Abstract

Introduction/Background People experiencing homelessness remains a major public health challenge in Lancashire, experiencing disproportionately poorer health outcomes, with low health literacy being a contributing factor. This reduces engagement in preventive health behaviours, particularly cancer screening, with approximately 54% of homeless individuals reported having a cervical screening in the past three years, compared with approximately 70% in the general population. There exists limited research on how health literacy affects cervical screening uptake among homeless individuals in the UK, therefore presenting an opportunity to improve screening engagement in this underserved group.

Methodology This mixed-methods study employed an educational outreach initiative delivered through several sessions to women at homeless shelters in Lancashire. Cervical screening teaching involved illustrated leaflets, a PowerPoint presentation, and a speculum to visually represent the procedure and enhance understanding. After obtaining consent, participants completed a survey based on the Health Belief Model that consisted of 18 items. This served as a framework to guide 25-40 minutes semi-structured interviews, which aimed to confirm participant understanding and explore confidence, barriers, and perceptions.

Results Thirty participants attended cervical cancer education sessions focused on screening and speculum use. All participants identified barriers related to limited health awareness, fear, and/or embarrassment when engaging with clinicians, and difficulties accessing healthcare services. Following the education sessions, all participants reported feeling empowered, informed and valued accessibility of the services located near shelters. The socioecological framework was used to map the facilitators to overcome these barriers, highlighting development needs at the individual, organisational, and policy levels.

Conclusion Raising awareness through targeted education enhanced understanding on screening uptake and identified persistent health disparities within women experiencing homelessness.