The use of digital health technologies has proved to have a strong effect on basic healthcare, leading to their growing recognition as social determinants of health. Access to telemedicine among the general population substantially increased during the pandemic and continues to be more commonly accepted and better regulated. However, people in vulnerable situations are found to use less such services. Simona Barbu, Policy Officer, FEANTSA - the European Federation of National Organisations working with the Homeless discusses.
European digitalisation was brought to a new level following the COVID-19 pandemic. However, ‘digital poverty’ remains a reality across Europe for already marginalised groups and communities.
The use of digital health technologies has proved to have a strong effect on basic healthcare, leading to their growing recognition as social determinants of health. Access to telemedicine among the general population substantially increased during the pandemic and continues to be more commonly accepted and better regulated. However, people in vulnerable situations are less likely to use these services.
Effective health communication with people experiencing homelessness requires an understanding of the practical and social challenges that they face. Homelessness and health peer workers are uniquely positioned to connect with people through shared experience. This article explores how through advocacy and support in healthcare settings, peers overcome pre-existing barriers to access health services as well as new ones emerging from digitalisation.
A digital-first system that leaves some behind
As healthcare digitalisation expanded, telemedicine use in Europe has surged. The World Health Organization (WHO) reports that over 78% of European member states explicitly address telehealth in their national policies.
Digital-first healthcare increasingly includes AI-enabled tools such as chatbots and automated triage systems, which may further mediate access to services.
However, important disparities remain across countries, while the risk of inequalities continues to grow among marginalised communities and groups. For people experiencing homelessness, several factors may lead to digital exclusion.
Navigating a health system that expects people to change and adapt to its rigid and inflexible demands is already a challenge for someone living through a personal crisis. This is further accentuated by long waiting times, lengthy queues and, at times, negative experiences such as being on the receiving end of harsh attitudes within the healthcare system. Internalised barriers such as fatalism, denial or the need to prioritise immediate survival are also common challenges.
Against a background of discrimination and stigmatisation, digital-first healthcare communication such as online appointments, patient portals, text messaging, the use of apps and electronic records may increase the distance between patients and healthcare professionals. Other factors contributing to the digital exclusion of people experiencing homelessness include the unaffordability of digital devices or data contracts, alongside the limited number of free Wi-Fi hotspots and public computers within social support services. In some countries, improving digital literacy and confidence may also be necessary to support effective use of digital health services and treatment adherence.
People experiencing homelessness are not inherently digitally excluded, and assuming otherwise may oversimplify the issue. But the ways in which they use digital services may be different. Difficulties may arise in navigating online administrative procedures, set up appointments or conduct entire medical consultations online (at least in an initial phase).
Trust, not transactions: why peer support matters
Peer workers play an important role in addressing these barriers, as these are not abstract to them; they have lived through this and will know how to offer support in a meaningful and respectful manner.
When communicating with patients who experience homelessness, people must consider the unique challenges that people face when they do not have a place to call home. Communication should be free of prejudice, and aimed at building a genuine connection. Health and homelessness peer workers are in a unique position to find a common ground easier with people facing homelessness.
They have an important role in advocating and accompanying their peers in health settings, including when digitalisation becomes a barrier. Peer workers take the time and attention needed to communicate, showing people that they are valued, rejecting ‘dehumanising categorisation’ and challenging ‘the official narrative that separates the “healthy” from the “sick,” the “integrated” from the “excluded”. Through their presence, peers may contribute to increased confidence and remind people that there will be ‘always a way’. Instead of labelling them as ‘the problem’, a peer will ‘recognise them, not through a manual, but through shared scars, through a common path travelled’ and remind people about their strength and resources acquired in their journey ‘against the current’. Having been through similar situations, peers are a motivation and an inspiration themselves. Basing their communication on an ‘experiential authority’, peers speak from within and with the community. The result will be that people’s confidence is restored and barriers to accessing health services as well as experimenting with more digital tools will be diminished.
Lived experience as healthcare infrastructure
Peers bring a unique form of expertise that can make services more accessible, friendly and responsive to the people who need them most. Their role in supporting people to navigate healthcare systems often begins long before an appointment is made, as conversations about health naturally emerge through discussions about everyday challenges such as housing, income, wellbeing or digitalisation. Through relationships built on trust and shared experience, peers empower individuals to engage with services, understand health and digitalisation information and access appropriate care.
At the same time, peers play a vital bridging role between healthcare professionals and service users. By working within services, they help practitioners better understand the realities of living in precarious circumstances, ensuring that policies and practices are informed by lived experience. In doing so, peers not only improve access to healthcare but also challenge stigma, reduce discrimination and promote more compassionate, person-centred approaches to care.
Digital health won’t work without human connection
As healthcare systems continue to embrace telemedicine and other digital-first approaches, the importance of maintaining human connections should not be overlooked. Clear, consistent communication should happen both offline and online through trusted sources. Experience shows that peer support workers can strengthen trust, improve engagement with treatment, increase appointment attendance and support continuity of care, particularly for people facing multiple barriers to access. Peers also make services more inclusive by challenging stigma and bringing lived experience into everyday practice. Digital innovation may transform how healthcare is delivered, but peer support remains essential to ensuring that these advances are accessible, equitable and responsive to those most at risk of being left behind.
In focus
- Use peer support – lived experience builds trust and encourages engagement.
- Keep human contact – combine digital services with personal support.
- Remove digital barriers – improve access to devices, internet and digital skills.
- Design for inclusion – make digital healthcare simple, flexible and accessible.
- Embed lived experience – involve peers in designing and improving services.
More information
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