Effectiveness of Interventions for Meaningful Activity Participation in Homelessness: A Systematic Review.

None of the 12 included studies were designed to test meaningful activity participation as a primary outcome; it was one of several measures of psychosocial well-being, so the interventions were not tailored to this goal. The studies used at least nine different measures of meaningful activity, making it impossible to compare results across studies or pool them statistically. Ten of the 12 studies were quasi-experimental, and several did not report p-values or effect sizes, limiting the ability to judge the size of any effect. Participants were predominantly men, White or Black, and heterosexual, with very little representation of 2SLGBTQIA+ individuals, women, or Indigenous peoples. Eleven of the 12 studies were conducted in the US or Canada, and one in Scotland, so the findings may not transfer to other cultural or service contexts. The review excluded grey literature, conference abstracts, and studies in low- and middle-income countries, which may have omitted relevant work.

Funded by a Canadian Institutes of Health Research Project Grant (2022, Grant 469885). Funder named: Institute of Health Services and Policy Research. No other conflicts of interest or industry funding were declared.

Do not assume Housing First improves meaningful activity participation. Two of the included studies found no benefit on this outcome, and one found the Housing First group actually scored lower than the control group on community functioning at 12 months. Housing First is well supported for housing stability, but this review shows that stability alone does not translate into more meaningful activity.