People experiencing homelessness suffer extreme health inequalities. The average age of death is 47 years for people who are homeless and even lower for women (43 years), they are between 5-7 times more likely to die prematurely than the general population. People who are homeless are more vulnerable to tuberculosis, hepatitis C and HIV, injury and chronic physical and poor mental health that result from limited access to health care and harsh living conditions.
Access to health services is hindered by organisational challenges, fear of stigma and difficulties reconciling daily demands of being homeless with prioritising care. As a result, presentation at health care is delayed until it is urgent and use of accident and emergency services and hospitals is high; this represents potentially avoidable ill-health and distress, but also significant health system costs. The health care costs of people who are homeless are estimated to be 8 times higher than the general population.
Groundswell, a third sector organisation, have pioneered Homeless Health Peer Advocacy (HHPA) among homeless populations in London, a model that is being adopted by others.
Peer advocates who themselves have experience of homelessness provide one-to-one support to attend health care appointments. The availability of a trusted advocate, with similar experience, to guide health care encounters; overcome logistical, structural and psychosocial challenges; and enhance individual and community understanding could be an acceptable, effective and cost-efficient intervention.
This research led by the London School of Hygiene and Tropical Medicine in collaborate with Kings College, UCL and in collaboration with Groundswell will evaluate how and to what extent the intervention changes the way homeless populations use outpatient and emergency services and how it shapes other health and social outcomes (e.g. mental health, drug use and access to drug and alcohol or mental health services). Qualitative research methods (interviews and observation) will also be used to understand how peer advocacy works and on what health and social outcomes.
We will compare how engagement with peer advocates affects homeless peoples’ use of health services and their health through a survey of 600 people who are currently homeless, some who work with peer advocates and some who do not and linking individuals to routinely recorded electronic health records.
We will look at how much the intervention costs, and is cost saving, compared to no intervention in relation to increasing planned use of health services and decreasing use of emergency services and hospital care.
The research team has extensive multi-disciplinary experience of research with homeless and excluded populations. We will involve peers and the homeless in the study both as researchers and on the advisory group. The study will be overseen by an advisory group consisting of people with experience of homelessness, agencies providing specialist services for homeless populations, policy makers and researchers.
Findings will be disseminated at workshops for:
- community groups for people currently or previously homeless;
- policy makers and service providers; and
- agencies employing peer advocates to integrate findings into existing interventions
Kate joined Groundswell in October 2012 and has been working in volunteer management for the last fifteen years. Her first job was managing London Nightline where she was the only paid member of staff, working with 100 volunteers. Since then she has worked in a variety of different volunteer management roles including National Volunteer Manager at Terrence Higgins Trust and Information Officer at Volunteering England. She has also managed projects making volunteering more accessible; spearheading the campaign to allow volunteers on benefits to claim lunch expenses. Kate now oversees the Homeless Health Peer Advocacy (HHPA) service across London.
Martin oversees Groundswell’s Insight and Action work. He joined Groundswell in April 2014 so he could follow his passion for peer–research and participatory practice. Previously Martin has worked for various homelessness organisations, at home and abroad, including Crisis, Broadway, Homeless Link and Casa Ioana (Bucharest).
Mani joined Groundswell in August 2019 as HHPA Systems Manager. He has over 10 years’ experience working within the IT sector, where he has helped organisations leverage the power of technology to achieve business goals. He is coordinating the quantitative study’s intervention arm.
Oz is a Vaccination Coordination Administrator at Groundswell. He is mainly responsible for coordinating vaccination events for people experiencing homelessness and manages the distribution of “My Right to Healthcare Cards”. He has coordinated HHPA Peer Advocates and the clients to be recruited for HHPA Evaluation Survey Project.
Lucy is the project Principle Investigator. Lucy is a Public Health Epidemiologist with expertise in mixed-methods evaluations of complex interventions among excluded populations, particularly sex workers and people who inject drugs.
Sujit is an epidemiologist and statistician, with extensive experience working on research studies in low- and middle-income countries. He is coordinating the evaluation’s quantitative study.
Lead on economic evaluation
Rosa's training is in health economics and public health. Previously she worked at Oxford in the Department of Public Health and York Health Economics Consortium. She has specific expertise in modelling and economic evaluation and will lead the cost-consequence analysis and supervise the costing data collection.
Paniz is a research assistant on the project. She has a background in Global Health and Reproductive and Sexual Health Research. Her main role on the project is to set up site visits for data collection and to help conduct interviews with clients across different day-centres and hostels in London.
Andy is a qualitative social scientist working in health services research linked to broader questions of inequality and urban exclusion. He is leading the evaluation’s qualitative study.
PJ is a sociologist in health and social inequalities, with a professional background in both academia and the third sector. PJ is coordinating the evaluation’s qualitative arm.
Andrew is a Professor in Epidemiology and Inclusion Health and Director of the UCL Institute Epidemiology and Healthcare. He recently founded the Centre for Public Health Data Science to act as a focus for public health research utilising big data and health informatics technologies. He will advise on all aspects of the quantitative studies.
Serena is an HEE/NIHR Clinical Doctoral Research Fellow investigating hospital care in homeless populations. Her research aims to inform the development of best practice guidance for a public health preventative approach to homeless hospital care. She will advise on the data linkage and analysis.
Rob is a Wellcome Trust Intermediate Clinical Fellow and Public Health Specialist. Rob aims to make invisible populations visible by using data to understand the health needs of people experiencing homelessness, substance use, imprisonment or migration. The research group he leads in Public Health Data Science works towards this aim by using complex health data and digital interventions to equitably improve health. Rob leads the team which will link the evaluation’s quantitative data with NHS records.
Dr Al Story is the founder and Clinical Lead of the pan-London UCLH Find&Treat Service with a 20-year track record of translational research and health service innovation with excluded and marginalised populations. His research interests include serious public health infections, integrated outreach service models, point of care diagnostics, peer-led interventions, and using mobile digital technologies to promote engagement and treatment continuity. He is UCL Associate Professor of Inclusion Health and co-director of the UCL Collaborative Centre for Inclusion Health. He will advise on all aspects of the study and brings extensive expertise in working with populations experiencing homelessness.
Dee is a Public Health Data Analyst/Scientist. Her research interests are social inclusion, with particular focus on homelessness, sexual health, migrant health and infectious diseases. She is currently working on a number of projects which use complex datasets bought about through data linkage, in order to research health outcomes and interventions in these areas and their populations.
Groundswell Peer Advocate
Revive Dental Care
Kings Health Partners Pathway, UCL, Pathway
Associate Professor - LSHTM
London Borough of Tower Hamlets
Professor at the University of Exeter
University of Manchester/Independent statistician
Senior Research Fellow - Kings College London
Pathway and Faculty of Homeless and Inclusion Health
Heriot Watt University
PJ Annand, Lucy Platt, Sujit Rathod, Paniz Hosseini, Andrew Guise, 2022
Social Science and Medicine https://doi.org/10.1016/j.socscimed.2022.114770
Andrew Guise, 2022
The Big Issue
Andy Guise, Stan Burridge, P.J. Annand, Martin Burrows, Lucy Platt, Sujit D. Rathod, Paniz Hosseini, Michelle Cornes, 2022
Qualitative Research in Health https://doi.org/10.1016/j.ssmqr.2021.100038
Sujit D Rathod, Andrew Guise, P J Annand, Paniz Hosseini, Elizabeth Williamson, Alec Miners, Kate Bowgett, Martin Burrows, Robert W Aldridge, Serena Luchenski, Dee Menezes, Alistair Story, Andrew Hayward, Lucy Platt, 2021
BMJ Open doi: 10.1136/bmjopen-2021-050717
Lucy Platt, Sujit D Rathod, Paola Cinardo, Andrew Guise, Paniz Hosseini, P J Annand, Julian Surey, Martin Burrows, 2021
J Epidemiol Community Health doi: 10.1136/jech-2021-216889
Check this page at a later date.
Despite the challenges faced during the COVID-19 pandemic, we are proud to say that we have wrapped up our data collection and will be starting the analysis shortly. A big thank you to all the clients and sites which were involved with the recruitment and for all your ongoing support with the research.
We have some new publications related to the research - you can have a look on our publications page to view them
After a pause due to the ongoing COVID-19 pandemic, we are back with the hopes of recruiting clients across different day centres and hostels in London.
The safety of clients, staff and our colleagues will remain our priority and we will be following all COVID-19 safety measures.