Lived Experience of Household Overcrowding Measure (LE-HOMe): A mixed-methods feasibility study to measure household...

Household overcrowding is a growing problem in England. It increases the risk of health outcomes including infections, injuries and poor mental health. For councils to monitor overcrowding at household level, methods are required to identify which homes are overcrowded and how it affects residents. Measures may need to be tailored for families, where overcrowding limits children's ability to play, study and socialise.

To establish the feasibility of developing a method to identify households with families at high risk of overcrowding affecting their well-being.

Describe effects of household overcrowding on family well-being through discussions with people with experience of overcrowding. Operationalise a method in one council, by combining publicly available and council-held data, to identify households with families at risk of the health effects of overcrowding. Understand the wider applicability of this method to other councils and its implications for population-level intervention design.

An explanatory sequential mixed-methods design was used with resident and community engagement throughout. First, interviews and focus groups were conducted with parents with lived experience of overcrowding and community representatives and service professionals in two boroughs of London. From discussions with these groups, a description of overcrowding affecting households with families was shared with one London local authority. Informed by this information, this local authority obtained and combined relevant population and housing data to generate two measures of household overcrowding in households with dependent children. The first measure replicated the 'bedroom standard', the most used overcrowding metric. The second measure assessed overcrowding by space available to families. A logistic regression was conducted to examine associations between overcrowding and repairs for damp and mould was undertaken. The methods and illustrative results on overcrowding prevalence from one council were shared with other councils, housing associations and researchers to understand its wider applicability.

Analysis of data from 47 parents (n = 25) and staff (n = 22) illustrated how effects of living in overcrowding can be influenced by the space available, and the number of bedrooms in the home, by the condition of the property (particularly damp/mould) and children's age. Using data available to councils, we identified overcrowding in families comparable to national estimates of overcrowding using the 'bedroom standard' and the 'space standard'. While prevalences were similar using space and bedroom standards [34.6% (95% confidence interval: 34.0% to 35.3%) vs. 36.1% (95% confidence interval: 35.4% to 36.8%)], each identified distinct cohorts of households). Using one of the local measures, we found overcrowded council homes had 1.31 times (95% confidence interval: 1.14 to 1.50, p < 0.001) higher risk of needing damp and mould repairs than households not in overcrowding. Stakeholder discussion with 30 participants across six English regions emphasised the importance of local measures for identifying populations at risk and for evaluating impacts of local policies and interventions.

This project demonstrated the feasibility of generating locally derived measures of overcrowding at household level that are granular enough to: (1) examine variations in overcrowded by household composition and (2) evaluate potential impacts of other policies/services on overcrowded households.

The project was limited in its geographical transferability; the qualitative research was conducted in two boroughs of London and the quantitative research in only one borough. There were also limitations to data access and quality on population data and housing data which affected the robustness of overcrowding indices.

Household-level identification of overcrowding is needed to develop and evaluate public health interventions to support families living in overcrowding.

This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR154776.