Youth-Friendly Sexual and Reproductive Healthcare with Female Youth Experiencing Homelessness

Background and Purpose: Reducing the barriers female youth experiencing homelessness (YEH) face in accessing comprehensive and culturally appropriate reproductive and sexual healthcare (SRH) has remained a perennial issue. Female YEH are more likely than their housed counterparts to experience an unplanned pregnancy, contract an STI, or engage in higher-risk sexual behaviors; however, they are also more likely to report a desire to uptake contraception and use healthcare services. To meet these needs, our team developed and tested Wahine (“woman”) Talk, a comprehensive SRH program delivered by an interdisciplinary team (social work/public health/medicine). Wahine Talk was explicitly developed for female YEH and uses an integrated intervention to provide education, contraception, and other medical services. The current qualitative study explores how Wahine Talk provides youth-friendly SRH for female YEH.

Methods: Following Wahine Talk, seven program providers and 35 female, majority Native Hawaiian and other Pacific Islander YEH aged 14-22 (M=18.9) years participated in in-depth individual interviews and focus groups regarding their experiences of receiving and delivering Wahine Talk. We transcribed the data verbatim and analyzed the transcripts using Template Analysis, organized by CDC’s youth-friendly SRH care domains of privacy, confidentiality, consent, cultural and linguistic appropriateness, comprehensive services, and parent/guardian involvement.

Results: The interview analyses suggest that Wahine Talk’s iterative process for improving the program and building participant relationships has been beneficial. Providers noted that integrating participant feedback into the next wave of the program facilitated more frequent and higher-quality interactions with the program participants. Throughout program delivery, the relationship between providers and participants focused on building trust and open communication, which likewise helped support staff in connecting participants to healthcare, housing, and employment opportunities. Participants reiterated the importance of the providers being non-judgmental as an essential component to feeling comfortable to discuss SRH with the providers and continue participation in the program. As one participant said in discussing her experience “the staff really make you feel welcome about telling the truth...they treat us like a homie” and several participants referred to staff members as their friend or being like a family member.

Conclusions and Implications: Culturally appropriate SRH for female YEH requires an integrated, sophisticated understanding of patient needs and higher levels of patient-provider interaction to be successful and retain patients in care. Wahine Talk is a holistic approach that offers a promising way to deliver youth-friendly care to female YEH. Social workers are uniquely positioned across sectors to deliver or facilitate delivery of youth-friendly SRH to female YEH.