Quality of Health Care: The Views of Homeless Youth


  • Josephine Ensign

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    • Address correspondence to Josephine Ensign, F.N.P., Dr.P.H., Associate Professor, Department of Psychosocial and Community Health, University of Washington, Box 357263, Seattle, WA 98195.

  • Support for the research for this article came from the Agency for Health Care Research and Quality grant no. HS11414-02. Views expressed in this article are the sole responsibility of the author and are not those of the funding agency.


Objective. To develop homeless-youth-identified process and outcome measures of quality of health care.

Data Sources/Study Setting. Primary data collection with homeless youth from both street and clinic settings in Seattle, Washington, for calendar year 2002.

Study Design. The research was a focused ethnography, using key informant and in-depth individual interviews as well as focus groups with a purposeful sample of 47 homeless youth aged 12–23 years.

Data Collection/Extraction Methods. All interviews and focus groups were tape-recorded, transcribed, and preliminarily coded, with final coding cross-checked and verified with a second researcher.

Principal Findings. Homeless youth most often stated that cultural and interpersonal aspects of quality of care were important to them. Physical aspects of quality of care reported by the youth were health care sites separate from those for homeless adults, andsites that offered a choice of allopathic and complementary medicine. Outcomes of health care included survival of homelessness, functional and disease-state improvement, and having increased trust and connections with adults and with the wider community.

Conclusions. Homeless youth identified components of quality of care as well as how quality of care should be measured. Their perspectives will be included in a larger follow-up study to develop quality of care indicators for homeless youth.