Title: Developing participatory research to understand the health & treatment needs of mid-life & older women experiencing homelessness & substance use in UK
Funder: Economic and Social Research Council

Abstract: The key aim of this fellowship is to co-develop a proposal for a participatory research study to investigate the health needs, treatment provision, and health support preferences for mid-life and older women who use substances (drugs and/or alcohol) and experience homelessness in Scotland. In order to meet this aim, a number of objectives will be achieved through the period of the fellowship. The objectives are to: 1. Produce publications in order to build on my current publication record; 2. Engage with a range of different audiences to communicate my PhD research findings; 3. Build networks to develop impact opportunities and inform and support further research and professional development; 4. Undertake further training to improve research and related skills; 5. Information gathering for grant development. The first objective of the fellowship is to enhance and strengthen my publication record. To achieve this I will produce and submit three high-quality peer-reviewed papers to journals which focus on substance use in order to communicate the findings from the PhD. The first paper will examine the therapeutic landscapes available to women in recovery, focusing on the impact of felt and enacted stigmatising processes. The second paper will draw on the themes of connecting and belonging, exploring the social relationships that facilitate and impede women's journeys out of substance use, into and through recovery. The third paper will be a reflexive methods-based paper that will draw on the use of object-elicitation methods (OEM) in the PhD. The second objective is to engage with a range of audiences to communicate the PhD research findings. This will be achieved through the development and hosting of a workshop event for key stakeholders on the health and treatment experiences of mid-life and older women experiencing (or who have experienced) homelessness and/or substance use. The workshop event will be aimed at a target audience of practitioners involved in supporting women experiencing homelessness and/or substance use. This would include GPs and practitioners from a range of statutory and non- governmental organisations across the UK, academics and policy makers working in the areas of homelessness and/or substance use and women experiencing or with lived experience of homelessness and/or substance use. The third objective is to build networks to develop impact opportunities to communicate the PhD research findings. This will be achieved through the workshop event described above and through building additional networking opportunities with national and international academics, practitioners and peer networks in the fields of substance use, health and homelessness. I will achieve this through identifying and attending national and international conferences and workshops at which to present my thesis findings, as well as through the professional and academic networks associated with the University of Stirling and mentors Professor Parkes and Dr Carver. The fourth objective is to undertake further training to improve my research and related skills. I will focus on developing my research skills in innovative participatory and creative research methods, as well as project proposal and grant development. The fifth objective is to collect information on women who experience homelessness and substance use for the purpose of developing a grant proposal to explore health and treatment experiences of this marginalised group. This will be achieved through a combination of the objectives described above, the establishment of a project working group comprised of women with lived/living experience of homelessness and substance use, a rapid review of health-based interventions to identify effective tools for improving patient/practitioner communications and the distribution of an online survey to practitioners working with women experiencing homelessness and substance use.

Lay abstract: Current research into homelessness in Scotland has yet to investigate the needs of mid-life and older women who are facing homelessness at the same time as coping with substance use (drugs and alcohol). There is little research that focuses on the challenges faced by women who experience homelessness compared with research on homelessness in general and less still that seeks to understand the specific health needs of women approaching or in later life (Sutherland et al, 2022). Housing is an important social determinant of health, and there is evidence that shows women experiencing homelessness have poorer mental and physical health outcomes than women in the wider population (Beijer & Andréasson, 2010). Moreover, women who are experiencing homelessness are more likely to have experienced higher rates of diagnosed mental health issues, suicidal ideation and attempts, and childhood trauma than men who are experiencing homelessness (Sosenko et al, 2020; Milaney et al, 2020). Factors such as poor mental health, domestic violence, and family background (Anderson & Raynes, 2004) can impact on women's access to and retention of safe tenancies, whilst additional barriers to secure housing include structural factors such as poverty, education, employment and involvement with the criminal justice system (Norman & Pauly, 2013). The Fellowship will help me build on my PhD, moving beyond the health needs and treatment experiences of older women in recovery from substance use, to investigate the needs of a particularly marginalised group of women, namely women experiencing the intersection of homelessness, ageing, and substance use. The PhD sets the foundations for exploring mid-life and older women's health needs by recognising the complexity of women's lives, especially among those who live on the margins of society (Shaw, 2021). The Fellowship will provide an important starting point for planning innovative participatory research with this under-researched and marginalised group. A critical element of the Fellowship will include a project working group of mid-life and older women with lived experience in the development of a grant application for further research. The participation of women with lived experience will ensure the research proposal is designed to produce meaningful outcomes that will have practical impacts for women experiencing homelessness and the practitioners who support them. Over the course of the Fellowship I aim to publish the findings from my PhD nationally and internationally in order to maximise impact and engagement. I will expand my research network and develop specific skills in participatory research, project development and grant applications. I will also undertake information gathering through a range of networking opportunities, a rapid review of interventions to improve practitioner/patient communications, an online survey with practitioners and the preparation of grant applications in order to continue this important line of research. The motivation for this Fellowship application is to develop work that will increase understanding of the intersection of homelessness, substance use, health, ageing, and gender.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH