Cardiovascular screening in homeless outreach: An operationally-ethical protocol

Area of Science:

• Public Health
• Cardiovascular Disease Research
• Health Equity

Background:

• Homeless populations face high cardiovascular disease (CVD) rates but are underrepresented in health screenings.
• Existing outreach methods lack standardized, ethical, and feasible physiological risk assessment tools.
• A gap exists between passive outreach and resource-intensive mobile clinics for homeless health screening.

Purpose of the Study:

• To develop and implement an ethical, field-based methodology for cardiovascular screening in homeless outreach programs.
• To prioritize participant safety, informed consent, and operational feasibility in a low-resource setting.
• To create a standardized and replicable framework for assessing CVD risk factors.

Main Methods:

• A cross-sectional quality improvement needs assessment was conducted in San Francisco homeless outreach missions.
• The framework included volunteer training, capacity screening, verbal consent, vital sign collection, and emergency protocols.
• Participants were unsheltered adults meeting decisional capacity criteria with voluntary informed consent.

Main Results:

• The framework achieved 100% fidelity in capacity and consent verification among 116 participants.
• Emergency protocols were activated for 9 acute events.
• Key findings included detection of hypertensive crisis (10.17%), nicotine use (15.38%), and diabetes (13.16%).

Conclusions:

• The developed framework is a replicable, ethically grounded model for CVD risk screening in homeless outreach.
• It demonstrated high fidelity in ethical procedures and identified significant physiological risks.
• The model offers scalable integration of evidence-based assessments into humanitarian fieldwork.