"Is It Really Confidential?" A Content Analysis of Online Information About Sexual and Reproductive Health Services for Adolescents

Confidentiality in the Care of Adolescents: Technical Report

Confidentiality is a foundational element of high-quality, accessible, and equitable health care. Despite strong grounding in federal and state laws, professional guidelines, and ethical standards, health care professionals and adolescent patients face a range of complexities and barriers to seeking and providing confidential care to adolescents across different settings and circumstances. The dynamic needs of adolescents, the oftentimes competing interests of key stakeholders, the rapidly evolving technological context of care, and variable health care billing and claims requirements are all important considerations in understanding how to optimize care to focus on and meet the needs of the adolescent patient. The following assessment of the evolving evidence base offers a view of the current state and best practices while pointing to numerous unmet needs and opportunities for improvement in the care experiences of youth as well as their health outcomes.

Annual STI Testing Among Sexually Active Adolescents

OBJECTIVES

National guidelines call for annual testing for certain sexually transmitted infections (STIs) among specific adolescent populations, yet we have limited population-based data on STI testing prevalence among adolescents. With inclusion of a new item in the 2019 national Youth Risk Behavior Survey, we provide generalizable estimates of annual STI testing among sexually active high school students.

METHODS

We report weighted prevalence estimates of STI testing (other than HIV) in the past 12 months among sexually active students (n = 2501) and bivariate associations between testing and demographic characteristics (sex, age, race and ethnicity, sexual identity, and sex of sexual contact). Multivariable models stratified by sex and adjusted for demographics examine the relationships between testing and sexual behaviors (age of initiation, number of sex partners, condom nonuse at last sexual intercourse, and substance use at last sexual intercourse).

RESULTS

One-fifth (20.4%) of sexually active high school students reported testing for an STI in the previous year. A significantly higher proportion of female (26.1%) than male (13.7%) students reported testing. Among female students, prevalence differed by age (≤15 years = 12.6%, age 16 = 22.8%, age 17 = 28.5%, or ≥18 years = 36.9%). For male students, there were no differences by demographic characteristics, including sexual identity, but most sexual risk behaviors were associated with increased likelihood of STI testing (adjusted prevalence ratios ranging from 1.48 to 2.47).

CONCLUSIONS

Low prevalence of STI testing suggests suboptimal adherence to national guidelines, particularly for sexually active adolescent females and young men who have sex with men who should be tested for Chlamydia and gonorrhea annually.

Supporting Patient-centered Communication on Adolescent Sexual and Reproductive Health-Perspectives to Build an Appointment Planning Tool

STUDY OBJECTIVE

Input from adolescents and healthcare providers is needed to develop electronic tools that can support patient-centered sexual and reproductive (SRH) care. This study explores facilitators and barriers to patient-centered communication in the context of developing an electronic appointment planning tool to promote SRH communication in clinic settings.

DESIGN

In-depth interviews were conducted to explore what constitutes adolescent-friendly SRH care and communication, as well as on the design of the appointment planning tool. Interviews were coded iteratively, and analyzed using the software Atlas.TI v8.

SETTING

An adolescent primary care clinic, and a pediatric and adolescent gynecology clinic.

PARTICIPANTS

Adolescent girls (N=32; ages 14-18) and providers who care for adolescent girls (N=10).

MAIN OUTCOME MEASURES

Thematic analyses explored facilitators/barriers to SRH communication and care and preferences for the tool.

RESULTS

Facilitators identified by adolescents and providers included: direct patient/provider communication; adolescent-driven decision-making regarding care and contraceptive choice; supplementing clinic visits with electronic resources; and holistic care addressing physical, mental, and social needs. Barriers identified by participants included: limited time for appointments; limited adolescent autonomy in appointments; and poor continuity of care when adolescents cannot see the same provider. Given the complexity of issues raised, adolescents and providers were interested in developing an appointment planning tool to guide communication during appointments, and contributed input on its design. The resulting Appointment Planning Tool app pilot is in progress.

CONCLUSIONS

Qualitative interviews with adolescents and providers offer critical insights for the development and implementation of mobile health (mHealth) tools that can foster patient-centered care.

Information needs and services for autism in China: is there any gap between them?

Purpose

This study aims to explore the gap between information needs and services for autism in China.

Design/methodology/approach

The gap is revealed by investigating the status quo of autism information needs and services. The authors extracted categories and subcategories of information needs through content analysis of academic documents and then supplemented the subcategories through text mining of an online forum. Meanwhile, categories and subcategories of information services were extracted through content analysis of autism websites. Finally, the authors matched the two to explore the gap and designed a quantitative index to measure it.

Findings

A total of eight and ten categories of information needs and services are extracted, respectively. In total, six categories of information needs can be partly matched, but nearly half of the subcategories failed. Huge gaps in economic support, sociality and policy mechanisms categories are observed through the quantitative index and medium gaps in social resource services and employment categories while almost no gaps in psychological/emotional counseling, rehabilitation skills training and professional knowledge/information categories.

Originality/value

This study takes a deep insight into the gap between autism information needs and services in China, providing evidences and suggestions for information providers to improve their services. Academic documents and online forum data are adopted to avoid the impact of stigmatization, which provides a multi-source data analysis approach for the information needs of special groups.

Searching for online health information instead of seeing a physician: a cross-sectional study among high school students in Belgrade, Serbia

OBJECTIVES

Fear of being judged and stigmatized has been reported as barriers for adolescents to timely use healthcare services. The objective of this study was to examine the prevalence and factors associated with online health information seeking instead of seeing a physician among high school students.

METHODS

A cross-sectional questionnaire-based study was carried out in four out of 21 public high schools in Belgrade, from December 2016 to January 2017 (n = 702, 41.9% males, 15-19 years old). The association of socio-demographic characteristics, digital literacy, interest in health topics and the use of online platforms with health information seeking was analysed using multinomial regression models.

RESULTS

More than half of high school students (56.6%) search for online health information instead of seeking a physician. Being male, having lower-grade point average, attending humanities-languages program, older age at first Internet use, better e-health literacy, use of smartphones, interest in sexually transmitted diseases and mental health, use of websites run by physicians and Youtube was associated with online health information seeking instead of in-person visit to a physician.

CONCLUSIONS

Setting up safe and supportive online platform could help adolescents improve health education. Physicians who see adolescent patients should encourage discussions about sensitive health topics.

Confidentiality Matters but How Do We Improve Implementation in Adolescent Sexual and Reproductive Health Care?

Confidentiality protections are a key component of high-quality adolescent sexual and reproductive health (SRH) care. Research has shown that adolescents value confidentiality and are more likely to seek care and provide honest information when confidentiality protections are implemented. However, many adolescents do not receive confidential SRH care. We synthesize studies of adolescents, parents, and providers to identify confidentiality-related factors that may explain why adolescents do not seek care or receive confidential services when they do access care. We present themes relevant to each population that address individual-level knowledge, attitudes, and behaviors, as well as clinic-level characteristics such as protocols, billing mechanisms, and clinic type. These findings have the potential to inform intervention efforts to improve the delivery of confidential SRH care for young people.