Fostering Safety, Support, and Hope: A Qualitative Study of Multistakeholder Perspectives on Designing Health Care Services for Women Who Use Drugs in Seattle, Washington, 2023.

Background: Women who use drugs (WWUD) experience increasingly worse outcomes from drug use as compared to men. Additionally, transactional sex, unstable housing, and unmet needs may further complicate their ability to get needed health care. To inform the design of gender-based, mobile health services, we sought perspectives on health care service delivery from WWUD and health care and harm reduction professionals (HHRPs) in Seattle, WA.

Materials and methods: In 2023, we conducted qualitative interviews with WWUD (n = 16) and HHRPs (n = 5) in the Seattle, Washington area. Interviews focused on experiences receiving health care services, barriers and facilitators to accessing care, and preferences for health care service delivery. Interviews were audio recorded, transcribed, and double coded. Final learnings were reviewed with the study's community advisory boards.

Results: All WWUD participants identified as cisgender women, 12 (75%) identified as White, and 11 (69%) had unstable housing. Analysis identified four themes that characterized perspectives of WWUD and HHRP on health care service delivery needs, embodied by: safety, stigma, hope, and resiliency. Participants described that lack of safety and unmet basic needs made it challenging for WWUD to ever feel healthy (theme 1), and that WWUD felt stigmatized by mainstream health care services in intersectional ways (theme 2). However, participants shared that these burdens were lessened when health care teams created space for hope in care delivery interactions (theme 3) and built resiliency by reducing barriers and complementing care with structural supports (theme 4).

Discussion: In this small qualitative sample, WWUD experienced a myriad of intersecting challenges that perpetuated marginalization and health disparities. This population may benefit from interventions rooted in intersectional and trauma-informed approaches.