{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T11:00:57Z","timestamp":1765882857635,"version":"3.48.0"},"reference-count":45,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"unspecified","delay-in-days":28,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,7,11]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Housing First (HF) is an evidence-based approach to ending homelessness, particularly for individuals with mental illness. Yet, limited research explores which aspects of HF programmes facilitate change over time, within the context of a programme theory of change (ToC). A particular research gap includes how mechanisms of change within HF programmes differ between men and women. This study examines gender-specific pathways of change in the HF model based on secondary qualitative data from Toronto\u2019s original At Home\/Chez Soi (AH\/CS) trial, focusing on outcomes of housing stability, socio-economic status, health and overall well-being.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This was a secondary qualitative analysis of the AH\/CS trial data. This analysis was guided using a gender-sensitive ToC framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Settings<\/jats:title>\n                    <jats:p>This multisector study was conducted in a large Canadian urban centre in Toronto, Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 32 participants (23 men and nine\u2009women) who identified themselves as male or female, 18\u2009months after their enrolment in the treatment arm of the Toronto site of the AH\/CS randomised controlled trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data collection and analysis<\/jats:title>\n                    <jats:p>Semistructured interviews were conducted as part of the trial\u2019s qualitative study. Thematic analysis was guided by the ToC framework and conducted using NVivo software. We assessed differences between men and women across the following outcome domains: housing stability, financial status, physical and mental health, substance use recovery and inpatient care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The findings largely confirmed the ToC with participants, particularly women, experiencing greater improvements across all mechanisms of change, especially in housing stability, financial status and health outcomes. Men faced ongoing challenges, including difficulty maintaining stable income, limited engagement with education\/training and continued struggles with mental health and substance use. Despite these improvements, both men and women participants reported ongoing challenges in achieving consistent income and accessing education or training opportunities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study provides insight into how mechanisms of change within HF programmes differ between men and women. It underscores the need for ongoing programme adaptation and gender-responsive evaluation to meet the diverse needs of individuals, particularly those with mental health illness and histories of chronic homelessness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-094840","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T05:40:27Z","timestamp":1753767627000},"page":"e094840","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Testing the theory of change for Housing First: a secondary qualitative analysis of gender differences in the experiences of men and women in the AH\/CS trial"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"isrctn42520374","registry":"10.18810\/isrctn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7904-414X","authenticated-orcid":false,"given":"Samira","family":"Alfayumi-Zeadna","sequence":"first","affiliation":[{"name":"MAP Centre for Urban Health Solutions, St Michael\u2019s Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa","family":"Perri","sequence":"additional","affiliation":[{"name":"University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1131-8439","authenticated-orcid":false,"given":"Cilia","family":"Mejia-Lancheros","sequence":"additional","affiliation":[{"name":"Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada"},{"name":"Division of Social Behavioral Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Woodhall","sequence":"additional","affiliation":[{"name":"University of New Brunswick, Fredericton, New Brunswick, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maritt","family":"Kirst","sequence":"additional","affiliation":[{"name":"Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret","family":"Douglin","sequence":"additional","affiliation":[{"name":"Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chloe","family":"Reiser","sequence":"additional","affiliation":[{"name":"Department of Social Science, University of New Brunswick, Fredericton, New Brunswick, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"O\u2019Campo","sequence":"additional","affiliation":[{"name":"MAP Centre for Urban Health Solutions, St Michael\u2019s Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada"},{"name":"University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,7,28]]},"reference":[{"key":"2025121602565989000_15.7.e094840.1","unstructured":"National Alliance to End Homelessness . 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The state of emergency shelters in Europe. 2019."},{"key":"2025121602565989000_15.7.e094840.4","doi-asserted-by":"publisher","DOI":"10.1001\/JAMAINTERNMED.2013.1604"},{"key":"2025121602565989000_15.7.e094840.5","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1080\/15381501.2015.1123210","article-title":"Homelessness and residential instability as covariates of HIV risk behavior among residents of single room occupancy housing","volume":"15","author":"Bowen","year":"2016","journal-title":"J HIV AIDS Soc Serv"},{"key":"2025121602565989000_15.7.e094840.6","unstructured":"National Health Care for the Homeless Council . Homeless Mortality, Available: https:\/\/nhchc.org\/homeless-mortality\/?gclid=Cj0KCQiA7bucBhCeARIsAIOwr--X1fxNE-J51pz4rN7xzyDPe8seLYIryaImAF90wBPUyiiptrOPtugaAliQEALw_wcB"},{"key":"2025121602565989000_15.7.e094840.7","unstructured":"City of Toronto, 2021 Annual Review of Statistics on Deaths of Shelter Residents, 2021. 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