Vulnerable groups’ engagement with interventions to mitigate the health impacts of exposure to extreme temperature events: a qualitative systematic review

Abstract

Abstract Extreme temperature events are becoming more frequent. Such events are defined as unusually hot weather persisting for at least two consecutive days (heatwave) or unusually cold weather persisting for at least two consecutive days (cold wave) within the context of geographical norms. Exposure to these events can exacerbate physical and mental health and wellbeing and increase mortality rates. Various interventions are currently in place to reduce exposure to extreme temperature events and their associated health impacts; however, there are growing concerns that these interventions do not meet the needs of those most vulnerable. To support the development of equitable interventions, this systematic review aims to synthesise the literature on the factors affecting vulnerable groups’ perspectives and engagement with such interventions. We searched four large databases for qualitative studies using terms related to interventions, extreme temperatures, temperature related health impacts, and vulnerable populations. This review was registered with PROSPERO (CRD420251023140). Following the PRISMA guidelines, 3,296 articles were screened independently by two reviewers, with 17 articles meeting our inclusion criteria. Interventions were categorised into one of four groups: ( i ) changes to an individual’s activities of daily living, ( ii ) modifying an individual’s living environment, ( iii ) implementing workplace heat protection policies, or ( iv ) engaging with public health educational material. Most of the literature discussed interventions used during extreme heat events. Factors affecting engagement were mapped to the socioecological model (SEM) and the capability, opportunity, and motivation (COM-B) model. Various factors were found to affect engagement, with knowledge, autonomy and access to resources being common across all. A key area for future qualitative research is to expand our understanding of vulnerable groups’ engagement with interventions used during extreme cold waves given the significantly higher frequency of health impacts compared to heat events.