Premature and preventable homeless mortality from an occupational perspective: a systematic review using meta-ethnography

Introduction/Aims Homelessness impacts health and wellbeing and is a risk factor for preventable and premature death. The aim of this study was to examine how occupational therapists can work with people experiencing homelessness to address health inequity and improve health and wellbeing. Methods A systematic review of qualitative research was conducted, and data were synthesised using meta-ethnography to answer the question: What is the evidence for the potential for occupational therapy to reduce the risk of preventable and premature mortality in the UK's homeless population? Results Seven studies were included in the review, with the overarching finding that barriers to healthcare are present for those experiencing homelessness. The three sub-themes were internal barriers, external barriers and conflicting priorities. Conclusions People experiencing homelessness face multiple barriers to healthcare and have competing priorities. This contributes to low health service usage and engagement, health inequities and increased risk of premature death. Implications for practice Occupational therapy has the potential to remove barriers to care by increasing confidence and self-esteem, support with self-care and daily routine, promoting belonging and inclusivity and advocating for appropriate environments (housing), which could have a positive impact on the health of people experiencing homelessness. Further research is required to assess the impact of occupational therapy input and interventions on mortality risk.