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Lookup NU author(s): Neha JainORCiD, Emma AdamsORCiD, Dr Emma JoyesORCiD, Gillian McLellan, Martin Burrows, Dr Laura McGowanORCiD, Lorenzo Iafrate, David Landes, Professor Falko Sniehotta, Professor Eileen KanerORCiD, Professor Sheena Ramsay
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2024 Jain et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background: Severe and multiple disadvantage (SMD) is the combined effect of experiencing homelessness, substance use and repeat offending. People experiencing SMD have high burden of physical and mental health issues. Oral health is one of the most common health problems in people experiencing SMD which interacts with substance use, smoking, and unhealthy diet to create a cycle of harm and disadvantage. However, burden of these conditions is worsened by poor access to health services. This study aimed to identify pathways to improve engagement and access to health interventions, for oral health, substance and alcohol use, smoking and diet. Methods: Using a qualitative methodology, interviews/focus groups were conducted with: (a) people experiencing SMD in Newcastle Upon Tyne/Gateshead; and (b) frontline staff, volunteer workers, policy makers and commissioners from London, Plymouth and Newcastle Upon Tyne/Gateshead. Data was analysed iteratively using thematic analysis. Results: Twenty-eight people experiencing SMD (age range: 27–65 years; 21% females) and 78 service providers (age range: 28–72 years, 63% females) were interviewed or included in focus groups. Data were organized into two overarching factors: barriers to accessing health interventions and improving access to health interventions. Barriers included: wider disadvantages of people experiencing SMD leading to low priority for support for oral health and associated health behaviours, psychosocial factors, waiting period and physical space. Factors that improved access to interventions included: positive relationships between service provider and person experiencing SMD, including a support worker, location of services and outreach services. Conclusions: The findings suggest the need for flexibility in offering services for oral health and related health behaviours for people experiencing SMD. Training health care providers and co-developing services with people with lived experience of SMD can help prevent (re)stigmatization. Systems-based approach to address factors on an environmental, organizational, inter-personal and individual level is needed. The results from this study could be extrapolated to other health intervention such as vaccinations and sexual and reproductive health.
Author(s): Jain N, Adams EA, Joyes EC, McLellan G, Burrows M, Paisi M, McGowan LJ, Iafrate L, Landes D, Watt R, Sniehotta FF, Kaner E, Ramsay SE
Publication type: Article
Publication status: Published
Journal: PLoS ONE
Year: 2024
Volume: 19
Issue: 12
Online publication date: 18/12/2024
Acceptance date: 21/11/2024
Date deposited: 07/01/2025
ISSN (electronic): 1932-6203
Publisher: Public Library of Science
URL: https://doi.org/10.1371/journal.pone.0315254
DOI: 10.1371/journal.pone.0315254
Data Access Statement: The data generated and/or analyzed during the current study are not publicly available due to the highly sensitive nature of the data and to protect participant’s confidentiality as they could contain potentially identifiable information. Data collected from interviews with people experiencing severe and multiple disadvantage (SMD) contains sensitive information, and while the transcripts are anonymized, when put together with other information the data can become identifying. Summaries are available from the corresponding author on reasonable request. Requests for data can be sent to the Newcastle University Faculty of Medical Sciences Institutional Review Board at fmsethics@newcastle.ac.uk
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