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

BACKGROUND

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.

METHODS

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).

PLANNED OUTCOME: 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.