Protocol for a mixed methods realist evaluation of the Intervention to optiMise Palliative caRe for peOple with liVed Experience of homelessness (IMPROVE).

Abstract

People experiencing homelessness have poor health outcomes as a result of co-occurring physical and mental health issues, frequently in association with addictions. They experience difficulties accessing all types of health care. As a result, they often die young, and with limited support.Based on previous research, a Community of Practice intervention was developed to facilitate local, inter-professional and inter-agency collaboration to improve health and social care for people experiencing homelessness with advanced ill health. This intervention was initially used in 9 places during 2021-2024 with positive impacts reported. A realist evaluation is being undertaken to understand what works, for whom, and why, and then to implement suggested changes, and evaluate the optimised intervention (IMPROVE). •Phase 1: Practitioners involved in the Community of Practice intervention thus far will be interviewed to explore their views of the intervention and its impact. Service users will be interviewed regarding their experiences, and what they feel health and care professionals need to know. Workshops will be conducted to present back the findings and programme theory to participants.•Phase 2: Adaptions will be made to the Community of Practice Intervention based on findings from Phase 1.•Phase 3: 10 sites across England will use the optimised intervention (referred to as IMPROVE) in 2026. The implementation and impact of IMPROVE will be monitored in these sites, using questionnaires, session observations, an action learning set, and interviews. Key outcomes will include the impact on staff knowledge and resilience, integration between services, and impacts on care. The research programme has lived experience involvement threaded throughout, and this will be evaluated via a Study within a Project (SWAP). An evidence-based Community of Practice intervention to facilitate interprofessional working around support for people experiencing homelessness with advanced ill health will be made widely available. People experiencing homelessness die young, and their end-of-life experiences are often unplanned and undignified. Frontline homelessness workers, such as homeless hostel staff, often struggle to get health and social care support for their clients. This project aims to increase multi-professional and multi-agency working, to reduce burnout for staff and improve care for people experiencing homelessness with advanced ill health.Prior to this project, we created a Community of Practice (CoP) intervention using website-based films and resources, which brings frontline homelessness practitioners and health/social care professionals together in a locality to connect with each other and learn how to improve care. The intervention includes training for professionals who want to run the intervention.The CoP intervention was used in 9 places, over 3 years (2021-2024), in the UK. 179 people have attended sessions; 52 people have been trained as facilitators.This project aims to upgrade the CoP intervention based on feedback and then find out how well the updated intervention works. We will: •talk to people that have already used the CoP intervention•revise the intervention based on their suggestions•work with ten new sites across England to test the revised intervention, to understand whether it has an impact, what the impact is and what factors influence the impact. If workers have better knowledge, understand each other’s roles and work better together, it will help to improve care. It may also help staff to feel less isolated and better supported. We understand the importance of working with people with a lived experience of homelessness in research. We have a lived experience steering group consisting of 6 people with lived experience of homelessness. . We will work to embed the final version of the programme in health care systems across the UK, via the NHS, Marie Curie and clinical networks.