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McFadden V, Porada K, Emlen N, Pickett ML, Quinn K. Hospitalized Adolescents' Perspectives on Sexual and Reproductive Health Discussions. Hosp Pediatr 2024:e2023007606. [PMID: 38887815 DOI: 10.1542/hpeds.2023-007606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES Experts recommend that providers discuss adolescent patients' sexual and reproductive health (SRH) at any health care encounter, including hospitalizations. The purpose of this qualitative study was to gain insight into hospitalized adolescents' experiences and perspectives on SRH discussions (SHDs) to better inform patient-centered care. METHODS Private semistructured interviews were conducted with hospitalized adolescents aged 13 to 17 years. Interviews were coded and analyzed using thematic analysis. Themes were developed through an iterative process with focus on the primary research aim. RESULTS Twenty participants were interviewed with a median age of 15.4 years. Adolescents expressed a range of preferences related to SHDs with providers. Themes included (1) experiences discussing SRH with providers, (2) SHDs during hospitalization, (3) communication preferences, and (4) perceptions of why providers initiate SHDs. Viewpoints about SHDs during hospitalizations varied, including that they addressed unmet needs, as well as that they seemed irrelevant to some participants. Aspects that facilitate SHDs include brevity with relevant depth, nonjudgmental provider demeanor, and reassurance of privacy. Some participants believed providers could judge the depth of discussion needed on the basis of the adolescent's age or personality. CONCLUSIONS This study highlights variation in adolescents' preferences around SHDs with health care providers. Providers should initiate SHDs with statements of purpose and confidentiality. Given the variation in adolescents' perspectives, tools to privately collect self-reported behaviors before an SHD may help providers frame the conversation to the adolescent's specific SRH needs and communication style preferences.
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Affiliation(s)
| | - Kelsey Porada
- Section of Hospital Medicine, Department of Pediatrics
| | - Nicole Emlen
- Section of Hospital Medicine, Department of Pediatrics
| | | | - Katherine Quinn
- Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Chung RJ, Lee JB, Hackell JM, Alderman EM. Confidentiality in the Care of Adolescents: Technical Report. Pediatrics 2024; 153:e2024066327. [PMID: 38646698 DOI: 10.1542/peds.2024-066327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 04/23/2024] Open
Abstract
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.
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Affiliation(s)
- Richard J Chung
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Janet B Lee
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Jesse M Hackell
- Department of Pediatrics, New York Medical College, Valhalla, New York
| | - Elizabeth M Alderman
- Division of Adolescent Medicine, Department of Pediatrics, Albert Einstein College of Medicine and The Children's Hospital at Montefiore, Bronx, New York
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Bahl D, Bassi S, Manna S, Arora M. Adolescent Friendly Health Clinics (AFHCS) in India and their compliance with government benchmarks: A scoping review. F1000Res 2023; 12:517. [PMID: 37614564 PMCID: PMC10442587 DOI: 10.12688/f1000research.131112.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 08/25/2023] Open
Abstract
Background: Adolescent Friendly Health Clinics (AFHCs) are one of the critical pillars of India's Adolescent Health Programme-Rashtriya Kishor Swasthya Karyakram that seeks to enable all adolescents to realize their full potential by making informed decisions concerning their health and by accessing the services. Thus, a review was conceptualised to assess the compliance of AFHCs with the benchmark proposed by the Government under Rashtriya Kishor Swasthya Karyakram. Methods: Three databases (PubMed, Scopus and Google Scholar) were searched for articles published between 2014 and December 2022. A snowball search strategy was also used to retrieve all published articles. Based on the search strategy eight studies were included. Results: AFHCs are not fully compliant with all the benchmarks proposed by the government of India. Evidence from the primary studies showed that the benchmarks need attention as privacy was lacking (six out of seven studies), unavailability of Information Education and Communication material (four out of five), signages (two out of four), referrals (one out of two), and judgemental attitude of health care providers (one out of 3). Conclusions: There is a pressing need to focus on the fulfilment of these gaps to make the clinics adolescent-friendly. This might increase the utilisation of available services in AFHCs by adolescents and will improve their health. The improved health will catalyse achieving the Sustainable Development Goals indicators that are associated with nutrition, reproductive health, sexual and intimate partner violence, child marriage, education, and employment.
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Affiliation(s)
- Deepika Bahl
- Health Promotion Division, Public Health Foundation of India, Gurgaon, Haryana, 122002, India
| | - Shalini Bassi
- Health Promotion Division, Public Health Foundation of India, Gurgaon, Haryana, 122002, India
| | - Subhanwita Manna
- Health Promotion Division, Public Health Foundation of India, Gurgaon, Haryana, 122002, India
| | - Monika Arora
- Health Promotion Division, Public Health Foundation of India, Gurgaon, Haryana, 122002, India
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Agostino H, Toulany A. Considerations for privacy and confidentiality in adolescent health care service delivery. Paediatr Child Health 2023; 28:172-183. [PMID: 37205141 PMCID: PMC10186092 DOI: 10.1093/pch/pxac117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 06/13/2022] [Indexed: 05/21/2023] Open
Abstract
A hallmark of delivering quality adolescent health care services is the provision of confidential care. Key tenets when providing confidential care for adolescents include time alone with a health care provider, maintaining the privacy of health information, and securing informed consent for services without permission from a parent, guardian, or caregiver. While confidentiality is a basic principle for all health care encounters regardless of age, the unique considerations for capable adolescent patients are not always realized or appreciated. By ensuring appropriate quantity and quality of confidential care for adolescents, clinicians are better equipped to elicit a comprehensive history and physical examination, while empowering the adolescent involved to develop agency, autonomy, trust, and responsibility for their own health care decision-making and management.
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Affiliation(s)
- Holly Agostino
- Canadian Paediatric Society, Adolescent Health Committee, Ottawa, Ontario, Canada
| | - Alene Toulany
- Canadian Paediatric Society, Adolescent Health Committee, Ottawa, Ontario, Canada
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Les considérations en matière de confidentialité et de protection de la vie privée lors de la prestation des services de santé aux adolescents. Paediatr Child Health 2023; 28:178-183. [PMCID: PMC10186098 DOI: 10.1093/pch/pxac118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
La confidentialité des soins fait partie des caractéristiques des services de santé de qualité aux adolescents. Du temps seul à seul avec le professionnel de la santé, l’accès à l’information en matière de santé réservé aux personnes autorisées et l’obtention d’un consentement éclairé avant de donner les services sans demander le consentement d’un parent, d’un tuteur ou d’un proche, font partie des fondements des soins confidentiels aux adolescents. La confidentialité est un principe fondamental qui s’applique à toutes les rencontres médicales, quel que soit l’âge, mais les considérations propres aux patients adolescents aptes ne sont pas toujours comprises ni prises en compte. S’ils donnent aux adolescents des soins confidentiels d’une quantité et d’une qualité appropriées, les cliniciens sont mieux en mesure d’obtenir une anamnèse et un examen physique complets, et ils habilitent les adolescents à développer leur capacité d’agir, leur autonomie, leur confiance et leur responsabilité à l’égard de leurs décisions en matière de santé et de la prise en charge de leurs propres soins.
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Agostino H, Burstein B. Perceived barriers to the provision of adolescent confidential care in a tertiary care setting. Paediatr Child Health 2023; 28:91-96. [PMID: 37151926 PMCID: PMC10156935 DOI: 10.1093/pch/pxac094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/19/2022] [Indexed: 12/27/2022] Open
Abstract
Objective Adolescents are more likely to seek care and disclose sensitive health information if confidentiality is assured. Little is known regarding the provision of confidential care to adolescents in the hospital setting. We sought to understand confidentiality practices and barriers for adolescents cared for in a tertiary hospital setting. Methods This was a cross-sectional survey of all Emergency Department (ED), hospitalist, and resident physicians at a tertiary paediatric hospital from May/2019 to July/2019. Participants were asked multiple choice questions regarding practices, comfort, and barriers to confidential care. Results Response rate was 91% (n = 72/79; 26 ED, 14 hospitalists, 32 residents). Overall, 47% of respondents doubted that confidential care was being consistently provided to adolescents. Fifty-eight per cent of attendings and 31% of residents reported usually/always offering confidential care. Factors most reported to influence the provision of confidential care were chief complaint (75%), time of visit (45%), and patient age (25%). Barriers to the quantity or quality of confidential care were identified by 89%, most commonly including time constraints (21%), perceived parental resistance (26%), lack of private space (26%), and the belief that confidentiality is not necessary for all adolescent encounters (34%). Forty per cent of respondents reported breaching confidentially and discussing sensitive topics with adolescents in front of family members. Overall, only 45% felt they had received adequate training on how best to deliver confidential care, and 75% reported a desire for additional training. Conclusion Results suggest inadequate provision of confidential care in a tertiary teaching hospital, with several potentially modifiable barriers.
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Affiliation(s)
- Holly Agostino
- Division of Adolescent Medicine, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Brett Burstein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Rea S, Mikesell L, Cuddihy C, Perry M, Allison B. Exploring the Complexity of Telehealth Privacy Through a Lens of Adolescent Development. QUALITATIVE HEALTH RESEARCH 2023; 33:220-235. [PMID: 36655804 DOI: 10.1177/10497323231151596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Many challenges exist related to ensuring adolescent privacy with health care providers (HCPs), and the rapid integration of telehealth visits has created additional complexities in organizing privacy for adolescents. Through interviews with adolescent patients and their parents (n = 34), this qualitative analysis aimed to explore the complicated relationship and balance of adolescent alone time with HCPs, parental presence and support, and organization of privacy in order to consider how privacy during telehealth visits may contribute to adolescents' healthy development. A framework by Blum et al. (2014) proposed four central goals of adolescent development: emotional security, engagement with learning, self-efficacy, and decision-making skills. This conceptual framework was used to outline the ways in which adolescent privacy during telehealth impacts adolescent development. Some adolescents reported that having their parents present during their telehealth visit afforded reassurance and comfort, and many parents explained that they served as a role-model during their adolescent's telehealth visit. However, other adolescents felt higher emotional security when they could establish an independent relationship with their HCP, with many describing how privacy during their telehealth visit enabled them to have more sensitive discussions with their HCP. Adolescents and parents also reported that telehealth allowed increased experiential learning for adolescents, given their proficiency with technology and ability to access their health care visits autonomously. Furthermore, the organization of privacy was complicated by a lack of understanding whose responsibility it was to facilitate alone time between the adolescent and HCP, as well as external factors such as location and quality of technology and the proximity of family members in the home. By ensuring opportunities for private healthcare encounters, both in telehealth and in-person visits, HCPs and parents can help support adolescents in achieving successful and healthy development.
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Affiliation(s)
- Samantha Rea
- 12267Wayne State University School of Medicine, Detroit, MI, USA
| | | | | | - Martha Perry
- 2332University of North Carolina System, Chapel Hill, NC, USA
| | - Bianca Allison
- 2332University of North Carolina System, Chapel Hill, NC, USA
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8
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Donck E, Devillé C, Van Doren S, De Coninck D, Van Bavel J, de Winter P, Toelen J. Parental Perspectives on Adolescent Health-Related Confidentiality: Trust, Responsibility, and Disease Etiology as Key Themes. J Adolesc Health 2023; 72:21-26. [PMID: 36216676 DOI: 10.1016/j.jadohealth.2022.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 07/18/2022] [Accepted: 08/28/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE As children progress through adolescence, they become more independent and more responsible regarding their health. This shift in responsibility from the parents to the adolescent poses a challenge for healthcare professionals who must consider both parties. Pediatricians and other healthcare professionals may encounter problems regarding consent and confidentiality. This study aimed to investigate the opinions of Belgian parents of adolescents concerning cases about confidentiality in adolescent health problems. METHODS A qualitative methodology with semi-structured interviews and a case-based approach was chosen to answer our study aim. Belgian parents of adolescents were recruited voluntarily; 20 parents were interviewed. Parents' opinions on four different cases regarding confidentiality were obtained. Interviews were audio- and video-recorded and transcribed verbatim. Independent coding of the transcripts was conducted. RESULTS Parents' opinions differ considerably when asked if a physician has to maintain confidentiality toward the adolescent, depending on the content of the case. Opinions appear underpinned by three factors: trust, responsibility of the different parties, and the etiology of the problem. DISCUSSION This study shows that the nature, severity, and frequency of the medical issue at hand shape the opinions of parents toward patient confidentiality, on top of the trust and responsibility factors also highlighted in previous work. This is in contrast to the Belgian legislation, which focuses on maturity regardless of context.
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Affiliation(s)
- Eva Donck
- Faculty of Medicine, KU Leuven, Leuven, Belgium
| | | | - Shauni Van Doren
- LUCAS - Centre for Care Research and Consultancy, Leuven, Belgium
| | | | - Jan Van Bavel
- Centre for Sociological Research, KU Leuven, Leuven, Belgium; Leuven Child and Youth Institute, KU Leuven, Leuven, Belgium
| | - Peter de Winter
- Leuven Child and Youth Institute, KU Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Pediatrics, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Jaan Toelen
- Leuven Child and Youth Institute, KU Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
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Vanwymelbeke J, De Coninck D, Matthijs K, Van Leeuwen K, Lierman S, Boone I, de Winter P, Toelen J. Clinical adolescent decision-making: parental perspectives on confidentiality and consent in Belgium and The Netherlands. ETHICS & BEHAVIOR 2022. [DOI: 10.1080/10508422.2022.2086873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - David De Coninck
- Centre for Sociological Research, KU Leuven
- Leuven Child and Youth Institute, KU Leuven
| | - Koen Matthijs
- Centre for Sociological Research, KU Leuven
- Leuven Child and Youth Institute, KU Leuven
| | - Karla Van Leeuwen
- Leuven Child and Youth Institute, KU Leuven
- Parenting and Special Education, KU Leuven
| | - Steven Lierman
- Leuven Child and Youth Institute, KU Leuven
- Leuven Institute for Healthcare Policy, KU Leuven
| | - Ingrid Boone
- Leuven Child and Youth Institute, KU Leuven
- Faculty of Law and Criminology, KU Leuven Campus Kulak Kortrijk
| | - Peter de Winter
- Leuven Child and Youth Institute, KU Leuven
- Department of Development and Regeneration, KU Leuven
- Department of Pediatrics, Spaarne Gasthuis
| | - Jaan Toelen
- Leuven Child and Youth Institute, KU Leuven
- Department of Development and Regeneration, KU Leuven
- Department of Pediatrics, University Hospitals Leuven
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Krass P, Tam V, Min J, Joslin I, Khabie L, Wilkinson TA, Wood SM. Adolescent Access to Federally Funded Clinics Providing Confidential Family Planning Following Changes to Title X Funding Regulations. JAMA Netw Open 2022; 5:e2217488. [PMID: 35713904 PMCID: PMC9206194 DOI: 10.1001/jamanetworkopen.2022.17488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE In May 2019, new federal regulations regarding Title X funding were introduced. There has been no formal evaluation of the impact of this regulatory shift as it pertains to minors' access to services. OBJECTIVE To explore the geography of federally funded clinics providing confidential reproductive care to adolescents following changes to Title X funding regulations. DESIGN, SETTING, AND PARTICIPANTS This retrospective cross-sectional study used a population-based sample of US Census tracts. All clinics participating in the Title X program in August 2018 and August 2020 were included in the analysis. Data were analyzed from January to December 2021. EXPOSURES Period, defined as before and after the 2019 Title X rule change (August 2018 and August 2020, respectively). MAIN OUTCOMES AND MEASURES US Census tracts were evaluated for the availability of confidential family planning care within a 30-minute drive, according to the presence of a Title X clinic or a permissive state law. Census tracts in which minors lost access to confidential care after the rule change were characterized in terms of demographic characteristics. Univariate logistic regression evaluated associations between Census tract characteristics and the odds of losing vs maintaining access to legally protected confidential minor services. RESULTS The study included 72 620 Census tracts, accounting for approximately 324 697 728 US residents (99.96% of the population). After the Title X rule change, 1743 clinics in the Title X program left (39.0%) and minors living in 6299 Census tracts (8.7%) lost access to confidential family planning care, corresponding to an estimated 933 649 youth aged 15 to 17 years. Minors living in rural Census tracts (odds ratio [OR], 1.27; 95% CI, 1.18-1.36) and those in the Midwest (OR, 2.41; 95% CI, 2.24-2.60) had higher odds of losing access to care. Minors living in Census tracts with a higher Social Vulnerability Index (OR, 0.51; 95% CI, 0.47-0.55), a larger proportion of Black individuals (OR, 0.34; 95% CI, 0.31-0.37), and/or a larger proportion of Hispanic individuals (OR, 0.45; 95% CI, 0.42-0.49) were less likely to lose access to care. CONCLUSIONS AND RELEVANCE These findings suggest that there were losses in access to legally protected confidential reproductive health services for youth after the 2019 Title X rule change. Although evidence-based Title X guidelines have since been reinstated, state laws that ensure adolescent confidentiality in obtaining family planning services may protect youth from future alterations to the Title X program.
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Affiliation(s)
- Polina Krass
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia
- PolicyLab and the Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Vicky Tam
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jungwon Min
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Isabella Joslin
- Pediatric Residency Program, Yale University School of Medicine, New Haven, Connecticut
| | - Lily Khabie
- School of Arts and Sciences, University of Pennsylvania, Philadelphia
| | - Tracey A. Wilkinson
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis
| | - Sarah M. Wood
- PolicyLab and the Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Corley AG, Sprockett A, Montagu D, Chakraborty NM. Exploring and Monitoring Privacy, Confidentiality, and Provider Bias in Sexual and Reproductive Health Service Provision to Young People: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116576. [PMID: 35682160 PMCID: PMC9180733 DOI: 10.3390/ijerph19116576] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/13/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023]
Abstract
Purpose: Poor privacy and confidentiality practices and provider bias are believed to compromise adolescent and young adult sexual and reproductive health service quality. The results of focus group discussions with global youth leaders and sexual and reproductive health implementing organizations indicated that poor privacy and confidentiality practices and provider bias serve as key barriers to care access for the youth. Methods: A narrative review was conducted to describe how poor privacy and confidentiality practices and provider bias impose barriers on young people seeking sexual and reproductive health services and to examine how point of service evaluations have assessed these factors. Results: 4544 peer-reviewed publications were screened, of which 95 met the inclusion criteria. To these articles, another 16 grey literature documents were included, resulting in a total of 111 documents included in the review. Conclusion: Poor privacy and confidentiality practices and provider bias represent significant barriers for young people seeking sexual and reproductive health services across diverse geographic and sociocultural contexts. The authors found that present evaluation methods do not appropriately account for the importance of these factors and that new performance improvement indicators are needed.
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Wilkins NJ, Rasberry C, Liddon N, Szucs LE, Johns M, Leonard S, Goss SJ, Oglesby H. Addressing HIV/Sexually Transmitted Diseases and Pregnancy Prevention Through Schools: An Approach for Strengthening Education, Health Services, and School Environments That Promote Adolescent Sexual Health and Well-Being. J Adolesc Health 2022; 70:540-549. [PMID: 35305791 PMCID: PMC9260911 DOI: 10.1016/j.jadohealth.2021.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/18/2020] [Accepted: 05/04/2021] [Indexed: 10/18/2022]
Abstract
Adolescents' health behaviors and experiences contribute to many outcomes, including risks for HIV, other sexually transmitted diseases, and unintended pregnancy. Public health interventions and approaches addressing risk behaviors or experiences in adolescence have the potential for wide-reaching impacts on sexual health and other related outcomes across the lifespan, and schools are a critical venue for such interventions. This paper describes a school-based program model developed by the Centers for Disease Control and Prevention's Division of Adolescent and School Health for preventing HIV/sexually transmitted diseases, unintended pregnancy, and related health risk behaviors and experiences among middle and high school students. This includes a summary of the theoretical and evidence base that inform the model, and a description of the model's activities, organized into three key strategies (sexual health education, sexual health services, and safe and supportive environments) and across three cross-cutting domains (strengthening staff capacity, increasing student access to programs and services, and engaging parent and community partners). The paper also outlines implications for adolescent health professionals and organizations working across schools, clinics, and communities, to address and promote adolescent sexual health and well-being.
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Affiliation(s)
- Natalie J. Wilkins
- Division of Adolescent and School Health National Center for HIV/AIDS, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, MS US8-1 Atlanta, GA 30329,b Corresponding author: , 770-488-1392
| | - Catherine Rasberry
- Division of Adolescent and School Health National Center for HIV/AIDS, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, MS US8-1 Atlanta, GA 30329
| | - Nicole Liddon
- Division of Adolescent and School Health National Center for HIV/AIDS, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, MS US8-1 Atlanta, GA 30329
| | - Leigh E. Szucs
- Division of Adolescent and School Health National Center for HIV/AIDS, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, MS US8-1 Atlanta, GA 30329
| | - Michelle Johns
- Division of Adolescent and School Health National Center for HIV/AIDS, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, MS US8-1 Atlanta, GA 30329
| | - Sandra Leonard
- Division of Adolescent and School Health National Center for HIV/AIDS, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, MS US8-1 Atlanta, GA 30329
| | - Sally J. Goss
- Division of Adolescent and School Health National Center for HIV/AIDS, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, MS US8-1 Atlanta, GA 30329
| | - Heather Oglesby
- Division of Adolescent and School Health National Center for HIV/AIDS, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, MS US8-1 Atlanta, GA 30329
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Watson DL, Shaw PA, Petsis DT, Pickel J, Bauermeister JA, Frank I, Wood SM, Gross R. A retrospective study of HIV pre-exposure prophylaxis counselling among non-Hispanic Black youth diagnosed with bacterial sexually transmitted infections in the United States, 2014-2019. J Int AIDS Soc 2022; 25:e25867. [PMID: 35192740 PMCID: PMC8863354 DOI: 10.1002/jia2.25867] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 12/14/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Youth account for a disproportionate number of new HIV infections; however, pre-exposure prophylaxis (PrEP) use is limited. We evaluated PrEP counselling rates among non-Hispanic Black youth in the United States after a bacterial sexually transmitted infection (STI) diagnosis. METHODS We conducted a retrospective cohort study of Black youth receiving care at two academically affiliated clinics in Philadelphia between June 2014 and June 2019. We compared PrEP counselling for youth who received primary care services versus those who did not receive primary care services, all of whom met PrEP eligibility criteria due to STI diagnosis per U.S. Centers for Disease Control and Prevention clinical practice guidelines. Two logistic regression models for receipt of PrEP counselling were fit: Model 1 focused on sexual and gender minority (SGM) status and Model 2 on rectal STIs with both models adjusted for patient- and healthcare-level factors. RESULTS Four hundred and sixteen patients met PrEP eligibility criteria due to STI based on sex assigned at birth and sexual partners. Thirty patients (7%) had documentation of PrEP counselling. Receipt of primary care services was not significantly associated with receipt of PrEP counselling in either Model 1 (adjusted OR (aOR) 0.10 [95% CI 0.01, 0.99]) or Model 2 (aOR 0.52 [95% CI 0.10, 2.77]). Receipt of PrEP counselling was significantly associated with later calendar years of STI diagnosis (aOR 6.80 [95% CI 1.64, 29.3]), assigned male sex at birth (aOR 26.2 [95% CI 3.46, 198]) and SGM identity (aOR 317 [95% CI 39.9, 2521]) in Model 1 and later calendar years of diagnosis (aOR 3.46 [95% CI 1.25, 9.58]), assigned male sex at birth (aOR 18.6 [95% CI 3.88, 89.3]) and rectal STI diagnosis (aOR 28.0 [95% CI 8.07, 97.5]) in Model 2. Fourteen patients (3%) started PrEP during the observation period; 12/14 (86%) were SGM primary care patients assigned male sex at birth. CONCLUSIONS PrEP counselling and uptake among U.S. non-Hispanic Black youth remain disproportionately low despite recent STI diagnosis. These findings support the need for robust investment in PrEP-inclusive sexual health services that are widely implemented and culturally tailored to Black youth, particularly cisgender heterosexual females.
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Affiliation(s)
- Dovie L. Watson
- Department of Medicine (Infectious Diseases)University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of BiostatisticsEpidemiology and InformaticsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Pamela A. Shaw
- Kaiser Permanente Washington Health Research InstituteSeattleWashingtonUSA
| | - Danielle T. Petsis
- Craig Dalsimer Division of Adolescent MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- PolicyLabChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Julia Pickel
- PolicyLabChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - José A. Bauermeister
- Department of Family & Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ian Frank
- Department of Medicine (Infectious Diseases)University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Sarah M. Wood
- Craig Dalsimer Division of Adolescent MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- PolicyLabChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Robert Gross
- Department of Medicine (Infectious Diseases)University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of BiostatisticsEpidemiology and InformaticsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
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Stavleu DC, Peter de Winter J, Veenstra X, van Stralen KJ, De Coninck D, Matthijs K, Toelen J. Parental Opinions on Medical Decision-Making in Adolescence: A Case-Based Survey. J Dev Behav Pediatr 2022; 43:17-22. [PMID: 34117204 DOI: 10.1097/dbp.0000000000000978] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/08/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Patient trust and consent are complex topics for health care workers in pediatrics, specifically when relating to adolescent's legal status. In the context of medical decisions, not much work has been performed to understand the opinion of parents on health care decision-making, especially on confidentiality concerning their adolescent children. The purpose of this research was to assess the parental opinions on these decisions and the influence of different perspectives. METHODS We used a case-based methodology to assess parental opinions on fictional medical decisions. A survey was provided to parents in 2 pediatric outpatient departments in Belgium and the Netherlands. The survey contained cases regarding medical care related to confidentiality and consent about which participants gave their opinion. RESULTS In total, 222 surveys were completed. Overall, most parents would allow an adolescent to make his/her own decision (58.6%-70.4%), except in the case of confidentiality on alcohol-related trauma (28.9%). The results show a significant difference in how parents responded when answering from the parental perspective or adolescents' perspective. They granted significantly more authority to the adolescent in the latter view. CONCLUSION Our study shows that parents who were confronted with cases from an adolescent perspective were significantly more likely to give the patient authority. In addition, the medical issue and context influence how the parents responded. These data provide insight into the parental opinions and could lead to more evidence-based frameworks for shared medical decision-making of adolescents and their parents.
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Affiliation(s)
- Debbie C Stavleu
- Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp, the Netherlands
| | - J Peter de Winter
- Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp, the Netherlands
- Department of Development and Regeneration, KU Leuven, Belgium
| | - Xandra Veenstra
- Department of Pediatrics, University Hospitals Leuven, Flanders, Belgium
| | | | | | - Koen Matthijs
- Centre for Sociological Research, KU Leuven, Belgium
| | - Jaan Toelen
- Department of Development and Regeneration, KU Leuven, Belgium
- Department of Pediatrics, University Hospitals Leuven, Flanders, Belgium
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15
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De Coninck D, Matthijs K, de Winter P, Toelen J. Late adolescents' own and assumed parental preferences towards health-care related confidentiality and consent in Belgium. PLoS One 2021; 16:e0252618. [PMID: 34077468 PMCID: PMC8171959 DOI: 10.1371/journal.pone.0252618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/18/2021] [Indexed: 12/05/2022] Open
Abstract
Objectives Health care professionals regularly struggle with issues relating to confidentiality and consent for physical and/or mental health issues among adolescents. We investigate late adolescents’ own and assumed parental preferences towards health-care related confidentiality and consent. Methods We analyzed online survey data of four vignettes from 463 first-year university students at KU Leuven (Flanders, Belgium). We used paired samples t-tests to assess the (in)consistency between attitudes of late adolescents and their assumed parental attitudes, independent samples t-tests to estimate gender differences, and binomial logistic regressions to analyze the association of assumed parental preferences with late adolescents’ own preferences. Results Attitudinal inconsistencies were present in all vignettes. Late adolescents were significantly more in favor of confidentiality and adolescent consent than what they believed their parents were. Gender differences were limited. Binomial logistic regressions indicated that assumed parental preferences were strongly associated with late adolescents’ own preferences. Conclusions Findings suggest a clear difference between late adolescents’ preferences and assumed parental preferences: they believe that their parents are less inclined to favor confidentiality and adolescent consent. We also find that this difference depends on the case, indicating that there is no such thing as general ‘confidentiality preferences’. Rather, a decision- and/or context-specific perspective should be adopted.
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Affiliation(s)
- David De Coninck
- Centre for Sociological Research, KU Leuven, Leuven, Belgium
- * E-mail:
| | - Koen Matthijs
- Centre for Sociological Research, KU Leuven, Leuven, Belgium
| | - Peter de Winter
- Department of Pediatrics, Spaarne Gasthuis, Hoofddorp, The Netherlands
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Jaan Toelen
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Division of Woman and Child, Department of Pediatrics, UZ Leuven, Leuven, Belgium
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Duncan RE, Williams BJ, Knowles A. Adolescents, Risk Behaviour and Confidentiality: When Would Australian Psychologists Breach Confidentiality to Disclose Information to Parents? AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rony E Duncan
- The Centre for Adolescent Health, Royal Children's Hospital,
- Murdoch Childrens Research Institute,
- Department of Paediatrics, The University of Melbourne,
- Psychological Sciences and Statistics, Faculty of Life and Social Sciences, Swinburne University of Technology,
| | - Ben J Williams
- Psychological Sciences and Statistics, Faculty of Life and Social Sciences, Swinburne University of Technology,
| | - Ann Knowles
- Psychological Sciences and Statistics, Faculty of Life and Social Sciences, Swinburne University of Technology,
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Parry RA, Sayner R, Davis SA, Beznos BY, Carpenter DM, Sleath BL. Communication about Contraception with Adolescent Females with Asthma in Pediatric Visits. J Pediatr Adolesc Gynecol 2020; 33:372-376. [PMID: 32087401 PMCID: PMC7434659 DOI: 10.1016/j.jpag.2020.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/07/2020] [Accepted: 02/13/2020] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE The occurrence and characteristics of contraception discussions with adolescents are unexplored. Our study sought to address this gap using transcripts of audiotaped healthcare visits. DESIGN, SETTING, AND PARTICIPANTS This study was a secondary analysis of 153 transcripts of medical visits with female adolescents with asthma. Medical visits took place among 4 outpatient clinics in North Carolina. MAIN OUTCOME MEASURES Transcripts were reviewed for occurrence and characteristics of contraception discussions. Demographics were collected from adolescent interviews, caregiver questionnaires, and provider questionnaires. RESULTS Contraception was mentioned in 3% (n = 5) of office visits. Conversations about contraception included the topics of contraception efficacy (20%), contraception side effects (60%), contraception adherence (20%), and adolescent sexual health (20%). No conversations included the topics of contraception indication or alternative methods. CONCLUSIONS Conversations about contraception occurred infrequently in healthcare visits. When conversations did occur, the topics that they covered lacked alignment with guideline recommendations.
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Affiliation(s)
- Rachel A Parry
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Robyn Sayner
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Bethany Y Beznos
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Betsy L Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Baroudi M, San Sebastian M, Hurtig AK, Goicolea I. The perception of youth health centres' friendliness: does it differ between immigrant and Swedish-Scandinavian youths? Eur J Public Health 2020; 30:780-785. [PMID: 32417877 PMCID: PMC7445032 DOI: 10.1093/eurpub/ckaa077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Ensuring a good quality service and equal access according to need for all young people is a key objective of the Swedish health system. The aim of this study was to explore youths' perception of youth health centres' (YHCs') friendliness and to assess the differences in perception between immigrant and Swedish-Scandinavian youths. METHODS All YHCs in the four northern counties in Sweden were invited (22 centres), and 20 agreed to participate. Overall, 1089 youths aged 16-25 years answered the youth-friendly health services-Sweden questionnaire between September 2016 and February 2017. Thirteen sub-domains of friendliness were identified and their scores were calculated. Multilevel analysis was used to examine the differences in perception between immigrant and Swedish-Scandinavian youths. RESULTS Our sample consisted of 971 Swedish-Scandinavian youths (89.2%) and 118 immigrants (10.8%). Generally, both groups perceived the services to be very friendly. All 13 sub-domains were rated more than three in a four-point scale except for fear of exposure and parental support of psychosocial services. However, immigrant youths perceived YHCs less friendly than their counterparts, particularly regarding the domains of equity, respect, quality and parental support. CONCLUSIONS Our study suggests that even though youths perceived YHCs as highly friendly, there is a space for improvement regarding access to health care. Our findings highlight the importance of an open and culturally sensitive attitude of the staff and the need to engage parents and community as a key to improve immigrant youths' accessibility to health care.
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Affiliation(s)
- Mazen Baroudi
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | - Anna-Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Isabel Goicolea
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Richards NK, Crockett E, Morley CP, Levandowski BA. Young women's reproductive health conversations: Roles of maternal figures and clinical practices. PLoS One 2020; 15:e0228142. [PMID: 31971983 PMCID: PMC6977719 DOI: 10.1371/journal.pone.0228142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 01/08/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore the role of clinical providers and mothers on young women's ability to have confidential, candid reproductive health conversations with their providers. METHODS We conducted 14 focus groups with 48 women aged 15-28 years (n = 9), and 32 reproductive healthcare workers (n = 5). Focus groups were audio recorded and transcribed. Data were analyzed using inductive coding and thematic analyses. We examined findings through the lens of paternalism, a theory that illustrates adults' role in children's autonomy and wellbeing. RESULTS Mothers have a substantial impact on young women's health values, knowledge, and empowerment. Young women reported bringing information from their mothers into patient-provider health discussions. Clinical best practices included intermingled components of office policies, state laws, and clinical guidelines, which supported health workers' actions to have confidential conversations. There were variations in how health workers engaged young women in a confidential conversation within the exam room. CONCLUSIONS Both young women and health workers benefit from situations in which health workers firmly ask the parent to leave the exam room for a private conversation with the patient. Young women reported this improves their comfort in asking the questions they need to make the best decision for themselves. Clinic leadership needs to ensure that confidentiality surrounding young women's reproductive health is uniform throughout their practice and integrated into patient flow.
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Affiliation(s)
- Nicole K. Richards
- Department of Family Medicine, State University of New York Upstate Medical University, Syracuse, New York, United States of America
- Department of Public Health and Preventive Medicine, State University of New York Upstate Medical University, Syracuse, New York, United States of America
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Christopher P. Morley
- Department of Family Medicine, State University of New York Upstate Medical University, Syracuse, New York, United States of America
- Department of Public Health and Preventive Medicine, State University of New York Upstate Medical University, Syracuse, New York, United States of America
- Department of Psychiatry, Upstate University Hospital, Syracuse, New York, United States of America
| | - Brooke A. Levandowski
- Department of Family Medicine, State University of New York Upstate Medical University, Syracuse, New York, United States of America
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York, United States of America
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20
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Zucker NA, Schmitt C, DeJonckheere MJ, Nichols LP, Plegue MA, Chang T. Confidentiality in the Doctor-Patient Relationship: Perspectives of Youth Ages 14-24 Years. J Pediatr 2019; 213:196-202. [PMID: 31230890 DOI: 10.1016/j.jpeds.2019.05.056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/16/2019] [Accepted: 05/21/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the experiences of youth regarding confidentiality with their healthcare provider and how confidentiality affects their interactions with the healthcare system. STUDY DESIGN Using MyVoice, a national mixed methods text message poll, 4 qualitative probes were asked to 1268 youth age 14-24 years from July 2017 through December 2017. Respondents were asked about their opinions and experiences with confidentiality in their healthcare. Data were analyzed using a modified grounded theory approach. RESULTS The overall response rate was 75% (n = 948) with a mean age of 18.6 years (SD = 3.2). Respondents were mostly female (56%) and white (70%) with 44% reporting some college education or greater. Qualitative analysis revealed that the majority of youth have not had a conversation with their provider about confidentiality; many youth think all care should be confidential; youth worry about privacy and future discrimination; and youth may lie about their risk behaviors or not seek healthcare when concerned about confidentiality. CONCLUSIONS Confidentiality in healthcare is concerning to many youth and affects how they interact with the healthcare system. It is imperative for healthcare providers to discuss confidentiality while building trusting relationships with each youth to provide the highest level of care for this vulnerable population.
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Affiliation(s)
- Noah A Zucker
- University of Michigan Medical School, Ann Arbor, MI.
| | | | | | - Lauren P Nichols
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Tammy Chang
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
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Pampati S, Liddon N, Dittus PJ, Adkins SH, Steiner RJ. Confidentiality Matters but How Do We Improve Implementation in Adolescent Sexual and Reproductive Health Care? J Adolesc Health 2019; 65:315-322. [PMID: 31227388 PMCID: PMC8130220 DOI: 10.1016/j.jadohealth.2019.03.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/03/2019] [Accepted: 03/26/2019] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Sanjana Pampati
- Oak Ridge Institute for Science and Education (ORISE), Atlanta, Georgia.
| | - Nicole Liddon
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Patricia J Dittus
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan Hocevar Adkins
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Riley J Steiner
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Steiner RJ, Pampati S, Rasberry CN, Liddon N. "Is It Really Confidential?" A Content Analysis of Online Information About Sexual and Reproductive Health Services for Adolescents. J Adolesc Health 2019; 64:725-731. [PMID: 30850311 PMCID: PMC9125409 DOI: 10.1016/j.jadohealth.2018.11.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/02/2018] [Accepted: 11/27/2018] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Riley J. Steiner
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia,Address correspondence to: Riley J. Steiner, M.P.H., Ph.D., Centers for Disease Control and Prevention, Division of Adolescent and School Health, 1600 Clifton Road NE, Mailstop E-75, Atlanta, GA 30329-4027. (R.J. Steiner)
| | - Sanjana Pampati
- Oak Ridge Institute for Science and Education (ORISE), Atlanta, Georgia
| | - Catherine N. Rasberry
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia
| | - Nicole Liddon
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia
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Four steps to preserving adolescent confidentiality in an electronic health environment. Curr Opin Obstet Gynecol 2018; 28:393-8. [PMID: 27454851 DOI: 10.1097/gco.0000000000000305] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Best practices in adolescent care require the ability to provide confidential services, particularly for reproductive health care. As systems implement electronic health records and patients use health portals to access information and communicate with their healthcare team, special attention should be paid to protection of adolescent confidentiality in the electronic environment. RECENT FINDINGS Professional organizations have issued guidance for electronic health records and portal use, but implementation has varied widely between systems, with multiple risks for breaches of confidentiality. Despite interest from patients and families, adolescent health portal use remains low. SUMMARY Understanding the legal and electronic environments in which we care for adolescent patients allows us to educate, advocate, and implement our electronic tools in a way that respects our adolescent patients' need for confidential care, the importance of their caregivers in promoting their health, and the legal rights of both.
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Abstract
Objectives Given poor compliance by providers with adolescent health risk assessment (HRA) in primary care, we describe the development and feasibility of using a health information technology (HIT)-enhanced HRA to improve the frequency of HRAs in diverse clinical settings, asking adolescents' recall of quality of care as a primary outcome. Methods We conducted focus groups and surveys with key stakeholders (Phase I) , including adolescents, clinic staff and providers to design and implement an intervention in a practice-based research network delivering private, comprehensive HRAs via tablet (Phase II). Providers and adolescents received geo-coded community resources according to individualized risks. Following the point-of-care implementation , we collected patient-reported outcomes using post-visit quality surveys (Phase III). Patient-reported outcomes from intervention and comparison clinics were analyzed using a mixed-model, fitted separately for each survey domain. Results Stakeholders agreed upon an HIT-enhanced HRA (Phase I). Twenty-two academic and community practices in north-central Florida then recruited 609 diverse adolescents (14-18 years) during primary care visits over 6 months; (mean patients enrolled = 28; median = 20; range 1-116; Phase II). Adolescents receiving the intervention later reported higher receipt of confidential/private care and counseling related to emotions and relationships (adjusted scores 0.42 vs 0.08 out of 1.0, p < .01; 0.85 vs 0.57, p < .001, respectively, Phase III) than those receiving usual care. Both are important quality indicators for adolescent well-child visits. Conclusions Stakeholder input was critical to the acceptability of the HIT-enhanced HRA. Patient recruitment data indicate that the intervention was feasible in a variety of clinical settings and the pilot evaluation data indicate that the intervention may improve adolescents' perceptions of high quality care.
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Vallance AK. 'Shhh! Please don't tell…’ Confidentiality in child and adolescent mental health. BJPSYCH ADVANCES 2018. [DOI: 10.1192/apt.bp.114.013854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryConfidentiality in child and adolescent mental health is a complex and often challenging matter. Not only do young people frequently present to services in situations of risk, they often prefer to keep information confidential from parents and/or other professionals. This article explores confidentiality in the context of child and adolescent mental health services (CAMHS), particularly when the clinician is having to make decisions on whether to maintain or to breach it. Ethical principles (both deontological and consequentialist) and legal and regulatory frameworks (relating to human rights, case law and General Medical Council guidance) are outlined. Four hypothetical case scenarios are used to illustrate how to apply such principles: when a young person seeks confidential access to treatment, and when he or she discloses information that could signify a risk to self, to others or from others. Finally, practical suggestions on how to share information are explored.
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Fuentes L, Ingerick M, Jones R, Lindberg L. Adolescents' and Young Adults' Reports of Barriers to Confidential Health Care and Receipt of Contraceptive Services. J Adolesc Health 2018; 62:36-43. [PMID: 29157859 PMCID: PMC5953199 DOI: 10.1016/j.jadohealth.2017.10.011] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/04/2017] [Accepted: 10/16/2017] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this study was to describe adolescents' and young adults' concerns about confidential reproductive health care and experience with time alone with a provider, and examine the association of these confidentiality issues with receipt of contraceptive services. METHODS Data from the 2013 to 2015 National Survey of Family Growth were analyzed using Poisson regression to describe 15- to 25-year-olds' confidential reproductive health-care concerns and time alone with a provider at last health-care visit according to sociodemographic characteristics. We also assessed whether confidentiality issues were associated with obtaining contraceptive services among females. RESULTS Concerns about confidential reproductive health care were less common among 15- to 17-year-olds who were covered by Medicaid compared to their parents' private insurance (adjusted risk ratio [ARR] = .61, confidence interval [CI] .41-.91) and had high-school graduate mothers compared to college-graduate mothers (ARR = .68, CI .47-.99), and were more common among those who lived with neither parent compared to living with both parents (ARR = 2.0, CI 1.27-3.16). Time alone with a provider was more common among black girls than white girls (ARR = 1.57, CI 1.11-2.22) and less common among girls covered by Medicaid than those with parents' private insurance (ARR = .72, CI .56-.92). Time alone was less common among boys living with neither parent compared to living with two parents (ARR = .48, CI .25-.91) and with high-school graduate mothers compared to college-graduate mothers (ARR = .59, CI .42-.84). Among sexually experienced girls and women, confidentiality concerns were associated with a reduced likelihood of having received a contraceptive service in the past year. CONCLUSIONS Greater efforts are needed to support young Americans in receiving confidential care.
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Fuzzell L, Shields CG, Alexander SC, Fortenberry JD. Physicians Talking About Sex, Sexuality, and Protection With Adolescents. J Adolesc Health 2017; 61:6-23. [PMID: 28391967 DOI: 10.1016/j.jadohealth.2017.01.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/12/2016] [Accepted: 01/29/2017] [Indexed: 11/29/2022]
Abstract
Adolescent-physician communication about sexual behaviors, sexuality, and protective behaviors is vital for the support of sexual minorities and the prevention of sexually transmitted infections and unintended pregnancies. The objective of this review is to identify sexual topics that physicians and adolescents discuss during medical encounters and examine the quantity and quality of that communication. We performed a systematic literature review of major databases through May 2016. We identified 33 papers that focused on adolescent-physician communication about three major sexual health topics: coital or noncoital sexual behaviors, sexual orientation or attractions, and sexually protective or preventative behaviors. Communication between adolescents and physicians about these sexual topics is infrequent and coincides with calls for improvement in clinical sex communication. Communication about sexual attractions, sexual orientation, and noncoital sexual behaviors were the rarest in practice, whereas mentions of contraception were more frequent. The review also highlights substantial limitations with this body of research, and more advanced research designs are warranted. Associations between clinical sexual communication and sexual health outcomes (e.g., contraceptive use and sexually transmitted infection occurrence) would improve knowledge of the effectiveness of communication in practice.
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Affiliation(s)
- Lindsay Fuzzell
- Department of Human Development and Family Studies, Purdue University, West Lafayette, Indiana.
| | - Cleveland G Shields
- Department of Human Development and Family Studies, Purdue University, West Lafayette, Indiana
| | | | - J Dennis Fortenberry
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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Talib HJ, Silver EJ, Alderman EM. Challenges to Adolescent Confidentiality in a Children's Hospital. Hosp Pediatr 2016; 6:490-5. [PMID: 27461762 DOI: 10.1542/hpeds.2016-0011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Protecting confidentiality for hospitalized adolescents can be challenging and may interfere with optimal adolescent-friendly care. The goal of this study was to explore physician trainees' experience with adolescent confidentiality at an academic children's hospital. METHODS A total of 175 trainees were invited to complete an online survey about knowledge, attitudes, and experiences with confidential adolescent concerns in the inpatient setting. A total of 133 (76%) responded: 78% female; 65% pediatric or family medicine residents; and 35% medical students. RESULTS In the past year, 56 (42%) of 133 trainees cared for a hospitalized adolescent whose confidentiality had been breached. Barriers to ensuring confidentiality included: patient/family not knowledgeable about minor consent law (50%); trainees not knowledgeable about minor consent law (47%); and hospital discharge summary requiring parental signature (47%). On patient- and family-centered rounds (PFCR), respondents reported that minor adolescents (aged <18 years) compared with young adults (aged ≥18 years) were more likely to have social history discussed away from the bedside (91% vs 84%; P < .001) and less likely to have confidential time with the medical team (28% vs 47%; P < .001). Barriers to participation in PFCR included the following: patient was sleeping (61%), patient declined to participate (51%), and confidentiality concerns (32%). CONCLUSIONS Breaches in confidentiality for hospitalized adolescents are a common trainee experience. On PFCR, adolescents are less likely to have confidential time with the medical team than young adults. In trainees' experience, hospital systems such as PFCR and discharge procedures pose inherent challenges to confidentiality for minor adolescent patients, as do lack of knowledge of minor consent laws by both clinicians and families.
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Affiliation(s)
| | - Ellen J Silver
- Division of General Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, New York
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Ermakova T, Fabian B, Zarnekow R. Improving Individual Acceptance of Health Clouds through Confidentiality Assurance. Appl Clin Inform 2016; 7:983-993. [PMID: 27781238 DOI: 10.4338/aci-2016-07-ra-0107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 09/12/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cloud computing promises to essentially improve healthcare delivery performance. However, shifting sensitive medical records to third-party cloud providers could create an adoption hurdle because of security and privacy concerns. OBJECTIVES This study examines the effect of confidentiality assurance in a cloud-computing environment on individuals' willingness to accept the infrastructure for inter-organizational sharing of medical data. METHODS We empirically investigate our research question by a survey with over 260 full responses. For the setting with a high confidentiality assurance, we base on a recent multi-cloud architecture which provides very high confidentiality assurance through a secret-sharing mechanism: Health information is cryptographically encoded and distributed in a way that no single and no small group of cloud providers is able to decode it. RESULTS Our results indicate the importance of confidentiality assurance in individuals' acceptance of health clouds for sensitive medical data. Specifically, this finding holds for a variety of practically relevant circumstances, i.e., in the absence and despite the presence of conventional offline alternatives and along with pseudonymization. On the other hand, we do not find support for the effect of confidentiality assurance in individuals' acceptance of health clouds for non-sensitive medical data. These results could support the process of privacy engineering for health-cloud solutions.
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Affiliation(s)
- Tatiana Ermakova
- Dr. Tatiana Ermakova, August-Bebel-Str. 89, 14482 Potsdam, Germany,
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Abstract
This update of the 2008 statement from the American Academy of Pediatrics redirects the discussion of quality health care from the theoretical to the practical within the medical home. This statement reviews the evolution of the medical home concept and challenges the provision of quality adolescent health care within the patient-centered medical home. Areas of attention for quality adolescent health care are reviewed, including developmentally appropriate care, confidentiality, location of adolescent care, providers who offer such care, the role of research in advancing care, and the transition to adult care.
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Nair M, Baltag V, Bose K, Boschi-Pinto C, Lambrechts T, Mathai M. Improving the Quality of Health Care Services for Adolescents, Globally: A Standards-Driven Approach. J Adolesc Health 2015; 57:288-98. [PMID: 26299556 PMCID: PMC4540599 DOI: 10.1016/j.jadohealth.2015.05.011] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 05/20/2015] [Accepted: 05/26/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE The World Health Organization (WHO) undertook an extensive and elaborate process to develop eight Global Standards to improve quality of health care services for adolescents. The objectives of this article are to present the Global Standards and their method of development. METHODS The Global Standards were developed through a four-stage process: (1) conducting needs assessment; (2) developing the Global Standards and their criteria; (3) expert consultations; and (4) assessing their usability. Needs assessment involved conducting a meta-review of systematic reviews and two online global surveys in 2013, one with primary health care providers and another with adolescents. The Global Standards were developed based on the needs assessment in conjunction with analysis of 26 national standards from 25 countries. The final document was reviewed by experts from the World Health Organization regional and country offices, governments, academia, nongovernmental organizations, and development partners. The standards were subsequently tested in Benin and in a regional expert consultation of Latin America and Caribbean countries for their usability. RESULTS The process resulted in the development of eight Global Standards and 79 criteria for measuring them: (1) adolescents' health literacy; (2) community support; (3) appropriate package of services; (4) providers' competencies; (5) facility characteristics; (6) equity and nondiscrimination; (7) data and quality improvement; and (8) adolescents' participation. CONCLUSIONS The eight standards are intended to act as benchmarks against which quality of health care provided to adolescents could be compared. Health care services can use the standards as part of their internal quality assurance mechanisms or as part of an external accreditation process.
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Affiliation(s)
- Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
| | - Valentina Baltag
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Krishna Bose
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Cynthia Boschi-Pinto
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Thierry Lambrechts
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Matthews Mathai
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
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Rodriguez MA, Fang CM, Gao J, Robins C, Rosenthal MZ. Perceptions of the Limitations of Confidentiality Among Chinese Mental Health Practitioners, Adolescents and Their Parents. ETHICS & BEHAVIOR 2015. [DOI: 10.1080/10508422.2015.1038748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Brittain AW, Williams JR, Zapata LB, Moskosky SB, Weik TS. Confidentiality in Family Planning Services for Young People: A Systematic Review. Am J Prev Med 2015; 49:S85-92. [PMID: 26190851 PMCID: PMC4579525 DOI: 10.1016/j.amepre.2015.04.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 03/25/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
CONTEXT Family planning services are essential for reducing high rates of unintended pregnancies among young people, yet a perception that providers will not preserve confidentiality may deter youth from accessing these services. This systematic review, conducted in 2011, summarizes the evidence on the effect of assuring confidentiality in family planning services to young people on reproductive health outcomes. The review was used to inform national recommendations on providing quality family planning services. EVIDENCE ACQUISITION Multiple databases were searched to identify articles addressing confidentiality in family planning services to youth aged 10-24 years. Included studies were published from January 1985 through February 2011. Studies conducted outside the U.S., Canada, Europe, Australia, or New Zealand, and those that focused exclusively on HIV or sexually transmitted diseases, were excluded. EVIDENCE SYNTHESIS The search strategy identified 19,332 articles, nine of which met the inclusion criteria. Four studies examined outcomes. Examined outcomes included use of clinical services and intention to use services. Of the four outcome studies, three found a positive association between assurance of confidentiality and at least one outcome of interest. Five studies provided information on youth perspectives and underscored the idea that young people greatly value confidentiality when receiving family planning services. CONCLUSIONS This review demonstrates that there is limited research examining whether confidentiality in family planning services to young people affects reproductive health outcomes. A robust research agenda is needed, given the importance young people place on confidentiality.
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Affiliation(s)
| | - Jessica R Williams
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida; Manila Consulting Group, Inc., McLean, Virginia
| | | | - Susan B Moskosky
- Office of Population Affairs, USDHHS, Washington, District of Columbia
| | - Tasmeen S Weik
- Office of Population Affairs, USDHHS, Washington, District of Columbia
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Zhang J, Jemmott JB, Jemmott LS. Mediation and moderation of an efficacious theory-based abstinence-only intervention for African American adolescents. Health Psychol 2015. [PMID: 26214076 DOI: 10.1037/hea0000244] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This secondary data analysis sought to determine what mediated reductions in self-reported sexual initiation over the 24-month postintervention period in early adolescents who received "Promoting Health among Teens," a theory-based, abstinence-only intervention (Jemmott, Jemmott, & Fong, 2010). METHOD African American Grade 6 and 7 students at inner-city public middle schools were randomized to 1 of 5 interventions grounded in social-cognitive theory and the theory of reasoned action: 8-hr abstinence-only targeting reduced sexual intercourse; 8-hr safer-sex-only targeting increased condom use; 8-hr and 12-hr comprehensive interventions targeting sexual intercourse and condom use; 8-hr control intervention targeting physical activity and diet. Primary outcome was self-report of vaginal intercourse by 24 months postintervention. Potential mediators, assessed immediately postintervention, were theory-of-reasoned-action variables, including behavioral beliefs about positive consequences of abstinence and negative consequences of sex, intention to have sex, normative beliefs about sex, and HIV and sexually transmitted infection (STI) knowledge. We tested single and serial mediation models using the product-of-coefficients approach. RESULTS Of 509 students reporting never having vaginal intercourse at baseline (324 girls and 185 boys; mean age = 11.8 years, SD = 0.8), 500 or 98.2% were included in serial mediation analyses. Consistent with the theory of reasoned action, the abstinence-only intervention increased positive behavioral beliefs about abstinence, which reduced intention to have sex, which in turn reduced sexual initiation. Negative behavioral beliefs about sex, normative beliefs about sex, and HIV/STI knowledge were not mediators. CONCLUSIONS Abstinence-only interventions should stress the gains to be realized from abstinence rather than the deleterious consequences of sexual involvement.
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Jemmott III JB, Jemmott LS, O’Leary A, Icard LD, Rutledge SE, Stevens R, Hsu J, Stephens AJ. On the Efficacy and Mediation of a One-on-One HIV Risk-Reduction Intervention for African American Men Who Have Sex with Men: A Randomized Controlled Trial. AIDS Behav 2015; 19:1247-62. [PMID: 25449552 PMCID: PMC4503868 DOI: 10.1007/s10461-014-0961-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We examined the efficacy and mediation of Being Responsible for Ourselves (BRO), an HIV/STI risk-reduction intervention for African American men who have sex with men (MSM), the population with the highest HIV-diagnosis rate in the US. We randomized African American MSM to one of two interventions: BRO HIV/STI risk-reduction, targeting condom use; or attention-matched control, targeting physical activity and healthy diet. The interventions were based on social cognitive theory, the reasoned-action approach, and qualitative research. Men reporting anal intercourse with other men in the past 90 days were eligible and completed pre-intervention, immediately post-intervention, and 6 and 12 months post-intervention surveys. Of 595 participants, 503 (85 %) completed the 12-month follow-up. Generalized-estimating-equations analysis indicated that, compared with the attention-matched control intervention, the BRO intervention did not increase consistent condom use averaged over the 6- and 12-month follow-ups, which was the primary outcome. Although BRO did not affect the proportion of condom-protected intercourse acts, unprotected sexual intercourse, multiple partners, or insertive anal intercourse, it did reduce receptive anal intercourse compared with the control, a behavior linked to incident HIV infection. Mediation analysis using the product-of-coefficients approach revealed that although BRO increased seven of nine theoretical constructs it was designed to affect, it increased only one of three theoretical constructs that predicted consistent condom use: condom-use impulse-control self-efficacy. Thus, BRO indirectly increased consistent condom use through condom-use impulse-control self-efficacy. In conclusion, although BRO increased several theoretical constructs, most of those constructs did not predict consistent condom use; hence, the intervention did not increase it. Theoretical constructs that interventions should target to increase African American MSM’s condom use are discussed.
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Duncan RE, Hall AC, Knowles A. Ethical Dilemmas of Confidentiality With Adolescent Clients: Case Studies From Psychologists. ETHICS & BEHAVIOR 2014. [DOI: 10.1080/10508422.2014.923314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Caregivers' intentions to disclose HIV diagnosis to children living with HIV in South Africa: a theory-based approach. AIDS Behav 2014; 18:1027-36. [PMID: 24310931 DOI: 10.1007/s10461-013-0672-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
When children know their HIV serostatus, they are more likely to cooperate with steps to manage their health and the risk of transmitting HIV to others. Mounting evidence indicates that caregivers often do not disclose to HIV-positive children that the children are living with HIV, but little is known about the modifiable determinants of pediatric HIV disclosure. The present study examined theory-of-planned-behavior predictors of the intention to disclose to children their HIV diagnosis. The participants were 100 caregivers of HIV-positive children in Eastern Cape Province, South Africa. Proportional-odds logistic regression analysis revealed that normative support for disclosure and caregiver-child communication predicted the intention to disclose, whereas behavioral beliefs regarding the consequences of disclosing and self-efficacy to disclose did not. The results suggest that interventions to increase pediatric HIV disclosure in South Africa should help caregivers enlist support for disclosure among important referents and improve communication with their HIV-infected children.
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Posserud MB, Breivik K, Gillberg C, Lundervold AJ. ASSERT--the Autism Symptom SElf-ReporT for adolescents and adults: bifactor analysis and validation in a large adolescent population. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:4495-4503. [PMID: 24176259 DOI: 10.1016/j.ridd.2013.09.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 09/17/2013] [Accepted: 09/19/2013] [Indexed: 06/02/2023]
Abstract
With a view to developing a brief screening instrument for autism symptoms in a general population of adolescents, seven items from the Asperger syndrome (and high-functioning autism) diagnostic interview were adapted for use as self-report in an online questionnaire for youths aged 16-19 years (N=10,220). The selected items target lack of social understanding (4 items) and rigid and repetitive behavior and interests (RRBI; 3 items). Factor analyses were performed, and the seven items were also validated against self-reported ASD diagnosis. Best statistical model fit was found for a bifactor model with one general factor and two domain specific factors tied to social difficulties and RRBI. Both the general and the domain specific factors were associated with self-reported ASD diagnoses. The scale (referred to as the Autism Symptom SElf-ReporT for Adolescents and Adults--ASSERT) had good screening properties with a receiver operating curve-area under the curve (ROC-AUC) of 0.87 and a diagnostic odds ratio (DOR) of 15.8. Applying a modified scoring of the scale further improved the screening properties leading to a ROC-AUC of 0.89 and a DOR of 24.9. The ASSERT holds promise as a brief self-report screen for autism symptoms in adolescents, and further studies should explore its usefulness for adults.
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Affiliation(s)
- Maj-Britt Posserud
- Department of Child and Adolescent Psychiatry, Haukeland University Hospital, 5021 Bergen, Norway; Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Health, Uni Research, P.O. Box 7800, 5020 Bergen, Norway; K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen, P.O. Box 7800, Bergen, Norway.
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Green TC, Johnson J, Harrington M, Pouget ER, Rhodes AG, Taxman FS, O'Connell DJ, Martin SS, Prendergast M, Friedmann PD. Parole officer-parolee relationships and HIV risk behaviors during community supervision. AIDS Behav 2013; 17:2667-75. [PMID: 22038082 DOI: 10.1007/s10461-011-0081-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We tested if good parole officer (PO)-parolee relationships reduce HIV risk behaviors during parole, as they do for risk of rearrest. Analyses used data from 374 parolees enrolled in a randomized clinical trial. Past month HIV risk behaviors were assessed by interview at baseline, 3- and 9-months after parole initiation. The Working Alliance Inventory and the Dual-Role Relationships Inventory measured PO relationship. Gender-stratified multivariate regressions tested associations of PO-parolee relationship with sex with multiple partners, unprotected sex with risky partner(s), and drug injection. Women parolees (n = 65) who reported better PO relationship characteristics were less likely to report having multiple sex partners [adjusted odds ratio: 0.82 (0.69, 0.98) at 3-months, 0.89 (0.80, 0.99) at 9-months], and, among those reporting multiple sex partners, had fewer partners on average [adjusted relative risk 0.98 (0.96, 0.99)]. These effects were not found among men. PO-parolee relationship quality can influence sexual risk behaviors among women parolees.
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Abstract
Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases, remain a growing worldwide problem and public health issue. This article covers the epidemiology of STIs, the history and physical findings, screening guidelines, and the general plan to combat STIs. Prevention is discussed using the latest information from the Centers for Disease Control and Prevention and other references. Infections discussed from the standpoint of cause, epidemiology, risk factors, clinical disease, diagnosis, and treatment include gonorrhea, Chlamydia trachomatis, Trichomonas vaginalis, syphilis, chancroid, Herpes simplex, lymphogranuloma venereum, granuloma inguinale, Herpes papilloma virus, Molluscum contagiosum, and pubic lice.
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Affiliation(s)
- William Markle
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Evolving capacity and decision-making in practice: adolescents' access to legal abortion services in Mexico City. REPRODUCTIVE HEALTH MATTERS 2013; 21:167-75. [PMID: 23684199 DOI: 10.1016/s0968-8080(13)41708-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Malin BA, Emam KE, O'Keefe CM. Biomedical data privacy: problems, perspectives, and recent advances. J Am Med Inform Assoc 2012; 20:2-6. [PMID: 23221359 DOI: 10.1136/amiajnl-2012-001509] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Abstract
Privacy and security of health information is a basic expectation of patients. Despite the existence of federal and state laws safeguarding the privacy of health information, health information systems currently lack the capability to allow for protection of this information for minors. This policy statement reviews the challenges to privacy for adolescents posed by commercial health information technology systems and recommends basic principles for ideal electronic health record systems. This policy statement has been endorsed by the Society for Adolescent Health and Medicine.
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Denny S, Farrant B, Cosgriff J, Hart M, Cameron T, Johnson R, McNair V, Utter J, Crengle S, Fleming T, Ameratunga S, Sheridan J, Robinson E. Access to private and confidential health care among secondary school students in New Zealand. J Adolesc Health 2012; 51:285-91. [PMID: 22921140 DOI: 10.1016/j.jadohealth.2011.12.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 12/12/2011] [Accepted: 12/13/2011] [Indexed: 12/01/2022]
Abstract
PURPOSE Private and confidential health care is an important indicator of the quality of health care for adolescents. The objective of this study was to determine the prevalence of health care utilization and private and confidential health care among a nationally representative population of high school students. METHODS A two-stage cluster sample of 9,107 students (grades 8-12, response rate 73%) from 96 New Zealand high schools (response rate 84%) participated in a 2007 health survey using Internet tablets. Questions included when and where they had accessed health care, if their health care provider had explained that their health care was confidential, and if they had been seen in private by their health care provider. RESULTS Although 83% of students had accessed health care in the previous 12 months, only 27% of students reported receiving private and confidential health care. Students who had accessed health care from a school-based health center (adjusted relative risk [95% confidence interval] 1.54 [1.42-1.66]) or family planning/sexual health clinics (adjusted relative risk = 2.1 [1.9-2.26]) were more likely to report receiving private and confidential health care compared with students who had not accessed health care from these settings. CONCLUSIONS While most young people access health care from their family doctor or general practitioner's clinic, rates of private and confidential health care were low suggesting that opportunities to adequately explore and respond to important yet sensitive topics are compromised in primary care settings.
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Affiliation(s)
- Simon Denny
- Department of Community Paediatrics, School of Population Health, the University of Auckland, New Zealand.
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Frerich EA, Garcia CM, Long SK, Lechner KE, Lust K, Eisenberg ME. Health care reform and young adults' access to sexual health care: an exploration of potential confidentiality implications of the affordable care act. Am J Public Health 2012; 102:1818-21. [PMID: 22897544 DOI: 10.2105/ajph.2012.300857] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
One provision of the 2010 Affordable Care Act is extension of dependent coverage for young adults aged up to 26 years on their parent's private insurance plan. This change, meant to increase insurance coverage for young adults, might yield unintended consequences. Confidentiality concerns may be triggered by coverage through parental insurance, particularly regarding sexual health. The existing literature and our original research suggest that actual or perceived limits to confidentiality could influence the decisions of young adults about whether, and where, to seek care for sexual health issues. Further research is needed on the scope and outcomes of these concerns. Possible remedial actions include enhanced policies to protect confidentiality in billing and mechanisms to communicate confidentiality protections to young adults.
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Affiliation(s)
- Ellen A Frerich
- School of Nursing, University of Minnesota, Minneapolis, USA.
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Jaruseviciene L, Lazarus JV, Zaborskis A. Attitude of Lithuanian Residents to Confidentiality of Adolescent Sexual and Reproductive Health Care. Cent Eur J Public Health 2011; 19:210-6. [DOI: 10.21101/cejph.a3680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Langille DB, Asbridge M, Kisely S, Leblanc MB, Schaller E, Lynk A, Allen M. The relationship of sex and risk behaviours to students' use of school-based health centres in Cape Breton, Nova Scotia. Paediatr Child Health 2011; 13:605-9. [PMID: 19436499 DOI: 10.1093/pch/13.7.605] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2008] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Among other benefits, school-based health centres (SBHCs) are thought to provide opportunities to identify and help adolescents with risk-taking behaviours. The present study examined the use of SBHCs at three high schools in Cape Breton, Nova Scotia, to determine the extent to which SBHCs reach students at risk, and whether there are sex differences with respect to this reach. METHODS Self-administered surveys of students in grades 10 to 12 at the three high schools were carried out in May 2006. RESULTS The response rate was 70% of registered students. Boys were more often at risk than girls due to substance use, while girls were more often at risk due to sexual activity and suicidal thoughts. More girls visited SBHC nurses than boys (49% versus 10%; P<0.001). After adjusting for age, boys who saw a SBHC nurse were significantly more likely to engage in all risk-taking behaviours than boys who did not see a nurse; girls who saw a nurse engaged in most risk-taking behaviours significantly more often than girls who did not. However, no more than 22% of students with each specific risk behaviour used SBHCs to address those risks, with the exception of girls consulting for sexual health reasons, who made up 59% of all girls in the schools who reported being sexually active. CONCLUSIONS Boys infrequently use SBHCs, and many at-risk students of both sexes do not use SBHCs. If the full potential for these SBHCs to help students with risk behaviours is to be realized, the need to increase reach to students is clear.
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Affiliation(s)
- Donald B Langille
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia
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Marcell AV, Matson P, Ellen JM, Ford CA. Annual physical examination reports vary by gender once teenagers become sexually active. J Adolesc Health 2011; 49:47-52. [PMID: 21700156 PMCID: PMC3124664 DOI: 10.1016/j.jadohealth.2010.10.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 10/11/2010] [Accepted: 10/21/2010] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Few sexually active male adolescents receive sexual and reproductive health (SRH) services. To understand this, we examined the association between sexual behavior status and physical examination of the adolescents over time. METHODS We conducted longitudinal cohort analysis of the National Longitudinal Study of Adolescent Health with 9,239 adolescents who completed the baseline school (1994/1995) and wave 2 (1996) follow-up surveys approximately 1.5 years later (retention rate = 71%). The logistic regression models were fitted with random effects to estimate individual odds of reporting a physical examination in the past 12 months at follow-up, compared with baseline, stratified by sexual behavior status and gender, and adjusting for sociodemographic and healthcare access factors. RESULTS In all, 34.5% of male and 38.2% of female adolescents reported experiencing vaginal intercourse by follow-up, and 22.4% of male and 24.7% of female adolescents reported first experiencing intercourse during the study period. Among sexually active adolescents, about half reported having annual physical examinations and one-fifth reported not having any physical examinations. Among female adolescents, baseline to follow-up examination reports significantly increased in the following: sex initiators (adjusted odds ratio [OR] = 2.09, 95% confidence interval [CI] = 1.66-2.64); those reporting sex at both times (OR = 2.16, CI = 1.51-3.09); and those reporting no sex either time (OR = 2.47, CI = 2.00-3.04). Among male adolescents, baseline to follow-up examination reports significantly increased in those reporting no sex either time (OR = 1.57, CI = 1.26-1.96) and showed increasing trends in sex initiators (OR = 1.27, CI = .92-1.76). DISCUSSION A majority of sexually active adolescents report annual physical examinations over time. Providers should not miss opportunities to deliver evidence-based SRH to sexually active adolescents. Future efforts are needed to increase access of all adolescents to SRH services. MESH TERMS: Health Services Accessibility, Male, Female.
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Affiliation(s)
- Arik V Marcell
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland, USA.
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McKee MD, Rubin SE, Campos G, O'Sullivan LF. Challenges of providing confidential care to adolescents in urban primary care: clinician perspectives. Ann Fam Med 2011; 9:37-43. [PMID: 21242559 PMCID: PMC3022043 DOI: 10.1370/afm.1186] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Clinician time alone with an adolescent has a major impact on disclosure of risk behavior. This study sought to describe primary care clinicians' patterns of delivering time alone, decision making about introducing time alone to adolescents and their parents, and experiences delivering confidential services. METHODS We undertook qualitative interviews with 18 primary care clinicians in urban health centers staffed by specialists in pediatrics, family medicine, and adolescent medicine. RESULTS The annual preventive care visit is the primary context for provision of time alone with adolescents; clinicians consider the parent-child dynamic and the nature of the chief complaint for including time alone during visits for other than preventive care. Time constraints are a major barrier to offering time alone more frequently. Clinicians perceive that parental discomfort with time alone is rare. Many clinicians wrestle with internal conflict about providing confidential services to adolescents with serious health threats and regard their role as facilitating adolescent-parent communication. Health systems factors can interfere with delivery of confidential services, such as inconsistent procedures for determining whether unaccompanied youth would be seen. CONCLUSION Despite competing time demands, clinicians report commitment to offering time alone during preventive care visits and infrequently offer it at other times. Experienced clinicians can gain skills in the art of managing complex relationships between adolescents and their parents. Office systems should be developed that enhance the consistency of delivery of confidential services.
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Affiliation(s)
- M Diane McKee
- Department of Family and Social Medicine, Montefiore Medical Center, Bronx, NY, USA.
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Abstract
OBJECTIVE To understand adolescents' preferences for multidimensional aspects of privacy, including psychological, social, and physical, and confidentiality (informational privacy) in the health care setting. PATIENTS AND METHODS Fifty-four adolescents with and without chronic illness participated in 12 focus groups composed of participants of the same age (11-14 or 15-19 years), gender, and health status. Health care preferences, including privacy and confidentiality, were discussed, and themes were determined. On the basis of a literature review, Burgoon's framework best represented participant feedback. The data were categorized as representations of informational, psychological, social, or physical privacy. RESULTS Maintaining informational privacy (ie, keeping information confidential) was most salient to the adolescents. Younger adolescents were concerned with information being disclosed to others (ie, health care providers), whereas older adolescents worried more about information being disclosed to parents. Other privacy aspects (psychological, social, and physical) also were important. To protect psychological privacy, adolescents were cautious about revealing sensitive information for fear of being judged by providers. To protect social privacy, they were reluctant to talk with unfamiliar or multiple providers, and they did not want to discuss issues they perceived as unrelated to their health care. Adolescents who commented about physical privacy said that they thought about their physical safety during physical examinations, as well as their visibility to others, and said that they were more comfortable when examinations were performed by female rather than male providers. CONCLUSIONS Adolescents value all aspects of privacy. Providers should address not only informational but also psychological, social, and physical privacy to improve the care of adolescent patients.
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Affiliation(s)
- Maria T Britto
- Center for Innovation in Chronic Disease Care, Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, 3333 Burnet Avenue, MLC 7027, Cincinnati, OH 45229, USA.
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