Richer Life Histories: A Realist Synthesis of History Taking in Homelessness Care

Abstract

Objective: To examine how interventions support history taking for people experiencing homelessness, and to identify the contexts and mechanisms that enable fuller life histories to be shared in healthcare encounters.

Design: A realist review.

Data Sources: MEDLINE, Scopus, Web of Science, and PsycINFO, supplemented by citation tracking and expert input.

Results: Thirteen studies were included. Interventions such as trauma-informed practice, peer navigation, and collaborative care were found to enhance disclosure when delivered in safe, validating, and trusting environments. Mechanisms of recognition, agency, and authenticity enabled richer narratives, while outcomes included more complete histories, stronger therapeutic relationships, and better engagement with care. Organisational stability and teamwork were key enabling conditions.

Conclusion: History taking should be recognised as a relational practice dependent on trust, validation, and safety. Embedding trauma-informed and participatory approaches, supported by peers and stable services, can foster more equitable and person-centred healthcare for people experiencing homelessness.