Feasibility and implementation insights from implementing the health navigator model for cancer prevention among people experiencing homelessness across Europe.

Abstract

Cancer-related mortality among People Experiencing Homelessness (PEH) is twice as high as in the housed population, with one-third of deaths in this community linked to conditions preventable through timely healthcare. The Health Navigator Model (HNM) is a person-centred approach to improve healthcare access for PEH. This study assessed the feasibility of implementing the HNM across four European countries. A non-randomised, single-arm pilot study was conducted from June 2022 to December 2023 in Austria, Spain, Greece, and the UK. Trained Health Navigators supported adult PEH-excluding those with cancer diagnoses or cognitive impairments-through tailored guidance, education, and referrals. Feasibility indicators (demographics, recruitment, retention, engagement) were collected at baseline and follow-up points. Health Navigators' experiences were explored via qualitative interviews. Out of 1981 individuals approached, 652 PEH participated. The average age was 47.4 years; 64.1% were male, 41.6% relied on state benefits and 62.4% had experienced homelessness for over a year. Nineteen Health Navigators (mean age 34.95 years) were involved. Engagement included cancer education (N = 494), health consultations (N = 286), specialist referrals (N = 212), and screening tests (N = 169). Follow-up rates were 69% at the first time point and 42.5% at the second. Low cancer awareness, prioritisation of subsistence needs over health, and system-level barriers were identified as challenges, while building trust with individuals and stakeholders emerged as facilitators. Health Navigators reported increased empathy, awareness of PEH's needs, and confidence in empowering them as key benefits of their role. Training skilled Health Navigators, building trust and fostering strong inter-organisational collaborations are key to successfully implementing the HNM among PEH.