Factors That Influence Quality of Life in People Experiencing Homelessness: A Systematic Mixed Studies Review

Abstract

Background: An emerging category of morbidity in research among people experiencing homelessness (PEH) is quality of life (QoL). Conceptual Framework: The Commission on Social Determinants of Health (CSDH) framework was used to explain the relationship between the resulting factors and their impact on QoL among PEH. Purpose: The purpose of this systematic mixed studies review was to explore the factors that are associated with QoL among homeless individuals. Method: A systematic mixed studies review was conducted using CINAHL, Medline, PubMed, and SocIndex databases. Quantitative, qualitative, and mixed methods studies were included and synthesized employing results-based convergent synthesis design. Results: The initial search resulted in 757 studies with 55 studies meeting the inclusion criteria. Thematic analysis revealed themes influencing QoL among PEH categorized by the CSDH determinants of structural, social cohesion and social capital, and intermediary determinants. Among these themes, higher social status, strong relationships, better reported physical and mental health, and a positive life outlook were associated with increased QoL. Social isolation, substance use, poorer life outlook, increased years spent homeless, and perceived quality of housing were associated with decreased QoL. Age, sex, and housing programs revealed inconsistent results on QoL. Implications: While the factors presented in this review indicate some consistent relationships with QoL in PEH, this review has shown QoL among this population is complex and multifactorial. Future research should focus on relationships between the CSDH determinants, particularly the psychosocial factors and the QoL priorities defined by PEH, and how they may influence QoL among PEH.