Health navigation for cancer screening uptake in people experiencing homelessness, Madrid 2019-2022

Problem

People experiencing homeless face 2-3 times higher cancer mortality than the general population due to structural barriers (lack of identification, digital exclusion, fragmented care). Screening participation rates remain below 15% in this group. An evidence-based, transferable intervention is needed to close this gap.

Description

Between 2019-2022, the CANCERLESS project co-designed a Health Navigator model with homeless individuals and professionals in Madrid.

Objectives

1) identify barriers to cancer screening access; 2) implement intersystem pathways (social services + primary care); 3) improve screening adherence for colorectal, breast and cervical cancer.

Methods

Proactive navigator-led interviews, motivational interviewing, social accompaniment.

Results

In Madrid, the Navigator contacted 266 homeless people from municipal and Non Governmental Organization networks. Of these, 197 (74.1%) agreed to participate. Among participants, 167 (84.7%) met screening criteria: 46 women for breast cancer, 80 women for cervical cancer, and 132 person for colorectal cancer. Only 20 people (12%) refused or did not complete screening due to individual barriers (fear of results, previous cancer experience, workday loss). Critically, access to screening was only possible with Health Navigator accompaniment. Main barriers: acceptability (11 cases), accessibility (7 cases), non-localisation (2 cases).

Lessons

Health Navigation co-designed with homeless people effectively overcomes structural and personal barriers, enabling cancer screening uptake where baseline participation was <15%. Key

lessons

accompaniment is essential; navigation must bridge social and health systems; co-design with end-users ensures feasibility. Recommended actions: integrate navigators into routine primary care and social services across Europe. This model is transferable to other vulnerable groups facing access barriers.

Key messages

• Health Navigation co-designed with homeless people increases cancer screening uptake by bridging social and healthcare systems in Madrid.

• CANCERLESS Madrid: 197 homeless people participated, 84.7% met screening criteria. Only 12% refused. Navigator accompaniment essential. Impact: reduced inequalities.