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.
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.
Alec is a health economist. His main research interests are in assessing the cost-effectiveness of HIV / hepatitis C & B / STIs treatments, methods of case finding and prevention, mainly from a high-income perspective. He is also interested in patient preferences regarding HIV service configurations and is a member of the NIHR's Health Protection Research Unit in Blood Borne Viruses and STIs. Alec will lead the cost-consequence analysis and supervise the costing data collection.
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
Senior Research Fellow - Kings College London
Pathway and Faculty of Homeless and Inclusion Health
Check this page at a later date for publications
Check this page at a later date.