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Barriers and bridges to care: voices of homeless female adolescent youth in Seattle, Washington, USA


Josephine Ensign, Department of Psychosocial and Community Health, University of Washington, Box 357263, Seattle, WA 98195, USA. E-mail:


Barriers and bridges to care: voices of homeless female adolescent youth in Seattle, Washington, USA

Aim. The purpose of this study was to conduct an assessment of reproductive health-seeking behaviours, sources of advice, and access to care issues among a sample of clinic-based homeless adolescent women.

Background. Adolescent women are among the most vulnerable and medically underserved subgroups within the homeless population in the United States. Homeless youth are rarely invited to participate in research aimed at improving their access to appropriate health care. Also, the culture in which they live and the personal experience of being homeless are often not addressed.

Study method. The research was descriptive, using focus groups and individual interviews with a purposeful sample of 20 female youth, aged 14–23 years.

Findings. The women said that they seek health advice from other women, including their mothers even while they are homeless. They reported first trying self-care interventions, and going to clinics when self-care actions no longer worked. They stated that the main barriers to health care were lack of insurance, confusion over consent, transportation problems, lack of respect (from providers) for their own self-knowledge, and judgementalism from providers.

Conclusion. Using the concept of cultural competency, the results provide insights into how to improve communication and health care services for these women.

Recommendations. Health care providers need to recognize and appreciate the lifestyle, beliefs, and adaptive attitudes of homeless youth, rather than labelling them as ‘deviant’. All personnel who interact with and on behalf of homeless youth must be adequately trained in general knowledge regarding the health of homeless youth as well as in an understanding of the role that culture plays in their health-seeking behaviours.