Improving access to healthcare services for people experiencing homelessness: evidence from a scoping review of...

People experiencing homelessness display substantial health inequalities when compared to the housed population. Existing studies on access tend to focus on isolated initiatives within specific geographic contexts, often lacking in comparative analyses. The research aims to address this gap, answering to the question "which types of interventions support access to care for people experiencing homelessness?" and thus providing evidence on the types of interventions that foster access to healthcare services for people experiencing homelessness.

We performed a scoping review of scientific literature published between 2000 and 2023. Included studies focused on interventions improving access to care services for people experiencing homelessness. Qualitative and quantitative data were extracted, and findings were synthesised and assessed against the Levesque framework of access to care.

Forty-eight studies were included. Healthcare services varied from primary care to outpatient, mental health, prevention, emergency and hospital-based care. Four main types of interventions were determined, answering various access needs. Outreach and community-based interventions were found to ensure available and acceptable responses for people experiencing homelessness; case management and peer support were considered relevant for navigation across and towards services; service integration and coordination efforts were deemed as essential in offering complete responses for multifaceted and complex needs; and digital healthcare interventions proved to make health information more reachable.

This paper sheds light on the inner complexity of this target population and informs about valuable strategies and approaches that can be pursued when designing and implementing interventions to improve people experiencing homelessness access to care.