eHealthism in inclusion health: a qualitative longitudinal study with women experiencing homelessness

While inclusion health approaches are increasingly recognised in research, policy, and practice as essential to addressing health inequities and social exclusion, there is limited understanding of how women experiencing homelessness engage with digital health. This represents a salient knowledge gap, given the growing interest in digital health to improve access, flexibility, and patient empowerment for marginalised populations. This study aimed to explore: (1) how women experiencing homelessness access and use digital technologies to support their health and wellbeing in everyday life; and (2) how their engagement with digital health is shaped by, and shapes, their interactions with health and social care systems, as well as with third-sector organisations.

This qualitative longitudinal study gathered data through narrative interviews and participant observations with nine women experiencing homelessness in London, England. Data were analysed using a three-phase phenomenological-hermeneutic approach inspired by Ricoeur's narrative and interpretation theory. Women with lived experience of homelessness contributed to the study design and recruitment processes, co-produced study materials, supported the analysis and interpretation of findings, and co-produced recommendations.

Using eHealthism as an interpretive lens, our analysis identified three themes: (1) Taking care of my health on my own terms - with or without digital tools; (2) When digital tools are not enough - I still need support; and (3) Digital health can work - but it's not the same as seeing someone face-to-face.

Based on the findings, we propose a three-layer conceptual framework of exclusion mechanisms in eHealthism, along with corresponding recommendations for inclusion health. Together the individual, relational, and contextual layers of exclusion mechanisms challenge assumptions of individual responsibility and universal digital empowerment, highlighting the need for meaningful choice in hybrid care and for ongoing, trauma‑informed relational support. Addressing these complexities is essential for developing inclusive digital health strategies that advance health equity for women experiencing homelessness and other groups at risk of social exclusion.