Healthcare access and perceived value of liver screening among people experiencing homelessness and substance use disorders: a qualitative study

BACKGROUND: People experiencing homelessness face multiple barriers to healthcare and are at increased risk of advanced liver disease, which often remains undiagnosed. This study explored the acceptability and perceived value of a novel liver screening pathway using Vibration Controlled Transient Elastography (VCTE), embedded within an assertive outreach drug and alcohol service. METHODS: Semi-structured interviews were conducted with service users experiencing homelessness (n = 12) post-VCTE. Questionnaires assessing substance use history, social networks, and readiness to change were used to characterise the participants. Qualitative data was analysed using thematic analysis. RESULTS: Participants’ scores indicated high levels of readiness to change and limited social networks. Three interrelated themes were identified in the semi-structured interviews. First, participants reported co-occurring vulnerabilities—including polysubstance use, housing precarity, and trauma—which, in combination with previous negative experiences and stigma, contributed to reduced engagement with conventional healthcare services. Second, the provision of VCTE within an assertive outreach drug and alcohol service was perceived as a more accessible and acceptable alternative to mainstream pathways. Third, the screening encounter was experienced as a reflective moment, with several participants describing increased awareness of liver health and, in some cases, enhanced motivation to modify risk behaviours. CONCLUSIONS: Liver screening embedded within an outreach-based drug and alcohol service was acceptable for users of those services and, for some, represented an opportunity for reflection and harm reduction. Findings support the integration of non-invasive liver screening into services for people experiencing homelessness to improve early detection and engagement with care.