A scoping review on healthcare access challenges among people experiencing homelessness

Abstract

Abstract Introduction People experiencing homelessness (PEH) face heightened health risks. Understanding healthcare access barriers specific to this population is key to informing equitable, effective, and sustainable strategies. Methods A scoping review was conducted to explore barriers and facilitators to healthcare access, as well as the acceptability and adherence to interventions from the perspective of PEH. The review followed Joanna Briggs Institute guidelines and PRISMA-Sc reporting. Searches were conducted in PubMed, Embase, and Web of Science (January 2025). Peer-reviewed interventional and observational studies were included. Findings were mapped using the Socio-Ecological Model (SEM). Results A total of 127 studies (50,201 PEH) published between 1989-2024 were included. Most were qualitative (n = 75) and addressed general health services (n = 20), addiction treatment (n = 20), mental health services (n = 6), and COVID-19 vaccination (n = 6). Interpersonal barriers-such as stigma, discrimination, and difficult relationships with healthcare providers-were frequently reported. Respectful, non-judgmental care and trust-building were commonly cited facilitators. Individual-level barriers included physical, cognitive, or behavioral challenges (including substance use), limited knowledge about services, and fear rooted in past experiences. Community-level barriers encompassed transportation and associated costs, while services provided by civil society organizations were described as key facilitators. Structural barriers included bureaucratic complexity and long waiting times. Reported acceptability of interventions ranged from 28-100%, and adherence from 30-95%. Conclusions Tailored public policies addressing the needs of PEH are essential. Improving healthcare delivery for this population requires a focus on accessibility, respectful care, and simplified administrative processes. Key messages • People experiencing homelessness face multi-level barriers to healthcare access - addressing stigma, service complexity, and structural inequities is essential for improving health equity. • Tailored, respectful, and simplified healthcare interventions - especially those involving trusted community providers - can improve acceptability and adherence among homeless populations.