Interventions to improve sexual heath among the homeless community: a realist review protocol

<ns3:p>Background People experiencing homelessness face profound sexual health inequities, driven by overlapping structural vulnerabilities including housing instability, stigma, limited healthcare access, and social exclusion. Interventions designed to improve sexual health outcomes within this population are diverse, ranging from peer-led education to nurse-led clinical models and structural supports such as housing. However, the effectiveness of these interventions depends on the content of the interventions as well as varying significantly across circumstances and subpopulations. A realist approach is useful for understanding how, for whom, and under what circumstances interventions produce intended (and unintended) outcomes. Methods This review will follow Pawson’s six-step realist synthesis methodology. An initial programme theory has been developed through preliminary literature searches and will be refined iteratively as new evidence is gathered. Published and grey literature will be systematically searched and selected for their relevance to developing and testing Context–Mechanism–Outcome Configurations. Data extraction will focus on identifying key information which can contribute to understanding contextual factors, mechanisms, and outcomes across intervention types. The synthesis will develop, refine, and test theories that explain how sexual health interventions produce change in varied contexts. Patient and public involvement contributors will be consulted throughout the review to validate findings and support interpretation. Conclusion This review will generate transferable insights into how sexual health interventions for people experiencing homelessness work across different contexts. By identifying mechanisms that spark outcomes, and the conditions that shape them, the findings will support more context-sensitive and effective policy, practice, and service design. The results will be disseminated through peer-reviewed publications, practitioner-facing summaries, and community-informed outputs.</ns3:p>