ORCID

Abstract

Background Severe and multiple disadvantage (SMD) is the combined effect of experiencing homelessness, substance use and repeat offending. People experiencing SMD have high burden of physical and mental health issues. Oral health is one of the most common health problems in people experiencing SMD which interacts with substance use, smoking, and unhealthy diet to create a cycle of harm and disadvantage. However, burden of these conditions is worsened by poor access to health services. This study aimed to identify pathways to improve engagement and access to health interventions, for oral health, substance and alcohol use, smoking and diet. Methods Using a qualitative methodology, interviews/focus groups were conducted with: (a) people experiencing SMD in Newcastle Upon Tyne/Gateshead; and (b) frontline staff, volunteer workers, policy makers and commissioners from London, Plymouth and Newcastle Upon Tyne/Gateshead. Data was analysed iteratively using thematic analysis. Results Twenty-eight people experiencing SMD (age range: 27–65 years; 21% females) and 78 service providers (age range: 28–72 years, 63% females) were interviewed or included in focus groups. Data were organized into two overarching factors: barriers to accessing health interventions and improving access to health interventions. Barriers included: wider disadvantages of people experiencing SMD leading to low priority for support for oral health and associated health behaviours, psychosocial factors, waiting period and physical space. Factors that improved access to interventions included: positive relationships between service provider and person experiencing SMD, including a support worker, location of services and outreach services. Conclusions The findings suggest the need for flexibility in offering services for oral health and related health behaviours for people experiencing SMD. Training health care providers and co-developing services with people with lived experience of SMD can help prevent (re)stigmatization. Systems-based approach to address factors on an environmental, organizational, inter-personal and individual level is needed. The results from this study could be extrapolated to other health intervention such as vaccinations and sexual and reproductive health.

Publication Date

2024-12-18

Publication Title

PLoS ONE

Volume

19

Issue

12

ISSN

1932-6203

Acceptance Date

2024-11-21

Deposit Date

2026-02-06

Funding

This research is supported by the National Institute of Health and Care Research (NIHR) Policy Research Programme (NIHR200415). EAA was supported by the NIHR School for Public Health Research (SPHR) Pre-doctoral Fellowship, Grant Reference Number PD-SPH-2015 and the NIHR Applied Research Collaboration (ARC) North East and North Cumbria (NENC) (NIHR200173). Now, EAA (Doctoral Research Fellow, NU-010978) is funded by the NIHR for this research project. EK is supported by an NIHR Senior Investigator award and directs the NIHR funded Applied Research Collaboration North East and North Cumbria. SER, EK, EAA, LJM, NJ are members of Fuse, The Centre for Translational Research in Public Health (www.fuse.ac.uk) and NIHR Applied Research Collaboration North East North Cumbria. Fuse is a UK Clinical Research Collaboration (UKCRC) Public Health Research Centre of Excellence. Funding for Fuse from the British Heart Foundation, Cancer Research UK, National Institute of Health Research, Economic and Social Research Council, Medical Research Council, Health and Social Care Research and Development Office, Northern Ireland, National Institute for Social Care and Health Research (Welsh Assembly Government) and the Wellcome Trust, under the auspices of the UKCRC, is gratefully acknowledged. FFS and EK are Senior Investigators in the NIHR Policy Research Unit in Behavioural Science. EK is supported by a NIHR Senior Investigator Award. The views expressed are those of the author(s) and not necessarily those of NIHR, NHS or the Department of Health & Social Care. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.

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