Collaboration in the provision of care, support, and participatory opportunities for women with comorbidities experiencing homelessness

BACKGROUND: Women experiencing homelessness have complex needs. Although participation and shared decision-making are legal rights, meaningful involvement remains challenging. The study was conducted with a Women Advisory Board (WAB). AIM: To investigate professionals' perceptions of prerequisites and opportunities for participation and shared decision-making for women with comorbidities experiencing homelessness, regarding collaboration to provide care and support - and to ascertain the Women's Advisory Board's reasoning about the professionals' perceptions. METHODS: Twelve interviews with professionals in social services, healthcare and non-governmental organisations in Sweden were conducted and analysed with content analysis. RESULTS: Professionals reported that collaboration for women with comorbidities experiencing homelessness often fails. Organisations work in isolation, lack a holistic perspective, and avoid responsibility. Women are seldom heard, while bureaucratic language and professional control dominate. Meetings overlook lived experiences of illness, substance use disorder, and homelessness, hindering participation. These women are vulnerable, ashamed, and exposed to violence. Effective collaboration requires a woman-centred approach, adaptation, preparation, and follow-up. The WAB's reasoning confirmed these perceptions. CONCLUSION: Professionals and the WAB agree that collaboration requires committed and flexible professionals, who work together acknowledging the individual woman's circumstances-not their own organisational framework. It is questionable whether user participation is possible under the prevailing conditions.