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Background <p>People experiencing homelessness (PEH) face significant barriers to accessing cancer prevention services. The CANCERLESS project co-developed and implemented the Health Navigator Model (HNM) – a person-centred approach using trained health navigators to provide tailored support, promote cancer awareness, and facilitate access to preventive services – in Austria, Greece, Spain, and the UK. This study examined the HNM’s impact on healthcare empowerment, health-related quality of life (HRQoL), and self-rated health among PEH.</p> Methods <p>This non-randomised, single-arm study included 652 PEH from 16 pilot sites in four European countries between June 2022 and December 2023. Healthcare empowerment, HRQoL, and self-rated health were assessed using the healthcare empowerment questionnaire and the EQ-5D-5L (including the EQ Visual Analogue Scale) when participants entered and completed the intervention. A per-protocol analysis with repeated measures ANOVA revealed changes over time and between countries.</p> Results <p>Participants were predominantly male (64.1%) and middle-aged (mean 47.4, SD 13.8), with secondary education (58.0%), and varied legal status and experiences of homelessness. Despite a drop-out rate of 57.5%, significant improvements in overall healthcare empowerment (F = 44.325, <i>p</i>&lt;.001, η²=0.026), HRQoL (F = 4.421, <i>p</i> = .036, η²=0.002), and self-rated health (F = 16.945, <i>p</i>&lt;.001, η²=0.011) were observed, particularly in Austria and the UK.</p> Conclusions <p>The HNM holds promise for improving healthcare empowerment and HRQoL among PEH, but context-specific factors and a considerable drop-out pose challenges.</p> Trial registration <p>This study was registered retrospectively on June 6, 2022, in the registry of ClinicalTrials.gov under the number NCT05406687.</p>

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Empowerment and quality of life through cancer prevention in people experiencing homelessness: evaluating the Health Navigator Model

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月19日

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  • Tobias Fragner,
  • Tamara Alhambra-Borrás,
  • Ascensión Doñate-Martínez,
  • Vicent Blanes-Selva,
  • Juan M. García-Gómez,
  • Julia Gawronska,
  • Maria Moudatsou,
  • Ioanna Tabaki,
  • Katerina Belogianni,
  • Pania Karnaki,
  • Miguel Rico Varadé,
  • Rosa Gómez Trenado,
  • Jaime Barrio-Cortes,
  • Lee Smith,
  • Alejandro Gil-Salmeron,
  • Igor Grabovac

摘要

Background

People experiencing homelessness (PEH) face significant barriers to accessing cancer prevention services. The CANCERLESS project co-developed and implemented the Health Navigator Model (HNM) – a person-centred approach using trained health navigators to provide tailored support, promote cancer awareness, and facilitate access to preventive services – in Austria, Greece, Spain, and the UK. This study examined the HNM’s impact on healthcare empowerment, health-related quality of life (HRQoL), and self-rated health among PEH.

Methods

This non-randomised, single-arm study included 652 PEH from 16 pilot sites in four European countries between June 2022 and December 2023. Healthcare empowerment, HRQoL, and self-rated health were assessed using the healthcare empowerment questionnaire and the EQ-5D-5L (including the EQ Visual Analogue Scale) when participants entered and completed the intervention. A per-protocol analysis with repeated measures ANOVA revealed changes over time and between countries.

Results

Participants were predominantly male (64.1%) and middle-aged (mean 47.4, SD 13.8), with secondary education (58.0%), and varied legal status and experiences of homelessness. Despite a drop-out rate of 57.5%, significant improvements in overall healthcare empowerment (F = 44.325, p<.001, η²=0.026), HRQoL (F = 4.421, p = .036, η²=0.002), and self-rated health (F = 16.945, p<.001, η²=0.011) were observed, particularly in Austria and the UK.

Conclusions

The HNM holds promise for improving healthcare empowerment and HRQoL among PEH, but context-specific factors and a considerable drop-out pose challenges.

Trial registration

This study was registered retrospectively on June 6, 2022, in the registry of ClinicalTrials.gov under the number NCT05406687.