Kate Frazer

Background: Irish Travellers are a distinct minority ethnic group with a long tradition of nomadism on the island of Ireland. Travellers have a significantly reduced life expectancy and experience greater health inequalities. Limited evidence describes how cancer awareness and engagement with prevention, screening and early diagnosis are shaped by structural and service contexts. Methods: This qualitative study was undertaken as part of a larger multi‐method study co‐developed with the Health Service Executive, National Cancer Control Programme, National Social Inclusion Office, and Pavee Point Traveller and Roma Centre‐ a human rights advocacy and Irish Non‐Governmental Organisation (NGO). The study aimed to understand cancer awareness and attitudes among Irish Travellers, identify barriers and enablers to cancer risk reduction behaviours and early diagnosis of cancer. In‐person interviews were completed with 22 adult Irish Travellers (18 individual interviews and two group interviews with two participants each) and were transcribed verbatim and analysed using collaborative reflexive thematic analysis. Results: Four themes described the interactions between everyday structural disadvantage, culture, privacy, fear and family roles; systems‐level barriers; and Traveller‐led and service‐level enablers. Awareness did not always translate into an opportunity to act. Racism and discrimination, literacy barriers, living conditions, limited service choice, inaccessible communication and inflexible appointment systems constrained engagement. Pride in Traveller identity, trusted relationships, Traveller Community Health Workers, accessible information and culturally safe services supported engagement. Conclusions: Improving cancer awareness requires more than individual behaviour change. Equitable engagement with prevention, screening and early diagnosis depends on anti‐racist, accessible and flexible mainstream services developed in partnership with Travellers and their organisations. Traveller Community Health Workers are a major strength, and their expertise should be harnessed within health systems. Patient and Public Contribution: The study was co‐developed with Pavee Point Traveller and Roma Centre, who are represented as co‐authors on the paper and were members of the study working group. They took part in all aspects of the study, including providing anti‐discrimination training, recruitment, interpretation of findings, and providing lived‐experience expertise throughout the drafting of the paper.

Family homelessness is shaped by social and structural determinants of health, including poverty, housing insecurity, fragmented services, and unequal access to support. Families with infants and young children are particularly vulnerable to the health and developmental effects of housing instability. Public Health Nurses (PHNs) are uniquely positioned at the interface of health services, family life, and community systems. Through universal reach, relational continuity, developmental surveillance, safeguarding, advocacy, and interagency coordination, PHNs help families remain connected to care despite repeated moves and service fragmentation. However, this connective work is often under‐recognized in policy, workforce planning, and service evaluation. This policy perspective paper argues that family homelessness is a public health and health equity issue that requires explicit recognition of PHNs as essential connective infrastructure and continuity providers within integrated responses to family homelessness. Strengthening the role of PHNs requires policy and organizational investment in clear referral pathways, digital connectivity supports, adequate staffing, clinical supervision, and evaluation frameworks that capture prevention, advocacy, and sustained connection to care. Making PHN work visible is both a professional nursing priority and a health policy requirement. Recognizing, resourcing, and evaluating PHN continuity work is essential to reducing inequalities and protecting the health and wellbeing of families experiencing homelessness.

Background: The vision for integrated care is a system that is coordinated and person-centred. However, many people experience fragmented and inequitable care. Irish Travellers, a minority ethnic group with around 45,000 people, face reduced life expectancy, poorer health outcomes, systemic racism, and the effects of broader social determinants of health. Systemic racism within mainstream health services contributes to inequalities in access, participation, and outcomes for Irish Travellers. Although often unconscious or hidden, racism is frequently systemic and structural. 3 Braverman suggests that systemic and structural racism can exist within systems, laws, and policies—both written and unwritten—and result in negative health effects, often remaining invisible to those unaffected. Our study aimed to understand cancer awareness among Irish Travellers and to identify barriers and facilitators to cancer awareness and preventive screening. Approach: Qualitative interviews were undertaken with Travellers [November 2023 to February 2024] following ethical approval [RCPI RECSAF 191] as part of a larger multi-method co-designed study with Pavee Point Traveller and Roma Centre, a national Traveller organisation with recognised expertise in Traveller health. Recruitment and organisation of interviews were led by Traveller Health Workers working in Traveller organisations and Traveller Primary Health Care Traveller Projects in partnership with UCD researchers. Face-to-face interviews were digitally recorded by researchers, with consent, and transcribed verbatim. We conducted 22 interviews, employing thematic analysis methods, identifying barriers and facilitators to cancer awareness. Results:Participants highlight the influence of family, traditions that encompass religion and personal values, and the need for individual privacy. Religiosity among Travellers can result in "burying [one’s] head in the sand' or praying for a miracle cure. However, structural racism was evident when Travellers were accessing primary care and is demonstrated in the following three examples: 1) a lack of gender appropriate services for men if it’s prostate cancer and if it’s a woman GP, … there’s some concerns and sensitivities there for Traveller men and [..] for Traveller women if they’re seeing a male doctor’; 2) appointment delays ‘ it's nowadays the doctor you could be waiting up to a week for an appointment’ 3) a lack of privacy ‘how can you tell your problems, especially private problems, to a secretary, not the doctor’. Implications: Structural and systemic racism limit Travellers’ cancer awareness, equality of access to healthcare and health outcomes. Working in partnership with Traveller organisations and Traveller Community Health Workers is critical to reduce systemic inequity; targeted efforts and mainstreaming of Traveller health are required. References All-Ireland Traveller Health Study [Internet]. gov.ie. 2020. Available from: https://www.gov.ie/en/department-of-health/publications/all-ireland-traveller-health-study/ Health Service Executive. National Traveller Health Action Plan 2022-2027. Working together to improve the health experiences and outcomes for Travellers. [Internet]. 2022. Available from: https://www.hse.ie/eng/services/publications/socialinclusion/national-traveller-health-action-plan-2022-2027.pdf Braveman PA, Arkin E, Proctor D, Kauh T, Holm N. Systemic And Structural Racism: Definitions, Examples, Health Damages, And Approaches To Dismantling: Study examines definitions, examples, health damages, and dismantling systemic and structural racism. Health affairs. 2022 Feb 1;41(2):171-8.

Background: Preceptorship is a widely recognized pedagogy which positions experienced nurses as mentors, educators and assessors in the clinical environment. Public Health Nurse (PHN) preceptors are instrumental to the education and development of PHN students. This study aimed to evaluate PHN preceptors’ perceived recognition, preparedness and support in their roles and to determine overall satisfaction. Methods: A cross‐sectional survey included a validated instrument modified for the Irish community context and convenience sampling methods to target PHN preceptors associated with one Higher Education Institution, following low‐risk ethical approval in 2024. Subscale domains included preparedness, recognition, support and satisfaction. Data were analyzed using descriptive and inferential statistics and STROBE guidelines used for reporting. Results: A response rate of 35.8% ( n = 86) was attained. The Preparedness domain demonstrated the highest consensus ( M = 12.48, SD = 2.06), indicating that respondents felt prepared for their Preceptorship role. Respondents demonstrated high levels of agreement with pedagogical competencies related to making objective student assessments and supporting skills development. Barriers included insufficient time to engage with preceptorship. The results reveal a disconnect between preceptors perceiving that they were highly valued by students but that the preceptorship role was not formally acknowledged as part of their workload at an organizational level. High attendance was reported at preceptor education sessions (87.2%) and a preference for future education to be delivered online (46.4%). Conclusion: PHN preceptors are critical to integrating theoretical learning in the clinical practice environment. While results demonstrate high satisfaction and confidence, significant challenges exist at the systems level to balance the role and demands of preceptorship, within workloads due to time constraints. At a time when primary care settings are being prioritized for healthcare, the workforce challenges need to be understood and solutions co‐created. Future research should incorporate qualitative methods to explore the experiences of preceptors and PHN students. Clinical Trial Registration: Clinical trial registration was not applicable to the study.

Background: The Traveller population is a distinct minority ethnic group, formally recognised by the Irish Government in 2017. Irish Travellers have a lower life expectancy and poorer health expectancy than the general population. Internationally, HPV self-sampling is being considered as an option to improve uptake in cervical screening, particularly in underrepresented groups. It is not currently offered in Ireland, but assessment of acceptability is ongoing. The aim of this study was to determine the uptake of cervical screening and the acceptability of HPV self-sampling in eligible Traveller women. Methods: A face-to-face survey by and with Travellers, adapted from the National Cancer Control Programme’s (NCCP) 2022 National Survey on Cancer Awareness, was conducted by Traveller Community Health workers in partnership with Pavee Point Traveller and Roma Centre. Results: 483 Travellers participated; 306 (63.1%) were women and 191 (39.5%) were in the eligible group for cervical screening (women aged 25-65). Of these, 142 (74%) had ever received an invitation; of those who received an invitation, 125 (89%) attended at least once. Over 73% of those attending cervical screening advised they attended all screening appointments. 37 (19.4%) reported HPV self-sampling as acceptable, 87 (45.5%) as unacceptable to them and 31 (16.2%) were unsure and would like more information. Of the 37 who reported HPV self-sampling as acceptable, 18 (50%) were non (7) or irregular (11) attenders at screening. Conclusion: HPV self-sampling has the potential to overcome, for some Traveller women, the practical and personal barriers which may prevent them from responding to standard cervical cancer screening.

Background: Homelessness is a significant public policy and health service challenge globally. Often identified as a ‘ wicked problem’ homelessness is hard to define with limited data confirming the exact numbers of people who are homeless due to varying metrics employed many of which likely exclude women by design. Research and policy have primarily focused on the experiences of single men, and the impact of homelessness on women and their experiences of it are not well understood. Objective: To synthesise evidence from qualitative studies of homelessness to identify key dimensions of women in high-income countries (HIC) and their experiences navigating lives when homeless. Methods: Systematic searches of six databases [MEDLINE, Embase, Global Health, PsycINFO, CINAHL and ASSIA] were completed from 2012 to 8th January 2024. We included peer-reviewed publications published in English reporting primary qualitative data on women’s experiences of homelessness in high-income countries only. A review protocol was developed and published. Noblit and Hare’s Metaethnography steps guided the synthesis and are reported according to the eMERGe guidelines. Findings: Thirty-two studies were identified describing the experiences of 227 women across nine HICs. A conceptual model comprising three themes is presented within a social-ecological theoretical framework within structural and temporal axes of impact with effects on individual and societal levels. These themes, 1) Precarity, 2) Existing with Risk and Surviving, and 3) Fracturing Identity, describe the implications of homelessness and how the experience of precarity impacts identity and decision-making abilities. The impact of risk arising from violence and exclusion, coupled with descriptions of shame and stigma, presents insight into women’s experiences that have hitherto had a limited presence in clinical discourses. Conclusions: The evidence in this review highlights the perpetual reporting of a deficit lens on homelessness. Women experiencing homelessness in HICs are a heterogeneous group that is poorly recognised and understood in the literature. It appears that there is a lack of tailored and responsive service availability and that this further perpetuates the structural underpinnings of homelessness, which cluster in highly gendered ways.