A stakeholder co-design approach for designing a dental service for homeless adults

Background:
The homeless population in Glasgow faces a cliff edge of inequality accessing dental services. The heterogeneous nature of patients presents a significant challenge when designing services to meet their needs, as well as stereotypically being labelled as a “hard-to-reach” patient group. ‘Experts-by-experience’ – with lived experience of homelessness – should be empowered to share their knowledge and expertise as part of identifying solutions to developing a dental service.

Aim:
This study aims to co-design an innovative, sustainable dental service for adults experiencing homelessness in Glasgow.

Methodology:
Ethical approval was granted to use an iterative, qualitative methodology. Two focus groups were established, with the common subject of “suggestions or enablers for establishing a homeless dental service”. Findings were transcribed and analysed using thematic analysis, identifying common themes in both groups. These were evaluated to develop principles for future service development.

Results:
The first group involved seven experts-by-experience, with lived experience of homelessness, while the second group comprised of five dental care professionals and one expert-by-experience.
The main themes were identified as enablers for establishing a homeless dental service:

Peer support and mentoring
Addresses the Needs of Patients
Delivered in an appropriate environment
Staff Trained Appropriately
Relatable Dental Education

Conclusion:
The common themes identified from both groups serve as guiding principles for establishing any new dental service for adults experiencing homelessness. The challenges accessing dental care while homeless are well-known, however, this study found that empowering individuals with lived-experience to help others overcome these barriers, is valued highly amongst experts-by-experience. Dental care professionals raised issues around governance and service integration between healthcare and other sectors. This highlights the need for more studies to investigate empowering individuals with lived experience of homelessness to become link workers between patients, 3rd sector services and healthcare.