Table 1.

Examples of health system challenges that impede people experiencing homelessness from accessing and using self-care interventions

Health system challenge20	Examples
Accessibility	Institutional barriers deny access to primary healthcare and self-care interventions (eg, needing an address to register with a primary healthcare facility)
Quality	Stigmatising attitudes of health workers towards people experiencing homelessness make initial diagnosis of health conditions such as hypertension or diabetes difficult
Agency	Lack of trust in healthcare providers, especially because of previous bad experiences, as well as self-stigma and poor self-esteem of people experiencing homelessness prevents engagement in self-care
Information	Most health education and information on self-care come from health workers, media, or internet, all often inaccessible to people experiencing homelessness
Utilisation	Uptake is limited by lack of privacy to conduct a self-test privately and confidentially (eg, for pregnancy, HIV, or human papillomavirus) and nowhere to safely keep a supply of prescribed drugs or a fridge to store those that need to be kept cold (eg, antibiotics for sexually transmitted infections)
Social support	Lack of partner, family, or other social network means no one to help and no place to recuperate from illness or injury that is protected from the elements (sun, rain, wind)
Cost	Out-of-pocket expenses at the point of delivery for commodities for self-care (eg, menstrual products, over-the-counter medicines) or travel to a health facility are barriers to access for someone with no income