Background: People experiencing homelessness (PEH) have a higher prevalence of adverse health outcomes and premature mortality compared to the non-homeless population. These include a higher burden of cancer and cancer-specific morbidity and mortality—outcomes that may be a consequence of significant barriers to accessing primary and secondary prevention and community health services. This study aimed to better comprehend the health needs and barriers to accessing preventive cancer care for PEH across four European countries as well as necessary considerations for developing interventions around cancer prevention for this population. Methods: In this exploratory qualitative study, 69 semi-structured interviews were conducted across Austria, Greece, Spain, and the UK, with a sample comprising 15 professionals working in homelessness support services, 19 health professionals, and 35 PEH. Interviews took place between August 1 and October 31, 2021, and data were analysed inductively and iteratively following a thematic approach. Findings: Findings were organised into two overarching themes: (1) Experiences and understanding of cancer prevention and treatment and (2) Considerations for program interventions. While cancer was a significant worry among PEH across all settings, they generally had minimal knowledge and understanding of cancer symptoms and prevention. Specific programs for cancer prevention for PEH were described as almost non-existent. Health professionals in some settings indicated that cancer in PEH was often missed in the early stages and instead diagnosed when the severity of symptoms intensified. Interpretation: Overall, our findings indicate many commonalities in the health needs of PEH and the barriers they face when they seek access to cancer-specific healthcare services in the European context. Funding: This study received funding from the European Union’s Horizon 2020 Research and Innovation Programme under GA 965351.

Background People experiencing homelessness (PEH) have a higher prevalence of adverse health outcomes and premature mortality compared to the general population, including a higher burden of cancer and cancer-specific mortality (Thomas, 2012). These outcomes are associated with several etiological factors and may lead to significant barriers to accessing primary and secondary prevention and community health services. The CANCERLESS project (EU Horizon 2020) aims to enable PEH in Europe to access cancer prevention measures at an early stage by developing a novel care model, the Health Navigator Model (HNM). Implementing this co-designed person-centered and community-based intervention may be a way to address the growing health and social disparities in PEH and promote their timely access to cancer prevention services. Methods To qualitatively adapt the HNM to structural conditions in four European healthcare systems, we collected data through 69 semi-structured interviews between August and October 2021 with PEH, both with and without direct experiences of cancer, as well as with health and social care professionals. Interviews conducted by partners in Austria, Greece, Spain, and the United Kingdom were transcribed verbatim and thematically analyzed utilizing the approach set out by Saldaña (2021). Results We derived the two overarching themes (1) Experiences and understanding of cancer prevention and treatment, and (2) Considerations for program intervention. While cancer was a major source of worry, participants’ responses indicated that PEH generally had very limited knowledge and understanding of cancer symptoms and cancer prevention. Across all settings, programs and activities for cancer prevention geared towards PEH were described as effectively non-existent, and very few participants experiencing homelessness recalled being invited to a screening appointment. As a result, health and social care professionals in some settings indicated that cancer in people experiencing homelessness was often missed in the early stages, and instead only picked up when the severity of symptoms intensified. Conclusions As cancer-specific knowledge among PEH is limited, engagement on educational and awareness-building levels in this population is needed. To achieve this, communication around cancer should be multilingual, accessible, and simple, while medical staff should be trained to provide more inclusive health services (Hauff & Secor-Turner, 2014).

People experiencing homelessness (PEH) face a disproportionately high prevalence of adverse mental health outcomes compared with the non-homeless population and are known to utilize primary healthcare services less frequently while seeking help in emergency care facilities. Given that primary health services are more efficient and cost-saving, services with a focus on mental health that are co-designed with the participation of users can tackle this problem. Hence, we aimed to synthesize the current evidence of such interventions to assess and summarize the characteristics and effectiveness of co-designed primary mental healthcare services geared towards adult PEH. Out of a total of 10,428 identified records, four articles were found to be eligible to be included in this review. Our findings show that co-designed interventions positively impacted PEH’s mental health and housing situation or reduced hospital and emergency department admissions and increased primary care utilization. Therefore, co-designed mental health interventions appear a promising way of providing PEH with continued access to primary mental healthcare. However, as co-designed mental health interventions for PEH can improve overall mental health, quality of life, housing, and acute service utilization, more research is needed.