ORIGINAL RESEARCH article
Front. Public Health
Sec. Public Health Policy
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1672014
This article is part of the Research TopicChanging Healthcare through Innovation in Clinical Management and Healthcare Policy Strategies: Focus on Quality Improvement for the PatientView all 9 articles
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
Provisionally accepted
Dr Daniela Oehring1*
Martha Paisi1
Mona Nasser1
Theo Jackson2Ryan Young3Lynne Wooff4Helen Partidge5Jacqueline Conaty2Samantha Dorney-Smith2- 1University of Plymouth, Plymouth, United Kingdom
- 2Pathway, London, United Kingdom
- 3Brownlow Health, Liverpool, United Kingdom
- 4Bolton NHS Foundation Trust, Bolton, United Kingdom
- 5Bournemouth Diabetes and Endocrine Service, University Hospitals Dorset, UK, Bournemouth, United Kingdom
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Abstract 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.
Keywords: Ill-housed persons, Diabetes Mellitus, Healthcare Disparities, Patient Care Management, Health Services Accessibility
Received: 23 Jul 2025; Accepted: 29 Sep 2025.
Copyright: © 2025 Daniela Oehring, Paisi, Nasser, Jackson, Young, Wooff, Partidge, Conaty and Dorney-Smith. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dr Daniela Oehring, daniela.oehring@plymouth.ac.uk
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