Work Package Two: Lived experience of PD housing and health
Research Questions
What are the health needs of populations living in PD housing which cannot be obtained through data linkage with hospital episode statistics (e.g. mental health or non-severe asthma exacerbations that do not require hospitalisation)?
Which characteristics of PD housing do residents perceive as being disruptive or supportive for daily activities related to sleep, diet, social interaction, work, study and caring responsibilities?
How do residents perceive the indoor comfort of PD housing and in which ways do they modify their environment to reduce any discomfort?
Approach
This WP applies social research methods and builds on the WP1 analysis of the characteristics of PD housing and the health needs of occupants by exploring the perceptions and lived experiences of residents. Data will be gathered through an online survey and an in-home interview with environmental assessment. The qualitative components of this WP are informed by a socioecological conceptual framework for the health impacts of urban environments, the THRIVES framework (Pineo, 2020), recognising the importance of individuals’ diverse experiences of social and physical environments. Ethics approval through the UCL Research Ethics Committee will be sought for all WP2 activities. Information sheets will explain the risks/benefits of participation, giving participants the option to receive summary results of the study, in addition to an incentivisation voucher. Helpline details will be provided for Shelter charity in recognition that some participants may be experiencing housing insecurity. Participants can drop out of the survey, interview or environmental assessment at any point during data collection.
Sampling and data collection: Survey
Online survey participants will be recruited through postal invitations sent to a random sample of 20,000 PD homes throughout England, with an expected 1,000 responses with appropriate incentivisation (a £10 voucher for each individual completing the survey). The survey invitation would be translated into the ten most common other languages spoken in England as identified by Office for National Statistics (ONS). The survey consent process will be embedded into the first page of the online survey, where participants will confirm their eligibility (over 18 years of age) and consent to participate. The survey items will be informed by existing health and housing survey instruments (e.g. Adamkiewicz et al., 2014), experience from a pilot study on health and PD housing currently being undertaken by Clifford and Pineo (funded by the Impact on Urban Health charity), the steering committee, the public involvement panel and all project partners and investigators. The pilot study survey was informed by a focus group with participants experiencing housing insecurity and poor-quality housing. The survey will measure the respondents’ views about their: accommodation (e.g. access to daylight, space, noise), demographics (age, household composition, education, race/ethnicity, income, employment, disability), health conditions (physical and mental health and subjective wellbeing), health-related behaviours (e.g. sleep, physical activity, etc.) and experiences in the home (e.g. thermal comfort, safety perceptions, ability to cook in the home).
With appropriate use of UCL’s Data Safehaven for the survey, it would be feasible to ask for the postcode of respondents to the survey. There could then be a comparison between responses received and the geographical spread of identified PDR housing and postcards sent out as survey responses come in. The location of PDR housing will have been mapped against indicators such as neighbourhood socioeconomic deprivation and any obvious bias in the survey responses could be identified as responses are coming in (this would be spread over several months). Attempts to address obvious bias could then be addressed by then sending researchers to door knock at buildings within under-represented locations and encourage residents answering doors to complete the survey. This approach has been successfully utilised by Clifford and Pineo in their pilot research on PDR housing and health in four London boroughs funded by Impact on Urban Health which has had an 8.4% response rate on the survey.
Sampling and data collection: Interviews
Survey participants (>18 years) from a range of property types and geographic locations will be invited to participate in an in-person interview in their home, with a target of 100 interviews (with incentivisation - a £20 voucher for each interviewee). Most PD conversions are in urban areas, and we aim to conduct interviews in all eight core cities of England plus across Greater London and the South East. Two researchers will attend each interview and obtain written consent before entering the resident’s home. Our partners, homeless charity Groundswell, will conduct interviews with vulnerable populations in temporary housing in PD conversions (from previous research we estimate this to be about a third of the population, or 30 interviewees). The interview guide will focus on indoor environmental quality (IEQ) factors associated with those health outcomes most frequently found in PD housing residents (via WP1) and the survey responses, alongside participants’ experiences of IEQ. Participants will also be prompted to discuss wider social and environmental factors which they believe affect their health (e.g. tenure security, access to amenities and green infrastructure) or their ability to modify their home environment to increase health, comfort and wellbeing (e.g. ability to install thermal comfort adaptations, such as window blinds). The interview guide will be co-created with the steering committee, Groundswell and peer researchers. It will also be informed by the results of our pilot study (Clifford and Pineo) which involves 25-30 interviews with residents in PD housing in four London boroughs. Drawing on the survey responses, bi-lingual researchers will conduct interviews if required.
Sampling and data collection: Environmental Assessment
All interview participants (target = 100) will be asked to consent to an environmental assessment. In collaboration with WP3, the researchers will be trained to identify basic household characteristics and conditions related to health (e.g., mould and damp, pest infestation, ventilation characteristics, daylight and combustion sources) in a household environmental assessment and conduct a more detailed physical building survey for the homes which would then be monitored in WP3 (including key building dimensions and fabric characteristics). Residents will be encouraged to contribute to the assessment, discussing their perceptions and experiences of the indoor environment. Where consent is received, researchers will photograph internal conditions of PD housing units to create images for WP5 engagement with policy and decision-makers.
Analysis
Descriptive statistics will be produced from the survey data. The THRIVES framework conceptual lens highlights the need to evaluate health risks and outcomes through a multi-scalar perspective (across space and time), building on Krieger’s (1994) ecosocial theory, Agyeman’s (2013) ‘just sustainabilities’ and Meadow’s (2008) work on systems thinking. The THRIVES framework will inform the analysis of survey and interview data by considering how Krieger’s four constructs (embodiment, pathways of embodiment, cumulative interplay, and accountability and agency) relate to residents’ experiences of health, comfort and wellbeing in PD housing, within the context of a changing climate. From thematic analysis of our interview data, we will identify common themes related to residents’ perceptions of PD housing conditions and how these relate to health, equity and health-related behaviours. Triangulation of data from WP3 and the WP1 data linkage will increase confidence in our findings and potential generalisability beyond the interview properties to the wider PD housing stock. The survey will be designed to allow benchmarking against key existing data sets such as the English Housing Survey data, thus giving us some comparable data to the wider national housing stock and general population. The analysis will also be used to identify possible interventions to improve residents’ health and comfort both through education materials (e.g. strategies to improve thermal comfort in certain PD housing types) and design measures (e.g. installation of sun shades), linking back to the guidance documents and workshops which form part of WP5.