Cancer prevention for people experiencing homelessness: Co-designing the Health Navigator Model

INTRODUCTION: Cancer is the second leading cause of death for people experiencing homelessness (PEH) due to limited access to cancer prevention services. This study aimed to co-adapt the Health Navigator Model (HNM), integrating end-users’ and organizations’ voices in the design of a care delivery model combining Patient Navigation and Patient Empowerment - models that have been shown to benefit different health outcomes by reducing health inequalities and improving access to cancer prevention services. METHODS: Participatory qualitative research was conducted through focus groups between December 2021 and January 2022 across four European countries (Austria, Greece, Spain, and United Kingdom). Seven focus groups with an overall sample size of 56 participants were conducted, including 41 professional stakeholders and 15 PEH. Focus groups were audio-recorded, transcribed verbatim, and thematically analyzed. RESULTS: Analysis identified four key features of the HNM, including (1) assessment of needs and barriers to access health care (e.g., seeking solutions regarding barriers to care); (2) promoting cancer awareness and self-management (e.g., encouraging user involvement in health-related decisions); (3) facilitating access to preventive services (e.g., coordinating and supporting attendance of clinical appointments); (4) providing practical assistance (e.g., assisting with paperwork). Regarding the profile of health navigators, a health or social care professional background accompanied by active engagement with relevant/local stakeholders to improve intervention delivery is enhanced. CONCLUSIONS: The HNM is a person-centered intervention to improve self-care and build relationships with PEH. Health Navigators should provide practical assistance, coordinate access to cancer prevention care and promote cancer awareness and self-management. The HNM is currently piloted and evaluated across four European countries as part of the Horizon 2020 CANCERLESS project (GA 965351). KEY MESSAGES: • The Health Navigator Model is a person-centered intervention responsive to the needs of people experiencing homelessness, building trusting relationships, and improving levels of self-care. • Health Navigators should provide people experiencing homelessness with practical assistance and coordinated access to cancer prevention care while promoting cancer awareness and self-management.