An Integrated Approach To Cardiovascular Disease In Homeless Individuals: A Qualitative Study

BackgroundHomelessness 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. ObjectivesTo understand and make recommendations to improve CVD care in homeless populations through those with lived experience and professional expertise. MethodFour 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. ParticipantsThe 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. ResultsParticipants 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. ConclusionsCVD 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.