{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T15:08:23Z","timestamp":1788793703041,"version":"build-2803163510"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T00:00:00Z","timestamp":1724630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oral. Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>The homeless population faces a \u201ccliff edge of inequality\u201d when trying to access essential dental services. There are several additional barriers to accessing dental care in comparison to the general population and the heterogeneous nature of patients presents a significant challenge when designing dental services to meet their needs. Following the Smile4Life report in 2009, there is limited up-to-date and population-specific evidence available for the optimal model of service delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>This study aimed to co-design principles for a prospective dental service for adults experiencing homelessness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A qualitative methodology was used to incorporate experts-by-experience into elements of co-designing a dental service for adults experiencing homelessness. The study combined elements of an experienced-based co-design framework for healthcare innovation with community-based participatory research. Focus groups with people experiencing homelessness and healthcare practitioners were conducted to identify principles for any prospective dental service, as well as several barriers and enablers to establishing a homeless dental service. The findings were transcribed and analysed using thematic analysis on Nvivo software.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From the qualitative analysis five key themes emerged: (1) Impact and expectations of oral health while experiencing homelessness, (2) Barriers to accessing dental care; (3) Practitioner's views about homelessness and access to care; (4) Barriers to designing a homeless service and (5) Enablers for co-designing a new model of dental care delivery for the homeless population.<\/jats:p><jats:p>Five key principles for a new model of homeless dental service were identified: (i) Services designed to address the needs of patients; (ii) Services delivered in a safe and welcoming environment (iii) Training and consistency of staff; (iv) Focus on dental education (v) Developing peer mentoring and peer support.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>While the barriers to accessing dental care while homeless are well established and understood by healthcare practitioners, more work is required to gain consensus on the most effective way to deliver an innovative a sustainable dental service for patients experiencing homelessness. Previous negative experiences, lack of readily available information on services and barriers to access in the current system could be addressed by developing peer mentors within the homeless community, empowering individuals to share their knowledge and skills to support others in improving their oral health.<\/jats:p><\/jats:sec>","DOI":"10.3389\/froh.2024.1355429","type":"journal-article","created":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T06:01:26Z","timestamp":1724652086000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["A stakeholder co-design approach to designing a dental service for adults experiencing homelessness"],"prefix":"10.3389","volume":"5","author":[{"given":"Declan","family":"Cairns","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Rodriguez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,8,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2","DOI":"10.3390\/ijerph182111660","article-title":"Homelessness and public health: a focus on strategies and solutions","volume":"18","author":"Sleet","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/cdoe.12500","article-title":"Inclusion oral health: advancing a theoretical framework for policy, research and practice","volume":"48","author":"Freeman","year":"2020","journal-title":"Community Dent Oral Epidemiol"},{"key":"B3","first-page":"172","article-title":"Homelessness: reducing health disparities","volume":"163","author":"Plumb","year":"2000","journal-title":"Cmaj"},{"key":"B4","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1111\/j.1740-9713.2004.00058.x","article-title":"Status syndrome","volume":"1","author":"Marmot","year":"2004","journal-title":"Significance"},{"key":"B5","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1016\/S0140-6736(71)92410-X","article-title":"The inverse care law","volume":"1","author":"Hart","year":"1971","journal-title":"Lancet"},{"key":"B6","volume-title":"Homelessness, Health, and Human Needs","year":"1988"},{"key":"B7","volume-title":"Smile4life: The Oral Health of Homeless People Across Scotland","author":"Coles","year":"2009"},{"key":"B8","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1016\/S0140-6736(17)31869-X","article-title":"Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis","volume":"391","author":"Aldridge","year":"2018","journal-title":"Lancet"},{"key":"B9","doi-asserted-by":"publisher","first-page":"910","DOI":"10.1186\/s12913-022-08265-y","article-title":"Access to healthcare for people experiencing homelessness in the UK and Ireland: a scoping review","volume":"22","author":"McNeill","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"B10","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1111\/j.1754-4505.2008.00046.x","article-title":"The oral health of homeless adolescents and young adults and determinants of oral health: preliminary findings","volume":"28","author":"Chi","year":"2008","journal-title":"Spec Care Dentist"},{"key":"B11","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1038\/sj.bdj.2016.56","article-title":"Evaluation of a community dental service for homeless and \u2018hard to reach\u2019 people","volume":"220","author":"Caton","year":"2016","journal-title":"Br Dent J"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1003","DOI":"10.11124\/JBISRIR-2016-003200","article-title":"Action research in the healthcare field: a scoping review","volume":"16","author":"Cordeiro","year":"2018","journal-title":"JBI Database System Rev Implement Rep"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e002154","DOI":"10.1136\/bmjdrc-2021-002154","article-title":"Using a community-based participatory research approach to meaningfully engage those with lived experience of diabetes and homelessness","volume":"9","author":"Campbell","year":"2021","journal-title":"BMJ Open Diabetes Res Care"},{"key":"B14","volume-title":"Homelessness in Scotland: 2020\u201321","year":"2021"},{"key":"B15","article-title":"Expert by Experience Involvement Handbook \u2013 Pathway. 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