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

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.