{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T07:56:24Z","timestamp":1781164584101,"version":"3.54.1"},"reference-count":17,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Translating Innovative Ideas for the Public Good (TIIP) Award from Innovate Carolina at the University of North Carolina"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>In Burke County, North Carolina, a Hepatitis A outbreak among unsheltered residents exposed gaps in access to clinic-based care and prompted early, ad hoc \u201cbackpack medicine\u201d outreach efforts to deliver care directly in nontraditional settings. While this approach addressed immediate needs, it highlighted the inadequacy of isolated interventions, prompting local partners to pursue more structured, coordinated, and community-driven approaches to homeless health system design. This project report describes how Burke County Public Health, in partnership with the University of North Carolina at Chapel Hill, applied systems thinking, community coalition building, and human-centered design to transition from reactive outreach to a structured, sustainable mobile health delivery model for people experiencing homelessness. Guided by Community Coalition Action Theory (CCAT), partners used human-centered design methods to engage over 40 community stakeholders and 10 individuals with lived experience of homelessness or housing instability. Through empathy mapping, iterative prototyping, and thematic analysis, the team identified priority service gaps, defined operational requirements, and developed prototype service models, while building cross-agency readiness for implementation.<\/jats:p>","DOI":"10.3390\/ijerph23060784","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T06:57:17Z","timestamp":1781161037000},"page":"784","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Community Coalition Building and Human-Centered Design Strategies to Advance Homeless Health Systems: A Case Study from Rural North Carolina"],"prefix":"10.3390","volume":"23","author":[{"given":"Ashley","family":"Jarrett","sequence":"first","affiliation":[{"name":"Burke County Public Health, Morganton, NC 28655, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5622-233X","authenticated-orcid":false,"given":"Oscar","family":"Fleming","sequence":"additional","affiliation":[{"name":"Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Shomali","sequence":"additional","affiliation":[{"name":"Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7919-8833","authenticated-orcid":false,"given":"William","family":"Romani","sequence":"additional","affiliation":[{"name":"Innovate Carolina, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Ferdinand, A.O., Bolin, J.N., Callaghan, T., Rochford, H.I., Lockman, A., and Johnson, N.Y. (2023). Rural Healthy People 2030, Texas A&M University School of Public Health, Texas A&M Health Southwest Rural Health Research Center.","DOI":"10.21423\/1969.1\/1581900"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1186\/s12939-026-02840-z","article-title":"Barriers to and facilitators of healthcare access among people experiencing homelessness: A systematic scoping review","volume":"25","author":"Gorski","year":"2026","journal-title":"Int. J. Equity Health"},{"key":"ref_3","first-page":"e38761","article-title":"Street Medicine: Barrier Considerations for Healthcare Providers in the U.S","volume":"15","author":"Tito","year":"2023","journal-title":"Cureus"},{"key":"ref_4","unstructured":"U.S. Census Bureau (2026, March 30). 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Available online: https:\/\/heller.brandeis.edu\/iere\/pdfs\/housing\/systems-change.pdf."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/6\/784\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T06:58:07Z","timestamp":1781161087000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/6\/784"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,11]]},"references-count":17,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["ijerph23060784"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23060784","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,11]]}}}