TY - JOUR
AU - D. Oehring
AU - M. Paisi
AU - M. Nasser
AU - T. Jackson
AU - R. Young
AU - L. Wooff
AU - H. Partridge
AU - J. Conaty
AU - S. Dorney-Smith
A1 - 
AB - INTRODUCTION: People experiencing homelessness (PEH) face food insecurity, unstable housing and fragmented services that render conventional diabetes pathways unworkable and amplify complications. METHODS: Between January and April 2024, we conducted a nationwide, cross-sectional mixed-methods survey of front-line professionals via NHS, inclusion-health and voluntary-sector networks, analysing quantitative data (n = 104) with ANOVA, Kruskal-Wallis tests and ordinal logistic regression, and subjecting free-text responses to reflexive thematic analysis, before converging findings to develop the Integrated Holistic Diabetes Care Model for Homelessness (IHD-CMPH). RESULTS: Respondents comprised specialist diabetes clinicians (31%), homelessness/inclusion-health staff (38%) and VCSE providers (32%); median perceived Type 1 prevalence among PEH was 20% versus 8% nationally (p < 0.001). Fifty-seven per cent rated diabetes outcomes for PEH as poor or very poor, and 66% reported more frequent amputations and vision loss. Clear organisational policies (OR 1.62, 95% CI 1.06-2.48), cross-sector collaboration (OR 2.76, 1.20-6.36) and outreach-specific training (OR 2.50, 1.50-4.17) were independently associated with better outcomes. Thematic analysis highlighted service fragmentation, inflexible appointments and insufficient homelessness-specific education. DISCUSSION: Diabetes inequities among PEH stem chiefly from modifiable structural failures rather than patient non-adherence. The novel IHD-CMPH, anchored in outreach and mobile screening, provides a scalable framework to operationalise inclusion-health policy, improve glycaemic surveillance and avert avoidable admissions; this first national study translating multi-sector front-line evidence into a coherent policy model offers concrete levers for health-system reform and equity advancement.
AD - Faculty of Health, School of Health Professions, University of Plymouth, Plymouth, United Kingdom.; Faculty of Health, Peninsula Dental School, University of Plymouth, Plymouth, United Kingdom.; Pathway, London, United Kingdom.; Brownlow Health General Practice, Liverpool, United Kingdom.; Bolton Diabetes and Endocrine Service, Bolton Foundation Trust, Bolton, United Kingdom.; Bournemouth Diabetes and Endocrine Service, University Hospitals Dorset, Bournemouth, United Kingdom.
AN - 41158567
BT - Front Public Health
C5 - Healthcare Disparities; Education & Workforce
DO - 10.3389/fpubh.2025.1672014
DP - NLM
ET - 20251013
JF - Front Public Health
LA - eng
N2 - INTRODUCTION: People experiencing homelessness (PEH) face food insecurity, unstable housing and fragmented services that render conventional diabetes pathways unworkable and amplify complications. METHODS: Between January and April 2024, we conducted a nationwide, cross-sectional mixed-methods survey of front-line professionals via NHS, inclusion-health and voluntary-sector networks, analysing quantitative data (n = 104) with ANOVA, Kruskal-Wallis tests and ordinal logistic regression, and subjecting free-text responses to reflexive thematic analysis, before converging findings to develop the Integrated Holistic Diabetes Care Model for Homelessness (IHD-CMPH). RESULTS: Respondents comprised specialist diabetes clinicians (31%), homelessness/inclusion-health staff (38%) and VCSE providers (32%); median perceived Type 1 prevalence among PEH was 20% versus 8% nationally (p < 0.001). Fifty-seven per cent rated diabetes outcomes for PEH as poor or very poor, and 66% reported more frequent amputations and vision loss. Clear organisational policies (OR 1.62, 95% CI 1.06-2.48), cross-sector collaboration (OR 2.76, 1.20-6.36) and outreach-specific training (OR 2.50, 1.50-4.17) were independently associated with better outcomes. Thematic analysis highlighted service fragmentation, inflexible appointments and insufficient homelessness-specific education. DISCUSSION: Diabetes inequities among PEH stem chiefly from modifiable structural failures rather than patient non-adherence. The novel IHD-CMPH, anchored in outreach and mobile screening, provides a scalable framework to operationalise inclusion-health policy, improve glycaemic surveillance and avert avoidable admissions; this first national study translating multi-sector front-line evidence into a coherent policy model offers concrete levers for health-system reform and equity advancement.
PY - 2025
SN - 2296-2565
SP - 1672014
ST - Diabetes care for people experiencing homelessness in the UK: insights from a national survey of frontline professionals and the development of an integrated care model
T1 - Diabetes care for people experiencing homelessness in the UK: insights from a national survey of frontline professionals and the development of an integrated care model
T2 - Front Public Health
TI - Diabetes care for people experiencing homelessness in the UK: insights from a national survey of frontline professionals and the development of an integrated care model
U1 - Healthcare Disparities; Education & Workforce
U3 - 10.3389/fpubh.2025.1672014
VL - 13
VO - 2296-2565
Y1 - 2025
ER -