Differences in health status, health behaviour and healthcare utilisation between Immigrant and native homeless people in Spain: An exploratory study

Strategies for improving access to primary care services for homeless immigrants in England: a Delphi study

AIM

The aim of the study was to identify the most prioritized strategies in improving access to primary care services (PCS) for homeless immigrants.

BACKGROUND

The issue of improving access to PCS for homeless immigrants is a complex and multifaceted one, and yet there is limited research on the strategies aimed at improving these services. Hence, the need for more studies that directly engage homeless immigrants and service providers in understanding their barriers to accessing PCS and their preferences for improving access to these services.

METHODS

The study used a two round Delphi method to elicit the views of stakeholders. The Delphi process utilized a web-based questionnaire. The stakeholders included healthcare providers and voluntary sector providers. The first round had a total of 58 items belonging to 14 categories. The second round comprised a total of 25 items belonging to 12 categories which were preselected based on participants' ranking of their importance in the first round. Participants were required to rank the relative importance of all the items on a 5-point Likert scale. Data were analysed using the STATA-15 software package.

FINDINGS

A total of 12 stakeholders participated in both rounds of the Delphi survey. The top three strategies encompassed fighting against discrimination and prejudice, improving and promoting mental health services, and empowering homeless immigrants. These evidence-based strategies hold the potential to support the implementation of healthcare interventions aimed at improving access to PCS and healthcare outcomes for homeless immigrants. However, it is crucial to conduct further research that includes homeless immigrants in the Delphi study to gain insights into the strategies that are most important to them in enhancing access to PCS, as they are the primary target users. Such research will contribute to the development of comprehensive and effective interventions tailored to the specific needs of homeless.

Barriers and facilitators to health care access for people experiencing homelessness in four European countries: an exploratory qualitative study

BACKGROUND

People experiencing homelessness (PEH) are known to be at higher risk of adverse health outcomes and premature mortality when compared to the housed population and often face significant barriers when attempting to access health services. This study aimed to better understand the specific health care needs of PEH and the barriers and facilitators associated with their timely and equitable access to health services in the European context.

METHODS

We conducted an exploratory cross-national qualitative study involving people with lived experience of homelessness and health and social care professionals in Austria, Greece, Spain, and the UK. A total of 69 semi-structured interviews comprising 15 social care professionals, 19 health care professionals, and 35 PEH were completed, transcribed, and analysed thematically.

RESULTS

Findings were organised into three overarching themes relating to the research question: (a) Health care needs of PEH, (b) Barriers to health care access, and (c) Facilitators to health care access. Overall, the general health of PEH was depicted as extremely poor, and mainstream health services were portrayed as ill-equipped to respond to the needs of this population. Adopting tailored approaches to care, especially involving trusted professionals in the delivery of care, was identified as a key strategy for overcoming existing barriers.

CONCLUSIONS

The results of this study indicate there to be a high degree of consistency in the health care needs of PEH and the barriers and facilitators associated with their access to health care across the various European settings. Homelessness in itself is recognized to represent an essential social determinant of health, with PEH at risk of unequal access to health services. Changes are thus required to facilitate PEH's access to mainstream primary care. This can also be further complemented by investment in 'in-reach' services and other tailored and person-centred forms of health care.

TRIAL REGISTRATION

This study was registered retrospectively on June 6, 2022, in the registry of ClinicalTrials.gov under the number NCT05406687.

Differences in Drug Use among Persons Experiencing Homelessness According to Gender and Nationality

The main aims of this article are to update the data related to drug and alcohol use in persons experiencing homelessness (PEH) who use shelters, and to see if there are significant differences in their drug use depending on their gender and nationality. The article presents an analysis of the interconnections between the results of drug dependence detection tools (Alcohol Use Disorders Identification Test (AUDIT), Drug Abuse Screening Test (DAST-10), Severity of Dependence Scale (SDS)) according to gender and nationality with the intention of identifying specific needs that lead to new lines of research into better approaches to homelessness. A cross-sectional, observational and analytical method was used to analyse the experiences of persons experiencing homelessness who use various shelters in the cities of Madrid, Girona, and Guadalajara (Spain). The results show that there are no gender differences in the risks of using drugs and drug addiction, but there are differences in terms of nationality for drug addiction, with Spanish nationals showing a greater tendency to develop drug addiction. These findings have significant implications, as they highlight socio-cultural and socio-educational influence as risk factors in drug addiction behaviours.

The Association of Interpersonal Relationships and Social Services with the Self-Rated Health of Spanish Homelessness

Understanding the specific factors associated with poor health is critical to improve the health of homeless people. This study aimed to analyze the influence of personal variables, interpersonal relationships, and the influence of social services on the health of homeless people. A secondary analysis was applied to cross-sectional data from a sample of 1382 homeless people living in the Basque Country (Spain) (75.69% male). Multinomial logistic regression modelling was used to analyze the relationship between health and personal variables, interpersonal variables, perceived help and use of the social services. Relationships with the family, using a day center, and a sufficient and high perceived help of the social services were significant factors associated with good health. On the other hand, spending the day alone or using mental and health care services are associated with poor health. In the same way, the longer a person has been homeless, the worse their expected state of health is. Addressing housing exclusion, promoting interpersonal relationships, using a day center, and developing the use and perceived helpfulness of social services stand out as key factors in improving health status. Social policies are usually focused on housing. However, this paper also highlights the relevance of developing interpersonal relationships and using day centers to improve homeless people’s health.