Abstract
<title>Abstract</title> <p> <bold>Background</bold> Interventions that seek to improve the health of PEH are recognizing the need to simultaneously address structural and social determinants of health. These interventions are inherently complex, as they include multiple components, address multiple needs, attempt to coordinate responses within a complex organizational context or across multiple systems, and are implemented within a dynamic social context. In this study, we discuss the process of developing the Theory of Change (ToC) for the Navigator Program, a complex intervention to support people experiencing homelessness (PEH) during and after hospitalization. <bold>Methods</bold> We applied a ToC approach to articulate the causal pathways by which the intervention is hypothesized to achieve specific outcomes. We drew on previous studies done by our team, as well as existing evidence and experience of team members. Here, we articulate our process for developing the Navigator Program’s ToC, providing a worked example for how similar programs might support effective program operations and evaluations. <bold>Results</bold> The initial ToC presented here represents the multiple causal pathways we hypothesize the Navigator Program will support PEH during and after hospitalization. It outlines the resources/inputs, setting/context and short-term and long-term outcomes of the Navigator Program, as well as the assumptions, rationale and interventions needed to move from one outcome to the next. Importantly, this ToC provides a clear framework for the forthcoming outcomes and process evaluations. <bold>Conclusion</bold> A ToC ensures that interventions are logically designed using existing evidence and tacit knowledge, brings forward hidden assumptions, and supports rigorous evaluation. It can help programs manage expectations with funders, partners and the public of what the program has been developed to achieve, and what is beyond its scope. Additionally, a ToC can help hold programs accountable for the work they are being funded to complete, ensuring that programs are reporting on metrics that evaluate the issues and outcomes they were aiming to achieve. Clinical Trial Number: NCT04961762 </p>