Community-Based A1C Screening Initiative to Improve Diabetes Risk Identification Among People Experiencing Homelessness

Abstract Purpose: People experiencing homelessness (PEH) experience high rates of undiagnosed diabetes yet face significant barriers to preventive screening. This quality improvement project aimed to improve access to diabetes screening for PEH through on-site hemoglobin A1C (A1C) testing in a trusted community setting. Methods: On-site A1C screening was implemented at the Utah County Food and Care Coalition (F&CC) using a low-barrier, community-based approach. Screening was conducted during routine service hours and integrated into existing workflows. Process, outcome, and balancing measures were used to evaluate feasibility, reach, and unintended effects. Results: The intervention primarily supported identification of diabetes risk and referral to follow-up care rather than short-term changes in glycemic control. Screening was implemented without disrupting workflow or increasing staff burden. The project also facilitated collaboration among community partners and provided experiential learning opportunities for nursing students. Discussion: Findings align with the existing literature, indicating that community-based screening interventions serve as effective entry points to care for PEH. Embedding preventive services within trusted community organizations enhances engagement and access while supporting sustainable and low-resource implementation. These results highlight the role of nurse practitioner-led initiatives in advancing health equity through accessible preventive care. Keywords: PEH (people experiencing homelessness), A1C, diabetes, screenings