Trust Relationships Research Articles

Beyond Hemoglobin A1c—Outcomes That Matter to Individuals With Type 1 Diabetes in Adopting Digital Health Interventions for Self-Management Support: Qualitative Study

Background Type 1 diabetes is a demanding chronic condition that requires diligent blood glucose monitoring and timely insulin administration by patients who must integrate self-management into their daily lives. Objective This study aimed to better understand what outcome measures are important to individuals living with type 1 diabetes (T1D) in Ontario, Canada, to help inform the development of type 1 diabetes virtual self-management Education and support (T1ME) trial. Methods A qualitative approach was used, in which we conducted 6 focus groups with a total of 24 adult participants living with T1D (from age 18 to >65 years) in Ontario. Each focus group was semistructured in nature; participants were encouraged to talk openly about their experiences with T1D self-management and provide their perspectives on more focused topics such as technology and relationships with health care providers. Results An interpretive analysis helped us devise a framework for our results that centered around 6 main discussion themes: (1) adapting self-management to meet evolving needs, (2) looking “beyond A1c” toward more personalized indicators of glycemic management, (3) the benefits and challenges of adopting new T1D technology, (4) establishing trusting relationships with diabetes care providers, (5) perceived benefits of peer support, and (6) pre– and post–COVID-19 perspectives on virtual care. Conclusions Our goal is for these findings to help facilitate the development of patient-oriented outcome measures that are in line with the unique needs and preferences of T1D patients in this new, more virtual landscape of clinical care, education, and self-management support.

Opportunities of integrated care to improve equity for adults with complex needs: a qualitative study of case management in primary care.

People living in precarious socio-economic conditions are at greater risk of developing mental and physical health disorders, and of having complex needs. This places them at risk of health inequity. Addressing social determinants of health (SDH) can contribute to reducing this inequity. Case management in primary care is an integrated care approach which could be an opportunity to better address SDH. The aim of this study is to better understand how case management in primary care may address the SDH of people with complex needs. A case management program (CMP) for people with complex needs was implemented in four urban primary care clinics. A qualitative study was conducted with semi-structured interviews and a focus group with key informants (n = 24). An inductive thematic analysis was carried out to identify emerging themes. Primary care case managers were well-positioned to provide a holistic evaluation of the person's situation, to develop trust with them, and to act as their advocates. These actions helped case managers to better address individuals' unmet social needs (e.g., poor housing, social isolation, difficulty affording transportation, food, medication, etc.). Creating partnerships with the community (e.g., streetworkers) improved the capacity in assisting people with housing relocation, access to transportation, and access to care. Assuming people provide their consent, involving a significant relative or member of their community in an individualized services plan could support people in addressing their social needs. Case management in primary care may better address SDH and improve health equity by developing a trusting relationship with people with complex needs, improving interdisciplinary and intersectoral collaboration and social support. Future research should explore ways to enhance partnerships between primary care and community organizations.

Making a human's trust repair for an agent in a series of tasks through the agent's empathic behavior

As AI technology develops, trust in agents (including robot, AI and anthropomorphic agent) is becoming more important for more AI applications in human society. Possible ways to improve the trust relationship include empathy, success-failure series, and capability (performance). Appropriate trust is less likely to cause deviations between actual and ideal performance. In this study, we focus on the agent's empathic behavior and success-failure series to increase trust in agents. We experimentally examine the effect of empathic behavior from agent to person on changes in trust over time. The experiment was conducted with a two-factor mixed design: empathic behavior (available, not available) and success-failure series (phase 1 to phase 5). An analysis of variance (ANOVA) was conducted using data from 200 participants. The results showed an interaction between the empathic behavior factor and the success-failure series factor, with trust in the agent repairing when empathic behavior was present. This result supports our hypothesis. This study shows that designing agents to be empathic behavior is an important factor for trust and helps humans build appropriate trust relationships with agents.

A Preliminary Study of the Relevance of Zhu You Shu and Narrative Medicine

Abstract Zhu You Shu (祝由术 a form of traditional Chinese spiritual healing) originated in ancient times and was extensively utilized in China. This paper illustrates the origin, concept and techniques of Zhu You Shu in traditional Chinese medicine (TCM) and explores the correlation between Zhu You Shu and the three focuses and three elements of narrative medicine. The elements of Zhu You Shu, such as Zhu Shuo Bing You (祝说病由 explanation the original cause of the disease) and Qing Zhi Xiang Sheng (情志相胜 generation and restraint of emotions) share fundamental similarities with narrative medicine. Based on the principles of Zhu You Shu and narrative medicine, the doctor engages in active listening and communication with the patient to establish a trusting relationship. Utilizing the Qing Zhi Xiang Sheng technique, the doctor seeks to understand and regulate the patient's psychological processes. By integrating psychological cues, the aim is to restore emotional balance and enhance the patient's emotional and mental well-being while fostering a lasting emotional bond and providing spiritual support. Zhu You Shu has the potential to enhance the clinical pathway of narrative medicine in TCM. Simultaneously, the progress of narrative medicine will offer more sophisticated contemporary medical theories to assist the advancement of Zhu You Shu.

Attitudes towards geroprotection: measuring willingness, from lifestyle changes to drug use

IntroductionGeroprotection is an emerging field of research focused on devising strategies for combating the mechanisms of ageing. This study held three aims: 1) to explore the willingness to utilise five different geroprotective measures (i.e., exercise, supplements, intermittent fasting, metformin, and rapamycin use), 2) to explore whether the willingness differs based on respondents’ sociodemographic characteristics and 3) to explore the association between trust in medical institutions and willingness to utilise different geroprotective measures.MethodsA questionnaire was used to assess the attitudes of a sample of the Dutch population by way of both convenience and snowball sampling (final N = 178). Descriptive data and bivariate correlations were used in the analyses.ResultsRelatively high social acceptance of both exercise (66%) and supplements (82%) was found, whereas intermittent fasting (30%), metformin (26%), and rapamycin (10%) were less supported. Males were significantly more likely to be open to exercise and women to supplement use. Trust in medical institutions correlated significantly with the willingness to start metformin.DiscussionExploratory research can only provide a first step in understanding the social acceptance of geroprotection measures. Nevertheless, this study clearly illustrates more well-known measures promoted by public health policy are also more accepted and used. Public health campaigns could consider the sex differences in the uptake of exercise and supplements, and future research may want to delve deeper into the role of facilitating trust relations between medical institutions and the public in promoting the use of geroprotective drugs.

Cultural Censorship and Institutional Trust in Africa

What are the consequences of cultural censorship on trust? Previous literature on institutional and political trust informs this article which extends the work to consider the importance of artistic spaces for shaping political attitudes. These spaces may allow individuals to form trust relationships with each other. The importance of these cultural spaces is highlighted when, in both democracies and autocracies, we observed cultural censorship. While the rationale for censorship may differ across regime types, some of the effects look strikingly similar. Using survey data from the Afrobarometer and measures of censorship from Varieties of Democracy, this article suggests that trust in executive and legislative institutions among regime supporters is increased, when autocracies engage in cultural censorship. Additionally, this article argues that trust in the ruling party increases and trust in the opposition party decreases with more cultural censorship in both autocracies and democracies. Taken together this descriptive initial test of the theory, consistent with the theory presented, offers additional insights about how authoritarian regimes might use cultural censorship to maintain system support, but also suggest reasons why even democratic regimes can be motivated to engage in censorship for political gain.

Trust and Organizational Commitment in a Postpandemic Environment.

This study aimed to evaluate nurses' trust in their leader and organizational commitment, examining the relationship between these factors postpandemic and investigating if age, tenure, and specialty area predicted trust and commitment. The nursing shortage was intensified by COVID-19. Nonnursing studies have explored the relationship of employee trust with organizational commitment, illustrating sparsity in nursing literature. This study used a cross-sectional, descriptive, correlational design. An electronic survey was sent to more than 1000 nurses, with a final sample size of 135 over 6 weeks. Results demonstrated high levels of both trust and commitment. The correlation coefficients of all study variables were significant (P < 0.001). Organizational tenure predicted employee trust. Developing leadership skills in building trust with the nursing team contributes to increased organizational commitment. Interventions such as leader development in establishing trust and building relationships with their team members may improve nurse retention and organizational commitment.

Cultural Differences: When Hospitals Own Practices

This article investigates the challenges faced by a respected hospital system after acquiring three medical practices. Despite financial stability, these practices struggled to adapt to hospital ownership, resulting in decreased performance, morale, and patient satisfaction. The core issue identified was a cultural clash between the hospital’s structured business model and the more flexible, informal management style of the practices. The article underscores the importance of understanding cultural differences and setting clear expectations in hospital-practice partnerships. By addressing these issues early, organizations can avoid frustration and build a cooperative, goal-oriented environment. The goal is to develop a trusting relationship between the hospital and its acquired practices, resulting in improved performance and satisfaction for all stakeholders.

REGULAÇÃO E PROTEÇÃO DE DADOS PESSOAIS NA INDÚSTRIA DE TELECOMUNICAÇÕES: A IMPLEMENTAÇÃO DA LEI GERAL DE PROTEÇÃO DE DADOS E A GESTÃO DA VIOLAÇÃO DE SIGILO

The present work aims to analyze Brazilian legislation aimed at protecting personal data and violations of these standards, especially in the telecommunications sector. For its idealization, consultations were carried out in articles, bibliographies, jurisprudence, legislation and informative websites based on a qualitative approach with a special focus on the analysis of the General Data Protection Law (LGPD) and the Marco Civil da Internet. The study examines how the sharing of personal data by mobile phone operators compromises consumer privacy, highlighting the responsibilities of companies and the consequences of data leaks. Despite efforts to adapt to standards, the confidentiality of personal data is constantly violated, as private telephone companies do not comply with legislative legalities to protect fundamental rights. This highlights the essential role of regulatory bodies, such as the National Telecommunications Agency (ANATEL), in ensuring data protection and building a relationship of trust between companies and consumers.

Instagram live-streamings: how does influencer–follower congruence affect Gen Z trust, attitudes and intentions?

Purpose Influencer marketing is nowadays an essential practice for companies wishing to establish a rapprochement with its customers and gain their trust. Building close relationships can be fulfilled through Instagram live-streamings. Drawing upon equilibrium theory and brand extension theory, this paper aims to determine the effect of influencer–follower congruence on trust, attitudes and intentions in Instagram live-streamings. Design/methodology/approach A survey was carried out on a sample of 330 Generation Z Instagram users exposed to a live-streaming of an influencer promoting a clothing brand on Instagram. A PLS analysis was performed to validate the proposed model. Findings Results revealed that influencer–follower congruence in a live-streaming promotes followers’ trust toward the brand. In addition, influencer reputation is found to reinforce this relationship. Moreover, results showed that brand trust mediates the effect of influencer–follower congruence on brand attitude. Besides, the latter turns out be a mediator of the relationship between brand trust and followers’ intentional reactions. Research limitations/implications The study has focused on one particular live-streaming as well as a particular influencer which reduces the generalizability of the results. Future research should therefore replicate the study with different stimuli. Furthermore, it would be interesting to manipulate influencer–follower congruence in an experiment to explore the effect of varying congruence levels on trust. Practical implications This paper highlights the importance of using live-streamings for brands, especially when Gen Z is targeted. This tool can be considered as very useful to establish a trust relationship with young consumers. Moreover, the study emphasizes on the importance of choosing influencers whose image is in line with that of their followers to establish close relationships with them and gain their trust. The findings also suggest that to further strengthen trust toward the influencer, the latter should benefit from a prior good reputation. Originality/value Despite abundance of research on communication strategies on Instagram, little has focused on live-streamings. Particularly, research on influencer–follower congruence is relatively rare. Thus, this study contributes to the understanding of the effects of influencer–follower congruence on followers of Instagram live-streamings and offers valuable theoretical and practical implications in this field.

Three-dimensional trust: disentangling trust relations in the context of converted asylum seekers

ABSTRACT Forced migration always involves dramatic life changes, but with converted asylum seekers, these changes become especially devastating. Conversion entails building relationships with local religious groups while former social ties usually get severed. Typically, forced migrants seek support from friends, family and relatives. For converted asylum seekers, these bases of security often turn into sources of psychological violence and threats. We examine how converted asylum seekers and members of the congregations they join experience and make sense of trust. We have interviewed representatives of both groups to understand the role of trust in their relationships and in relation to other actors involved in the asylum process. Methodologically, we test Frederiksen’s distinction between three dimensions of trust (relations, objects and situations) on an empirical case and develop this analytical tool further. The findings emphasize the complex and dynamic role that proximity, affects and temporality play in relation to trust. Theoretically, we offer a definition of trust that emphasizes affects and ascribed moral agency instead of belief in the good will of another toward oneself.

Co-producing evidence to inform universal health coverage implementation in Ireland: 2019-2024

Abstract Background In 2017, Ireland’s parliamentary health committee published a ten-year health reform plan, entitled Sláintecare, with the aim of delivering universal healthcare. Endorsed by government in 2018, progressing Sláintecare remains government policy in 2024. In 2019, Prof Burke was awarded public funding to co-produce knowledge for the design and implementation of the regions, a key aspect of Sláintecare. In 2020, with the arrival of COVID-19, regional reform was paused and the research pivoted to capture the learning from the COVID-19 health system response to inform Sláintecare. In 2022/3, the research returned to focus on the regions. Methods Foundations’ research resulted in 14 peer-reviewed publications between 2019 and 2023. These were mixed-methods using qualitative and quantitative data and analysis. Coproduction with health system leaders that were devising and implementing the regions and the COVID-19 health system response underpinned the research. Results There are 14 academic publications from the Foundations Research (2019-2023). At the core of co-production is trust and good working relationships. Co-producing research with senior policy makers and implementers has benefits and drawbacks. The benefits include access to resources and data and that the data and knowledge generated are more likely to be adopted. Drawbacks include control over areas researched, denial of access to data and lack of openness to research findings. Producing controversial findings, unpopular with government, minister or health system leaders can also lead to difficulties for the research team. Discussion/conclusions Details of the coproduction process with senior health system and policy leaders will be presented. It will detail specific examples of the research which were initiated by the health system and those that came from the academic research team. It will give examples of how the research influenced the policy making and implementation processes. Key messages • Co-producing research between academics and health system and policy leaders leads to better use of evidence. • Trust and good workign relationships are key to co-producing research that is used in policy making and implementation processes.

Public trust in national electronic health record systems: A scoping review of qualitative studies

Abstract Background Having public trust in national electronic health record systems (EHRs) is essential for the successful implementation of electronic health records within a country’s healthcare system. Without trust, people are less likely to consent to sharing their health data through an EHR and government stakeholders will have difficulties promoting uptake and facilitation of EHRs. Research investigating public trust in EHRs is limited, however. In response, we conducted a scoping review in order to gain clarity on the influences and themes behind public trust in EHRs, which can support the implementation of EHRs. Methods We reviewed 27 qualitative studies focusing on public trust in EHRs. Studies were identified between January 2022 and June 2022 and were ascertained using an inclusive search method and guided by the PRISMA-ScR checklist. In an iterative process, conceptual themes were derived, and detail the promoters and outcomes of public trust in EHRs. Results Three major themes that describe the promoters of public trust in EHRs and two major themes that detail the outcomes once public trust in EHRs exists were ascertained from the literature. Additional findings bring forth the consequential role of healthcare actors in the public trust building process. Conclusions Results show comprehension, autonomy, and data protection are key concepts that help build and consolidate public trust in EHRs, while the public and the healthcare system benefit from public trust in EHRs. Furthermore, health system actors can be supportive or detrimental to the implementation of EHRs. Their effect is dependent on their activities within the health care system and how the public perceives those activities. Based on: Papadopoulos K, von Wyl V, Gille F. What is public trust in national electronic health record systems? A scoping review of qualitative research studies from 1995 to 2021. DIGITAL HEALTH. 2024;10. doi:10.1177/20552076241228024 Key messages • This research clarifies the conceptualizations that make up the trust relationship between the public and EHRs. • The findings can assist researchers, policymakers, and other health system actors in attaining a better understanding of the intricacies of public trust in EHRs.

Patients’ trust in health information sources as an antecedent of novel healthcare technology usage

Abstract Background As professional health information sources, healthcare maintenance organizations (HMOs) need to convince patients of the necessity, efficiency, and reliability of technology-based services to increase and optimize their usage. It raises the question of whether patients’ trust in health information sources shapes the use of technology-based services and, in return, increases their willingness to use novel healthcare services in the future. Methods Data were collected through an online close-ended survey among 668 adult Israeli citizens insured with Israeli health insurance (85% of them Jewish, 52.5% female, and in their early 40s, with half holding an academic degree). The survey explored actual use and willingness to use innovative healthcare technologies and the trust respondents attributed to various sources of health information. Data were analyzed by SPSS 28. Results Participants generally use healthcare technology primarily to schedule appointments, search for medical information, and make health-related requests. To quite an extent, they are willing to be treated with innovative healthcare technologies (e.g., for radiological purposes and personally tailored medication). Preliminary results suggest that trust in the measured formal health information sources (i.e., formal health providers, HMO, HMO online services) was positively associated with technology-based healthcare services usage (r=.14 - .20, p&amp;lt;.001). A positive association also emerged between the current use of healthcare technology and the willingness to use innovative medical technologies in the future (r=.23, p&amp;lt;.001). Conclusions HMOs, as key players, have the power to maximize the usage of advanced health services by establishing trusting relationships with their patients. This will increase the usage of healthcare technology-based services and generate positive patient experiences, which will result in the willingness to experience novel types of health services in the future. Key messages • Encouraging patients to use technology-based health services will maximize the potential inherent in the use of innovative health services and treatments in the future. • Nurturing trusting relationships with patients at any level in the health system will increase their compliance with health providers’ recommendations to use advanced health services.

Strengthening the quality of primary healthcare services and interdisciplinary collaboration

Abstract Background Political organisations stress the need for preventive strategies to reduce the amount of avoidable hospital admissions, i.e. admissions that could have been avoided given timely and adequate care in the primary healthcare setting. Interdisciplinary collaboration has been suggested as a means to prevent hospitalizations, but effective implementation remains a challenge. Thus, there is a need for evidence-based strategies to prevent avoidable admissions and support interdisciplinary collaboration. The aim was to develop an evidence-based framework for preventive and coordinated interventions strengthening the quality of primary healthcare services and supporting interdisciplinary collaboration. Methods The project consists of three sub-studies: 1) a mixed methods systematic review following the JBI methodology; 2) a focus group study with primary healthcare providers in the Central Denmark Region, including general practitioners, physiotherapists, occupational therapists, home care providers, registered nurses and nurse specialists; and 3) a study using participatory design, where a framework for coordinated interventions were developed based on the results from study 1 and 2, supported by all stakeholders. Results Findings suggest that some hospitalizations can be prevented by intervening on mental factors, e.g., through trustful relations, and social factors, e.g., living situation. Also, a strong collaboration between healthcare providers from different disciplines and healthcare services is needed to improve the care pathway and prevent hospitalization. The collaboration may be strengthened if the health providers share a common language regarding the citizens’ health status. Conclusions Stakeholders at all levels should be informed about the relevance of considering mental, social and physical factors to improve the quality and responsiveness of primary healthcare services and to develop initiatives to support interdisciplinary collaboration. Key messages • By focusing on the whole person, it could be possible to provide more person-centred care through interdisciplinary collaboration and ultimately to prevent some admissions. • Well-established primary healthcare services are important to provide person-centred care through interdisciplinary collaboration.

Research-Based Practices to Engage Youth in a Vibrant Catholic Church: The Case for Implementing Sacred Listening Practices

This article explores the theological and practical implications of Sacred Listening, a concept developed in response to the Synod on Synodality initiated by Pope Francis. The Synod emphasizes the church’s call to a more relational and participatory ecclesial life, rooted in listening, dialogue, and accompaniment. Sacred Listening is proposed as a theologically grounded practice designed to rebuild trust and foster deeper connections within the faith community, particularly in a low-trust environment. Drawing on the theological principles of Imago Dei, as well as contemporary social science research, the article presents Sacred Listening as a means to move beyond traditional modes of institutional authority toward relational trust and authentic engagement. The article further introduces practical tools that operationalize these principles, providing concrete strategies for religious leaders to engage with their communities more effectively. This work contributes to the ongoing theological discourse on synodality and offers a framework for creating a more inclusive and responsive church in today’s complex social landscape.

Co-designed study with the Traveller Community in Ireland to determine cancer awareness &amp; attitudes

Abstract Background Irish Travellers are a distinct ethnic minority group (formal recognition March 2017). They experience higher mortality than the general population at all ages for all causes of death. Study Aim To determine cancer awareness and attitudes among the Traveller Community in Ireland, and to identify barriers/enablers to cancer risk reduction behaviours and early diagnosis of cancer. Methods A co-designed multi-method study was developed in collaboration with Pavee Point, a national NGO for Travellers, the National Social Inclusion Office (NSIO) and the National Cancer Control Programme (NCCP) including: 1. Consultation with Pavee Point and NSIO representatives to inform the study proposal and methodology. 2. Co-design of methodology for ethics applications and subsequent data collection plan including interview topic guides and the development of a culturally appropriate version of the NCCP’s 2022 National Survey on Cancer Awareness, adding questions on social determinants of health and screening participation. 3. Collaboration with 12 peer-led Primary Health Care for Travellers Projects (PHCTPs), to provide in-person training for Traveller Community Health Workers to undertake a cross-sectional survey of 380 adult Travellers. 4. Collaboration with PHCTPs to undertake 20 semi-structured interviews with Travellers. 5. Conduct of semi-structured interviews with healthcare professionals to explore perceptions of barriers/enablers for Travellers engaging with the health system. Lessons Learned Working closely and collaboratively with our study partners, we gained valuable insights which enabled effective and efficient data collection across 8 counties, while exceeding our survey target sample size. Implications for Research: Collaborative, trusting, and respectful relationships are critical for all studies, but particularly when working with minority groups. Conclusions The study findings will inform policy for improved cancer outcomes among Travellers in Ireland. Key messages • Formation of a collaborative and respectful relationship with the Traveller community has facilitated successful research. • Traveller Community Health Workers (peer researchers) were key to the success of data collection.

Co-producing research on universal health system reform in the context of COVID-19

Abstract Issue How to co-produce and embed research into universal health system reform implementation in the context of COVID-19. In many respects the pandemic revolutionised the use of data and research, with near real-time data informing key health policy and system decisions. This was evident in the production of publicly available data sets tracking COVID-19 infection as well as health system dashboard tracking activity in real-time and influencing day-to-day decisions made. How can this use of data and research evidence become the norm for all health system reform and policy decisions? Results The Foundations’ research project is a partnership project in place since Autumn 2019. Initially focused on producing evidence to inform the design and implementation of new regional areas with the Department of Health Sláintecare Reform Office and the Irish national Health Service Executive as partners. When COVID-19 occurred all work on the regions was paused the research pivoted to harness the learnings form the COVID-19 response to inform universal health system reform. The partnership applied research nature of the programme allowed research to be coproduced and co-designed with health system leaders, meant the researchers understood if and when it was possible to engage with partners and how to feed result into the health system at the earliest opportunity. Lessons Trust and pre-existing working relationships with partners allowed the research to pivot and to continue during the pandemic. The applied partnership nature of the research meant that at times the health system was very engaged in the research and at other times (eg during COVID waves and surges or the cyber-attack) there was limited engagement. The co-production nature of the research allowed a dynamic, ongoing, two-way learning between the health system and the research team. It is extremely difficult to measure impact of research on health system and reform decisions.

Parent-child communication and educational anxiety: a longitudinal analysis based on the common fate model

BackgroundIn the face of family stress and emerging family problems, the transactional model of stress and coping provides new perspectives for solving stress problems in the family. This study integrates it with the common fate model to reveal new paths for coping with educational anxiety problems from the level of parent-child dichotomous interaction in the family environment, aiming to provide some theoretical and practical support for alleviating parents’ education anxiety.MethodsThis study used a combination of interviews and questionnaires to stratify students and their parents from a public junior high school in Jinan City to participate in the study. Data were collected in two time periods (T1, T2; one year apart), and the demographic characteristics of parents and children, parent-child communication quality, education anxiety, and parent-child trust relationship of 495 families were finally analysed by SPSS 27.0.ResultsThe results found that (1) based on the Common Fate Model, quality of parent-child communication negatively predicted parents’ education anxiety; (2) quality of parent-child communication positively predicted parent-child trust relationship; (3) parent-child trust relationship negatively predicted parents’education anxiety; (4) parent-child trust relationship mediated quality of parent-child communication and education anxiety.ConclusionsThis study sheds light on research related to stress coping and anxiety relief in the family environment, and provides theoretical and practical support for understanding the interaction between parents and children at the family level, and coping with stressful events together. It implies that future researchers should not only focus on one aspect when coping with and dealing with family problems, but should analyse the family as a whole, including the communication status and parent-child relationship between parents and children.

Cancer prevention in people experiencing homelessness: feasibility of the Health Navigator Model

Abstract Background The Health Navigator Model (HNM) is a newly developed skill-mixed model that may improve access to cancer prevention services for over 895,000 People who are currently Experiencing Homelessness (PEH) in Europe. The aim of this study was to assess the feasibility and implementation of the model in European settings. Methods A co-designed pilot implementation study was undertaken in Austria, Spain, Greece and the United Kingdom. A total of 20 trained health navigators were appointed at support centres for PEH and facilitated PEH’s access to cancer prevention activities based on a comprehensive and tailored needs assessment. The study duration was 19 months, with two follow-ups. Feasibility data (recruitment/retention/participation rates, barriers, facilitators) were monitored throughout the study. Results More than 1,981 PEH were informed about the study and 652 of them participated. Most participants were male (64%), with low or no income (42%) and had previously experienced homelessness (51.7%). The mean age of participants was 47.4 years old. Overall, 69% of participants completed the first, and 42.5% completed the second follow-up. Main dropout reasons were loss of contact, loss of interest or having other priorities. Participants undertook a range of cancer prevention activities, including education (n = 494), workshops (n = 280), health consultations (n = 251), referrals for specialist care (n = 212) and cancer screening tests (n = 169). Difficulties in accessing the healthcare system, de-prioritising cancer and PEH’s complex needs were identified as the main barriers. Building trusting relationships with PEH, increasing cancer awareness and coordinating social and health services were identified as the main facilitators. Conclusions Implementing the Health Navigator Model was a feasible and dynamic process leading to improved equity and inclusion of people experiencing homelessness in cancer preventive services. Key messages • The Health Navigator Model is a feasible model to enhance cancer prevention among people experiencing homelessness following a person-centred, destigmatising approach. • Effective liaison between health and social services under the Health Navigator Model plays a critical role in facilitating access to cancer preventive care among people experiencing homelessness.