ORCID

Abstract

Introduction: People experiencing homelessness (PEH) face food insecurity, unstable housing and fragmented services that render conventional diabetes pathways unworkable and amplify complications. Methods: Between January and April 2024, we conducted a nationwide, cross-sectional mixed-methods survey of front-line professionals via NHS, inclusion-health and voluntary-sector networks, analysing quantitative data (n = 104) with ANOVA, Kruskal–Wallis tests and ordinal logistic regression, and subjecting free-text responses to reflexive thematic analysis, before converging findings to develop the Integrated Holistic Diabetes Care Model for Homelessness (IHD-CMPH). Results: Respondents comprised specialist diabetes clinicians (31%), homelessness/inclusion-health staff (38%) and VCSE providers (32%); median perceived Type 1 prevalence among PEH was 20% versus 8% nationally (p < 0.001). Fifty-seven per cent rated diabetes outcomes for PEH as poor or very poor, and 66% reported more frequent amputations and vision loss. Clear organisational policies (OR 1.62, 95% CI 1.06–2.48), cross-sector collaboration (OR 2.76, 1.20–6.36) and outreach-specific training (OR 2.50, 1.50–4.17) were independently associated with better outcomes. Thematic analysis highlighted service fragmentation, inflexible appointments and insufficient homelessness-specific education. Discussion: Diabetes inequities among PEH stem chiefly from modifiable structural failures rather than patient non-adherence. The novel IHD-CMPH, anchored in outreach and mobile screening, provides a scalable framework to operationalise inclusion-health policy, improve glycaemic surveillance and avert avoidable admissions; this first national study translating multi-sector front-line evidence into a coherent policy model offers concrete levers for health-system reform and equity advancement.

Publication Date

2025-10-13

Publication Title

Frontiers in Public Health

Volume

13

Acceptance Date

2025-09-29

Deposit Date

2025-10-29

Funding

The author(s) declare that financial support was received for the research and/or publication of this article. This work was supported by the Burdett Fund for Nurses grant number [Ref SB\ ZA\101010662\899626]. This survey was conducted as part of a 15-month quality improvement programme to foster collaboration among diabetes nurses, health nurses, and allied professionals. By facilitating the exchange of knowledge and frontline experiences, the programme sought to enhance care standards for homeless individuals with diabetes and inform integrated policy and practice reforms.

Keywords

ill-housed persons, Diabetes Mellitus, Healthcare Disparities, Patient Care Management, Health Services Accessibility, homelessness, Care Delivery

Creative Commons License

Creative Commons Attribution-NonCommercial 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

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Table_1.docx (33 kB)

Table_2.docx (53 kB)

Data_Sheet_1.pdf (100 kB)

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