PP70 Evaluation of user-perceived impact of edinburgh access practice keep well interventions on the health and wellbeing of gypsy/traveller and homeless service users: a mixed methods approach

Abstract

Background Gypsy/Travellers and homeless populations suffer from high levels of ill-health, but there is little evidence of successful preventative or treatment interventions for these groups. This study explores Gypsy/Traveller and homeless service users’ perceptions of the impact of an anticipatory care health intervention (‘Keep Well’), in which nurses and outreach workers provided a health check and support to address risk factors, particularly in relation to CVD. Service users were referred to the outreach workers for educational and motivational support, signposting/referral (to courses or services), or practical help (e.g. accompanying to appointments). Methods Gypsy/Traveller (n = 375) and homeless (n = 102) service users who accessed the service between 1 January 2010 and 20 June 2011 were compared using descriptive statistics of demographical and clinical data. Participants were recruited through Keep Well nurses and outreach workers. In-depth interviews were conducted with eight homeless and five Gypsy/Traveller service users, who were purposively sampled to generate maximally diverse samples in relation to age, sex and type of involvement in the project (e.g. number of contacts with nurse, whether they received support from the outreach workers). Interviews were transcribed and analysed using a Grounded Theory approach. Results Both Gypsy/Traveller and homeless service user groups were found to have substantial rates of ill-health, poor wellbeing and unhealthy behaviours. The groups differed on current smoking rates and average body mass indices but had similarly high levels of CVD risk (ASSIGN scores). Both groups felt a positive impact from the intervention but with emphasis on slightly differing elements. Gypsy/Travellers greatly valued the educative aspects of the service and receipt of diagnostic information, while homeless people benefitted from the support and the psychological “boost” they received from contact with the nurses and outreach workers. The relaxed, friendly, culturally sensitive and personal nature of Keep Well was instrumental in the successful engagement of these frequently unhealthy and challenging service users. Conclusion Based on the findings, we identify a need for specialist outreach services for these groups; highlight the value of practitioners’ cultural sensitivity and time spent building relationships; and recommend further research into the health profiles of, and effective interventions for, these groups.