Background
Methods
Inclusion criteria
Literature searches and study selection
Data extraction
Risk of bias assessment
Data synthesis
Results
Description of included studies
Results of the search
Included studies
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 |
Risk of bias in included studies
Findings
Primary outcomes
Study | Design/ duration | N | Outcome | Findings | Direction of effect / interpretation |
---|---|---|---|---|---|
Education, information or support | |||||
Rusness 1993 | UBA/ 1 month | 7 | Number with Anaemia (%) | 3 (43%) | Unclear if this is due to nutrition education classes: no pre-test values; 1 month study |
Number with Hypalbuminaemia (%) | 1 (14%) | ||||
Eating right skill score- food frequency data (Mean change) | “One third higher than pre test scores” | Educating shelter living women in healthy eating improved nutritional intake | |||
Numbers of women maintaining family targeted diet behaviour (%) | 6 (86%) | ||||
Derrickson 2003 (RCT) | RCT/ 1 month | 210 | Mean (SD) intake of fruit servings per day in compared groups post intervention | Intervention = 6.6 (7.5) Control = 4.5 (4.8) | Nutrition workshop increased average fruit and vegetable intake |
Mean (SD) intake of vegetable servings per day in compared groups post intervention | Intervention = 8.3 (7.8) Control = 6.3 (6.2) | ||||
Johnson 2009 | UBA/ 10 months | 50 | Proportion who ate more fruit and vegetables compared to baseline | 19% | Nutrition education classes made more people eat fruit and vegetable and yogurt, and =avoid carbohydrate |
Proportion who ate more yogurt compared to baseline | 3% | ||||
Proportion who tried to limit carb intake compared to baseline | 22% | ||||
Mean (SD) of fruit servings eaten daily | Pre-test = 0.83 (0.71) Post-test = 0.7 (0.65) | Nutrition education classes decreased mean fruit intake and increased carbohydrate intake | |||
Mean (SD) servings of bread, cereal, pasta, and rice (eaten) daily | Pre-test = 1.44 (1.16) Post-test = 1.83 (1.29) | ||||
Bonevski 2012 | UBA/ 1.5 months | 6 | Proportion who tried to eat more fruit N (%) | 4(66%) | Intervention increased attempts to eat fruit and vegetable |
Proportion who tried to eat more vegetable N (%) | 6 (100%) | ||||
Rustad 2013 | UBA/ 1.5 months | 118 | Mean (SD) of fruit serving intake | Pre-test = 1.3 (1.3) Post-test = 1.6 (1.4) | Nutrition and health education sessions increased fruit and vegetable intake |
Mean (SD) of vegetable serving intake | Pre-test = 1.5 (1.3) Post-test = 1.9 (1.5) | ||||
Barbour 2016 | UBA/ 6 months | 5 | Mean (range) fruit servings eaten/ day (compared to reference Daily recommended values) | Pre-test = 0.8 (0, 2.2) Post-test = 0.4 (0.0, 1.0) | Food literacy programme decreased mean fruit intake and mean diet quality score. |
Mean (range) vegetable servings eaten/ day (compared to reference Daily recommended values) | Pre-test = 2.7 (0.0, 11.9) Post-test = 3.6 (0.0, 12.0) | ||||
Intervention increased mean vegetable, iron, vitamin C, folate, calcium, and total energy intake | |||||
Mean (range) intake of Folate (B9) mg/day | Pre-test = 256 (211, 272) Post-test = 309 (108, 551) | ||||
Mean (range) intake of Calcium mg/day | Pre-test = 655 (365, 998) Post-test = 771 (423, 1367) | ||||
Mean (range) intake of Iron mg/day | Pre-test = 9.9 (6.6, 14.4) Post-test = 10.4 (5.3, 15.9) | ||||
Mean (range) vitamin C intake mg/24 h | Pre-test = 67 (10, 159) Post-test = 72 (0, 143) | ||||
Mean (range) diet quality score (max 100) | Pre-test = 45 (38, 61) Post-test = 41 (27, 60) | ||||
Mean (range) daily energy intake kJ | Pre-test = 7981 (2574, 11,384) Post-test = 10,244 (6321, 15,152) | ||||
Supplement provision | |||||
Darnton-Hill 1986 | Comparative survey/ 24 months | 106 | % deficient in vitamin B1 | NV gp = 45 V gp = 25 | Oral vitamin supplements reduced the number of people with vitamin deficiency |
% deficient in vitamin B6 | NV gp = 63 V gp = 21 | ||||
% deficient in vitamin C | NV gp = 29 V gp = 10 | ||||
% deficient in vitamin B12 | NV gp = 0 V gp = 0 | ||||
% deficient in folate (B9) | NV gp = 80 V gp = 49 | ||||
% deficient in iron | NV gp = 12 V gp = 15 | ||||
% deficient in zinc | NV gp = 25 Vgp = 25 | ||||
Mean (SD) levels of TPP% | NV gp = 15.3 (10.5) V gp = 10.5 (9.9) | Oral vitamin supplements don’t always improve group mean levels of vitamins | |||
Mean (SD) levels of vitamin B6 P5P% | NV gp = 57 (26.6) V gp = 36.2(31.4) | ||||
Mean (SD) levels of vitamin C μmol/L | NV gp = 34.9 (16.2) V gp = 72.6 (35.2) | ||||
Mean (SD) levels of serum Folate ng/ml | NV gp = 3.6 (4.0) V gp = 5.2 (4.0) | ||||
Mean (SD) levels of vitamin B 12 pmol/L | NV gp = 341 (203) V gp = 433 (223) | ||||
Drijver 1993 | UBA/ NR | 9 | Mean Tk activity increase (units) | Single injection: Before = 9.6; day 14 = 11.8 | Multivitamin injection keeps vitamin levels up for 14 days. |
Weekly injection: Before = 10.2; day7 = 12; day21 = 11.2; day35 = 12 | |||||
Mean TDP effect (%) | Single injection: Before = 18; day 14 = 9 | ||||
Weekly injection: Before = 17; day7 = 3; day21 = 5; day 35 = 5 | |||||
Food provision | |||||
Murakami 2013 | UBA/ NR | 315 | % of Clients eating below recommended energy intake | 79.0 | The hot meals do not fulfil energy needs for most participants, and even though provide a high fibre diet, still contribute to higher than recommended fat and saturate intake in many participants. |
Mean (SD) 24 h Energy intake kcal | 948.55 (108.75) | ||||
Proportion with above average fibre intake | 62.9% | ||||
Proportion with saturated fat above the recommended levels | 22% | ||||
Proportion with cholesterol intake above the recommended levels | 41% | ||||
Allen 2014 | UBA/ 12 months | 78 | Proportion eating more frequently and gaining weight | Numbers not reported: “many clients eat more frequently, and experience positive weight gain” | A subsidy to have one meal per day n may increase food intake |
Multicomponent interventions | |||||
Kendzor 2016 | RCT/ 1 month | 32 | Mean (cups) vegetable and fruit intake | Intervention = 3.56; controls =2; MD = 1.5 cups more in intervention at 4 week follow up | Newsletters, fruit/vegetables & pedometers with walking goals are able to increase fruit and vegetable intake |
Wiecha 1993 | Comparative survey/ 9 months | 77 | Mothers’ Mean (mg) Vitamin B6 intake per 1000 kcal | Kitchen facilities with or without food support (shelter group) = 0.68; no facilities or food(hotels group) = 0.55 | Provision of full kitchen facilities with or without added food support can increase intake of important micronutrients but not total protein or energy intake for families |
Mothers’ Mean (mg) Vitamin C intake per 1000 kcal | Kitchen facilities with or without food support (shelter group) = 61; no facilities or food(hotels) group =41 | ||||
Mothers’ Mean (g) protein intake per 1000 kcal | Kitchen facilities with or without food support (shelter group) = 35; no facilities or food(hotels) group =33 | ||||
Mothers’ Mean Energy (kcal) intake per 1000 kcal | Kitchen facilities with or without food support (shelter group) = 1980; no facilities or food(hotels) group =2016 | ||||
Kadoura 2014 | UBA/ 1 month | 25 | Mean change in frequency of fruit and vegetable intake (Cohen’s D) | 0.56 | Family physical activity, education/training, and a ‘healthy dinner ‘increased both amount and frequency of fruit and vegetable intake |
Mean change in amount of fruit and vegetable intake (Cohen’s D) | 0.87 | ||||
Grazioli 2015 | UBA/ 3 months | 6 | AST levels median (IQR) units | Baseline = 64.5 (34.5, 95.5), follow up = 60 (29.25, 90.5), Wilcoxon signed rank test = −0.77 | Detoxification with naltrexone and harm-reduction counselling with a focus on better diet habits led to no change in liver function tests post intervention |
ALT levels median (IQR) units | Baseline = 40.5 (30.25, 51.5), follow up = 32 (21.5, 56.75), Wilcoxon signed rank test = − 0.7 |
Secondary outcomes
Study | Intervention | Outcome Measure and Findings (USD)a |
---|---|---|
Darnton-Hill 1986 | Vitamin C, B complex, and thiamine regimen | Cost / day AUD (USD): 0.168 (0.12) |
B complex capsule | Cost / day AUD (USD): 0.085 (0.06) | |
Thiamine tablet 50 mg | Cost / day AUD (USD): 0.035 (0.03) | |
Vitamin C tablet 500 mg | Cost / day AUD (USD): 0.048 (0.03) | |
Darmon 2009 | Vitamin fortified chocolate spread plus street food | Cost of one RDA diet EUR(USD): 3.64 (5.07) |
Food aid meal along with street food | Cost of one RDA diet EUR(USD): 4.78 (6.6) | |
Street food alone | Cost of one RDA diet EUR(USD): 5.6 (7.7) | |
Garden 2013 | 2000 kcal day-food pack | Average cost USD: 1.3–1.5 |
Murakami 2013 | Breakfast (400 kcal) | Cost of one meal R$ (USD): 0.5 (0.15) |
Lunch (1200 kcal) | Cost of one meal R$ (USD): 1.0 (0.31) | |
Tarasuk 1994 | Communal cooking and dining in shelter kitchen | Staff needed to co-ordinate: 1 person |