{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:11:37Z","timestamp":1772169097179,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/hrbopenres.13154.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,1,21]],"date-time":"2021-01-21T00:00:00Z","timestamp":1611187200000}}],"reference-count":48,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2021,1,21]],"date-time":"2021-01-21T00:00:00Z","timestamp":1611187200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010414","name":"Health Research Board","doi-asserted-by":"publisher","award":["SPHeRE\/2013\/1"],"award-info":[{"award-number":["SPHeRE\/2013\/1"]}],"id":[{"id":"10.13039\/100010414","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["hrbopenresearch.org"],"crossmark-restriction":false},"short-container-title":["HRB Open Res"],"abstract":"<ns4:p>\n                    <ns4:bold>Background:<\/ns4:bold>\n                    Over the last several years, homelessness has increased in Ireland and across Europe. Rates have recently declined since the coronavirus disease 2019 (COVID-19) pandemic, but it is unclear whether emergency housing measures will remain in place permanently. Populations experiencing long-term homelessness face a higher burden of multi-morbidity at an earlier age than housed populations and have poorer health outcomes. However, this population also has more difficulty accessing appropriate health services. A realist review by the authors found that important health system contexts which impact access are resourcing, training, funding cycles, health system fragmentation, health system goals, how care is organised, culture, leadership and flexibility of care delivery. Using a realist evaluation approach, this research will explore and refine key system-level factors, highlighted in our realist review, in a local health care system.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Aim:<\/ns4:bold>\n                    The aim of this study is to understand how funding procedures and health system performance management impact service settings, staff, providers and their ability to make services accessible to populations experiencing homelessness.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Methods<\/ns4:bold>\n                    : A realist evaluation will be undertaken to explain how funding and health system performance management impact healthcare accessibility for populations experiencing homelessness. Data will be collected using qualitative and realist interview techniques and focus group methodology. Secondary data such as policy documents and budgets will utilised. The analysis will follow Pawson and Tilley\u2019s iterative phases starting with building an Initial programme theory, then data collection, data analysis, synthesis and finally building a refined programme theory.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Conclusion<\/ns4:bold>\n                    : Building on a realist review conducted by the same research team, this study will further test and refine findings that explain how health system factors impact healthcare accessibility for populations experiencing homelessness. The study has the potential to inform policy makers, health planners and managers of contextual factors that can be modified to increase healthcare accessibility.\n                  <\/ns4:p>","DOI":"10.12688\/hrbopenres.13154.2","type":"journal-article","created":{"date-parts":[[2021,1,21]],"date-time":"2021-01-21T12:15:28Z","timestamp":1611231328000},"page":"73","update-policy":"https:\/\/doi.org\/10.12688\/hrbopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Making healthcare accessible for single adults with complex needs experiencing long-term homelessness: A realist evaluation protocol"],"prefix":"10.12688","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3223-1420","authenticated-orcid":false,"given":"Rikke","family":"Siersbaek","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Ford","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0842-425X","authenticated-orcid":false,"given":"Cl\u00edona","family":"N\u00ed Cheallaigh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9419-1642","authenticated-orcid":false,"given":"Sara","family":"Burke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9306-0114","authenticated-orcid":false,"given":"Steve","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2021,1,21]]},"reference":[{"key":"ref-1","first-page":"2020","article-title":"Latest Figures on Homelessness in Ireland"},{"key":"ref-2","article-title":"Homeless numbers drop for a fifth consecutive month to 8,699 as Focus Ireland calls on government to keep vulnerable renters safe in their homes.","year":"2020 cited 2020 Aug 25"},{"key":"ref-3","first-page":"13-13","article-title":"What is ETHOS\u202f? European Typology of Homelessness","year":"2017"},{"key":"ref-4","first-page":"72","article-title":"Family Homelessness in Dublin: Causes, Housing Histories, and Finding a Home Full Report.","volume":"2","author":"A Long"},{"key":"ref-5","doi-asserted-by":"publisher","first-page":"1529-40","DOI":"10.1016\/S0140-6736(14)61132-6","article-title":"The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations.","volume":"384","author":"S Fazel","year":"2014","journal-title":"Lancet."},{"key":"ref-6","first-page":"80-100","article-title":"Shelter from the Storm: Trauma-Informed Care in Homelessness Services Settings.","volume":"3","author":"E Hopper","year":"2010","journal-title":"Open Health Serv Policy J."},{"key":"ref-7","doi-asserted-by":"publisher","first-page":"266-80","DOI":"10.1016\/S0140-6736(17)31959-1","article-title":"What works in inclusion health: overview of effective interventions for marginalised and excluded populations.","volume":"391","author":"S Luchenski","year":"2018","journal-title":"Lancet."},{"key":"ref-8","doi-asserted-by":"publisher","first-page":"e345-59","DOI":"10.1111\/hsc.12474","article-title":"Improving hospital discharge arrangements for people who are homeless: A realist synthesis of the intermediate care literature.","volume":"26","author":"M Cornes","year":"2018","journal-title":"Health Soc Care Community."},{"key":"ref-9","first-page":"2018","article-title":"Premature Ageing in the Homeless Population.","author":"E de Sousa"},{"key":"ref-10","article-title":"Homelessness: An unhealthy State Health Status, Risk Behaviours and Service Utilisation among Homeless People in Two Irish Cities.","volume":"97","author":"F O\u2019Reilly","year":"2015","journal-title":"Partnership for Health Equity."},{"key":"ref-11","doi-asserted-by":"publisher","first-page":"bjgpopen17X100941","DOI":"10.3399\/bjgpopen17X100941","article-title":"Multimorbidity, disadvantage, and patient engagement within a specialist homeless health service in the UK: an in-depth study of general practice data.","volume":"1","author":"A Queen","year":"2017","journal-title":"BJGP Open."},{"key":"ref-12","first-page":"2018","article-title":"Mortality amongst the homeless populatin in Dublin.","author":"J Ivers"},{"key":"ref-13","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1186\/s12875-015-0361-3","article-title":"Primary healthcare needs and barriers to care among Calgary\u2019s homeless populations.","volume":"16","author":"D Campbell","year":"2015","journal-title":"BMC Fam Pract."},{"key":"ref-14","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1186\/s12939-019-1002-6","article-title":"Making sense of street chaos: an ethnographic exploration of homeless people\u2019s health service utilization.","volume":"18","author":"A O\u2019Carroll","year":"2019","journal-title":"Int J Equity Health."},{"key":"ref-15","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1186\/s12939-016-0487-5","article-title":"Exploring levers and barriers to accessing primary care for marginalised groups and identifying their priorities for primary care provision: a participatory learning and action research study.","volume":"15","author":"P O\u2019Donnell","year":"2016","journal-title":"Int J Equity Health."},{"key":"ref-16","doi-asserted-by":"publisher","first-page":"405-12","DOI":"10.1016\/s0140-6736(71)92410-x","article-title":"THE INVERSE CARE LAW.","volume":"1","author":"J Hart","year":"1971","journal-title":"Lancet."},{"key":"ref-17","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1186\/1471-2458-13-577","article-title":"A cross-sectional observational study of unmet health needs among homeless and vulnerably housed adults in three Canadian cities.","volume":"13","author":"N Argintaru","year":"2013","journal-title":"BMC Public Health."},{"key":"ref-18","doi-asserted-by":"publisher","first-page":"1326-33","DOI":"10.2105\/AJPH.2009.180109","article-title":"The Unmet Health Care Needs of Homeless Adults: A National Study.","volume":"100","author":"T Baggett","year":"2010","journal-title":"Am J Public Health."},{"key":"ref-19","doi-asserted-by":"publisher","first-page":"97-103","DOI":"10.1016\/j.jadohealth.2003.06.011","article-title":"Access to health care among Australian adolescents young people\u2019s perspectives and their sociodemographic distribution.","volume":"34","author":"M Booth","year":"2004","journal-title":"J Adolesc Health."},{"key":"ref-20","doi-asserted-by":"publisher","first-page":"33-45","DOI":"10.1007\/s11524-013-9801-3","article-title":"Unmet Need for Medical Care and Safety Net Accessibility among Birmingham\u2019s Homeless.","volume":"91","author":"S Kertesz","year":"2014","journal-title":"J Urban Health."},{"key":"ref-21","doi-asserted-by":"publisher","first-page":"14-22","DOI":"10.1097\/jfn.0b013e31827a1e9d","article-title":"At a Crossroads: Reentry Challenges and Healthcare Needs Among Homeless Female Ex-Offenders.","volume":"9","author":"B Salem","year":"2013","journal-title":"J Forensic Nurs."},{"key":"ref-22","article-title":"Health Systems Strengthening Glossary."},{"key":"ref-23","first-page":"208-220","article-title":"A Framework for the Study of Access to Medical Care.","volume":"9","author":"L Aday","year":"1974","journal-title":"Health Serv Res."},{"key":"ref-24","doi-asserted-by":"publisher","first-page":"21-38","DOI":"10.5034\/inquiryjrnl_41.1.21","article-title":"A Framework for Evaluating Safety-Net and other Community-Level Factors on Access for Low-Income Populations.","volume":"41","author":"P Davidson","year":"2004","journal-title":"Inquiry."},{"key":"ref-25","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1186\/1471-2288-6-35","article-title":"Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups.","volume":"6","author":"M Dixon-Woods","year":"2006","journal-title":"BMC Med Res Methodol."},{"key":"ref-26","doi-asserted-by":"publisher","first-page":"546-546A","DOI":"10.2471\/BLT.13.125450","article-title":"Universal health coverage and universal access.","volume":"91","author":"D Evans","year":"2013","journal-title":"Bull World Health Organ."},{"key":"ref-27","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/1475-9276-12-18","article-title":"Patient-centred access to health care: conceptualising access at the interface of health systems and populations.","volume":"12","author":"M Levesque J-F, Harris","year":"2013","journal-title":"Int J Equity Health."},{"key":"ref-28","doi-asserted-by":"publisher","first-page":"121-30","DOI":"10.1080\/14767430.2020.1723301","article-title":"Retroductive theorizing in Pawson and Tilley\u2019s applied scientific realism.","volume":"19","author":"J Jagosh","year":"2020","journal-title":"J Crit Realism."},{"key":"ref-29","first-page":"196","article-title":"Evidence-based policy: a realist perspective.","author":"R Pawson","year":"2006"},{"key":"ref-30","first-page":"1997","article-title":"Realistic Evaluation","author":"R Pawson"},{"key":"ref-31","doi-asserted-by":"publisher","DOI":"10.21203\/rs.3.rs-79236\/v1","article-title":"Contexts and mechanisms that promote access to healthcare for populations experiencing homelessness: a realist review.","author":"R Siersbaek","journal-title":"BMJ Open."},{"key":"ref-32","first-page":"105-105","article-title":"Mapping of specialist primary health care services in England for people who are homeless.","author":"M Crane","year":"2018"},{"key":"ref-33","first-page":"2013","article-title":"The Costs of Homelessness in Europe: An Assessment of the Current Evidence Base","author":"N Pleace"},{"key":"ref-34","first-page":"2020","article-title":"Delivering health and care for people who sleep rough: Going above and beyond."},{"key":"ref-35","article-title":"Homelessness Report May 2020.","year":"2020"},{"key":"ref-36","article-title":"Independent Review of Homeless Services.","year":"2015"},{"key":"ref-37","first-page":"64","article-title":"Homeless and Inclusion Health standards for commissioners and service providers.","year":"2018"},{"key":"ref-38","article-title":"Improving access to health care for Gypsies and Travellers, homeless people and sex workers.","volume":"42","author":"P Gill","year":"2013"},{"key":"ref-39","doi-asserted-by":"crossref","DOI":"10.1108\/17570971111197184","article-title":"Turning the tide: a vision paper for multiple needs and exclusions","author":"A Page","year":"2011"},{"key":"ref-40","article-title":"Workforce Issues in Specialist Homelessness Services.","author":"N Cortis","year":"2017"},{"key":"ref-41","article-title":"More Than a Caring Personality: Factors Affecting Staff Retention in Non Profit Organisations in Ireland?","volume":"8","author":"E Mahon","year":"2016","journal-title":"Ir Soc Work."},{"key":"ref-42","first-page":"20","article-title":"Nursing care for people experiencing homelessness: A Survey of the QNI Homeless Health Network.","year":"2018"},{"key":"ref-43","article-title":"Recommendations to Government: Budget 2020","year":"2019"},{"key":"ref-44","article-title":"Inclusion health: Improving the way we meet the primary health care needs of the socially excluded.","year":"2010"},{"key":"ref-45","first-page":"2015","article-title":"Solutions from the Frontline."},{"key":"ref-46","article-title":"Improving hospital admission and discharge for people who are homeless.","year":"2012"},{"key":"ref-47","doi-asserted-by":"crossref","DOI":"10.12688\/hrbopenres.13154.1","article-title":"How accessible is healthcare for single adults experiencing long-term homelessness and complex needs? A realist evaluation protocol","author":"R Siersbaek","year":"2020"},{"key":"ref-48","doi-asserted-by":"publisher","first-page":"377-94","DOI":"10.1177\/1049732305285708","article-title":"Developing and Implementing a Triangulation Protocol for Qualitative Health Research.","volume":"16","author":"T Farmer","year":"2006","journal-title":"Qual Health Res."}],"container-title":["HRB Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/hrbopenresearch.org\/articles\/3-73\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/hrbopenresearch.org\/articles\/3-73\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/hrbopenresearch.org\/articles\/3-73\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,19]],"date-time":"2023-05-19T08:15:16Z","timestamp":1684484116000},"score":1,"resource":{"primary":{"URL":"https:\/\/hrbopenresearch.org\/articles\/3-73\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,21]]},"references-count":48,"URL":"https:\/\/doi.org\/10.12688\/hrbopenres.13154.2","relation":{"has-review":[{"id-type":"doi","id":"10.21956\/hrbopenres.14355.r28713","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/hrbopenres.14355.r28712","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/hrbopenres.14355.r28713","asserted-by":"object"},{"id-type":"doi","id":"10.21956\/hrbopenres.14355.r28712","asserted-by":"object"}]},"ISSN":["2515-4826"],"issn-type":[{"value":"2515-4826","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,21]]},"assertion":[{"value":"Indexed","URL":"https:\/\/hrbopenresearch.org\/articles\/3-73\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/hrbopenres.14355.r28712, Nigel Hewett, Pathway Charity, London, 08 Feb 2021, version 2, indexed","URL":"https:\/\/hrbopenresearch.org\/articles\/3-73\/v2#referee-response-28712","order":0,"name":"referee-response-28712","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/hrbopenres.14355.r28713, Barbara Clyne, Royal College of Surgeons in Ireland, Dublin, 25 Jan 2021, version 2, indexed","URL":"https:\/\/hrbopenresearch.org\/articles\/3-73\/v2#referee-response-28713","order":1,"name":"referee-response-28713","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Rikke Siersbaek<\/b>; \n<i>Posted: 25 Jan 2021<\/i>; Thanks very much for your helpful feedback!","URL":"https:\/\/hrbopenresearch.org\/articles\/3-73\/v2#referee-comment-3258","order":2,"name":"referee-comment-3258","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Health Research Board Ireland [SPHeRE\/2013\/1]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}