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This paper – the final paper of a series of three – aims to discuss the implications of the findings from a service user needs assessment of people experiencing homelessness in the Northwest of England. It will expand on the previous paper by offering a more detailed analysis and discussion of the identified key themes and issues. The service user needs assessment was completed as part of a review of local service provision in the Northwest of England against the backdrop of the COVID-19 pandemic.

Semi-structured questionnaires were administered and used by health-care professionals to collect data from individuals accessing the Homeless and Vulnerable Adults Service (HVAS) in Bolton. The questionnaires included a section exploring Adverse Childhood Experiences. Data from 100 completed questionnaires were analysed to better understand the needs of those accessing the HVAS.

Multiple deprivations including extensive health and social care needs were identified within the cohort. Meeting these complex needs was challenging for both service users and service providers. This paper will explore key themes identified by the needs assessment and draw upon further comments from those who participated in the data-gathering process. The paper discusses the practicalities of responding to the complex needs of those with lived experience of homelessness. It highlights how a coordinated partnership approach, using an integrated service delivery model can be both cost-effective and responsive to the needs of those often on the margins of our society.

Data collection during the COVID-19 pandemic presented a number of challenges. The collection period had to be extended whilst patient care was prioritised. Quantitative methods were used, however, this limited the opportunity for service user involvement and feedback. Future research could use qualitative methods to address this balance and use a more inclusive approach.

This study illustrates that the needs of the homeless population are broad and varied. Although the population themselves have developed different responses to their situations, their needs can only be fully met by a co-ordinated, multi-agency, partnership response. An integrated service model can help identify, understand, and meet the needs of the whole population and individuals within it to improve healthcare for a vulnerable population.

This study highlighted new and important findings around the resilience of the homeless population and the significance of building protective factors to help combat the multiplicity of social isolation with both physical and mental health problems.

The discussion provides an opportunity to reflect on established views in relation to the nature and scope of homelessness. The paper describes a contemporary approach to tackling current issues faced by those experiencing homelessness in the current context of the COVID-19 pandemic. Recommendations for service improvements will include highlighting established good practices including embedding a more inclusive/participatory approach.

The number of young people using e-cigarettes (commonly referred to as vaping) has grown at an alarming rate, creating the need for urgent action. This paper demonstrates rapid step-by-step iterative application of the Co-create, Build and Engage (CBE) framework to showcase how marketing was applied in response to emerging trends that have negative health and environmental consequences. This paper aims to demonstrate how CBE is applied iteratively, ensuring student feedback leads module development.

In Study 1, a pure seven-step co-design implementation, 19 high school students were invited to co-design a vaping prevention approach that would work for them and other people like them. During the sensitisation phase of co-design, students completed one Blurred Minds Vaping module. Feedback grids were provided, with students identifying likes, dislikes and ideas. This likeability data was used, together with input from technical experts and pedagogical best practice, in a 12-week research and development project that aimed to develop a new online learning module focused on vaping and their environmental impacts for the Blurred Minds Academy. The new module was tested with 20 high school students. Feedback grids were provided once again, allowing a comparison of results.

Examination of feedback grid data demonstrates that the newly developed Vaping and the Environment module was improved. Considerations taken on board in the new module design (e.g. increased variability within the module) overcame criticisms expressed previously (e.g. it was boring and too long). Other criticisms remained evident, albeit at a much lower proportion suggesting the new Vaping and the Environment module, and future Blurred Minds module development, would benefit from iterative CBE application.

Conduit et al. (2022) note that marketing academia has been criticised for having an increasingly less relevant managerial agenda. This paper outlines a rapid step-by-step application of marketing in response to one of society’s most pressing health challenges – vaping. The iterative application of CBE is outlined, demonstrating that the student experience can be enhanced when marketing’s continual improvement mindset is used. This is the first vaping prevention programme that has included substantive information around the negative impacts of vaping on the environment.