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Background
Adolescents in foster care and young adults formerly in foster care (AYAFC) face unique challenges in accessing medical care during the transition out of foster care into adulthood. How AYAFC and stakeholders perceive the material and psychological barriers to healthcare access is poorly understood, as is the impact of these barriers on sexual and reproductive health (SRH). This study aimed to identify critical barriers to healthcare access for AYAFC transitioning out of foster care.
Methods
This qualitative study recruited AYAFC and stakeholders involved in supporting foster care transition in North Texas to participate in focus groups. Recruitment of AYAFC participants occurred through community agencies serving transition-age youth. Stakeholders, including foster parents, caseworkers, healthcare professionals, and representatives of a wide range of organizations involved in the foster care transition process were recruited using convenience sampling. The focus group guide addressed domains of experiences accessing healthcare, existing health resources, and transition needs. Focus groups were recorded, transcribed, and analyzed with NVivo software to identify themes emerging from the discussions. This study was approved by the Institutional Review Board.
Results
Five focus groups of AYAFC and stakeholders were conducted, comprised of 2-6 participants each (N = 22), with two participants electing to complete an individual interview. Five major categories of barriers to healthcare emerged: psychological barriers, cognitive barriers, logistic barriers, organizational barriers, and financial/insurance barriers. These primary healthcare access barriers were seen to secondarily impact SRH. Focus group participants discussed barriers such as trauma-based fear of making or keeping gynecologist appointments, lack of perceived autonomy, dependence on caregivers to pick up contraceptive prescriptions, transportation challenges, and lack of school-based sexual education.
Conclusions
AYAFC face multifactorial barriers in accessing healthcare that consequently impact access to SRH care. Qualitative methods can empower partnering with AYAFC and stakeholders to identify these challenges and create solutions to improving healthcare access. An improved understanding of these access barriers may help the SRH of AYAFC by addressing gaps in contraceptive care, supporting trauma-informed care, and advocating for autonomy and reproductive justice. Future studies should examine interventions to reduce logistic and organizational barriers, promote resilience, and improve access to quality healthcare for young adults transitioning out of foster care.
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© 2023 Published by Elsevier Inc.
