Self-Management of Health Care Among Youth: Implications for Policies on Transitions of Care

Youth preferences for healthcare providers and healthcare interactions: a qualitative study

BACKGROUND

Patient-physician relationships in healthcare can influence healthcare provision, patient engagement, and health outcomes. Little is known about youth preferences on types and characteristics of their healthcare providers. The aim of this study was to assess youth perspectives on preferences for and interactions with their healthcare providers.

METHODS

We posed 5 open-ended questions to 1,163 MyVoice participants, a nationwide text message cohort of United States youth aged 14-24, on April 10, 2020 related to youth preferences for healthcare providers. Content analysis was used to develop a codebook. Responses were independently coded by two reviewers with discrepancies discussed to reach consensus. Descriptive statistics were calculated for demographics and frequency of codes.

RESULTS

944 (81%) participants responded to at least one question. Respondents had a mean age of 18.9 years (SD: 2.8) and were a majority female (53.6%) and White (56.3%). Youth reported "kindness" or other personality traits (31%) and education (30%) as important in choosing their doctor. Patient-physician concordance was not important to many youths (44%) and among those who reported concordance as important (55%), having the same gender was the most noted (68%). Youth suggested respect, open conversation, and addressing issues directly to help alleviate uncomfortable situations, though some would simply switch providers.

CONCLUSION

Personality and empathy are important provider characteristics valued by youth. Female respondents preferred gender concordant providers, particularly for sexual health-related issues, and non-white respondents were more likely to prefer racial concordance. Strengthening professional and interpersonal skills among youth-serving providers may improve healthcare engagement and satisfaction among youth.

COVID-19 Vaccine Perspective From Adolescents' Lens in the US

Introduction The COVID-19 pandemic has presented an unprecedented global health issue. The World Health Organization estimates 773 million confirmed cases and 7 million deaths. Vaccination continues to be the most effective way to prevent COVID-19 and has demonstrated safety and efficacy in all age groups. Though a lot of studies have looked at COVID-19 vaccination acceptance and hesitancy in adults, there is scarce research addressing adolescent vaccination readiness. COVID-19 infection in this age group may result in lost school days, school and community transmission, and loss of productivity for parents. Aim This study aims to determine COVID-19 vaccination rates and factors influencing its acceptance and hesitancy in adolescents in a community setting. Methods A voluntary survey was conducted at a local high school in May 2023. Information was collected about the demographics of adolescents and the educational background of parents/guardians. The survey assessed the COVID vaccine rate, reasons for COVID-19 vaccine acceptance or refusal, number of doses of COVID-19 vaccine and boosters received, prior history of COVID-19 infection, source of information on COVID-19 vaccine, flu vaccine acceptance by the students, and whether they would be willing to take a COVID-19 vaccine booster. Results Four hundred participants, ranging in age from 13 to 19, were surveyed. The vaccination rate in boys was comparable to that in girls. 72% received at least one COVID-19 vaccine, and 66% were considered completely vaccinated. Of those completely vaccinated, 80% had undergone further updated COVID-19 booster vaccinations. Adolescents whose parents/guardians were college graduates had a higher vaccination rate than those whose parents/guardians were not. Caucasians and Asians had a higher vaccination rate compared to African Americans and mixed races. The vaccination rate was not statistically different in adolescents with prior COVID-19 infection versus no prior infection. Flu vaccination was associated with higher COVID-19 vaccination rates. Lack of trust was an important reason for vaccine hesitancy, along with questions about efficacy, concerns about side effects, parent/guardian decisions, and religious reasons. Protecting oneself, family/friends, and community were the major reasons to take the vaccine. Parents/guardians, physicians, peers, television, social media, flyers, and schools were the primary sources that adolescents relied on for information about the COVID-19 vaccination. Conclusion Lower education attainment among parents/guardians, African Americans, and mixed races was associated with lower vaccination rates. Lack of trust in the vaccine, questions about efficacy, and fear of side effects were the most frequently cited reasons for vaccine hesitancy. Parent/guardian influence and religious reasons were other significant reasons for vaccine hesitancy. Flu vaccination was associated with higher COVID-19 vaccination rates. Understanding factors influencing COVID-19 vaccination will allow us to address barriers to COVID-19 vaccination and other vaccinations appropriate for this age group. Educating adolescents in schools, involving local and state health departments to increase awareness about the vaccine, and educating parents and guardians along with the teenagers can help increase the acceptance of the vaccine. These interventions will also positively affect the acceptance of the booster and prepare us for any future pandemics.

Attrition from Face-to-Face Pediatric Outpatient Chronic Pain Interventions: A Narrative Review and Theoretical Model

There is limited understanding of attrition (premature treatment withdrawal and non-completion) from pediatric chronic pain services. This narrative review aimed to summarize attrition prevalence from face-to-face pediatric outpatient chronic pain interventions, identify associated factors and develop a theoretical model to account for attrition in this setting. A comprehensive search of the published literature revealed massive variability (0-100%) in the reported attrition rates from pediatric chronic pain interventions that varied in type and format (individual vs. group, single discipline vs. interdisciplinary, psychological only vs. multiple combined interventions, of different durations). The factors associated with attrition from pediatric chronic pain programs varied between the studies: some have assessed patient sex, psychological and other comorbidities, avoidance strategies, missed schooling, family composition/tensions, caregiver catastrophizing, scheduling, caregiver leave and clinic access. A theoretical model is presented depicting youth, caregiver and service factors that may impact attrition from pediatric chronic pain interventions. Where available, literature is drawn from the pediatric chronic pain context, but also from adult chronic pain and pediatric weight management fields. The implications for research and clinical practice are discussed, including improved reporting, patient screening and targeted supports to promote intervention completion. This review contributes to a better understanding of attrition, which is crucial for optimizing pediatric chronic pain service outcomes.

Education level and COVID-19 vaccination willingness in adolescents

Vaccination is essential to control the COVID-19 pandemic. High vaccination willingness is a key for successful vaccination programs. This study assessed attitudes toward vaccination in Austrian adolescents and determined whether there are differences in vaccination readiness regarding education status, gender and migration background. Two cross-sectional online surveys were conducted from March to July 2021 in apprentices and high school students. Willingness to receive COVID-19 vaccination was rated on a 5-point scale. In total, n = 2006 (n = 1442 apprentices and n = 564 high school students) completed the survey. Willingness to receive COVID-19 vaccination was higher in students compared to apprentices (p < 0.001). Furthermore, migration background (p = 0.023) and female gender (p = 0.001) were associated with lower vaccination willingness. In conclusion, more efforts are required to improve confidence and willingness to vaccinate adolescents with lower educational levels, those with migrant backgrounds and females.

Young adults' perceptions of living with atopic dermatitis in relation to the concept of self-management: a qualitative study

OBJECTIVES

Learning to take control of one's health is an important part of the transition from adolescence to adulthood. This study aimed to explore young adults' perceptions of living with atopic dermatitis (AD) in relation to the concept of self-management.

DESIGN

A qualitative study with an inductive approach was performed through semistructured interviews (n=15). The interviews were recorded, transcribed verbatim and analysed with systematic text condensation.

PARTICIPANTS

Young adults (mean age 23,4 years) with persistent AD in a longitudinal population-based birth cohort. To capture experience of living with persistent AD (preschool/school-age onset) of different severity (mild to severe/very severe), a purposive selection was performed. In total, 15 young adults were included. Persistent AD (preschool/school-age onset) was defined as dry skin in combination with itchy rash of typical localisation in the 12 months preceding the 16-year and the 24-year follow-ups. Severity was self-assessed using the Patient Oriented Eczema Measure.

RESULTS

Despite having experience of AD since childhood, the respondents expressed uncertainty about treatment and how it affected their bodies. Their uncertainties and feelings affected how they used topical corticosteroids. The respondents emphasised that they perceived availability of healthcare and knowledge about treatment of AD among healthcare providers to be limited. The participants did not state any experiences of support to self-management from healthcare, which affect young adults' possibilities to take full control of their AD care.

CONCLUSIONS

Young adults with preschool/school-age onset of AD are unsure how to treat and manage the disease. One explanation may be insufficient transition process.

National Study of Youth Opinions on Vaccination for COVID-19 in the U.S

PURPOSE

This study aimed to understand the potential barriers and facilitators to COVID-19 vaccination among youth.

METHODS

Open-ended questions regarding COVID-19 vaccination were posed to a national cohort of 14- to 24-year-olds (October 30, 2020). Responses were coded through qualitative thematic analysis. Multivariable logistic regression tested the association of demographic characteristics with vaccination unwillingness.

RESULTS

Among 911 respondents (response rate = 79.4%), 75.9% reported willingness to receive a COVID-19 vaccine, 42.7% had unconditional willingness, and 33.3% were conditionally willing, of which the majority (80.7%) were willing if experts deemed vaccination safe and recommended. Preferred vaccine information sources were medical organizations (42.3%; CDC, WHO) and health care professionals (31.7%). Frequent concerns with vaccination included side effects (36.2%) and efficacy (20.1%). Race predicted vaccination unwillingness (Black: odds ratio = 3.31; and Asian: odds ratio = .46, compared with white, p < .001).

CONCLUSION

Most youth in our national sample were willing to receive a COVID-19 vaccine when they believe it is safe and recommended. Public health experts and organizations must generate youth-centered materials that directly address their vaccination concerns.