TITLE:
Current Advances in Adherence Support for Patients Experiencing Homelessness in America: A Scoping Review
AUTHORS:
Christopher Little, David Holmes
KEYWORDS:
Homeless, Unhoused, People Experiencing Homelessness, Unstably Housed, Treatment, Adherence, Psychosocial, Direct Action, Mobile Health, mHealth, Smartphone
JOURNAL NAME:
Open Journal of Social Sciences,
Vol.14 No.8,
August
25,
2026
ABSTRACT: Introduction: The number of people in America experiencing homelessness reached an all-time high in 2024. While housing remains the first priority, improving treatment adherence is expected to reduce the disease burden in this population and facilitate better integration with social support services. Methods: A scoping review was performed using PRISMA-ScR guidelines. The literature search was conducted via the databases PubMed, EMBASE, and Web of Science, as well as via the government registry ClinicalTrials.gov. We identified 249 records, after duplicate removal, which were screened by title and abstract, then by full-text review. Our inclusion criteria were trials published in English, between 2015 and 2025, in a peer-reviewed journal, with an intervention targeting treatment adherence improvement, and American participants described as either homeless or with a sample subset of participants described as homeless. Results: Twenty records met inclusion criteria for this review, although these represented only sixteen different trials, owing to three trials which spread data across multiple publications. Of these final sixteen, six are described here as psychosocial interventions, five are described here as direct action interventions, two were smartphone-based mobile health (mHealth) interventions, one was a contingency management trial, one was a trial of MAT managed by ED physicians, and the last was a trial of urine biomarker testing. Conclusions: The interventions with the strongest evidence for improving treatment adherence in homeless Americans were those described here as direct action. Conversely, the smartphone-based interventions showed the weakest evidence for adherence improvement. A common theme which emerged in this comparison was that interventions which did more to proactively engage patients and provide face-to-face support appeared to obtain better adherence.