Background: People experiencing homelessness (PEH) are among the most underresourced populations in the United States. Homelessness is associated with increased risk for myriad physical and behavioral health conditions and early mortality, so improving the health of PEH is of paramount importance to the US healthcare system. The COVID-19 pandemic and the related economic impact are leading to dramatic increases in homelessness, making research on improving the health and well-being of PEH particularly urgent. Due to stigma, discrimination, and socioeconomic marginalization, PEH have historically been denied voice and choice in healthcare and other services. Moreover, when PEH do receive health care, it is often not patient-centered or tailored to meet their needs and preferences.
Proposed Solution to the Problem: Resources to Empower Persons Experiencing homelessness in Comparative Trials (Project RESPECT) will generate resources that will advance patient-centered outcomes research (PCOR) and comparative clinical effectiveness research (CER) for PEH populations in the future.
Objectives: The primary objective of Project RESPECT is to improve the patient-centeredness of future research on health care that affects PEH.
Activities: Project RESPECT will accomplish its objective through four activities. First, it will develop adaptations to engagement and education resources that have been developed through previous PCORI-funded projects related to conditions that disproportionately impact PEH (including mental health disorders and substance use disorders) to be more patient-centered and culturally appropriate for PEH. Second, it will identify three priority research questions for future PCOR/CER for PEH. Third, it will develop a guide on how to engage PEH in PCOR/CER studies. Fourth, it will disseminate findings from these activities to researchers, homelessness advocates, and other stakeholders across the United States.
Projected Outcomes and Outputs: The short-term outcomes and deliverables of the project will be the generation of a PCOR/CER agenda that is relevant to PEH and the adaptation of PCORI-funded engagement tools and resources to be more culturally competent, relevant, and useful for PEH. The medium-term outcomes of the project will be the chance for funders and community agencies to develop focused programmatic and funding announcements that are designed to address the PCOR/CER questions identified during the project period, and for research teams to use the adapted tools to make their stakeholder engagement with PEH more effective. The long-term outcomes will be the generation of PCOR/CER knowledge that is relevant to PEH, and more meaningful and sustainable engagement of PEH in research projects through the use of the adapted engagement tools and resources.
Patient and Stakeholder Engagement Plan: Project RESPECT will have a stakeholder group consisting of 10 PEH and 8 researchers who will participate in up to 16 meetings over the course of the project period. Almost all of these stakeholders already have established working relationships with Project RESPECT investigators.
Project Collaborators: Akido Labs—a care delivery platform with the mission to ensure that the most vulnerable communities thrive—will serve as a subcontractor for this project. The University of Southern California’s Homeless Policy Research Institute will also partner with study investigators.