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Background Compassionate communities are rooted in a health promotion approach to palliative care, aiming to support solidarity among community members at the end of life. Hundreds of compassionate communities have been developed internationally in recent years. However, it remains unknown how their implementation on the ground aligns with core strategies of health promotion. The aim of this review is to describe the practical implementation and evaluation of compassionate communities. Methods We undertook a scoping review of the empirical peer-reviewed literature on compassionate communities. Bibliographic searches in five databases were developed with information specialists. We included studies in English describing health promotion activities applied to end-of-life and palliative care. Qualitative analysis used inductive and deductive strategies based on existing frameworks for categorization of health promotion activities, barriers and facilitators for implementation and evaluation measures. A participatory research approach with community partners was used to design the review and interpret its findings. Results Sixty-three articles were included for analysis. 74.6% were published after 2011. Health services organizations and providers are most often engaged as compassionate community leaders, with community members mainly engaged as target users. Adaptation to local culture and social context is the most frequently reported barrier for implementation, with support and external factors mostly reported as facilitators. Early stages of compassionate community development are rarely reported in the literature (stakeholder mobilization, needs assessment, priority-setting). Health promotion strategies tend to focus on the development of personal skills, mainly through the use of education and awareness programs. Few activities focused on strengthening community action and building healthy public policies. Evaluation was reported in 30% of articles, 88% of evaluation being analyzed at the individual level, as opposed to community processes and outcomes. Conclusions The empirical literature on compassionate communities demonstrates a wide variety of health promotion practices. Much international experience has been developed in education and awareness programs on death and dying. Health promotion strategies based on community strengthening and policies need to be consolidated. Future research should pay attention to community-led initiatives and evaluations that may not be currently reported in the peer-review literature.

Peer support workers-people with a significant lived and living experience of a social or health condition-use their experiential knowledge and obtain training to help and care for others. They are integrated in different clinical settings, including those for people experiencing homelessness. Most research on peer support implementation in homelessness has not considered the of the implementation, particularly in periods of crisis. During the COVID-19 pandemic crisis, a participatory research project examined the integration of a peer support worker in a primary and community care clinic that serves people experiencing homelessness in Montreal (Canada). This article presents a narrative case study analysis of the specific data on implementation derived from this project. Three main learning points are of interest regarding implementation: 1) crises can precipitate challenges but also particular opportunities for the implementation of peer support initiatives in homelessness; 2) even during a crisis, certain key steps cannot be skipped when the goal is a successful implementation; and 3) research can be an external asset for clinical teams as they struggle to deliver care during periods of crisis. Peer support initiatives in homelessness can be implemented in the Canadian context during periods of crisis-for example, the COVID-19 pandemic-for health and social care services. Moreover, the concept of itself can be reexamined by clinical and research teams worldwide as potentially enabling the implementation of novel initiatives.

IntroductionThe COVID-19 pandemic disproportionately affects people experiencing homelessness, both in terms of health and psychosocial impacts. Building trust and collaborations with healthcare services and community resources are paramount to mitigate the consequences of the pandemic, especially in heavily affected urban areas across Canada. Peer-support programs have been associated with improved sense of empowerment, quality of life, reduced substance use, and increased access and use of primary care services. However, it is unclear whether the implementation of a peer support intervention in homelessness is feasible in the context of a pandemic that has profound impacts on existing community services.Aims Objectives Theory or MethodsThis project aimed at assessing the benefits, feasibility and acceptability of implementing a peer-support intervention for people experiencing homelessness during the COVID pandemic in Montreal. Working collaboratively and playing a bridging role between primary care professionals and community organizations, a peer-support worker performed on-site visits in shelters, outreach interventions in the street, and participated in clinical discussions. He offered support through shared experiences, role modeling, and linkages to different resources. A focus group was conducted in March 2021 with clinicians, administrators and the peer-support worker himself to reflect on their experience of integrating a peer-support worker within their team.Highlights or Results or Key FindingsWe documented strong support and reciprocal benefits for all those involved in this initiative, including clinical team members, the peer-support worker himself and people living with homelessness. Three key findings emerged from our focus group. 1) Peer-support offers hope for people experiencing homelessness, through the embodied example of a peer who built a new life beyond his experience in the streets. 2) Peer-support acts as a bridge, helping to establish trustful relationships with people experiencing homelessness despite social stigma and suspicion toward public institutions. It practically helps to connect with a number of resources in the community and healthcare system. 3) Peer-support brings a sense of shared meaning among team members, reconnecting them with the purpose of their work during the darkest days of the COVID crisis. Peer-support also prevents compassion fatigue by supporting care providers in addressing their client’s psychosocial needs.ConclusionsPeer-support offered a model of hope for people experiencing homelessness during the COVID pandemic. It served as a bridge between health and community resources, and contributed to a sense of shared meaning and mutual support for care providers. Strong and productive relationships between clinical and community partners were also established.Implications for applicability/transferability sustainability and limitationsIt is feasible to implement peer-support in homelessness, even during an acute crisis such as a pandemic. Peer-support can act as a powerful leverage for integration between clinical and community care for people living with complex conditions. Future research should document the long-term impacts and sustainability of such programs.