Services and Interventions for People who are Homeless with Companion Animals (Pets): A Systematic Review Protocol

Background: Many people who are homeless own a companion animal (a ‘pet’). Pet ownership has positive impacts on health and wellbeing. However, for people who are homeless, pet ownership also creates multiple challenges and may be a barrier to exiting homelessness. This systematic review will identify the types, and outcomes, of services and interventions to support people who are homeless with pets. Methods/Design: This review will be conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Searches will be undertaken on five databases. Combinations of search terms and subject headings or index terms will be used. Citation chaining and citation tracking will also be undertaken. Literature will be screened for relevance in a two-step process. Each study will be quality assessed using an evidence-based tool relevant to its methods. Relevant data will be extracted and synthesised using a meta-analytic, or narrative, approach. Discussion: This review will address an identified gap in the knowledge about the types, and outcomes, of services/interventions for people who are homeless with pets. The results may increase recognition about the importance of protecting and promoting the relationship between people who are homeless and their pets, and inform future work.


Homelessness
In Australia, a person is considered to be 'homeless' if they lack access to "suitable accommodation alternatives"; this includes people who are unsheltered, as well as those staying in households other than their own, in overcrowded or substandard housing, and in emergency shelters (Australian Bureau of Statistics, 2018b). In Australia, approximately 116,000 people -

Review question
This review will answer the questions: (1) what services and interventions exist for, and (2) what is the impact or effect of these on, people who are homeless with a pet?

Study design
This study will involve a systematic review of the existing literature. Preliminary scoping searches have been undertaken to identify the types of literature likely to be available, suitable databases and effective search terms, to inform this protocol. The protocol has been reported using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines (Shamseer et al., 2015) (Additional File #1).

Participants, intervention design and focus, and outcomes of interest
Eligibility criteria for this review were developed using the PICO framework (population, intervention, comparator, outcome). This is recommended by the Cochrane Collaboration as a model for developing a relevant, well-defined review question . The application of the framework to the topic is as follows: • Population: people (1) who are homeless OR at risk of homelessness, according to the definition cited in the introduction (Australian Bureau of Statistics, 2018b), AND (2) who are accompanied by ≥1 pet(s) • Intervention: any service or intervention, implemented or planned, to: (1) prevent homelessness in people with a pet, AND/OR (2) provide support to people who are homeless with a pet, AND/OR (3) assist people to exit homelessness with a pet • Comparator: standard services or interventions for people who are homeless • Outcome: (1) the service/intervention type, AND (2) its impact or effect Qualitative, quantitative and mixed-methods studies will be considered for inclusion. Literature will be considered if it relates to Australia, OR to a similar international context (i.e. New Zealand, Western Europe [including the UK], North America [including the US]). Only literature published in English, in full-text and in a peer-reviewed journal will be considered. Literature which is not primarily focused on services and/or interventions will still be considered. Literature will be limited to that published 2010 to 2020 inclusive (10 years' duration). Literature on unaccompanied homeless animals (stray/shelter animals), which is not of direct relevance to the review topic, will be excluded.

Search strategy
Similar to the previous reviews on pet ownership and homelessness (Cleary et al., 2020;Kerman et al., 2019), the searches will use two groups of keywords: (1) those related to 'homelessness', and (2) those related to 'pets'. Index terms and subject headings will be used on databases where available. Sample search strategies are provided in Additional File #2. The keywords will be batched and placed in parentheses and combined using the AND/OR Boolean Social Science Protocols, June 2020, 1-12. http://dx.doi.org/10.7565/ssp.2020.2814 4 operators. Truncation will be used. Where possible, databases will be instructed to search article titles, abstracts and full text.

Information sources
Systematic searches will be undertaken on electronic databases. From the 82 databases tested in the scoping searches, the following were selected for use in the final searches: CINAHL Complete (via Ebscohost), Embase, MEDLINE (via Ebscohost), PsycInfo (via Ovid), Scopus and Web of Science (via Clarivate Analytics). Reference lists of each piece of literature selected for inclusion will also be manually searched. Citation tracking, where it is available on a database, will also be used.

Data collection
The results of each search will be exported into the current version of Endnote. Duplicate items will be identified and removed using EndNote's 'find duplicate' function. The remaining literature will be screened progressively against the eligibility criteria: (1) for all items: reading of the title and the abstract, then (2) for items which pass Step 1: reading of the full text. Each stage will be carried out by one researcher, and checked by a second researcher; if necessary, concurrence will be achieved through discussion or by involving a third researcher. The inclusion/exclusion process will be recorded in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) chart (Moher, Liberati, Tetzlaff, & Altman, 2009).

Data extraction
Data will be extracted using a standard, electronic data extraction table. Data extraction will be carried out by one researcher, and checked by a second researcher; if necessary, concurrence will be achieved through discussion or by involving a third researcher. The data extracted will include: • The type of study -including the author(s), the date of publication, the purpose/aim, the design/methods, the duration, the country/ies and the characteristics of the participants and their pets • The type of service/intervention -including its date of establishment, its aim/focus, its key activity(ies), its provider(s), its target population(s), its size/reach [i.e. the number of homeless people, pets, employees, volunteers and partners involved], its frequency/length, its geographical location(s), its setting(s) and its resource/funding requirements • The outcomes of the service/intervention -including physical health outcomes for the homeless person, psychological health outcomes for the homeless person, any outcomes for the pet(s), and the perceptions and experiences of the service's/intervention's key stakeholders (i.e. the homeless pet owner, the provider(s), the funder(s), the workers/volunteers, the community)

Quality assessment
Literature selected for inclusion will be evaluated using an evidence-based tool:

Data synthesis
As this review is expected to retrieve studies which use diverse methods, a narrative synthesis will be undertaken. Narrative syntheses involve describing and summarising the main features of the literature, and also critically investigating the similarities, differences, strengths and weaknesses in it (Lisy & Porritt, 2016). If possible, a meta-analysis will also be performed to evaluate the overall impacts or effects of the services and interventions identified.

Ethics
Human research ethics approval is not required for this systematic review.

Discussion
It must be acknowledged that the previous reviews on pet ownership in people who are homeless (Cleary et al., 2020;Kerman et al., 2019), and the scoping searches undertaken to prepare for this review, identified no high-grade studies about services/interventions for people who are homeless with pets. This includes no systematic reviews or randomised-controlled trials, which produce the highest level of evidence for decision-making (National Health and Medical Research Council, 2009). This may result in difficulties in evaluating the true impacts or effects of services/interventions identified. There is also expected to be a considerable lack of consistency across the studies.
Nevertheless, this systematic review will address an identified gap in the current knowledge about the types, and outcomes, of services/interventions for people who are homeless with pets. The results will inform future research on the topic, including the design, implementation and evaluation of evidence-based services and interventions for people who are homeless with pets. The results may also lead to an increased recognition among homelessness service providers, and also policy makers, about the importance of protecting and promoting the relationship between people who are homeless and their pet(s). (Shamseer et al., 2015) Section and topic 11a Describe the mechanism(s) that will be used to manage records and data throughout the review Section 2.5 Selection process 11b State the process that will be used for selecting studies (such as two independent reviewers) through each phase of the review (that is, screening, eligibility and inclusion in metaanalysis)

PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) Checklist
Section 2.5 Data collection process 11c Describe planned method of extracting data from reports (such as piloting forms, done independently, in duplicate), any processes for obtaining and confirming data from investigators Section 2.6 Data items 12 List and define all variables for which data will be sought (such as PICO items, funding sources), any pre-planned data assumptions and simplifications Section 2.6 Outcomes and prioritization 13 List and define all outcomes for which data will be sought, including prioritization of main and additional outcomes, with rationale Section 2.6

Risk of bias in individual studies
14 Describe anticipated methods for assessing risk of bias of individual studies, including whether this will be done at the outcome or study level, or both; state how this information will be used in data synthesis Section 2.7 15a Describe criteria under which study data will be quantitatively synthesised Data synthesis 15b If data are appropriate for quantitative synthesis, describe planned summary measures, methods of handling data and methods of combining data from studies, including any planned exploration of consistency (such as I 2 , Kendall's τ) Section 2.8 15c Describe any proposed additional analyses (such as sensitivity or subgroup analyses, metaregression) 15d If quantitative synthesis is not appropriate, describe the type of summary planned Meta-bias(es) 16 Specify any planned assessment of meta-bias(es) (such as publication bias across studies, selective reporting within studies) N/A Confidence in cumulative evidence 17 Describe how the strength of the body of evidence will be assessed (such as GRADE) Section 2.7