Important health provider characteristics: the perspective of urban ninth graders

Perspectives of Urban Adolescent Black Males and Their Parents on Well Care

OBJECTIVE

Adolescents have fewer well-care visits than all other age groups. Males and ethnic minorities are seen least often. We elicited from Black adolescent males and their parents key drivers of teen well-care seeking.

METHODS

We conducted separate semistructured interviews with Black adolescent males and their parents. We recruited parent-teen dyads from West Philadelphia. Eligible teens were age 13 to 18, with no complex chronic health conditions. We purposively sampled teens who had not received preventive care in at least 2 years, some of whom had since returned to care and some not. Interviews were recorded, transcribed, and coded by 2 coders using the constant comparative method, resolving discrepancies by consensus. Interviews continued until thematic saturation.

RESULTS

We interviewed 23 Black adolescent males (mean age 15) and 22 parents (20 mothers). Participants understood that teens should routinely receive preventive care. Four themes emerged: receiving preventive care is important to knowing teens are mentally and physically well; remembering to schedule/attend visits is challenging - participants find appointment reminders helpful; mothers noted that males of all ages are generally disengaged from health care; teens and parents felt that a "good" parent ensures teens receive preventive care.

CONCLUSIONS

Black adolescent males and their parents value regular preventive care as an opportunity to ensure the teen is physically and mentally well, but competing priorities interfere with care receipt. Results support testing the impact of reminders on receipt of care in this population. These reminders may be most effective if directed at mothers and focused on "good parenting."

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.

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

PURPOSE

Many young people are not aware of their rights to confidential sexual and reproductive health (SRH) care. Given that online health information seeking is common among adolescents, we examined how health education Web content about SRH for young people addresses confidentiality.

METHODS

In Spring 2017, we conducted Google keyword searches (e.g., "teens" and "sex education") to identify health promotion Web sites operated by public health/medical organizations in the United States and providing original content about SRH for adolescents/young adults. Thirty-two Web sites met inclusion criteria. We uploaded Web site PDFs to qualitative analysis software to identify confidentiality-related content and conduct thematic analysis of the 29 Web sites with confidentiality content.

RESULTS

Sexually transmitted infection testing and contraception were the SRH services most commonly described as confidential. Clear and comprehensive definitions of confidentiality were lacking; Web sites typically described confidentiality in relation to legal rights to receive care without parental consent or notification. Few mentioned the importance of time alone with a medical provider. Only half of the Web sites described potential inadvertent breaches of confidentiality associated with billing and even fewer described other restrictions to confidentiality practices (e.g., mandatory reporting laws). Although many Web sites recommended that adolescents verify confidentiality, guidance for doing so was not routinely provided. Information about confidentiality often encouraged adolescents to communicate with parents.

CONCLUSIONS

There is a need to provide comprehensive information, assurances, and resources about confidentiality practices while also addressing limitations to confidentiality in a way that does not create an undue burden on adolescents or reinforce and exacerbate confidentiality concerns.

Preferências dos adolescentes sobre os cuidados de saúde

Resumo Os adolescentes subutilizam os serviços de saúde sobretudo para efeitos de vigilância, o que constitui uma preocupação para os profissionais. Porque a adolescência é uma fase crucial à aquisição de comportamentos saudáveis e de atitudes facilitadoras do acesso a estes serviços, por isso encontrar formas de responder às necessidades específicas dos adolescentes, através da sua participação, constitui um importante investimento no bem-estar das gerações futuras. Este estudo exploratório e descritivo, de natureza qualitativa, com duas fases, teve como objetivos identificar e analisar as ideias e preferências dos adolescentes sobre os cuidados de saúde. Realizaram-se oito entrevistas de grupo com 64 adolescentes dos 13 aos 18 anos: quatro grupos focais (fase 1) e quatro grupos nominais (fase 2). Os dados foram tratados através da análise de conteúdo. Emergiram opiniões favoráveis e desfavoráveis. Nas suas preferências destacaram-se, nas condições dos serviços, haver menos tempo de espera e ambientes mais confortáveis e menos lotados; nas atitudes dos profissionais privilegiaram as competências técnicas, como o saber e a experiência, embora associadas às competências relacionais. Os resultados suportam a necessidade de mudanças nas práticas organizacionais e sobretudo nas atitudes dos profissionais.

"Treat Me Like a Normal Person!" A Meta-Ethnography of Adolescents' Expectations of Their Health Care Providers

PURPOSE

Preventive health care services provide an important opportunity to assist adolescents to establish and maintain a healthy lifestyle and assume an increasing independent role in their health care. National guidelines emphasize the importance of an annual wellness visit to identify and address risk-behaviors that contribute significantly to the morbidity and mortality in this population. Despite these recommendations, adolescents utilize preventive health care at declining rates throughout adolescence. The purpose of this study was to capture a more holistic view of what adolescents, as consumers of health care services, expect from their primary health care providers (HCPs).

METHOD

A metasynthesis of 12 qualitative research studies was conducted using Noblit and Hare's (1988) meta-ethnographic approach.

RESULTS

Five overarching metaphors, Talk with Me- Not at Me, Accept Me, Respect My Privacy and Confidentiality, Show Me You Are a Professional, and A Trusted Relationship described adolescents' expectations of their HCPs.

CONCLUSIONS

This study provides a more holistic view of adolescents' expectations of their HCPs. Clinical strategies are suggested to assist HCPs to meet adolescents' expectations.

Mapping the Views of Adolescent Health Stakeholders

PURPOSE

Health research that includes youth and family stakeholders increases the contextual relevance of findings, which can benefit both the researchers and stakeholders involved. The goal of this study was to identify youth and family adolescent health priorities and to explore strategies to address these concerns.

METHODS

Stakeholders identified important adolescent health concerns, perceptions of which were then explored using concept mapping. Concept mapping is a mixed-method participatory research approach that invites input from various stakeholders. In response to prompts, stakeholders suggested ways to address the identified health conditions. Adolescent participants then sorted the statements into groups based on content similarity and rated the statements for importance and feasibility. Multidimensional scaling and cluster analysis were then applied to create the concept maps.

RESULTS

Stakeholders identified sexually transmitted infections (STIs) and obesity as the health conditions they considered most important. The concept map for STIs identified 7 clusters: General sex education, support and empowerment, testing and treatment, community involvement and awareness, prevention and protection, parental involvement in sex education, and media. The obesity concept map portrayed 8 clusters: Healthy food choices, obesity education, support systems, clinical and community involvement, community support for exercise, physical activity, nutrition support, and nutrition education. Ratings were generally higher for importance than for feasibility.

CONCLUSIONS

The concept maps demonstrate stakeholder-driven ideas about approaches to target STIs and obesity in this context. Strategies at multiple social ecological levels were emphasized. The concept maps can be used to generate discussion regarding these topics and to identify interventions.

Valuing technology: A qualitative interview study with physicians about insulin pump therapy for children with type 1 diabetes

Insulin pumps for children with type 1 diabetes have been broadly adopted despite equivocal evidence about comparative effectiveness. To understand why and inform policy related to public funding for new technologies, we explored how physicians interpret the value of pumps. We conducted open-ended, semi-structured interviews with 16 physicians from a pediatric diabetes network in Ontario, Canada, and analyzed the data using interpretive description. Respondents recognized that pumps fell short of expectations because they required hard work, as well as family and school support. Yet, pumps were valued for their status as new technologies and as a promising step in developing future technology. In addition, they were valued for their role within a therapeutic relationship, given the context of chronic childhood disease. These findings identify the types of beliefs that influence the adoption and diffusion of technologies. Some beliefs bear on hopes for new technology that may inappropriately hasten adoption, creating excess cost with little benefit. On the other hand, some beliefs identify potential benefits that are not captured in effectiveness studies, but may warrant consideration in resource allocation decisions. Still others suggest the need for remediation, such as those bearing on disparity in pump use by socioeconomic status. Understanding how technologies are valued can help stakeholders decide how to address such beliefs and expectations in funding decisions and implementation protocols.

Student help seeking from pastoral care in UK high schools: a qualitative study

BACKGROUND

Little is known about high school students' perceptions of school-based pastoral support. This study aimed to explore this in the context of a high school-based emotional support project.

METHODS

Qualitative interviews explored perspectives on help seeking of students (N = 23) and staff (N = 27) in three UK high schools where a pastoral project was introduced. Data were analysed thematically.

RESULTS

Student peer groups perceived help seeking as a sign of weakness. However, students valued learning skills in managing emotions and friendships. Staff expressed concerns about students' ability to help seek proactively, and highlighted organisational influences on pastoral support.

CONCLUSIONS

Increasing student control over the process, and involving trusted staff, could encourage help seeking in high school. It is possible to access the views of students who do not help seek, to improve understanding of help-seeking behaviour.

Adolescent views on comprehensive health risk assessment and counseling: assessing gender differences

PURPOSE

Adolescence is an important time for the detection of health risk behaviors and factors with subsequent counseling and intervention. Limited research has examined adolescent perceptions of comprehensive health risk assessments (HRAs) and counseling with an assessment of gender differences.

METHODS

Participants were identified using Florida's Medicaid and State Children's Health Insurance Program databases. A total of 35 low-income, racially/ethnically diverse adolescents (ages 14-18 years) participated in eight focus groups stratified by gender. Adolescents completed an internet-based, tablet-administered, comprehensive HRA and then participated in a semi-structured interview. Discussions were recorded, transcribed, and analyzed using a multi-step, team-based approach applying grounded theory to determine major themes.

RESULTS

Male adolescents desired less parental involvement, had less understanding of the protections of clinical confidentiality and the need for comprehensive HRA, and placed greater emphasis on the importance of professional appearance. In contrast, more females valued face-to-face interactions and stressed the importance of concern from the health risk assessor. Overall, adolescents placed importance on their relationship with the health risk assessor, and on valuing trust, confidentiality, and nonjudgmental care. Adolescents preferred to complete HRAs in clinical, private, and professional settings, and reported that tablet technology supported their confidentially in completing the HRA. Furthermore, they stressed the importance of autonomy and learning about the health risk outcomes for risk reduction.

CONCLUSIONS

Gender differences exist in adolescent perceptions of comprehensive HRAs. Adolescent perceptions of HRAs support their use in confidential primary care settings using modalities that emphasize nonjudgmental, private care, and the use of communication techniques that respect adolescents' autonomy to change health risks.

Beyond prevention: promoting healthy youth development in primary care

Training primary care providers to incorporate a youth development approach during clinical encounters with young people represents an opportunity to integrate public health into primary care practice. We recommend that primary care providers shift their approach with adolescents from focusing on risks and problems to building strengths and assets. Focusing on strengths rather than problems can improve health by fostering resilience and enhancing protective factors among adolescents. A strength-based approach involves intentionally assessing and reinforcing adolescents' competencies, passions, and talents, as well as collaborating with others to strengthen protective networks of support for young people. Training programs should incorporate interactive strategies that allow clinicians to practice skills and provide tools clinicians can implement in their practice settings.

Parental expectations in the care of their children and adolescents with diabetes

There is little research about what parents of children with diabetes want and need from their health-care providers as they negotiate life with diabetes. Sixty-three parents of children with type 1 diabetes were interviewed. Interviews were tape-recorded and transcribed verbatim, and a content analysis of text data was conducted. Three themes emerged describing what they wanted in their relationships with diabetes providers: laying the foundation, providing clinical care, and engaging families as partners. Collectively, these data provide vivid insights into the parent's perspective regarding their needs from diabetes providers as well as their perceptions of interactions that were unhelpful or worse, hurtful or undermining.

Rethinking school-based health centers as complex adaptive systems: maximizing opportunities for the prevention of teen pregnancy and sexually transmitted infections

This article examines school-based health centers (SBHCs) as complex adaptive systems, the current gaps that exist in contraceptive access, and the potential to maximize this community resource in teen pregnancy and sexually transmitted infection (STI) prevention efforts. Adolescent pregnancy is a major public health challenge for the United States. Existing community resources need to be considered for their potential to impact teen pregnancy and STI prevention efforts. SBHCs are one such community resource to be leveraged in these efforts. They offer adolescent-friendly primary care services and are responsive to the diverse needs of the adolescents utilizing them. However, current restrictions on contraceptive availability limit the ability of SBHCs to maximize opportunities for comprehensive reproductive care and create missed opportunities for pregnancy and STI prevention. A clinical case explores the current models of health care services related to contraceptive care provided in SBHCs and the ability to meet or miss the needs of an adolescent seeking reproductive care in a SBHC.

Providing adolescent-friendly HPV education

Human papillomavirus (HPV) is the most common sexually transmitted infection, affecting more than 6.2 million individuals every year. Most new infections occur in adolescents and young adults shortly after the onset of sexual activity. Nurse practitioners play a key role in preventing HPV infection in teens through adolescent-friendly HPV education, prevention, and vaccination.

Contraceptive services in SBHCs: A community experience in creating change

School Based Health Centers (SBHCs) are teen-friendly community resources currently underutilized in efforts to prevent teen pregnancy. Much of the decline in the teen birth rate has been attributed to increased access and use of contraception by adolescents. Yet 60% of SBHCs nationwide, which provide health care services to adolescents, are prohibited from prescribing and/or dispensing contraception. Pregnancy prevention efforts targeting increased contraceptive availability and accessibility are likely to be enhanced by changing existing policies that restrict contraceptive services to adolescents through SBHCs nationwide. This article describes a successful community-based effort to change school district policy to provide contraceptive access through the SBHCs. The Transtheoretical model (TM) is applied retrospectively to describe this change process and provides a useful framework for nurses to consider in guiding community health policy initiatives.

The feasibility and acceptability of an approach to emotional wellbeing support for high school students

BACKGROUND

  Emotional wellbeing of young people has high global and national priority. UK high schools are under pressure to address this but lack evidence-based guidelines.

METHOD

  Students (N=23) (aged 11-16 years) and staff (N=27) from three urban UK high schools participated in qualitative interviews to explore the feasibility and acceptability of an approach to emotional wellbeing support. Key components were: self-referral, guided self-help, and delivery by school pastoral and support staff.

FINDINGS

  Confidentiality, emotional support, effectiveness and delivery modes were important to students. Organisational values influenced feasibility.

CONCLUSIONS

  Understanding a school's moral and operational framework can enhance the development of suitable emotional wellbeing support.

Young people's preferences for emotional well-being support in high school--a focus group study

PROBLEM

Schools have been identified as a suitable setting for the delivery of emotional well-being (EWB) support, but in the United Kingdom there is little empirical evidence from young people that can inform the development of appropriate school-based interventions.

METHODS

Fifty-four students (11-16 years) from three U.K. high schools discussed the content, delivery, and evaluation of acceptable, school-based, EWB support. Focus group methods were matched to the school setting and sensitive topic.

FINDINGS

Participants identified emotional difficulties in school, home, and with peer relationships. They said that some problems were too sensitive for them to seek help in school setting. They valued confidentiality, support, and effective help that were offered by people they experienced as friendly, trustworthy, and skilled. Teachers and peer mentors were not thought to fit these criteria, although trusted adults in mentor roles could meet their criteria. Participants recognized that they could hide their emotions, so their EWB would be difficult to assess. They described how the effect of emotional distress on their behavior is idiosyncratic, and therefore their EWB should not be judged simply on their behavior.

CONCLUSION

The way in which EWB support is delivered in school is an important aspect of the role of practitioners and educators attempting to provide it. Because young people are sensitive to the personal qualities and skills of people offering them help, programs to train school staff in emotional support roles are important to ensure trust and an environment open to students seeking assistance. Interventions for school-based EWB support need to consider subjective well-being as well as behavioral change.

Adolescents’ views of helping professionals: A review of the literature

This paper reviews 54 papers exploring adolescents' own views of their interactions with doctors, mental health workers and other 'helping professionals'. Twelve global themes emerge repeatedly in the qualitative literature, where adolescents are asked to talk about their preferences or their experiences of receiving help from such professionals. The twelve themes are reported and illustrated with results of related quantitative studies, and implications of these themes for professionals offering services to this age group are considered. Methodological limitations of the literature are discussed, along with suggestions for future research.

Weight and its relationship to adolescent perceptions of their providers (WRAP): a qualitative and quantitative assessment of teen weight-related preferences and concerns

PURPOSE

To examine the relationship of body weight to satisfaction with care in adolescents, and to obtain qualitative data on preferences for general and weight-related medical care in normal weight and overweight adolescents.

METHODS

The Weight and its Relationship to Adolescent Perceptions of their Providers survey, a 4-page questionnaire containing previously validated satisfaction scales and open-ended qualitative questions regarding health care preferences, was administered to 62 severely overweight (body mass index [BMI] 38.9 +/- 8.4 kg/m2) and 29 normal weight (BMI 22.5 +/- 4.0 kg/m2) adolescents (age 13.9 +/- 1.7 years; 57% female; 50% Caucasian, 47% African-American, 3% Hispanic).

RESULTS

The affective subscale of the medical satisfaction scale was negatively correlated with BMI standard deviation score (r = -.22, p < .05). Multiple regression models predicting affective satisfaction with medical care included BMI standard deviation score; however, continuity with provider appeared to be the strongest independent predictor of affective satisfaction. Fifty-five percent of participants identified their mother as the person they felt most comfortable talking with about weight, although 68% believed their provider knew the most about healthy eating. "Overweight" was identified by 47% of participants as the preferred term for heavy teens. Seventy-nine percent of overweight adolescents stated their health care provider discussed their weight with them; however, only 41% of overweight adolescents desired to discuss their weight. Compared to normal-weight adolescents, overweight teens were more likely to report that their provider raised topics of weight (p < .001), diet (p < .01), and exercise (p < .01) at their last physical, and were more likely to report that they would have liked their provider to discuss diet and exercise (both p < .05). Ten percent of overweight teens expressed concerns regarding the public location of their provider's office scale.

CONCLUSIONS

Satisfaction with affective aspects of the provider-patient relationship is negatively correlated with BMI standard deviation score. Length of experience with one's provider is also a strong predictor of teen satisfaction with their medical care. Teens prefer the term "overweight" for those with high body weight. Sensitivity to confidentiality, privacy, and embarrassment regarding physical examination and weight are important for teen satisfaction.

Adolescents' health beliefs are critical in their intentions to seek physician care

BACKGROUND

The examination of predictors of adolescents' intentions to use health care for different types of health issues has received little attention. This study examined adolescents' health beliefs and how they relate to intentions to seek physician care across different types of health problems.

METHODS

Two hundred ten high school students (54% females; 76.6% participation rate) completed a self-administered survey of four separate age- and gender-specific health case scenarios: an adolescent who has symptoms of pneumonia; smokes five cigarettes daily; plans to initiate sex; and has symptoms of depression. For each health scenario, participants rated the seriousness of the health problem, physician effectiveness, and intentions to seek physician care.

RESULTS

Most adolescents believed all health problems were serious except for planning to initiate sex (P < 0.001). Adolescents believed that physicians were most effective in diagnosis and treatment for pneumonia, followed by cigarette use, depression, and sex, respectively (P's < 0.001). Adolescents' intentions to seek physician care were greatest for physical as compared to risk behavior or mental health problems (P < 0.001). Multiple regression analyses revealed that adolescents had greater intentions to seek physician care for cigarette, sex, and depression when they believed physicians were effective and they perceived these as health problems after controlling for age and gender (all P's < 0.001). Health beliefs explained 12% to 49% of the variance in intentions to seek care (all P's < 0.001).

CONCLUSIONS

Adolescents' health beliefs are important when understanding intentions to seek physician care. Health care use may be improved by increasing adolescents' beliefs that physicians are effective in areas other than physical health, including risk behaviors and mental health.