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Changes in quality of life from a homelessness intervention: true change, response shift, or random variation

Quality of Life Research volume 26, pages 1853–1864 (2017)Cite this article

Abstract

Background and objective

Participants experiencing homelessness and mental illness who received housing and support through the At Home/Chez Soi trial showed modest gains in quality of life (QOL) compared to treatment as usual participants. Participants’ QOL ratings over time may have been affected by either response shift triggered by new life circumstances or by random variation in the meaning of QOL ratings. This study seeks to identify both phenomena to estimate the intervention’s effect on true change in QOL.

Methods

Using the residuals from a regression model of the global item of Lehman’s 20-item quality of life interview (QOLI-20), latent trajectory analysis was used to identify response shift, while a measure of overall variability in residuals identified random variation of QOL. The latter was used to adjust group comparisons of QOLI-20 total scores and the global item.

Results

Equivalent distributions of both groups’ participants across latent trajectory classes (χ2 = 2.97, p = .397) suggest that the intervention did not trigger response shift. However, random variation interacted significantly with the treatment effect on global item ratings. For every increase of one standard deviation of residuals, treatment odds ratios decreased by a factor of 0.70 (SE 1.18, p = .036, 95% CI 0.50–0.98).

Conclusions

Measuring random variation in QOL ratings from the standard deviation of residuals offers the ability to approximate, although indirectly, how participants’ QOL is truly affected by a housing intervention. Specifically, we found that QOL improvement is more evident when QOL ratings have a consistent meaning over time.

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Disclaimer

We thank Jayne Barker (2008–2011), Cameron Keller (2011–2012), and Catharine Hume (2012–2015), Mental Health Commission of Canada at Home/Chez Soi National Project Leads; the National Research Team; the 5 site research teams; the site coordinators; and the numerous service and housing providers, as well as persons with lived experience, who have contributed to this project and the research. This research has been made possible through a financial contribution from Health Canada. The views expressed herein solely represent the authors.

Funding

This research has been made possible through a financial contribution from Health Canada to the Mental Health Commission of Canada.

Role of the funder/sponsor

The Mental Health Commission of Canada oversaw the conduct of the study and provided training and technical support to the service teams and research staff throughout the project. However, the funder had no role in the analysis and interpretation of the data and preparation, review, or approval of the manuscript.

Author information

Authors and Affiliations

  1. Department of Epidemiology, McGill University, Montreal, Canada

    Guido Antonio Powell & Nancy Mayo

  2. Departments of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Canada

    Carol E. Adair

  3. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada

    David L. Streiner

  4. Center for Outcomes Research and Evaluation (CORE), Research Institute of McGill University Health Center, Montreal, Canada

    Nancy Mayo

  5. Douglas Institute Research Centre, McGill University, Montreal, Canada

    Eric Latimer

  6. Department of Psychiatry, McGill University, Montreal, Canada

    Eric Latimer

Authors
  1. Guido Antonio Powell
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  2. Carol E. Adair
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  3. David L. Streiner
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  4. Nancy Mayo
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Corresponding author

Correspondence to Guido Antonio Powell.

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Conflict of interest

Author CA was on contract to the Mental Health Commission of Canada as the quantitative research lead. Her role was otherwise the same as all other academic investigators. GP, DLS, NM, EL declare they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Powell, G.A., Adair, C.E., Streiner, D.L. et al. Changes in quality of life from a homelessness intervention: true change, response shift, or random variation. Qual Life Res 26, 1853–1864 (2017). https://doi.org/10.1007/s11136-017-1522-8

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