Background Populations facing severe and multiple disadvantage (SMD) – co-occurring homelessness, substance misuse and repeat offending, have high level of physical and mental ill-health. Poor oral health is one of the three most common physical health problems among this population, and it is closely linked with high levels of drug and alcohol use as well as smoking. Improving access to physical and mental health services, including dental health care, is a national priority highlighted by several government and non-government agencies. However, not much is known about the factors that impact the access to care by people living with SMD. This study aimed to explore the barriers and facilitators to improved access to health services (for oral health, substance and alcohol use, and smoking) for people with SMD.

Methods Between August 2021 and March 2022, a combination of in-person and online interviews/focus group discussions were conducted with people experiencing SMD in Newcastle and online interviews/focus group discussions were conducted with frontline staff, volunteers, policy makers, and commissioners from London, Plymouth and Newcastle upon Tyne. Data were analysed iteratively using thematic analysis and were organized and coded using NVivo 1.6.1.

Results 19 people with past or current experience of SMD (age range: 27–65 years; 79% male) and 78 service providers (age range: 28–72 years; 37% male) were interviewed. Data were broadly organized into the following four themes: environmental, organizational, inter-personal, and individual factors. Environmental factors included: integrative support, payment system, and availability of resources (funding, human resources and training); organizational factors included: availability of services, waiting lists and physical infrastructure; inter-personal factors included: establishing relationships, empathy or understanding amongst service providers and stigmatization; and individual factors included: motivation and priority for receiving health care as well as fear (of accessing services or repercussions). COVID-19 was identified as a cross-cutting theme across barriers in accessing support.

Conclusion People living with SMD face multiple adversities and health inequalities in accessing and engaging with health services which were further amplified during the COVID-19 pandemic. Our study highlights several factors across four domains that have a role in shaping experiences accessing oral health, substance use, and smoking services. These findings highlight the need for tailoring health services to better suit people with SMD which will help improve access to services that can address their respective health issues. Findings from our study could also be extrapolated to the planning and delivery of other health services for people with SMD.