How and why women’s life histories and homelessness services generate heterogeneous recovery outcomes in Barcelona: a co-created realist evaluation protocol
8 affiliations
- 1Hospital del Mar Research Institute
- 2Departament de Medicina i Ciencies de la Vida, Universitat Pompeu Fabra
- 3Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra
- 4Universitat Pompeu Fabra- Barcelona School of Management
- 5JHU-UPF Public Policy Center (JHU-UPF PPC), Universitat Pompeu Fabra (UPF), UPF Barcelona School of Management (UPF-BSM)
- 6Escola Superior d’Infermeria del Mar
- 7Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII)
- 8Glasgow Caledonian University School of Health and Life Sciences
Abstract
Introduction: Homelessness is rising in Spain, particularly in Barcelona, where women are the fastest-growing subgroup, accounting for approximately 30% of service places. Yet services have historically been designed by default for men. Women’s pathways into homelessness are shaped by individual, social, and structural determinants which increase trauma exposure and make this population highly heterogeneous. While evidence highlights the need for gender- and trauma-informed services adapted to different subgroups, there remains limited systematic understanding of how women’s life experiences influence their engagement with and outcomes from homelessness services. This study aims to understand how and why women’s life experiences and determinants interact with homelessness service and intervention elements to activate or inhibit mechanisms (e.g., personal strengths) leading to different recovery outcomes (e.g., identity), thereby informing recommendations on how services can better support person-centered recovery of women.
Methods: This study protocol describes a realist evaluation that will combine a realist review with realist interviews, using co-creation methodologies involving homelessness service users and providers, through Community Advisory Committees, in Barcelona. An initial programme theory will be co-designed in parallel with literature screening and appraisal. Data will be analyzed to extract context–mechanism–outcome configurations explaining how women’s experiences and determinants generate different outcomes when interacting with service/intervention components. Co-refined programme theories will subsequently be tested through interviews and focus groups, with data analyzed retroductively and co-interpreted using different theoretical lenses and approaches such as the Social Determinants of Health, Trauma Theory, Trauma-Informed Care and the Power Threat Meaning Framework.
Discussion: The study integrates realist evaluation with co-creation methodologies, enabling the development of evidence-based, context-sensitive middle-range programme theories while prioritizing the voices of both professionals and people with lived experience in the knowledge-building process, aiming for epistemic justice. Co-created causal, feminist and trauma-informed explanatory theories linking women’s experiences, mechanisms of change and intervention outcomes in Barcelona are intended to serve as a foundation for the co-production of actionable service guidelines for homelessness, as well as policy recommendations. Findings will be disseminated to both the academic and general public and will include the participation of co-researcher stakeholders for this purpose.
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BibTeX
@article{lopezfernandez2026womens,
title = {{How and why women’s life histories and homelessness services generate heterogeneous recovery outcomes in Barcelona: a co-created realist evaluation protocol}},
author = {Montserrat López-Fernández and Lucinda Cash-Gibson and Joana Morrison and Astrid Escrig Piñol and Philippe Mortier and Giuliana Raffaella Longworth},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1939870},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1939870/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - How and why women’s life histories and homelessness services generate heterogeneous recovery outcomes in Barcelona: a co-created realist evaluation protocol
AU - Montserrat López-Fernández
AU - Lucinda Cash-Gibson
AU - Joana Morrison
AU - Astrid Escrig Piñol
AU - Philippe Mortier
AU - Giuliana Raffaella Longworth
PY - 2026
DA - 2026/10/28
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1939870
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1939870/full
AB - Introduction: Homelessness is rising in Spain, particularly in Barcelona, where women are the fastest-growing subgroup, accounting for approximately 30% of service places. Yet services have historically been designed by default for men. Women’s pathways into homelessness are shaped by individual, social, and structural determinants which increase trauma exposure and make this population highly heterogeneous. While evidence highlights the need for gender- and trauma-informed services adapted to different subgroups, there remains limited systematic understanding of how women’s life experiences influence their engagement with and outcomes from homelessness services. This study aims to understand how and why women’s life experiences and determinants interact with homelessness service and intervention elements to activate or inhibit mechanisms (e.g., personal strengths) leading to different recovery outcomes (e.g., identity), thereby informing recommendations on how services can better support person-centered recovery of women. Methods: This study protocol describes a realist evaluation that will combine a realist review with realist interviews, using co-creation methodologies involving homelessness service users and providers, through Community Advisory Committees, in Barcelona. An initial programme theory will be co-designed in parallel with literature screening and appraisal. Data will be analyzed to extract context–mechanism–outcome configurations explaining how women’s experiences and determinants generate different outcomes when interacting with service/intervention components. Co-refined programme theories will subsequently be tested through interviews and focus groups, with data analyzed retroductively and co-interpreted using different theoretical lenses and approaches such as the Social Determinants of Health, Trauma Theory, Trauma-Informed Care and the Power Threat Meaning Framework. Discussion: The study integrates realist evaluation with co-creation methodologies, enabling the development of evidence-based, context-sensitive middle-range programme theories while prioritizing the voices of both professionals and people with lived experience in the knowledge-building process, aiming for epistemic justice. Co-created causal, feminist and trauma-informed explanatory theories linking women’s experiences, mechanisms of change and intervention outcomes in Barcelona are intended to serve as a foundation for the co-production of actionable service guidelines for homelessness, as well as policy recommendations. Findings will be disseminated to both the academic and general public and will include the participation of co-researcher stakeholders for this purpose.
SN - 2296-2565
ER -