Article Figures & Tables
Figures
- Figure 1:
Flow chart based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines.
Note: PICO = population, intervention, comparison, outcomes. *We originally searched bibliographical databases from the date of their inception; however, we soon recognized that evidence published since 2007 represents scholarly evolution in the field of migration and global health research. (18) As a result, we deviated from protocol and restricted date of publication from 2007 onward at the full-text screening phase of the review.
Tables
Component Definition Methodological limitations The extent to which problems were identified in the conduct of the primary studies that contributed to the evidence for a review finding Relevance The extent to which the primary studies supporting a review finding are applicable to the context specified in the review question Coherence The extent to which a review finding is based on a pattern of data that is similar across multiple individual studies and/or incorporates (compelling) explanations for any variations across individual studies Adequacy of data An overall determination of the degree of richness and/or scope of the evidence and of the quantity of data supporting a review finding Study Country Design Population Intervention Focus CASP risk to rigour Couch 2017 (40) Australia Semistructured interviews n = 24 (10 women and 14 men) aged 15 to 24 years Natural history study, no intervention To open up new areas of social enquiry and address the limited research focusing on refugee young people and homelessness. Low Couch 2011 (39) Australia Face-to-face dialogic interviews n = 9 (5 women and 4 men) aged 19 to 25 years Natural history study, no intervention To focus on the voices of refugee young people experiencing homelessness. Medium Couch 2012 (35) Australia Interviews n = 9 (5 women and 4 men) aged 19 to 25 years Natural history study, no intervention To evaluate the perception of refugee young people experiencing homelessness regarding service delivery and provision. Low D’Addario et al. 2007 (44) Canada Semistructured interviews and surveys 12 semistructured interviews, 36 individual interviews and 554 surveys Natural history study, no intervention To evaluate the role of social capital in housing trajectories of immigrants, with particular attention to the experiences of refugee claimants. Low Dwyer and Brown 2008 (38) UK Interviews and mini focus group n = 23 (13 men and 10 women) aged 27 to 54 years Natural history study, no intervention To outline the tiering of housing entitlement that exists within the generic population of dispersed forced migrants, and its role in rendering migrants susceptible to homelessness. Low Flatau et al. 2015 (6) Australia A cross-sectional survey, focus group discussions and transcent walks n = 20 (15 men, 4 women and 1 unknown), 19 of whom were aged between 22 and 51 years Natural history study, no intervention To report on the findings of the Refugees and Homelessness Survey that was completed with refugees experiencing homelessness or at risk of homelessness. Low Im 2011 (37) US In-depth individual interviews n = 26 (4 men and 22 women), mean age 36.6 years Natural history study, no intervention To explore the mental health of refugee families in the socioecological contexts of displacement and homelessness, and to investigate stressors and coping in relation to transition of resources, including social capital of refugee families. Low Kissoon 2010 (36) Canada Interviews n = 34 migrants (18 women, 16 men), 27 key informants from nongovernmental organization, legal and health sectors. Natural history study, no intervention To focus on the refugee determination system to draw attention to the intersection of illegality and vulnerability to persecution, and to identify the characteristics and homelessness experiences of nonstatus or undocumented migrant participants in Vancouver and Toronto. Medium Mostowska 2013 (42) Norway Narrative interviews and informal conversations n = 40 aged from 23 to 62 years, most between 35–55 years Natural history study, no intervention To discuss the results of fieldwork conducted among migrants of Polish descent experiencing homelessness in Oslo, Norway, with focus on the social networks that are a part of the migrants’ social capital. Medium Mostowska 2012 (43) Belgium Field notes, informal conversations and individual interviews n = 45 (6 women, 39 men) people of Polish descent who had been sleeping rough or reported an episode of rough sleeping in the recent past. Thirteen of the men were older than 55 years, and 16 people were younger than 35 years Natural history study, no intervention To acknowledge homelessness among migrants of Polish descent in Brussels and analyze their narratives using Julian Wolpert’s concept of “place utility” to confront the way they talk about their adaptation to the environment with the risks and opportunities they attach to staying in Brussels and to their possible return migration to Poland. High Paradis et al. 2008 (45) Canada Interviews n = 91 women-led homeless families Immigrant and refugee families v. Canadian-born families experiencing homelessness. Each woman was interviewed 3 times over the course of a year. To understand homelessness among immigrant and refugee families to improve public policy and programs for these families. Medium Sjollema et al. 2012 (46) Canada Semistructured interviews n = 26 women, most aged between 20 to 40 years Natural history study, no intervention To provide a context for understanding homelessness among newcomer women and to summarize the history of the found poem in a variety of disciplines with an emphasis on “social work and the arts” context. Medium Walsh et al. 2015 (47) Canada Semistructured, open-ended interviews n = 26 women aged from 22–64 years Natural history study, no intervention To explore housing insecurity among newcomer women to Montréal, Canada. Low Polillo and Sylvestre 2019 (48) Canada In-depth interviews n = 36 (23 foreign-born families, 13 Canadian-born families). Mean age for the foreign-born sample was 38.27 years (SD 9.57); 73.9% of the foreign-born sample are women Foreign-born v. Canadian-born families To investigate the experiences of foreign-born families in the 4 years before becoming homeless. Low Polillo et al. 2017 (49) Canada Interviews with adult heads of families n = 75 (Canadian-born interviewees: 6 men, 20 women, mean age 33.8 years; foreign-born: 14 men, 34 women, mean age 36.8 years) Foreign-born v. Canadian-born people To evaluate the health of foreign-born families staying in the emergency shelter system in Ottawa, and to compare their experiences to Canadian-born families who are also living in shelters. Low St-Arnault and Merali 2018 (41) Canada Interviews n = 19 (11 women, 8 men), aged 29 to 73 years, mean age 39 years Natural history study, no intervention To investigate pathways out of homelessness among a mixed sample of adult refugees who had experienced absolute or relative homelessness after their arrival in Canada, but who eventually became adequately settled in one of Canada’s large urban centres in Alberta. Low Ravnbøl 2017 (51) Denmark Semistructured interviews n = 40 Natural history study, no intervention To address health concerns and access to health services among migrants of Roma descent in the European Union, from a perspective of Romanian Roma who live in homelessness in Copenhagen. Medium Hanley et al. 2018 (50) Canada Semistructured, open-ended interviews n = 26 women aged 20 to 65 years Natural history study, no intervention To explore how health intersects with the experience of housing insecurity and homelessness, specifically for migrant women. Low Note: CASP = Critical Appraisal Skills Programme, SD = standard deviation.
Framework level Key findings GRADE-CERQual assessment Confidence in the evidence Explanation Discrimination Systemic racism: Refugees experienced individual and systemic racism, which exacerbated housing instability. Many refugees felt they were turned away from housing and emergency shelters because of their ethnicity, use of welfare cheques, history of trauma, language of origin, temporary resident status and the presence of children. Low Moderate concerns for methodological limitations and adequacy, and no-to-minor concerns for coherence and relevance. Mental health Mental health concerns: Lived experience of trauma and housing insecurity resulted in persistent psychological distress and mental health concerns. Moderate Very minor concerns for methodological limitations, no-to-very minor concerns for coherence, relevance and adequacy. Social networks and support Finding an advocate: Refugees who sought a culturally familiar community advocate were able to increase their social capital. Advocates included settlement counsellors and cultural brokers. These advocates were able to help refugees transition out of homelessness by providing social support, a place to stay and other resources. High Minor concerns for methodological limitations, no-to-very minor concerns for coherence, relevance and adequacy. Services: health and housing Poor access to services: Refugees and other migrants, particularly undocumented migrants, failed asylum seekers and those with humanitarian protection, are often unaware of support services and find them difficult to access and navigate. Moderate Minor concerns for methodological limitations, no-to-very minor concerns for coherence, relevance and adequacy. Unsafe housing: Refugees and other migrants perceived the housing options available to them as unsafe, poorly managed and unaffordable. High Minor concerns for methodological limitations, very minor-to-minor concerns for relevance and no-to-very minor concerns for coherence and adequacy. Family structure Facing a family separation: Several vulnerably housed refugees expressed difficulties learning a new culture, and parents struggled with the ability of their children to balance a new culture and the culture of their country of origin. This family conflict led to a loss of family support, which is a protective factor against homelessness. Low Moderate concerns for methodological limitations and relevance, no-to-very minor concerns for coherence and adequacy. Income Insufficient income assistance: Refugees and other migrants reported strained finances and inadequate financial support that led to difficulty meeting basic needs, housing insecurity and food instability. Low Moderate concerns for methodological limitations and relevance, no-to-very minor concerns for coherence and adequacy. Immigration status Impact of immigration status: Compared with status migrants, nonstatus migrants faced substantial barriers, such as limited rights to welfare, prohibition from taking up paid employment and rejection from shelter access. Low Serious concerns for methodological limitations, moderate concerns for relevance and no-to-very minor concerns for coherence and adequacy. Language Lack of language skills impeding access: Limited language skills among refugees impeded their ability to access most services, including housing services, and limited their social capital and connections beyond their original community. Moderate Moderate concerns for methodological limitations, no-to-minor concerns for coherence, adequacy and relevance. Outlier Adopting survival and coping strategies: Refugees and other migrants who faced insecure housing instability adopted survival and coping strategies that helped them to advocate for resources and develop a sense of belonging in their new community. Moderate Moderate concerns for relevance, no-to-minor concerns for coherence, relevance and adequacy. Note: GRADE-CERQual = Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative.
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