Evaluation of the implementation of a medical respite program for persons with lived experience of homelessness

ABSTRACT

Medical respite programs (MRPs) constitute a potential strategy to improve the continuum of care for persons who have lived experiences of homeless (PWLEH). A MRP was developed in Alberta, Canada, through a partnership between the provincial health authority (Alberta Health Services) and the province’s largest homeless shelter (Calgary Drop-In Centre). We conducted a qualitative study of 25 stakeholders who held an operational, administrative and/or healthcare provider role in the MRP’s design and implementation to evaluate the barriers and facilitators to its implementation using Proctor’s implementation framework.

While stakeholders had a common motivation of addressing health inequity, the program’s acceptability and fidelity were hampered by a lack of clear common objectives and expectations. Program adoption was difficult due to differences in organizational policies and priorities. Program staff and leadership were dedicated to the patient population, enhancing feasibility, but the limited training and experience of frontline providers specifically in addictions and mental health resulted in important needs not being met (affecting intervention appropriateness). The lack of integration with community resources, despite being intended as a program to transition patients from hospital to community, affected program penetration. Our findings are relevant for other jurisdictions and organizations aiming to develop and implement similar interventions.

KEYWORDS:

• Homelessness
• medical respite
• program implementation
• barriers and facilitators
• qualitative research

Acknowledgements

The study was conceived by KT and WG. KT and IN completed data collection, while analysis was completed by KT, IN, EG, and PH. The manuscript was initially drafted by PH and the figures were created by PH and EG. All of the authors, KT, IN, PH, and EG, and WG have contributed substantially to the manuscript and have approved the version that is being submitted. Data collection was done by KT and IN and analysis was conducted by KT, IN, and EG.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study received funding from M.S.I. Foundation, and is supported within the Social and Structural Vulnerabilities Program at the O’Brien Institute for Public Health (which has received philanthropic funds).

Notes on contributors

Peter Hoang

Dr. Peter Hoang is a geriatric medicine resident at the University of Toronto. His primary research interests are in improving the healthcare of older adults.

Iffat Naeem

Iffat Naeem is a medical student at the University of Calgary. She was a research associate at the University of Calgary and the Ward of the 21st Century (W21C).

Eshleen Kaur Grewal

Eshleen Kaur Grewal is a research associate at the University of Calgary. Her research interests are in knowledge translation for persons experiencing homelessness.

William Ghali

Dr. William Ghali is a general internal medicine physician, health services researcher, and Professor in the Departments of Medicine and Community Health Sciences at the University of Calgary. He is the vice-president of research at the University of Calgary.

Karen Tang

Dr. Karen Tang is a general internal medicine physician and an assistant professor in the Departments of Medicine and Community Health Sciences at the University of Calgary. She uses qualitative and quantitative methods to examine the effects of social status and social vulnerabilities on health and to evaluate complex interventions that address these social vulnerabilities and barriers to care.