Jain Neha, Adams Emma A, Joyes Emma C, McLellan Gillian, Burrows Martin, Paisi Martha, McGowan Laura J, Iafrate Lorenzo, Landes David, Watt Richard, Sniehotta Falko F, Kaner Eileen, Ramsay Sheena E
Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
Inclusive Insights, Bournemouth, United Kingdom.
PLoS One. 2024 Dec 18;19(12):e0315254. doi: 10.1371/journal.pone.0315254. eCollection 2024.
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.
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.
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.
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.
严重多重不利因素（SMD）是无家可归、物质使用和反复犯罪共同作用的结果。经历SMD的人群身心健康问题负担沉重。口腔健康是经历SMD的人群中最常见的健康问题之一，它与物质使用、吸烟和不健康饮食相互作用，形成一个伤害和不利的循环。然而，获得医疗服务的机会不足使这些情况的负担更加沉重。本研究旨在确定改善参与和获得口腔健康、物质和酒精使用、吸烟及饮食方面健康干预措施的途径。
采用定性研究方法，对以下人群进行了访谈/焦点小组讨论：（a）泰恩河畔纽卡斯尔/盖茨黑德经历SMD的人群；（b）来自伦敦、普利茅斯以及泰恩河畔纽卡斯尔/盖茨黑德的一线工作人员、志愿者、政策制定者和服务专员。使用主题分析法对数据进行迭代分析。
对28名经历SMD的人群（年龄范围：27 - 65岁；21%为女性）和78名服务提供者（年龄范围：28 - 72岁，63%为女性）进行了访谈或纳入焦点小组讨论。数据被归纳为两个总体因素：获得健康干预措施的障碍和改善获得健康干预措施的途径。障碍包括：经历SMD的人群面临的更广泛不利因素导致对口腔健康及相关健康行为的支持优先级较低、心理社会因素、等待期和物理空间。改善获得干预措施途径的因素包括：服务提供者与经历SMD的人群之间的积极关系，包括一名支持工作者、服务地点和外展服务。
研究结果表明，为经历SMD的人群提供口腔健康及相关健康行为服务需要灵活性。培训医疗保健提供者并与有SMD生活经历的人群共同开发服务有助于防止（再）污名化。需要采用基于系统的方法来解决环境、组织、人际和个人层面的因素。本研究结果可外推至其他健康干预措施，如疫苗接种以及性健康和生殖健康。
