Interventions to promote the health and well-being of children under 5s experiencing homelessness in high-income countries: a scoping review

Objectives Homelessness among families with children under 5 residing in temporary accommodation is a growing global concern, especially in high-income countries (HICs). Despite significant impacts on health and development, these ‘invisible’ children often fall through the gaps in policy and services. The study’s primary objective is to map the content and delivery methods of culturally sensitive interventions for children under 5 experiencing homelessness in HICs. Design A scoping review guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. Data sources Databases include PubMed, Medline, SCOPUS, The Cochrane Library and Google Scholar were searched up to 24 March 2022. Eligibility criteria This scoping review includes studies that describe, measure or evaluate intervention strategies aimed at improving child health programmes, specifically those yielding positive outcomes in key areas like feeding, nutrition, care practices and parenting. Data extraction and synthesis Articles were selected and evaluated by two independent reviewers, with a dispute resolution system involving a third reviewer for contested selections. The methodological quality of the studies was assessed using various tools including the Risk of Bias (RoB) tool, Cochrane RoB V.2.0, the Risk of Bias Assessment Tool for Non-randomized Studies (RoBANS) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), each selected according to the type of article. Results The database search yielded 951 results. After deduplication, abstract screening and full review, 13 articles met the inclusion criteria. Two predominant categories of intervention delivery methods were identified in this research: group-based interventions (educational sessions) and individual-based interventions (home visits). Conclusion This review highlights effective interventions for promoting the health and well-being of children under 5 experiencing homelessness, including educational sessions and home visits. Research has supported the importance of home visiting to be instrumental in breaking down language, cultural and health literacy barriers.

populations in homelessness?How to create appropriate, acceptable, and accessible communication materials?(e.g., through health visitors, family nurse partnerships, etc.) The scoping review is a core work package of the project titled, "Children in Homeless Accommodations Managing Pandemic Invisibility or Non-inclusive Strategies" to map the existing global evidence on the content and method of delivery of practical strategies and interventions to improve coverage, access, and utilization of early child health programmes in marginalized and excluded under5s.

OBJECTIVES
• O-1.To identify the evidence base available around the content of delivery of interventions programmes for families with children under 5.
• O-2.To explore the method of delivery of these interventions: when to intervene, how to intervene, entry points for crucial health concerns.
• O-3.To find out the most feasible settings in which the strategies and interventions are effective Specific parameters that will be mapped from studies that relate to the review objectives will comprise: (i) Challenge area
Types of studies: Studies of any design, where the study objective was to describe, measure, or evaluate the piloting or implementation of a strategy, tactics, process, and/or method targeted at improving child health programmes in High-income countries; 1.1.1.3.
Types of participants: Studies that include interventions for under-5 children; The review will look into two qualifiersmarginalized and excluded what?Populations?. Marginalization is defined as "a process whereby something or someone is pushed to the edge of a group and accorded lesser importance."Social exclusion is defined as " It involves the lack or denial of resources, rights, goods and services, and the inability to participate in the normal relationships and activities, available to the majority of people in a society, whether in economic, social, cultural or political arenas."Operationally these two terminologies have been defined to be inclusive of the following keywords: Types of intervention: Studies that will include interventions to improve or optimize the coverage of services, accessibility of the target population, and service utilization; we will include efficacy trials that include interventions only to improve specific health conditions within themes: feeding, nutrition, care practice, parenting, dental, wellbeing, and mental health, safe sleeping, physical activity, parenting support; inclusion of any bridging study will be decided jointly by the lead reviewers and the PI based on any added value) 1.1.1.5.
Screening Tool and Selection Method: All articles will be extracted and compiled in a single spreadsheet.The spreadsheet will be equipped with duplicate study filters, and inclusion filters (inclusion criteria not managed through Search Term) and selection columns.Inclusion filters will be filled in independently by one reviewer (YT).Selection filters will be applied independently by two reviewers (YT and KS).All studies selected by two reviewers will be included.All studies rejected by two reviewers will be rejected.All studies having one inclusion will be marked as disputed selection.In case of dispute in selection third expert reviewer (ML) will make the final inclusion decision.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Compliance: The reasons for exclusion will be recorded and mapped in a flow chart as per PRISMA guidelines.1.1.4.4.
Data Extraction: A data extraction form (DEF) will be developed as per CEB Critically Appraised Topics (CAT) guidelines by KS and piloted by two authors (YT and KS) on the first 6 article inclusions (3 each).The piloting will essentially inform whether the DEF can extract necessary and sufficient information as per the objectives set.Any queries raised by the pilot will be reviewed by ML, NS, and ZP.The form will be amended based on the pilot.Two reviewers (YT and KS) will use the finalized form to extract data from full-text articles.If clarification is required, a domain expert (NS, YP, ML) will be consulted.1.1.5.Assessment of Risk of Bias (RoB): RoB assessment will only be used for interventional studies for which results will be used for quantitative analysis or pooling.We will use multiple tools for risk of bias assessment based on the study typei.Systematic Reviews: GRADE for bias due to selective publication and selective non-reporting for systematic reviews ii.
Randomized Trials: Cochrane RoB 2.0 to assess multiple sources of bias iii.
Non-randomised studies of interventions: RoBANS for bias due to selective non-reporting and bias in the selection of the reported result.1.1.6.Critical Appraisal for the included studies: All studies will be critically appraised as per the CAT grading.1.2.

Quality Assessment https://www.who.int/hrh/retention/annex1_grade_evidence_profiles.pdf
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