Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Health Soc Care Community. 2022 Nov;30(6):e3406-e3434. doi: 10.1111/hsc.13944. Epub 2022 Aug 1.
People experiencing homelessness (PEH) have high rates of acute and chronic health conditions, complex support needs and often face multiple barriers to accessing health services. Financial incentive (FI) interventions have been found effective in improving service engagement and health outcomes for a range of health conditions, populations and settings, but little is known about their impact on PEH. We conducted a scoping review to explore the impact of FI interventions on treatment retention, adherence and other health outcomes of PEH. We searched seven electronic databases from inception to September 2021 to identify peer-reviewed published English language studies that used FI interventions with adult PEH. A scoping review methodology was used to chart relevant data uniformly. Descriptive statistics and narrative syntheses were used to describe outcomes. Thirty-three quantitative articles related to 29 primary studies were published between 1990 and 2021 and met inclusion criteria. Studies targeted three areas of health behaviour change: decreasing substance use or increasing abstinence rates, preventing or treating infectious diseases or promoting lifestyle/general health goal attainment. A variety of FIs were used (cash/non-cash, escalating/fixed schedule, larger/smaller amounts, some/all behaviours rewarded, certain/uncertain reward) across studies. Twenty-six of the primary studies reported significantly better outcomes for the participants receiving FI compared to controls. There were mixed findings about the efficacy of cash versus non-cash FIs, non-cash FIs versus other interventions and higher versus lower value of incentives. Furthermore, there was limited research about long-term outcomes and impacts. FIs have promise in increasing abstinence from substances, engagement in infectious disease treatment, retention in health services and general lifestyle modifications for PEH. Future research should examine long-term impacts and the contribution of co-interventions and intermediary lifestyle behaviour changes.
无家可归者（PEH）患有急性和慢性健康状况的比率较高，有复杂的支持需求，并且通常在获得医疗服务方面面临多种障碍。已经发现经济激励（FI）干预措施可有效改善一系列健康状况、人群和环境下的服务参与度和健康结果，但对于其对 PEH 的影响知之甚少。我们进行了范围界定审查，以探讨 FI 干预措施对 PEH 的治疗保留率、依从性和其他健康结果的影响。我们从成立到 2021 年 9 月，在七个电子数据库中搜索了同行评审的英文发表研究，这些研究使用了 FI 干预措施治疗成年 PEH。使用范围界定审查方法统一绘制相关数据。使用描述性统计和叙述性综合来描述结果。1990 年至 2021 年期间发表了 33 篇与 29 项主要研究相关的定量文章，符合纳入标准。研究针对健康行为改变的三个领域：降低物质使用或提高禁欲率、预防或治疗传染病或促进生活方式/总体健康目标的实现。在研究中使用了各种 FI（现金/非现金、递增/固定时间表、较大/较小金额、奖励某些/所有行为、确定/不确定奖励）。26 项主要研究报告称，接受 FI 的参与者的结果明显好于对照组。关于现金与非现金 FI 的疗效、非现金 FI 与其他干预措施以及激励价值高低的研究结果喜忧参半。此外，关于长期结果和影响的研究有限。FI 有望增加无家可归者对物质的戒除、参与传染病治疗、保持对卫生服务的参与度以及总体生活方式的改变。未来的研究应该检查长期影响以及共同干预措施和中介生活方式行为变化的贡献。
