We know people experiencing homelessness are disproportionately affected by physical health conditions.
The question is, "How can health providers such as members of PIF best support and reach people experiencing homelessness?".
While there's no clear-cut answer, this blog delves into how health providers can reflect on experiences and utilise them to develop content that is not only accessible but also relatable to those experiencing homelessness.
Understanding multiple disadvantage
One of the most important areas to consider is how to prevent individuals from having to meet specific criteria to access care.
This means moving away from rigid criteria-based access and toward meeting individuals where they are, tailoring care and resources to their unique needs.
This approach is especially important given many individuals experiencing homelessness face ‘multiple disadvantage’.
This term encompasses the often-overlooked myriad of challenges individuals facing homelessness endure, often in addition to physical health, and acknowledges the impact this has on their current circumstances.
Multiple disadvantage highlights the shortcomings of services, resources and systems that focus on singular issues or populations.
When services work towards meeting people’s needs but lack a comprehensive understanding of the barriers hindering their access to knowledge and care, they fall short.
When this happens, it can make accessing healthcare feel overwhelming, confusing, isolating, and difficult to manage independently.
The challenges of multiple disadvantage are often compounding. Where they intersect can include experiences of:
- Poverty
- Trauma
- Abuse and neglect
- Racism
- Homophobia
- Discrimination
- Marginalisation
- Low health literacy
- Digital exclusion
- Housing instability
- Mental health
- Substance use
- Domestic violence
- Homelessness
- Housing instability
- Language and communication needs
Navigating the challenges: considerations for reaching people experiencing homelessness
Understanding the diverse experiences within homelessness is crucial to creating effective and tailored resources.
Reflecting on these experiences highlights the importance of approaching health resources with empathy and sensitivity. Below are our top tips for building health resources.
1. Language matters: speak to what connects to people experiencing homelessness
The language we use is important and should consider the unique circumstances and challenges faced by people facing homelessness.
Conventional health literature often falls short, overlooking their needs, emphasising the need for tailored communication that truly connects with individuals.
Whether someone is dealing with the absence of support systems, navigating trauma, or confronting various facets of multiple disadvantage, every aspect underscores the importance of crafting information that speaks directly to their experiences.
It's not just about what is said but how it connects with the lived realities of those facing homelessness – an approach that bridges the gap conventional resources tend to overlook.
Take diabetes resources as an example. Not everyone experiencing homelessness has the facilities to store medication or has the means to buy food best for their condition, relying on donations or food banks.
A simple adaptation in the language of a resource could be acknowledging this can be confusing or challenging to navigate when housing is unstable and offering non-judgemental advice on how people can work with within their means or with what they have.
Key themes in this approach are:
People want to feel heard and understood: Incorporating trauma-informed language is crucial to feeling seen and destigmatising healthcare.
When developing resources, think about what that piece of information might mean for that individual who has faced various disadvantages. Speak in a language that feels comfortable, humanising and representative of people’s experiences and levels of understanding.
We find using street terminologies or every-day language rather than jargon or medical language can be a great way of allowing someone to feel seen. This approach actively works towards breaking down barriers and ensuring healthcare information is easily understood and relatable.
People want to understand and learn the necessary: Within the context of experiencing challenges and multiple disadvantage, time can be sensitive and individuals do not want to know information that is not relevant to their current situation. Communicating in a clear, simple language is important. It should also communicate important factors such as:
- Implications on health
- Accessibility and logistics. For example, state if a service is free or offer adaptations to make someone feel comfortable
- Next steps and actions
- Mitigating concerns and identifying support available
2. Consider different formats and presentation
Different formats of health information are important when supporting people with language and communication needs in the context of multiple disadvantage.
This is particularly relevant within an often-chaotic environment in hostels, rough sleeper hubs or day centres with other people who also have varied support needs.
Our aim is to integrate our own knowledge and guidance we offer during face-to-face interactions into written resources. Below are some examples of how this can be achieved:
- Space: When we are meeting to support people, especially within noisy hostels, we try to find a quiet as possible space, away from other distractions and interruptions.
- Within literature this can translate to adopting a clear, simple layout in a format tailored to the individual’s needs. An ideal approach is something tangible such as a paper they can take away but that can also be accessed online when needed. Think simple and not overwhelming.
- Focus: When meeting, we find choosing and focusing on one topic can help with an individual’s understanding of the topic and encourage more meaningful engagement with a plan. So, reducing small talk and bringing people back to the focus when the conversation strays off topic.
- Within your written resource do not overwhelm people with clinical language and try to cover all elements of a person's care or the health pathway for that need or condition. Focus on key elements that will relate to that person's need.
- Prompts, images, and reminders: During a support session, we bring people back to the focus by using visual aids and tangible resources they can take with them as a reminder of the ‘thing’ we are working on.
- Can your resource include images to relay the point again?
- Perhaps the format could be an info leaflet that turns into a poster if someone has a hostel room to stay in.
- Reflect and plan: The last thing we try to do within a session is really focus on what actions we are going to each take away and work on.
- Within the resource can you try to initiate this thought process with the person experiencing homelessness by providing top tips for taking actions or a clear diagram of the pathway they can access?
3. Capture voices and work with experts
People want to feel heard and seen within resources that are shared with them, and often people experiencing homelessness do not feel they are represented.
Capturing the voice of individuals and working in partnerships with experts is the key to creating tailored health information.
Take a health procedure as an example, literature could include peer experiences, advice on how to feel comfortable and prepared for the appointment and the benefits of attending. Other suggestions include:
Work with experts and embed real experiences: leaning on people with lived experience or experts within the field is a great way to pause, reflect and ensure resources are well considered and tailored to the needs of people experiencing homelessness.
We find working with key stakeholders such as people with lived experience, homeless charities and specialist healthcare professionals, social workers or support workers offer an invaluable insight into healthcare and conditions.
Embedding quotes and anecdotes of health conditions, services or procedures can destigmatise and mitigate an individual’s anxieties. Consider co-producing literature that is peer and expert-led and speaks to both experience and procedures.
4. Make resources practical and actionable:
Often the hardest part about addressing your health is taking that first step, particularly if you’ve tried many times before.
Making a health resource practical is largely about how it can inform and compel an individual to take matters into their own hands.
In an ideal world this would be in the context of regular input from homeless support services. However, where a person does not have that support, it is important to empower them with the tools and knowledge from resources to feel able and confident to take action.
It is hard when you feel like you have been disappointed by services in the past, so the resource needs to be transparent. Is it clear for the person:
- What do they need to do?
- What will services do for them?
Take sexual health screening resources as an example – in the context of multiple disadvantage the process brings up a range of emotions and practical concerns for people.
When outlining the various options, it's crucial to address the following considerations, allowing individuals to easily identify what aligns best with their needs whilst managing concerns that may come up:
- What if I want to complete the test at home?
- Can I access support in a clinical setting, and how can you ensure I won't face stigmatisation during my visit?
- How will I be supported throughout the process, considering my history of sexual trauma?
- What measures can be taken to feel comfort during the appointment?
- What outcomes do I hope to achieve, and can the service likely meet them during the appointment?
- Consider featuring a peer's account of the service's benefits to instil trust in the process.
- In the event of a positive result and lacking a place to stay, how will I be supported in terms of treatment?
- Lastly, if I encounter difficulties, is there a way to seek advice – perhaps through a helpline for questions or discussions about the process?
Empathy at the heart of health: our conclusions
In efforts to improve health outcomes for people experiencing homelessness, fostering empathy and understanding lies at the core.
By acknowledging the complexities of multiple disadvantage, we emphasise the need for tailored health content.
By embracing inclusive language and providing practical guidance, health resources can bridge the gap between conventional resources and the unique experiences of individuals facing homelessness.
It is not just about sharing information; it’s a commitment to connect with the lived experiences of those facing homelessness using empathy as a guiding compass towards health resources that resonates with the diverse narratives of those who are seldom heard.
Watch Taylor and Fiona's presentation at our Engaging with Seldom-Heard Groups webinar here.
Useful resources and recommended reading
The Unhealthy State of Homelessness 2022
The speech, language and communication needs of rough sleepers in London