Patient perspectives on telehealth access among people experiencing homelessness: a rapid review

Telehealth services are rapidly expanding across the globe yet under-served populations, particularly people experiencing homelessness (PEH), are at risk of being further marginalised in society if focussed interventions to address telehealth access are not implemented. The aim of this rapid review was to report on the patient experience of PEH when accessing telehealth services. Secondary objectives of the review were to summarise both the patient and health service outcomes that were reported. This rapid review identified peer reviewed literature that explored patient experiences of telehealth for people experiencing homelessness. Databases searched were MEDLINE, Embase, APA PsychINFO and CINAHL. Study characteristics were extracted and during the second-phase, two authors independently extracted data from each paper using a framework for evaluating telehealth outcomes (access to care, cost, experience, effectiveness) with a third author reviewing the extracted data and finalising the results table. Twelve eligible studies were identified with publication dates between 2020 and 2024. Two were qualitative, nine were quantitative and one was a mixed-methods study design. A large variation was found across the literature in relation to participant experience of telehealth for PEH. Telehealth was shown to be an acceptable form of healthcare for PEH. It was more acceptable in settings where participants were accessing it with clinician support, in an environment that was familiar to the participant, where the participant was living in at least temporary accommodation. Furthermore, telehealth was accessible where the processes to access telehealth were not prohibitive and where the internet connection was reliable. However, significant adaptions to improve a participant’s experience of telehealth was identified as a need. There is limited evidence available that explores the experiences of PEH when accessing telehealth. We have identified a number of simple factors that can be implemented to make telehealth services more accessible for PEH. Acknowledging that telehealth services are an accepted form of healthcare delivery across the globe, future research involving people experiencing primary homelessness and undertaking research utilising a digital inclusion framework would be of value. The review was registered on the International prospective register of systematic reviews, (PROSPERO in October 2023 CRD42023466817).