Measuring What Matters: Using Participatory Choice Modelling to Understand Preferences for Homelessness Integrated...

Area of Science:

• Public Health
• Health Services Research
• Social Determinants of Health

Background:

• People with experience of homelessness (PEH) face complex, interconnected needs.
• Effective Out-of-Hospital Care (OOHC) requires understanding and integrating patient preferences.
• Existing services may not adequately align with the lived realities of PEH.

Purpose of the Study:

• To identify the key preferences of PEH regarding Out-of-Hospital Care (OOHC).
• To inform the co-design of OOHC services that better meet the needs of PEH.
• To improve service engagement and health outcomes for this population.

Main Methods:

• A mixed-methods approach combining interviews, group discussions, and a Discrete-Choice Experiment (DCE).
• Co-design of study materials and data collection by researchers with lived experience of homelessness.
• Analysis of preferences using logistic regression and presentation via interactive dashboards.

Main Results:

• 108 PEH participated, indicating a preference for home-based care delivered by trusted housing workers with minimal behavioural restrictions.
• Accommodation type and behavioural rules were significant factors influencing service uptake.
• PEH confirmed the DCE findings accurately reflected their priorities, leading to service model adjustments in one locality.

Conclusions:

• Co-designing OOHC services with PEH is essential for effective care.
• Stability, trust, and reduced restrictions are key facilitators for service engagement among PEH.
• Findings provide actionable insights for policymakers and service providers to develop person-centred OOHC models.