorly defined. This review seeks to expand on the traditional narrative of homelessness as a primarily an experience of single men extending the narrative to women and their families. Homelessness as a concept is context bound is and hard to define, and many measurement approaches exclude women by design. This meta-ethnography presents a review of published evidence from studies located in high income countries that focus on women’s experiences. A deeper understanding of gender as a driver in social exclusion is critical to both planning and delivering improved health and care responses to marginalised and excluded groups. Methods: Following Noblit and Hare (1988) and the seven phases of the eMERGe guidelines (2019), we conducted a meta-ethnography. Systematic searches of MEDLINE, Embase, Global Health, PsycINFO, CINAHL and ASSIA were completed for the years 2012 to 2022. We included peer-reviewed publications published in English that reported primary qualitative data on women’s experiences of homelessness in high income countries. A study protocol was followed for rigour. This is registered with PROSPERO, CRD42022359937. Title and abstract screening were completed independently by three reviewers. The CASP checklist was utilised for methodological quality assessment. Data was 50% double blind extracted into a bespoke spreadsheet to ensure consistency of extraction and coding. We are in the final stages phases of the meta-ethnographic synthesis therefore present preliminary findings. Results: 33 articles reporting 32 studies from the 3078 records screened were included in the analysis. 37.5% of studies are from the USA (12/32) with 18.8 % (6/32) of studies reporting from Canada and from the UK, and 15.6% (5/32) studies were located in Australia. Evidence is also reported from Ireland, Israel and Poland. Using various qualitative designs, studies reported on 763 unique women’s experiences of homelessness. All studies included describe homelessness as a highly gendered experience with gender-based violence a key feature of the experience of homelessness for women, 9 of the 33 studies provide detailed evidence of this. A minority (6/32) studies present evidence of the recurrent nature of experiences of intimate partner violence, sexual assault, and exploitation both as key antecedents to women becoming homelessness and in remaining so. Discussion: Preliminary emergent themes from the meta ethnography indicate that women themselves experience significant harms whilst homeless, particularly gender-based violence and that homeless women are often trapped in a revolving cycle of housing and social exclusion by this. Many of the service responses described by women are gender blind in design and delivery which inadvertently compounds the challenges they face. Conclusion: Women experiencing homelessness are at the sharp edges of societal gender disparities. This results in reduced access to housing and health supports. Studies included primarily provided evidence from women in a range of temporary sheltered settings in North America. More evidence is needed of unsheltered women’s experiences in a European context.

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