Measuring What Matters: Using Participatory Choice Modelling to Understand Preferences for Homelessness Integrated Care

Introduction: People with experience of homelessness (PEH) often have multiple inter-related needs and for support rely on various services working together. To improve Out-of-Hospital Care (OOHC), it is crucial to understand their preferences. This study used a Discrete-Choice Experiment (DCE) to identify what matters most to them, ensuring services align with real-life experiences.

Methods: A mixed methods approach combined interviews, group discussions, and DCE data. Service users, providers, and planners participated in workshops. Researchers with lived experience of homelessness co-designed a user-friendly questionnaire and supported data collection, fostering trust. Preferences were analysed using logistic regression, with findings presented in clear, interactive dashboards.

Results: A total of 112 PEH participated from 10 sites, with 108 valid responses (35% response rate). Participants preferred care delivered at home, delivered by trusted housing workers, with minimal behavioural restrictions. Accommodation type and behavioural rules significantly influenced service uptake. DCE outputs were shared with PEH, who confirmed that the findings accurately reflected their priorities and real-life experiences. In one locality, insights were used to reshape service modelling.

Discussion & conclusion: This study highlights the importance of co-designing OOHC services with PEH. Stability, trust, and fewer restrictions encourage service engagement. These insights can guide policymakers and service providers in developing more effective, person-centred care models, ultimately improving access and outcomes for PEH.