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Tiffany-Appleton S, Mickievicz E, Ortiz Y, Migliori O, Randell KA, Rothman EF, Chaves-Gnecco D, Rosen D, Miller E, Ragavan MI. Adolescent Relationship Abuse Prevention in Pediatric Primary Care: Provider, Adolescent, and Parent Perspectives. Acad Pediatr 2023; 23:1151-1158. [PMID: 36584939 PMCID: PMC10293467 DOI: 10.1016/j.acap.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/15/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Adolescent relationship abuse (ARA) is associated with myriad negative health outcomes. Pediatric primary care presents an opportunity to engage adolescents and parents, who can be protective against ARA, in ARA prevention; however, no family-focused, health care-based ARA interventions exist. The purpose of this study is to explore the perspectives of adolescents, parents, and health care providers (HCPs) on incorporating ARA prevention into primary care, including 1) current discussions around ARA, 2) how to best include ARA prevention education, and 3) how to address implementation barriers. METHODS We conducted individual, semi-structured interviews with HCPs, adolescents ages 11 to 15, and parents recruited through convenience sampling. Transcripts were individually coded by 4 study team members (with every third transcript co-coded to assess discrepancies) and analyzed via thematic analysis. RESULTS Participants identified a need for pediatric HCPs to involve younger adolescents and parents in universal, inclusive ARA prevention and noted that HCPs require training, techniques, and resources around ARA. Participants acknowledged multilevel barriers to implementing primary care-based ARA prevention. They suggested that ARA education be intentionally integrated into HCP and clinic workflows and recommended strategies to garner adolescent and parent buy-in to facilitate ARA-focused conversations. CONCLUSIONS Pediatric primary care is a promising environment to involve parents and adolescents in universal ARA-prevention. Future research should contextualize these results with larger samples across multiple practice settings and integrate relevant partners in the development and evaluation of evidenced-based ARA prevention for pediatric primary care.
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Affiliation(s)
- Sarah Tiffany-Appleton
- Division of General Academic Pediatrics, Department of Pediatrics, University of Pittsburgh School of Medicine (S Tiffany-Appleton, E Mickievicz, Y Ortiz, O Migliori, D Chaves-Gnecco, and MI Ragavan), Pittsburgh, Pa; University of Pittsburgh School of Social Work (S Tiffany-Appleton and D Rosen), Pittsburgh, Pa
| | - Erin Mickievicz
- Division of General Academic Pediatrics, Department of Pediatrics, University of Pittsburgh School of Medicine (S Tiffany-Appleton, E Mickievicz, Y Ortiz, O Migliori, D Chaves-Gnecco, and MI Ragavan), Pittsburgh, Pa
| | - Yanet Ortiz
- Division of General Academic Pediatrics, Department of Pediatrics, University of Pittsburgh School of Medicine (S Tiffany-Appleton, E Mickievicz, Y Ortiz, O Migliori, D Chaves-Gnecco, and MI Ragavan), Pittsburgh, Pa
| | - Olivia Migliori
- Division of General Academic Pediatrics, Department of Pediatrics, University of Pittsburgh School of Medicine (S Tiffany-Appleton, E Mickievicz, Y Ortiz, O Migliori, D Chaves-Gnecco, and MI Ragavan), Pittsburgh, Pa
| | - Kimberly A Randell
- Children's Mercy (KA Randell), Kansas City, Mo; University of Missouri-Kansas City School of Medicine (KA Randell); University of Kansas School of Medicine (KA Randell), Kansas City, Kans
| | - Emily F Rothman
- Community Health Sciences, Boston University School of Public Health (EF Rothman), Boston, Mass; Department of Pediatrics, Boston University School of Medicine (EF Rothman), Boston, Mass
| | - Diego Chaves-Gnecco
- Division of General Academic Pediatrics, Department of Pediatrics, University of Pittsburgh School of Medicine (S Tiffany-Appleton, E Mickievicz, Y Ortiz, O Migliori, D Chaves-Gnecco, and MI Ragavan), Pittsburgh, Pa
| | - Daniel Rosen
- University of Pittsburgh School of Social Work (S Tiffany-Appleton and D Rosen), Pittsburgh, Pa
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine (E Miller), Pittsburgh, Pa
| | - Maya I Ragavan
- Division of General Academic Pediatrics, Department of Pediatrics, University of Pittsburgh School of Medicine (S Tiffany-Appleton, E Mickievicz, Y Ortiz, O Migliori, D Chaves-Gnecco, and MI Ragavan), Pittsburgh, Pa.
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Khetarpal SK, Tiffany-Appleton S, Mickievicz EE, Barral RL, Randell KA, Temple JR, Miller E, Ragavan MI. Sexual Health and Relationship Abuse Interventions in Pediatric Primary Care: A Systematic Review. J Adolesc Health 2023; 72:487-501. [PMID: 36623966 PMCID: PMC10033391 DOI: 10.1016/j.jadohealth.2022.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/23/2022] [Accepted: 11/14/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE Supporting adolescents in developing healthy relationships and promoting sexual and reproductive health (SRH) is an important responsibility of pediatric primary care providers. Less is known about evidence-based interventions in pediatric settings focused on healthy relationships and SRH. METHODS We conducted a systematic review to describe SRH and healthy relationship/adolescent relationship abuse (ARA) interventions for pediatric primary care over the past 20 years. Eligible articles were original research on an SRH-focused or ARA-focused intervention, conducted in-person within pediatric primary care or school-based health centers specifically for middle or high school-aged adolescents. Data abstracted from included articles included intervention description, content, delivery, evaluation design, and effectiveness of primary outcomes. Heterogeneous outcomes and evidence levels made conducting a meta-analysis infeasible. RESULTS Nineteen studies described 17 interventions targeting a variety of SRH and ARA topics (e.g., sexually transmitted infections, contraception, ARA). Interventions largely focused on screening/counseling adolescents (89%). Interventions generally were reported as being effective in changing adolescent health or practice-level outcomes. DISCUSSION This review provides preliminary evidence that SRH and ARA interventions in pediatric primary care settings can be effective in promoting adolescent health. Future work should consider ARA-specific prevention interventions, including parents in interventions, and strategies for implementation, dissemination, and scaling.
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Affiliation(s)
- Susheel Kant Khetarpal
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Pediatrics, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York.
| | - Sarah Tiffany-Appleton
- Division of General Academic Pediatrics, University of Pittsburgh and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erin E Mickievicz
- Division of General Academic Pediatrics, University of Pittsburgh and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Romina L Barral
- Division of Adolescent and Young Adult Medicine, Children's Mercy Kansas City, Kansas City, Missouri
| | - Kimberly A Randell
- Division of Emergency Medicine, Children's Mercy Kansas City, Kansas City, Missouri
| | - Jeff R Temple
- Center for Violence Prevention, University of Texas Medical Branch, Galveston, Texas
| | - Elizabeth Miller
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Maya I Ragavan
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Division of General Academic Pediatrics, University of Pittsburgh and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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