Accessing health and health behaviour interventions by people with severe and multiple disadvantage

Populations facing severe and multiple disadvantage (SMD) - co-occurring homelessness, substance misuse and offending, have high level of physical and mental ill-health. Poor oral health is one of the three common physical health problems among this population, and is closely linked with use of drugs, alcohol and smoking. However, little is known about pathways that improve access to health interventions for people living with SMD. This study examines organizational and individual factors that restrict access to health interventions and provides actionable suggestions for improving engagement of health services by people living with SMD. Between August 2021 and March 2022, interviews/focus group discussions were conducted with people experiencing SMD in Newcastle and with frontline staff, policy makers, and commissioners from London, Plymouth and Newcastle upon Tyne. Data were analysed iteratively using thematic analysis and were organized and coded using NVivo 1.6.1. 19 people with lived experience of SMD (age range: 27-65 years; 79% male) and 78 service providers (age range: 28-72 years; 37% male) were interviewed. The access to health interventions was reported to be affected by location, integration between services, use of technology, knowledge of services and inter-personal relationships. Furthermore, individual factors such as fear of seeking treatment, health behaviours and socio-economic disadvantage of the service user, and past experiences of treatment were common themes identified. People with SMD have complex health needs with co-occurring and linked conditions making usual pathway of care difficult to access. Reducing the number of appointments, sign posting services and coordinating with support workers may help alleviate the individual factors. Improving their health may require action across multiple domains to integrate care. Findings from our study could also be extrapolated to the planning and delivery of other health services for people with SMD.