{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T05:04:29Z","timestamp":1780549469514,"version":"3.54.1"},"reference-count":46,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Access to primary care services is essential for promoting mental health, yet immigrants experiencing homelessness face significant barriers to care. This study explores factors that influence access to primary care services in the UK. A qualitative design was employed, involving in-depth semi-structured interviews with 30 immigrants experiencing homelessness and 30 stakeholders across healthcare, voluntary, and local authority sectors. Data were analysed using thematic analysis, guided by the Levesque framework of healthcare access and an intersectionality lens. Findings reveal that access is influenced by intersecting structural barriers, including fear of detention and deportation, cultural stigma surrounding mental health, digital exclusion, and financial hardship. These barriers delay help-seeking and shift care-seeking toward emergency services. Increasing reliance on digital systems in primary care further excludes individuals with limited access to devices, connectivity, or digital skills. These findings indicate that barriers to accessing primary care services may hinder the early identification and preventive management of mental health needs among homeless immigrants. Improving access requires structural reforms that address legal, financial, and digital barriers, alongside more culturally responsive and trust-based care. Without such changes, digital health innovations risk reinforcing existing inequalities and limiting the role of primary care in early mental health intervention and prevention.<\/jats:p>","DOI":"10.3390\/ijerph23060726","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T09:33:14Z","timestamp":1780479194000},"page":"726","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Accessibility to Primary Care Services for Immigrants Experiencing Homelessness in England: A Qualitative Exploratory Study"],"prefix":"10.3390","volume":"23","author":[{"given":"Carol","family":"Namata","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Health, and Social Care, Canterbury Christ Church University, Canterbury CT1 1QU, UK"},{"name":"Faculty of Health Studies, Norquest College, Edmonton, AB T5J 1L6, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2151","DOI":"10.1590\/1413-81232017227.04472017","article-title":"Access to health care as a human right in international policy: Critical reflections and contemporary challenges","volume":"22","author":"Castillo","year":"2017","journal-title":"Cienc. Saude Coletiva"},{"key":"ref_2","first-page":"11","article-title":"Healthcare access disparities among marginalized communities","volume":"3","author":"Williamson","year":"2024","journal-title":"Glob. Perspect. Health Med. Nurs."},{"key":"ref_3","unstructured":"World Health Organization (2026, May 26). Refugee and Migrant Health 2026. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/refugee-and-migrant-health."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"100088","DOI":"10.1016\/j.ssmmh.2022.100088","article-title":"Structural barriers to refugee, asylum seeker and undocumented migrant healthcare access. Perceptions of Doctors of the World caseworkers in the UK","volume":"2","author":"Asif","year":"2022","journal-title":"SSM-Ment. Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e70077","DOI":"10.1111\/1467-9566.70077","article-title":"Inequality, Trust and Fear: Migrant Healthcare During the COVID-19 Pandemic and Beyond","volume":"47","author":"Hawthorne","year":"2025","journal-title":"Sociol. Health Illn."},{"key":"ref_6","unstructured":"NHS England (2026, May 26). Primary Care Services 2026, Available online: https:\/\/www.england.nhs.uk\/get-involved\/get-involved\/how\/primarycare\/."},{"key":"ref_7","unstructured":"National Health Service England (2026, May 26). NHS Services 2026, Available online: https:\/\/www.nhs.uk\/nhs-services\/."},{"key":"ref_8","unstructured":"NHS England (2026, May 26). Primary Care Mental Health 2026, Available online: https:\/\/www.england.nhs.uk\/london\/london-clinical-networks\/our-networks\/mental-health\/primary-care-mental-health\/."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1929","DOI":"10.2147\/RMHP.S416934","article-title":"GPs in UK: From health gatekeepers in primary care to health agents in primary health care","volume":"16","author":"Bi","year":"2023","journal-title":"Risk Manag. Healthc. Policy"},{"key":"ref_10","unstructured":"Office for National Statistics (2026, May 26). Long-Term International Migration, Provisional: Year Ending December 2025, Available online: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/populationandmigration\/internationalmigration\/bulletins\/longterminternationalmigrationprovisional\/latest\/."},{"key":"ref_11","unstructured":"Kirk-Wade, E. (2026, May 26). Migration Statistics 2026. Available online: https:\/\/researchbriefings.files.parliament.uk\/documents\/SN06077\/SN06077.pdf."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1177\/0020731414568511","article-title":"Experiences among undocumented migrants accessing primary care in the United Kingdom: A qualitative study","volume":"45","author":"Poduval","year":"2015","journal-title":"Int. J. Health Serv."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"ckac131.509","DOI":"10.1093\/eurpub\/ckac131.509","article-title":"Barriers to primary care access for asylum seekers and refugees in the UK: A systematic review","volume":"32","author":"Harrington","year":"2022","journal-title":"Eur. J. Public Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e537","DOI":"10.3399\/bjgp19X701309","article-title":"Access to primary health care for asylum seekers and refugees: A qualitative study of service user experiences in the UK","volume":"69","author":"Kang","year":"2019","journal-title":"Br. J. Gen. Pract."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"245","DOI":"10.5847\/wjem.j.issn.1920-8642.2012.04.001","article-title":"Immigrants and the utilization of hospital emergency departments","volume":"3","author":"Mahmoud","year":"2012","journal-title":"World J. Emerg. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/AWBT4827","article-title":"Digital First Primary Care for those with multiple long-term conditions: A rapid review of the views of stakeholders","volume":"12","author":"Newbould","year":"2024","journal-title":"Health Soc. Care Deliv. Res."},{"key":"ref_17","unstructured":"Wang, X. (2024). From Digital Access to Social Inclusion: An Investigation into the Supportive Role of Service Organizations on People Experiencing Homelessness. [Ph.D. Thesis, University of British Columbia]."},{"key":"ref_18","unstructured":"National Guideline Alliance UK (2026, May 26). Evidence Review for Views and Experiences of Health and Social Care for People Experiencing Homelessness: Evidence Review C London2022, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK579614\/."},{"key":"ref_19","unstructured":"Ministry of Housing Communities & Local Government (2026, May 26). Rough Sleeping Snapshot in England: Autumn 2025, Available online: https:\/\/www.gov.uk\/government\/statistics\/rough-sleeping-snapshot-in-england-autumn-2025\/rough-sleeping-snapshot-in-england-autumn-2025."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e526","DOI":"10.3399\/bjgp19X704633","article-title":"Provision and accessibility of primary healthcare services for people who are homeless: A qualitative study of patient perspectives in the UK","volume":"69","author":"Gunner","year":"2019","journal-title":"Br. J. Gen. Pract."},{"key":"ref_21","first-page":"26","article-title":"Factors associated with access to care and healthcare utilization in the homeless population of England","volume":"39","author":"Fok","year":"2017","journal-title":"J. Public Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/WXUW5103","article-title":"Integration, effectiveness and costs of different models of primary health care provision for people who are homeless: An evaluation study","volume":"11","author":"Crane","year":"2023","journal-title":"Health Soc. Care Deliv. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1080\/17571472.2015.1135659","article-title":"Promoting mental health and preventing mental illness in general practice","volume":"8","author":"Thomas","year":"2016","journal-title":"Lond. J. Prim. Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.jhealeco.2016.05.002","article-title":"Can increased primary care access reduce demand for emergency care? Evidence from England\u2019s 7-day GP opening","volume":"49","author":"Dolton","year":"2016","journal-title":"J. Health Econ."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/1475-9276-12-18","article-title":"Patient-centred access to health care: Conceptualising access at the interface of health systems and populations","volume":"12","author":"Levesque","year":"2013","journal-title":"Int. J. Equity Health"},{"key":"ref_26","unstructured":"Davis, K. (2014). Intersectionality as critical methodology. Writing Academic Texts Differently, Routledge."},{"key":"ref_27","unstructured":"Creswell, J.W., and Creswell, J.D. (2017). Research Design: Qualitative, Quantitative, and Mixed Methods Approaches, Sage Publications."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","year":"2007","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Moradi, B. (2017). (Re)focusing intersectionality: From social identities back to systems of oppression and privilege. Handbook of Sexual Orientation and Gender Diversity in Counseling and Psychotherapy, American Psychological Association.","DOI":"10.1037\/15959-005"},{"key":"ref_30","unstructured":"Crenshaw, K.W. (2013). Mapping the margins: Intersectionality, identity politics, and violence against women of color. The Public Nature of Private Violence, Routledge."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1080\/14780887.2020.1769238","article-title":"One size fits all? What counts as quality practice in (reflexive) thematic analysis?","volume":"18","author":"Braun","year":"2021","journal-title":"Qual. Res. Psychol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1177\/00380261221100359","article-title":"Cultivated invisibility and migrants\u2019 experiences of homelessness during the COVID-19 pandemic","volume":"71","author":"Stewart","year":"2023","journal-title":"Sociol. Rev."},{"key":"ref_33","unstructured":"Gov.UK (2026, May 26). Grounds for Refusal\u2014Rough Sleeping in the UK 2025, Available online: https:\/\/www.gov.uk\/government\/publications\/grounds-for-refusal-rough-sleeping\/grounds-for-refusal-rough-sleeping-in-the-uk-accessible-version."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"109","DOI":"10.12688\/wellcomeopenres.15358.1","article-title":"The negative health effects of hostile environment policies on migrants: A cross-sectional service evaluation of humanitarian healthcare provision in the UK","volume":"4","author":"Weller","year":"2019","journal-title":"Wellcome Open Res."},{"key":"ref_35","unstructured":"National Health Service England (2026, May 26). Primary Medical Services Policy and Guidance Manual (PGM) 2025, Available online: https:\/\/www.england.nhs.uk\/long-read\/primary-medical-services-policy-and-guidance-manual-pgm-2\/."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1080\/15332985.2024.2357357","article-title":"Lay perceptions of mental health among Afghan forced migrants residing in Finland","volume":"22","author":"Farahani","year":"2024","journal-title":"Soc. Work. Ment. Health"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"43","DOI":"10.36939\/cjur\/vol33no1\/art427","article-title":"Homelessness and housing insecurity among im\/migrants in Canada: A scoping review","volume":"33","author":"Hanley","year":"2024","journal-title":"Can. J. Urban Res."},{"key":"ref_38","unstructured":"Good Things Foundation (2026, May 26). Deep Poverty and Digital Exclusion in the UK 2025. Available online: https:\/\/www.goodthingsfoundation.org\/discover\/digital-inclusion-insights\/digital-inclusion-insights-2025\/deep-poverty-and-digital-inclusion-uk#:~:text=Links%20between%20deep%20poverty%20and,APLE%20Collective%202023."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1177\/14614448211063185","article-title":"Double lockdown: The effects of digital exclusion on undocumented immigrants during the COVID-19 pandemic","volume":"24","author":"Bastick","year":"2022","journal-title":"New Media Soc."},{"key":"ref_40","unstructured":"Flaubert, J.L., Le Menestrel, S., and Williams, D.R. (2021). CotFoN. Social Determinants of Health and Health Equity. The Future of Nursing 2020\u20132030: Charting a Path to Achieve Health Equity, National Academies Press."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e24917","DOI":"10.2196\/24917","article-title":"The effect of 24\/7, digital-first, NHS primary care on acute hospital spending: Retrospective observational analysis","volume":"23","author":"Winward","year":"2021","journal-title":"J. Med. Internet Res."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Jerjes, W., Harding, D., Jhass, A., and Arif, A. (2025). How digital health risks recreating the isolation it aims to solve for people with serious mental illness. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1620156"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1177\/00207314221075515","article-title":"Through an equity lens: Illuminating the relationships among social inequities, stigma and discrimination, and patient experiences of emergency health care","volume":"52","author":"Varcoe","year":"2022","journal-title":"Int. J. Health Serv."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/GRFV4068","article-title":"Understanding and improving the quality of primary care for people in prison: A mixed-methods study","volume":"12","author":"Bellass","year":"2024","journal-title":"Health Soc. Care Deliv. Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"20552076241255637","DOI":"10.1177\/20552076241255637","article-title":"Supporting patients with a mental health diagnosis to use online services in primary care. A qualitative interview study","volume":"10","author":"Parsons","year":"2024","journal-title":"Digit. Health"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Bunyi, J., Ringland, K.E., and Schueller, S.M. (2021). Accessibility and digital mental health: Considerations for more accessible and equitable mental health apps. Front. Digit. Health, 3.","DOI":"10.3389\/fdgth.2021.742196"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/6\/726\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T04:25:43Z","timestamp":1780547143000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/6\/726"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,29]]},"references-count":46,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["ijerph23060726"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23060726","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,29]]}}}