AN INTEGRATED APPROACH TO CARDIOVASCULAR DISEASE IN HOMELESS INDIVIDUALS: A QUALITATIVE STUDY

Abstract

Background: Homelessness is associated with an increased risk of cardiovascular disease (CVD), beyond impact of socioeconomic status. CVD is preventable and treatable, with barriers to both for homeless people. Those with lived experience of homelessness and health professionals with relevant expertise can help to understand and address these barriers. Objectives: To understand and make recommendations to improve CVD care in homeless populations through those with lived experience and professional expertise. Method: Four focus groups were conducted in March-July 2019. Three groups included people currently or previously homeless, each attended by a cardiologist (AB), a health services researcher (PB) and an 'expert by experience' (SB) who coordinated participants. One group included multidisciplinary health and social care professionals in and around London to explore solutions. Participants: The three homeless groups included 16 men and 9 women, aged 20- 60 years, of whom 24 were homeless and currently living in hostels and 1 rough sleeper. At least 14 discussed sleeping rough at some point. Results: Participants were aware of CVD risks and relevance of healthy habits but identified barriers to prevention and health access, starting with disorientation affecting planning and self-care, lack of facilities for food, hygiene, and exercise, and experiences of discrimination. Conclusions: CVD care for those experiencing homelessness should account for fundamental problems of the environment, be co-designed with service users and cover key principles: flexibility, public and staff education, integration of support, and advocacy for health service rights.

Competing Interest Statement

AB is supported by research funding from NIHR, European Union (part of the BigData@Heart Consortium, funded by the Innovative Medicines Initiative-2 Joint Undertaking under grant agreement No. 116074), British Medical Association (TP Gunton award), AstraZeneca and UK Research and Innovation.

Funding Statement

The authors are funded by the National Institute of Health Research (NIHR RP DG 0117 10003). The funding source made no contribution to the design; collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study was fully approved by London Camberwell St Giles Research Ethics Committee (18/LO/2153) on 21/12/2018.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

Yes

Data Availability

Due to the nature of the research, supporting data is not available.

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