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Table 1 Characteristics of included studies

From: Interventions for preventing or treating malnutrition in homeless problem-drinkers: a systematic review

Study

Location

Study design

Participants

Intervention

Comparison

Primary outcomes reporteda

N

Inclusion criteria

Recruitment

Homeless type (shelter/ rough sleeper)

Heavy drinkers

   

Educational information or support interventions

 Rusness 1993

USA

UBA

7

Homeless women at a shelter

Shelter

Shelter

NR

Biweekly classes focused on nutrition information, shopping and cooking skills

No control group

Nutritional status

 Hinton 2001

UK

UBA

18

Residents at the homeless shelter

A homeless shelter

Shelter dwellers

NR

a session on food hygiene and nutrition, a cooking competition

No control group

Nob

 Derrickson 2003

USA

RCT

210

Households at risk of homelessness who requested assistance between January to August 2001

NR, likely from the database of the Salvation Army Family Services Office

At risk households

NR

3-h nutrition workshop

1-h food safety workshop.

Nutritional status

 Heslin 2003

USA

Comparative survey

974

Homeless women of reproductive age in Los Angeles County shelters and meal programs.

Shelters and meal programs

NR, likely all types

NR

case manager assigned to optimise uptake of WIC

Homeless women in WIC without case manager

No

 Helfrich 2006

USA

UBA

32

Self-identify a life skill need, be willing to engage in sessions each week, able to give informed consent and understand English

Shelters/ emergency shelters, transitional/ emergency housing program

Shelter

NR

Life-skills workshops & individual sessions

No control group

No

 Johnson 2009

USA

UBA

50

Long-term residents in the shelter (2 to 6 months), have at least one child residing with her in the shelter, and is enrolled in the shelter’s life skills program

Two homeless shelters

Shelter

NR

Nutrition education classes

No control group

Nutritional status

 Bonevski 2012

Australia

UBA

6

>  18 years, English speaking, receiving accommodation support from the participating homeless centre

A non-government homelessness outreach centre

NR, likely shelter

58%

Telephone personal counselling on health

No control group

Nutritional status

 Rustad 2013

USA

UBA

118

English-speaking, low-income women living in the Minneapolis/ St Paul area

Soup kitchens, grocery stores, Laundromats, food shelves, and homeless shelters

NR, likely shelter or in transition

NR

3 nutrition and health education sessions

No control group

Nutritional status

 Barbour 2016

Australia

UBA

5

Young person engaged with case management services in the community agency, with an interest in eating healthier and improving their cooking skills

Agencies helping homeless youth

Crisis accommodation, sleeping rough and couch-surfing

NR

Food literacy programme, participants engaged in a 3-h group interactive session over 8 weeks

Daily recommended values DRVs for males of age 19–50 years

Nutritional status

Fortification / Supplement Interventions

 Darnton-Hill 1986

Australia

Comparative Survey

106

Quasi random selection: the first three attendees of the homeless shelter/clinic; first person sitting left of the entrance plus two more at the day centre

Homeless shelter, day centre, and a clinic

NR, Likely shelter and rough sleepers

70%

Men taking oral multivitamin

Not taking vitamins

Nutritional status

 Drijver 1993

Netherlands

UBA

9

Almost daily alcohol consumption for past 5 years; average use of 8 E (80 g) alcohol per day; age 20–65 years; no vitamin supplements in the past month; thiamine level < 110 nmol

Homeless houses and outpatient facilities for alcoholics

NR, likely all types

100% (all drinking > 5 years, 80 g or more /day)

Single or weekly Intramuscular injection of combined 200 mg thiamine, 100 mg pyridoxine, 1000 ng cyanocobalamin

No control group

Nutritional status

 Darmon 2009

France

Repeat Survey

130

Men attending any of the 8 emergency shelters in Paris (3 night shelters and 5 food aid day centres)

Emergency shelters

NR, Likely shelter and rough sleepers

NR, likely majority

Fortified chocolate spread distribution

No control group

No

Food provision interventions

 Garden 2013

Russia

Case (historical) control

142

All homeless patients with tuberculosis referred to a St. Petersburg’s Tuberculosis dispensary

Tuberculosis dispensary

NR, likely all types

45% (registered alcoholics)

Daily food packs including canned meat, bread, butter, egg and soup with cream, juice, tea and yoghurt (2000 kcal)

Homeless treated at the tuberculosis dispensary in previous years

No

 Murakami 2013

Brazil

UBA

315

Low income people (elderly, unemployed, homeless and itinerant) who have been to the restaurant ≥3 time per week

NR

NR, likely all types

NR

Low cost meals available at restaurants

No control group

Nutritional status

 Villena 2013

Spain

Survey

50

Clients coming to the meal provision centre

Community kitchen

NR, likely all types

NR

Evaluating five community kitchen menus

No control group

No

 Pelham-Burn 2014

UK

Survey

16

Clients coming to a meal provision centre

The lounge area / front desk of the meal provision centre

NR, likely all types

NR

Taste testing 12 lunch dishes.

No control group

No

 Allen 2014

Australia

UBA

78

Rooming house residents, homeless persons and others deemed eligible for entry to the project

Café Meals project database North Yarra Community Health

All types

19% alcohol dependent

Providing clients a subsidy that entitles them to one meal per day at one of four local cafés

No control group

Nutritional status

Multicomponent interventions

 Wiecha 1993

USA

Comparative Survey

77

Homeless families without overt substance abuse or emotional problems with a child under 6 placed by the public welfare in temporary accommodation

Shelters and meal programs

Transitional homeless

NR

Kitchen facilities without food support (shelter) versus facilities & food support (shelter)

No kitchen facilities or food support (hotels)

Nutritional status

 Tarasuk 1994

Canada

UBA

49

Homeless adult attenders of an inner city drop in centre

Drop in centre for homeless adults

All types

NR

Three sequential interventions: 1) weekly cooking classes; 2)making the centres’ kitchen available for use to street-living; 3)communal cooking and dining

No control group

No

 Hamm 1999

USA

UBA

31

families in transition- who are temporarily living in shelters, transitional housing or with friends/family

Homeless shelters, soup kitchens, transitional housing, nurseries and day-care centres and family support centres

Transitional homeless

NR

Group nutrition education classes, health checks and food pack vouchers useable at specified stores

Non-homeless WIC participants

No

 Stewart 2009

Canada

UBA

56

Homeless or in transition homeless youth

An employment programme and drop-in centres

All types

34% sought counselling for alcohol/ drugs

Weekly support groups (help with homework, course or job finding, recreational activity, meal, transport)

No control group

No

 Richards 2011

USA

Comparative Survey

11,181

Homeless pregnant women with complete data in the PRAMS database

PRAMS database

All types

NR

WIC homeless women

Non WIC homeless women

No

 Kadoura 2014

USA

UBA

25

Homeless families with at least one child at the shelter school. Speak English or Spanish.

Homeless shelter

Shelter

60% parents reported drug and alcohol use substance abuse

10 two-hour sessions, including physical activity, education/training, and a ‘healthy dinner’

Non concurrent national data

Nutritional status

 Grazioli 2015

USA

UBA

6

Homeless drinkers, with a disability; homeless for at least 1 year or on 4 or more separate occasions in the past 3 years; aged 21–65 years

2 community-based agencies

NR, likely all types

100%

Safer-drinking strategies: treatment with extended-release naltrexone and harm-reduction counselling

No control group

Liver function

 Kendzor 2016

USA

RCT

32

≥18 years of age; willing+ able to attend all visits; > 6th grade literacy level; able to walk; resident of the transitional shelter for ≤2 months.

One shelter

Shelter dweller

NR

Newsletters, fruit/veg provision & pedometers/ walking goals.

No Intervention: Paid assessment-only

Nutritional status

  1. Kcal kilo calories, N number of participants analysed, NR not reported, PRAMS Pregnancy Risk Assessment Monitoring System project for CDC, USA, RCT randomised controlled trial, UBA uncontrolled before after study, WIC The Special Supplemental Nutrition Program for Women, Infants, and Children in the USA. a Primary outcomes of the review that were reported in the study. b This means that the study did not measure or report any of the primary outcomes of this review