What does ‘housebound’ mean? Mixed-methods study to develop a consensus definition

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Abstract
Background: Housebound patients are an under-researched group who face challenges accessing primary health care and have complex needs. There is no consensus definition of ‘housebound’, hindering research. Aim: To develop a definition of housebound. Design & setting: A mixed-methods study using consensus methodology was conducted in the UK. Method: The study had the following parts: (i) a systematic review to examine how housebound was defined within UK literature; (ii) interviews to explore views of housebound people and carers ( n = 12); (iii) a consensus exercise with health and social care professionals ( n = 14) to agree a definition. An evidence summary was developed for each definition, combining review and interview data. A two-stage RAND/UCLA Appropriateness Method was used, with consensus defined as a median score ≥7/9 for clarity and appropriateness. Results: In total, 847 titles and abstracts were screened, and 413 articles underwent full-text review. Fifty-two definitions were identified, grouped under the following five themes: unable to attend the surgery; unable to leave the house; unable to leave the house without assistance; self-report of being housebound; and recorded as housebound on healthcare records. Subcategories of housebound included fully or semi, temporarily or permanently, and blockbound, housebound, chairbound, or bedbound. Six definitions met the top-scoring criteria, and a final definition was agreed: ‘Someone who is unable to leave their home or who requires significant assistance to do so. This may be due to illness, frailty, disability, surgery, mental ill health, or nearing the end of life.’ Conclusion: Our consensus definition can be used in UK research and may help policymakers and providers — within and outside the UK — evaluate and develop healthcare services for housebound patients.

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