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Bogart AR, Richards M, Sheeder J. Youth and Guardian Expectations of Privacy in Adolescent Health Care. J Adolesc Health 2024:S1054-139X(24)00175-7. [PMID: 38739058 DOI: 10.1016/j.jadohealth.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/29/2024] [Accepted: 03/29/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE Adolescent access to confidential care is codified by most states with age-specific laws; however, adolescent and guardian awareness of these laws are poorly understood. In this study, we assessed adolescent and guardian perceptions of conditional confidentiality in health care. METHODS We surveyed youth aged 11-18 years, and guardians accompanying youth seeking care at an urban adolescent outpatient clinic that provides adolescent primary and subspecialty care. Participants completed brief True/False surveys which queried whether a parent would be notified for common, hypothetical scenarios. We analyzed adolescent responses by age group and compared responses of adolescents and guardians. RESULTS Two hundred seventy nine adolescents and 178 guardians completed the survey. Among participants, 86% of adolescents and 67% of guardians believed they understood which health topics were confidential. Adolescent and guardian answers aligned with mandatory reporting laws for scenarios concerning safety and suicidality. Younger adolescents consistently underestimated their legal right to privacy for all hypothetical scenarios. Many adolescents anticipated disclosure to parents for confidential services, including contraception, pregnancy, and sexually transmitted infection testing. Guardians expected disclosure about sexual health services at higher rates than they did about substance use. DISCUSSION We identified age-associated knowledge gaps among participants pertaining to adolescent privacy in the clinical setting. These deficits were found in a setting where adolescent privacy is routinely discussed, and our findings may underestimate the knowledge gap in the general pediatric population where confidentiality may not be discussed as often. Providers caring for adolescents share the responsibility of educating both youth and families about the importance of adolescent confidentiality.
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Affiliation(s)
- Amanda R Bogart
- Section of Adolescent Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Children's Hospital Colorado, Aurora, Colorado.
| | - Molly Richards
- Section of Adolescent Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Children's Hospital Colorado, Aurora, Colorado
| | - Jeanelle Sheeder
- Division of Complex Family Planning, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
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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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Brisson J, Volesky-Avellaneda KD. Internet-Based Access to Sexual and Reproductive Health Services Among Colombian Youth: A Cross-Sectional Study. HISPANIC HEALTH CARE INTERNATIONAL 2024:15404153241246102. [PMID: 38613383 DOI: 10.1177/15404153241246102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Introduction: Sexual and reproductive health (SRH) is a sensitive subject, and young people may be unfamiliar with how to access SRH services. In this cross-sectional study, we examined young people's internet use to understand how they accessed SRH clinics in Colombia. This study also explored Colombian youth's interest in online material teaching how to access SRH services. Methods: During August 2019-February 2020, patients aged 10-24 years old presenting at two SRH clinics in Colombia were invited to answer a survey. Chi-square tests were performed to assess possible differences in how participants inquired how to access the clinic according to sociodemographic characteristics. Results: Among the 812 patients who participated, 91.4% were female and the median age was 19 years. To inquire how to access the SRH clinic, 30.7% of participants asked their parent(s) and 24.0% used the internet. Participants aged 20-24 years old were more likely to use the internet compared to younger participants (p < .001). Most respondents (81.5%) were interested in the availability of online material explaining how to access SRH services. Conclusions: While Colombian youth learned about how to access SRH clinics from several different sources, the vast majority indicated their interest in having access to online materials explaining how to access SRH services.
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Affiliation(s)
- Julien Brisson
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Karena D Volesky-Avellaneda
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Begay JL, Chambers RA, Rosenstock S, Kemp CG, Lee A, Lazelere F, Pinal L, Tingey L. Assessing the Effectiveness of the Respecting the Circle of Life Project on Condom and Contraception Self-efficacy Among American Indian Youth. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:283-291. [PMID: 37227589 PMCID: PMC10764457 DOI: 10.1007/s11121-023-01514-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 05/26/2023]
Abstract
Respecting the Circle of Life (RCL) is a teen pregnancy prevention program that was evaluated for effectiveness on sexual health risk behaviors through a two-arm randomized control trial (RCT) with American Indian (AI) youth ages 11-19. The objective of this study is to investigate the effects of RCL compared to a control group on items of condom and contraception self-efficacy. Linear regression analysis was used to compare differences in each item that included condom and contraception self-efficacy scales among the intervention and control participants at baseline, 3 and 9 months post intervention. Youth enrolled in the intervention reported higher levels of condom and contraception self-efficacy across almost all individual items. Exceptions include items related to partner negotiation of condom self-efficacy at 3 months (p = 0.227) and 9 months (p = 0.074) post intervention. Findings indicate RCL is effective at improving overall condom and contraception self-efficacy but did not impact the specific component of partner negotiation for either condom or contraception self-efficacy. This inquiry provides rationale to further explore components of RCL related to partner negotiation.
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Affiliation(s)
- Jaime L Begay
- Johns Hopkins Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, 327 Loloma Street, Tuba City, AZ, 86045, USA.
| | - Rachel A Chambers
- Johns Hopkins Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
| | - Summer Rosenstock
- Johns Hopkins Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
| | - Christopher G Kemp
- Johns Hopkins Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
| | - Angelita Lee
- Johns Hopkins Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, 102 General Crook Street, Fort Apache, AZ, 85926, USA
| | - Francene Lazelere
- Johns Hopkins Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, 102 General Crook Street, Fort Apache, AZ, 85926, USA
| | - Laura Pinal
- Johns Hopkins Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, 102 General Crook Street, Fort Apache, AZ, 85926, USA
| | - Lauren Tingey
- Johns Hopkins Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
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Laurenzi C, Operario D, Mutambo C, Mupakile E, Banda B, Ngakongwa F, Kilonzo R, Busakhwe C, Ronan A, Toska E. Lessons From Implementing Ask-Boost-Connect-Discuss, a Peer-Delivered Psychosocial Intervention for Young Mothers Living With HIV in Malawi, Tanzania, Uganda, and Zambia. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2300077. [PMID: 37903574 PMCID: PMC10615246 DOI: 10.9745/ghsp-d-23-00077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/26/2023] [Indexed: 11/01/2023]
Abstract
Adolescent girls and young women in sub-Saharan Africa are at high risk of HIV, unintended pregnancy, and early motherhood. These intersecting risks can adversely affect their developmental trajectories and lifelong well-being. Because young mothers living with HIV in these settings experience high levels of stigma, shame, and isolation, tailored psychosocial intervention approaches for this group are critical yet unavailable. Enlisting young peer supporters may be a promising way to expand the reach of health services and enhance psychosocial well-being. To date, few peer-based interventions have targeted young mothers living with HIV. In 2019-2021, we codeveloped a peer-based, facility-embedded intervention package, Ask-Boost-Connect-Discuss (ABCD), with young peer supporters to address the psychosocial needs of young mothers living with HIV in Malawi, Tanzania, Uganda, and Zambia. We then analyzed programmatic data from ABCD to assess the feasibility of using young peers to deliver psychosocial support. Data sources included post-intervention interviews, focus groups, and written feedback from multiple stakeholders (participants, peer supporters, their supervisors, and clinic-based mentors), which were analyzed thematically. We organized our findings according to Bowen et al.'s feasibility framework. Findings spoke to the acceptability, practicality, and integration of the ABCD program. We found that young peer supporters were seen as acceptable program implementers; able to adopt responsive, engaging, and nonjudgmental approaches; and supported through training, technical skills development, and supervision, alongside purposeful facility integration. Importantly, we also found evidence reflecting the roles of demand and adaptation in program delivery (i.e., how peers responded to emerging participant needs or pivoted in their approach based on shifting circumstances). We conclude that considerations of intervention feasibility and/or program fidelity should be attuned to the dynamic qualities of young peer supporters as implementers and should extend beyond standard modes of assessment to consider intervention codevelopment and implementation as an iterative and adaptive process.
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Affiliation(s)
- Christina Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
| | - Don Operario
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Chipo Mutambo
- Paediatric-Adolescent Treatment Africa, Cape Town, South Africa
| | | | | | | | | | - Chuma Busakhwe
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Agnes Ronan
- Paediatric-Adolescent Treatment Africa, Cape Town, South Africa
| | - Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Social Policy and Intervention, Oxford University, Oxford, United Kingdom
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Heath G, Clarke R, Ross J, Farrow C. Factors influencing non-attendance at sexual healthcare appointments in the UK: a qualitative study. Sex Health 2023; 20:461-469. [PMID: 37604779 DOI: 10.1071/sh23099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 08/01/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Missed sexual healthcare appointments lead to inefficiencies and wasted resources, longer waiting times and poorer outcomes. The aim of this research was to identify factors influencing non-attendance at sexual healthcare appointments and to make recommendations for interventions. METHODS Semi-structured interviews were carried out with UK-based sexual health service-users with experience of booking and missing appointments and sexual health professionals (n =28). Interviews were analysed using a thematic framework approach. RESULTS Perceptual, practical, and organisational factors were found to influence missed appointments. Perceptual factors included beliefs about the outcomes of attending; sense of responsibility to attend; and concerns about privacy and security. Practical factors included competing demands and disruption to daily life; ability to attend; and forgetting. Organisational factors included mode of appointment delivery and availability of appointments. CONCLUSIONS Interventions should combine strategies shown to be effective for overcoming practical barriers to attendance (e.g. reminder systems) with novel strategies communicating the benefits of attending and risks of missed appointments (e.g. behaviourally informed messaging). Text reminders containing behaviourally informed messages may be an efficient intervention for targeting perceptual and practical factors associated with missed appointments. Offering appointment modalities to suit individual preference and enabling service-users to remotely cancel/reschedule appointments maight further support a reduction in missed appointments.
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Affiliation(s)
- Gemma Heath
- School of Psychology, Aston University, Birmingham, UK
| | - Rebecca Clarke
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Jonathan Ross
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Claire Farrow
- School of Psychology, Aston University, Birmingham, UK
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Shakir RM, Doshi S, Blakeslee S, Jessee M. Seize the Opportunity: Increasing the HIV Screening Rate in Adolescents Presenting to a Community Pediatric Emergency Department. Pediatr Emerg Care 2023; 39:801-806. [PMID: 37665966 DOI: 10.1097/pec.0000000000003044] [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] [Indexed: 09/06/2023]
Abstract
OBJECTIVES Our objective was to increase human immunodeficiency virus (HIV) screening in adolescents presenting to our community pediatric emergency department with symptoms suggestive of a sexually transmitted infection (STI) and who were being tested for gonorrhea and chlamydia. Specifically, we aimed to increase the monthly average proportion of adolescents concurrently screened for HIV in this target group from 11% to 50% in 6 months. METHODS We identified barriers to HIV screening, focusing on physician-related challenges and adolescents' concerns about confidentiality. We designed interventions targeting these barriers and implemented them in plan-do-study-act cycles beginning in February 2020. We educated physicians and nurses about screening recommendations, emphasized a physician-conducted private interview during which confidential contact information could be obtained, and assured confidentiality on after visit summaries by removing STI results. We also provided regular feedback to physicians on the screening rate. In addition, we implemented an electronic health record quick order set and a documentation tool. Using a statistical process control chart, we measured the average monthly proportion of adolescents in the target group who were offered HIV screening or tested for HIV before and after interventions. RESULTS A total of 140 adolescents in the target group presented to our pediatric emergency department from February 2020 through December 2021. After plan-do-study-act cycles, the average monthly screening rate increased to 80%. CONCLUSIONS Raising physician awareness of HIV screening recommendations and the importance of conducting a private interview improved screening rates. Assuring adolescent minors of confidentiality in a private interview, removing STI results from the after visit summary, and obtaining confidential contact information were important measures to overcome confidentiality barriers.
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Affiliation(s)
- Rashida M Shakir
- From the Children's Hospital of Philadelphia at Virtua Mount Holly Hospital, Mount Holly, NJ
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Owens C, Gray SJ, Carter K, Hoffman M, Mullen C, Hubach RD. Implementation Facilitators and Barriers for Primary Care Providers Prescribing Daily Oral PrEP to Adolescents in the United States. AIDS Patient Care STDS 2023; 37:379-393. [PMID: 37566536 DOI: 10.1089/apc.2023.0090] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Abstract
Primary care providers (PCPs) are critical in prescribing human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) to adolescents at risk of HIV. More research is needed to identify facilitators and barriers PCPs encounter in prescribing PrEP to eligible adolescents post-Food and Drug Administration (FDA) approval. This online cross-sectional survey examined the PrEP implementation facilitators and barriers among a national sample of PCPs in the United States. PCPs (n = 502) specializing in family medicine or pediatrics were recruited from a Qualtrics panel from July 15 to August 9, 2022. We analyzed the collected data using content analysis and applied the Expert Recommendations for Implementing Change (ERIC) to codebook creation and data analysis. We conducted a Fisher's exact chi-square test of independence to compare facilitator and barrier prevalence differences between participants who had and had not prescribed PrEP to an adolescent patient. Results demonstrate that (1) distributing prescriber-focused educational materials, (2) involving parents, (3) changing liability laws, (4) enhancing adolescent PrEP uptake and adherence, (5) changing clinical resources, and (6) using mass/social media to change community norms might be strategies that influence PCPs prescribing PrEP to eligible adolescent patients. Results from this study could facilitate the planning of hybrid implementation-effectiveness trials designed to determine the acceptability, feasibility, and effectiveness of implementation strategies in improving the practices of PCPs prescribing PrEP to at-risk adolescents.
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Affiliation(s)
- Christopher Owens
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Samuel J Gray
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Kaileigh Carter
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Matt Hoffman
- School of Nursing, Texas A&M University, Bryan, Texas, USA
| | - Cody Mullen
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Randolph D Hubach
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
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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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Owens C, Currin JM, Hoffman M, Grant MJ, Hubach RD. Implementation Factors Associated With Primary Care Providers' Intention to Prescribe HIV PrEP to Adolescents in the United States. J Adolesc Health 2023; 73:181-189. [PMID: 37031092 DOI: 10.1016/j.jadohealth.2023.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/20/2022] [Accepted: 02/01/2023] [Indexed: 04/10/2023]
Abstract
PURPOSE In the United States, adolescents (those 13-18 years old) are a key age group of those at risk for and affected by HIV. Although HIV pre-exposure prophylaxis (PrEP), one promising HIV prevention tool, is approved for eligible adolescents to use, adolescent access to PrEP is limited by primary care providers' (PCPs) willingness to prescribe it. This study examined which Theoretical Domains Framework factors are associated with PCPs' intention to prescribe PrEP to sexually active adolescents. METHODS A total of 770 licensed PCPs practicing family medicine, internal medicine, or pediatrics in the United States completed an online cross-sectional questionnaire. Participants were recruited through a Qualtrics panel. We used a hierarchical regression to assess the association of demographic characteristics, sexual health care practices, and the 10 Theoretical Domains Framework factors with intention to prescribe PrEP to sexually active adolescents aged 13-18 years old. RESULTS Although nearly all PCPs had heard about PrEP (90.9%), 30.6% ever prescribed PrEP to an adolescent. Intention to prescribe PrEP to sexually active adolescents was associated with seven out of the 10 Theoretical Domains Framework factors: knowledge, skills, professional role, belief capacity, belief consequence, environmental resource, social influence, and emotion. DISCUSSION Our findings demonstrate that the Theoretical Domains Framework can be employed to understand the intrapersonal, interpersonal, and environmental factors associated with PCPs' intention to prescribe sexually active adolescents PrEP. Implementation strategies are needed to implement interventions that improve provider knowledge, attitudes, and skills related to prescribing PrEP to eligible adolescents.
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Affiliation(s)
- Christopher Owens
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas; Center for Health Equity and Evaluation Research, School of Public Health, Texas A&M University, College Station, Texas.
| | - Joseph M Currin
- Department of Behavioral Sciences and Leadership, United States Air Force Academy, Colorado Springs, Colorado
| | - Matt Hoffman
- School of Nursing, Texas A&M University, Bryan, Texas
| | - Morgan J Grant
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas; Center for Health Equity and Evaluation Research, School of Public Health, Texas A&M University, College Station, Texas
| | - Randolph D Hubach
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana
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Mehus CJ, Voller V, Gewirtz O'Brien JR, Gower AL, McRee AL, Sieving RE. How is Time Alone Introduced? Experiences and Preferences of Adolescents and Parents. J Adolesc Health 2023; 73:190-194. [PMID: 37061902 DOI: 10.1016/j.jadohealth.2023.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/01/2023] [Accepted: 02/17/2023] [Indexed: 04/17/2023]
Abstract
PURPOSE Time alone between health care providers and adolescent patients is a core element of quality adolescent primary care, yet not all adolescents receive this care. Clinicians' apprehension about how best to introduce time alone may contribute to lower levels of time alone. This study aims to understand how adolescent patients and their parents or guardians experience the introduction of time alone during adolescent preventive visits. METHOD We conducted semistructured interviews with adolescents, aged 11-17 years (n = 35) and a parent or guardian of the adolescent (n = 35) across metropolitan and nonmetropolitan areas of Minnesota. We used thematic analysis to describe (1) parent and adolescent experiences learning about time alone for the first time and (2) parent and adolescent reactions to this experience. RESULTS Key findings from this study suggest that adolescents prefer a universal application of time alone with an option to opt out (e.g., "At this age, I always ask parents to step out for a few minutes, are you okay with that?"), rather than opt in (e.g., "Would you like your parent to step out?"). Parents noted that time alone should not be a surprise but rather should be presented as routine, so they are not left to wonder if time alone was offered to their adolescent for a particular reason. DISCUSSION Findings suggest universal presentation of time alone with the option for adolescents to opt out may improve acceptability of time alone and support delivery of highquality care.
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Affiliation(s)
- Christopher J Mehus
- Department of Family Social Science and Center for Applied Research and Educational Improvement, University of Minnesota, St. Paul, Minnesota.
| | - Vanessa Voller
- College of Education and Human Development and School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Janna R Gewirtz O'Brien
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Amy L Gower
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Annie-Laurie McRee
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Renee E Sieving
- School of Nursing, University of Minnesota, Minneapolis, Minnesota
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Michaud PA, Takeuchi YL, Mazur A, Hadjipanayis AA, Ambresin AE. How to approach and take care of minor adolescents whose situations raise ethical dilemmas? a position paper of the European academy of pediatrics. Front Pediatr 2023; 11:1120324. [PMID: 37351318 PMCID: PMC10282839 DOI: 10.3389/fped.2023.1120324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/22/2023] [Indexed: 06/24/2023] Open
Abstract
In the care of adolescents, health care providers often face situations raising ethical concerns or dilemmas, such as refusal of a treatment or hospitalization, or request of confidentiality while engaging in risky behaviors or facing unplanned pregnancy. This position paper provides concrete avenues as how to assess the adolescent's capacity for autonomous decision making, e.g. the patient's competence in a specific situation, and how to elicit informed choice or consent. To do so, professionals need to be sensitized and trained as how to assess the cognitive and socio-psychological development of the young patient. Another challenge for the health professionals is to balance the needs to support patient's autonomy while offering secure guidance and protection if needed. To optimize such a process, they establish a climate of trust and empathy that will allow the patient to participate freely in the decision. In addition, especially when the decisions have potentially important consequences on the health and life, the professionals include, with the adolescent's permission, parents, caregivers or other significant adults, as well as they may request the opinion of other members of the health care team or expert colleagues such as ethicists.
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Affiliation(s)
| | - Yusuke-Leo Takeuchi
- Division for Adolescent Health, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Artur Mazur
- Faculty of Medicine, University of Rzeszow, Rzeszow, Poland
| | | | - Anne-Emmanuelle Ambresin
- Division for Adolescent Health, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Rabbani N, Bedgood M, Brown C, Steinberg E, Goldstein RL, Carlson JL, Pageler N, Morse KE. A Natural Language Processing Model to Identify Confidential Content in Adolescent Clinical Notes. Appl Clin Inform 2023; 14:400-407. [PMID: 36898410 PMCID: PMC10208722 DOI: 10.1055/a-2051-9764] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/01/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND The 21st Century Cures Act mandates the immediate, electronic release of health information to patients. However, in the case of adolescents, special consideration is required to ensure that confidentiality is maintained. The detection of confidential content in clinical notes may support operational efforts to preserve adolescent confidentiality while implementing information sharing. OBJECTIVES This study aimed to determine if a natural language processing (NLP) algorithm can identify confidential content in adolescent clinical progress notes. METHODS A total of 1,200 outpatient adolescent progress notes written between 2016 and 2019 were manually annotated to identify confidential content. Labeled sentences from this corpus were featurized and used to train a two-part logistic regression model, which provides both sentence-level and note-level probability estimates that a given text contains confidential content. This model was prospectively validated on a set of 240 progress notes written in May 2022. It was subsequently deployed in a pilot intervention to augment an ongoing operational effort to identify confidential content in progress notes. Note-level probability estimates were used to triage notes for review and sentence-level probability estimates were used to highlight high-risk portions of those notes to aid the manual reviewer. RESULTS The prevalence of notes containing confidential content was 21% (255/1,200) and 22% (53/240) in the train/test and validation cohorts, respectively. The ensemble logistic regression model achieved an area under the receiver operating characteristic of 90 and 88% in the test and validation cohorts, respectively. Its use in a pilot intervention identified outlier documentation practices and demonstrated efficiency gains over completely manual note review. CONCLUSION An NLP algorithm can identify confidential content in progress notes with high accuracy. Its human-in-the-loop deployment in clinical operations augmented an ongoing operational effort to identify confidential content in adolescent progress notes. These findings suggest NLP may be used to support efforts to preserve adolescent confidentiality in the wake of the information blocking mandate.
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Affiliation(s)
- Naveed Rabbani
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States
| | - Michael Bedgood
- California Department of Public Health, Richmond, California, United States
| | - Conner Brown
- Information Services Department, Lucile Packard Children's Hospital, Palo Alto, California, United States
| | - Ethan Steinberg
- Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, California, United States
- Department of Computer Science, Stanford University, Stanford, California, United States
| | - Rachel L. Goldstein
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States
| | - Jennifer L. Carlson
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States
| | - Natalie Pageler
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States
| | - Keith E. Morse
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States
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Brar P, Sieving RE, Steiner RJ, Gewirtz O'Brien JR, Moore MM, Mehus CJ, Ross C, Klein JD, Santelli J. Provider Facilitation of Parent-Adolescent Health Communication: Findings From a National Survey. J Pediatr Health Care 2023; 37:253-261. [PMID: 36624017 PMCID: PMC11034920 DOI: 10.1016/j.pedhc.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/01/2022] [Accepted: 11/11/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Primary care providers are well-positioned to facilitate parent-adolescent health communication. We examined provider-facilitated parent-adolescent health communication prevalence and associations with parent-adolescent health communication. METHOD Using data from a national survey of parent-adolescent dyads (n = 853), we calculated the prevalence of provider-facilitated parent-adolescent health communication about 11 topics as a result of adolescent's last preventive visit. We examined correlates of of provider-facilitatedparent-adolescent communication and associations with with parent-adolescent communication. RESULTS Eighteen percent of adolescents reported that a provider helped them talk with their parent about a health concern, with little variability by adolescent, parent, or provider characteristics. Prevalence of parent-adolescent communication because of an adolescent's last preventive visit ranged between 38.4% and 79.5%. Provider facilitation was positively associated with parent-adolescent communication for all topics. DISCUSSION Given the low prevalence of provider-facilitated-parent-adolescent health communication and positive associations between provider facilitation and parent-adolescent communication about multiple important health-related topics, efforts to improve this practice could be beneficial.
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15
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Nelson KM, Skinner A, Stout CD, Raderman W, Unger E, Raifman J, Agénor M, Ybarra ML, Dunsiger SI, Bryn Austin S, Underhill K. Minor Consent Laws for Sexually Transmitted Infection and Human Immunodeficiency Virus Services in the United States: A Comprehensive, Longitudinal Survey of US State Laws. Am J Public Health 2023; 113:397-407. [PMID: 36730879 PMCID: PMC10003504 DOI: 10.2105/ajph.2022.307199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 02/04/2023]
Abstract
Objectives. To assess changes in minor consent laws for sexually transmitted infection (STI) and HIV testing, treatment, and prevention services in all 50 US states and the District of Columbia from 1900 to 2021. Methods. We coded laws into minor consent for (1) health care generally; (2) STI testing, treatment, and prevention; (3) HIV testing, treatment, and prevention; and (4) pre- or postexposure prophylaxis for HIV prevention. We also coded confidentiality protections and required conditions (e.g., threshold clinician judgments). Results. The largest increase in states allowing minors to consent to STI services occurred during the 1960s and 1970s. By 2021, minors could consent independently to STI and HIV testing and treatment in all 50 states plus DC, STI prevention services in 32 jurisdictions, and HIV prevention services in 33 jurisdictions. Confidentiality protections for minors are rare. Prerequisites are common. Conclusions. Although the number of states allowing minors to consent independently to STI and HIV services has increased considerably, these laws have substantial limitations, including high complexity, prerequisites requiring clinician judgments, and neglect of confidentiality concerns. (Am J Public Health. 2023;113(4):397-407. https://doi.org/10.2105/AJPH.2022.307199).
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Affiliation(s)
- Kimberly M Nelson
- Kimberly M. Nelson and Claire D. Stout are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexandra Skinner, Will Raderman, and Julia Raifman are with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Emily Unger and S. Bryn Austin are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Madina Agénor and Shira I. Dunsiger are with the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI. Michele L. Ybarra is with the Center for Innovative Public Health Research, San Clemente, CA. Kristen Underhill is with Cornell Law School, Ithaca, NY
| | - Alexandra Skinner
- Kimberly M. Nelson and Claire D. Stout are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexandra Skinner, Will Raderman, and Julia Raifman are with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Emily Unger and S. Bryn Austin are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Madina Agénor and Shira I. Dunsiger are with the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI. Michele L. Ybarra is with the Center for Innovative Public Health Research, San Clemente, CA. Kristen Underhill is with Cornell Law School, Ithaca, NY
| | - Claire D Stout
- Kimberly M. Nelson and Claire D. Stout are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexandra Skinner, Will Raderman, and Julia Raifman are with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Emily Unger and S. Bryn Austin are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Madina Agénor and Shira I. Dunsiger are with the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI. Michele L. Ybarra is with the Center for Innovative Public Health Research, San Clemente, CA. Kristen Underhill is with Cornell Law School, Ithaca, NY
| | - Will Raderman
- Kimberly M. Nelson and Claire D. Stout are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexandra Skinner, Will Raderman, and Julia Raifman are with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Emily Unger and S. Bryn Austin are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Madina Agénor and Shira I. Dunsiger are with the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI. Michele L. Ybarra is with the Center for Innovative Public Health Research, San Clemente, CA. Kristen Underhill is with Cornell Law School, Ithaca, NY
| | - Emily Unger
- Kimberly M. Nelson and Claire D. Stout are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexandra Skinner, Will Raderman, and Julia Raifman are with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Emily Unger and S. Bryn Austin are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Madina Agénor and Shira I. Dunsiger are with the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI. Michele L. Ybarra is with the Center for Innovative Public Health Research, San Clemente, CA. Kristen Underhill is with Cornell Law School, Ithaca, NY
| | - Julia Raifman
- Kimberly M. Nelson and Claire D. Stout are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexandra Skinner, Will Raderman, and Julia Raifman are with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Emily Unger and S. Bryn Austin are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Madina Agénor and Shira I. Dunsiger are with the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI. Michele L. Ybarra is with the Center for Innovative Public Health Research, San Clemente, CA. Kristen Underhill is with Cornell Law School, Ithaca, NY
| | - Madina Agénor
- Kimberly M. Nelson and Claire D. Stout are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexandra Skinner, Will Raderman, and Julia Raifman are with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Emily Unger and S. Bryn Austin are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Madina Agénor and Shira I. Dunsiger are with the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI. Michele L. Ybarra is with the Center for Innovative Public Health Research, San Clemente, CA. Kristen Underhill is with Cornell Law School, Ithaca, NY
| | - Michele L Ybarra
- Kimberly M. Nelson and Claire D. Stout are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexandra Skinner, Will Raderman, and Julia Raifman are with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Emily Unger and S. Bryn Austin are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Madina Agénor and Shira I. Dunsiger are with the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI. Michele L. Ybarra is with the Center for Innovative Public Health Research, San Clemente, CA. Kristen Underhill is with Cornell Law School, Ithaca, NY
| | - Shira I Dunsiger
- Kimberly M. Nelson and Claire D. Stout are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexandra Skinner, Will Raderman, and Julia Raifman are with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Emily Unger and S. Bryn Austin are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Madina Agénor and Shira I. Dunsiger are with the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI. Michele L. Ybarra is with the Center for Innovative Public Health Research, San Clemente, CA. Kristen Underhill is with Cornell Law School, Ithaca, NY
| | - S Bryn Austin
- Kimberly M. Nelson and Claire D. Stout are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexandra Skinner, Will Raderman, and Julia Raifman are with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Emily Unger and S. Bryn Austin are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Madina Agénor and Shira I. Dunsiger are with the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI. Michele L. Ybarra is with the Center for Innovative Public Health Research, San Clemente, CA. Kristen Underhill is with Cornell Law School, Ithaca, NY
| | - Kristen Underhill
- Kimberly M. Nelson and Claire D. Stout are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexandra Skinner, Will Raderman, and Julia Raifman are with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Emily Unger and S. Bryn Austin are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Madina Agénor and Shira I. Dunsiger are with the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI. Michele L. Ybarra is with the Center for Innovative Public Health Research, San Clemente, CA. Kristen Underhill is with Cornell Law School, Ithaca, NY
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Kerolle S, Zuckerbraun N, Reed J, Pollack A, Lieberman J, Ruppert K, Hoehn E. Examining Parental Acceptance of Confidential Contraception Initiation in a Pediatric Emergency Department. Pediatr Emerg Care 2023; 39:125-129. [PMID: 35947074 DOI: 10.1097/pec.0000000000002818] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND The pediatric emergency department (PED) is a valuable site for contraceptive services among adolescents at risk for pregnancy. Studies have shown that adolescents are interested in such services; however, little is known about parental opinions on contraceptive care in the PED. We aimed to (1) assess parental acceptance of confidential provisions of contraception in the PED and (2) identify facilitators/barriers to parental acceptance of contraception in this setting. METHODS This study included parents/guardians of females aged 14 to 19 years who presented to the PED with any chief complaint. Participants completed a self-administered 25-question survey based on previously validated questions to assess their acceptance of contraception provisions, both confidentially and with parental involvement, for their adolescent in the PED. χ 2 or Fisher exact tests were used to examine variables associated with parental acceptance of confidential contraception. RESULTS Of the 102 parents/guardians surveyed, most parents (58/102, 57%) were accepting of confidential contraception for their adolescent. However, more parents (82/101, 81%) were accepting of contraception in the ED with their involvement, as opposed to confidentially without their involvement. Those accepting had an increased perceived risk of their adolescent having sex or becoming pregnant (mean [SD], 13 [20]; P = 0.02; odds ratio, 1.05; 95% confidence interval, 1.00-1.09), were aware of their adolescent's rights to confidential contraception (62%; P = 0.006; odds ratio, 3.18; 95% confidence interval, 1.39-7.28), and had slightly older teens (16 vs 15.5 years, P = 0.01). More parents accepted OCPs over IUDs in the PED (53/58, 91% vs 26/57, 46%). CONCLUSIONS Although most parents were accepting of the PED provider offering confidential contraception to their adolescent, more parents preferred to be involved with decisions regarding contraception, in a collaborative approach. Further research is necessary to better elucidate parental/adolescent preferences.
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Affiliation(s)
| | | | | | - Andrea Pollack
- From the UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Julia Lieberman
- From the UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Kristine Ruppert
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
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17
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Bedgood M, Rabbani N, Brown C, Goldstein R, Carlson JL, Steinberg E, Powell A, Pageler NM, Morse K. The Prevalence of Confidential Content in Adolescent Progress Notes Prior to the 21st Century Cures Act Information Blocking Mandate. Appl Clin Inform 2023; 14:337-344. [PMID: 37137339 PMCID: PMC10156443 DOI: 10.1055/s-0043-1767682] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/16/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND The 21st Century Cures Act information blocking final rule mandated the immediate and electronic release of health care data in 2020. There is anecdotal concern that a significant amount of information is documented in notes that would breach adolescent confidentiality if released electronically to a guardian. OBJECTIVES The purpose of this study was to quantify the prevalence of confidential information, based on California laws, within progress notes for adolescent patients that would be released electronically and assess differences in prevalence across patient demographics. METHODS This is a single-center retrospective chart review of outpatient progress notes written between January 1, 2016, and December 31, 2019, at a large suburban academic pediatric network. Notes were labeled into one of three confidential domains by five expert reviewers trained on a rubric defining confidential information for adolescents derived from California state law. Participants included a random sampling of eligible patients aged 12 to 17 years old at the time of note creation. Secondary analysis included prevalence of confidentiality across age, gender, language spoken, and patient race. RESULTS Of 1,200 manually reviewed notes, 255 notes (21.3%) (95% confidence interval: 19-24%) contained confidential information. There was a similar distribution among gender and age and a majority of English speaking (83.9%) and white or Caucasian patients (41.2%) in the cohort. Confidential information was more likely to be found in notes for females (p < 0.05) as well as for English-speaking patients (p < 0.05). Older patients had a higher probability of notes containing confidential information (p < 0.05). CONCLUSION This study demonstrates that there is a significant risk to breach adolescent confidentiality if historical progress notes are released electronically to proxies without further review or redaction. With increased sharing of health care data, there is a need to protect the privacy of the adolescents and prevent potential breaches of confidentiality.
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Affiliation(s)
- Michael Bedgood
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
- Information Services, Stanford Children's Health, Palo Alto, California, United States
- California Department of Public Health, Coronavirus Science Branch, Richmond, California, United States
| | - Naveed Rabbani
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
- Information Services, Stanford Children's Health, Palo Alto, California, United States
| | - Conner Brown
- Information Services, Stanford Children's Health, Palo Alto, California, United States
| | - Rachel Goldstein
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
- Information Services, Stanford Children's Health, Palo Alto, California, United States
| | - Jennifer L. Carlson
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
- Information Services, Stanford Children's Health, Palo Alto, California, United States
| | - Ethan Steinberg
- Stanford Center for Biomedical Informatics Research, Stanford University, Palo Alto, California, United States
| | - Austin Powell
- Information Services, Stanford Children's Health, Palo Alto, California, United States
| | - Natalie M. Pageler
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
- Information Services, Stanford Children's Health, Palo Alto, California, United States
| | - Keith Morse
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
- Information Services, Stanford Children's Health, Palo Alto, California, United States
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18
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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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Moore AL, Hasselbacher L, Tyler CP, Rodriguez-Ortiz AE, Gilliam M. Are Illinois Contraceptive Providers Comfortable Providing Care to Adolescents? Results From a Statewide Provider Needs Assessment. Womens Health Issues 2023; 33:36-44. [PMID: 35961851 DOI: 10.1016/j.whi.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 06/24/2022] [Accepted: 07/15/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Legislation allows adolescents to access comprehensive contraceptive care; however, provider practices remain unclear. We examined predictors of provider knowledge and comfort surrounding the provision of contraceptive care to adolescents. METHODS We mailed a survey to Illinois contraceptive providers (n = 251). Study outcomes include 1) knowledge of adolescent consent laws, 2) comfort asking for time alone with adolescents, 3) comfort providing contraception to adolescents without parental consent, and 4) comfort providing long-acting reversible contraception (LARC) to adolescents without parental consent. Using multivariable logistic regression, we estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs). RESULTS Most providers are knowledgeable of consent laws (90%) and report being comfortable asking for time alone with adolescents (94%) and comfortable providing contraception to adolescents without parental consent (88%). Having a large proportion of patients who are eligible for family planning services was associated with increased comfort asking for time alone with adolescents (aOR, 7.03; 95% CI, 1.58-31.3) and providing contraception to adolescents (aOR, 4.0; 95% CI, 1.4-11.1). Only one-half (54%) were comfortable providing LARC methods to adolescents, with higher comfort among providers who: received more than 2 days of formal family planning training (aOR, 2.77; 95% CI, 1.2-6.2), specialized in obstetrics-gynecology (aOR, 5.64; 95% CI, 2.1-15.1), and had a patient population with more than 50% patients from minoritized racial/ethnic groups (aOR, 2.9; 95% CI, 1.2-6.6). CONCLUSIONS Although knowledge of consent laws was high, gaps remain. Only one-half of our sample indicated comfort with the provision of LARC methods without parental consent. Additional efforts to increase provider comfort with all contraceptive methods and training on adolescent-centered practices may be required to meet the needs of adolescent patients.
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Affiliation(s)
- Amy L Moore
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
| | - Lee Hasselbacher
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois.
| | - Crystal P Tyler
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
| | | | - Melissa Gilliam
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
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20
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Mehus CJ, Gewirtz O'Brien JR, Gower AL, Klein JD, Santelli JS, Sieving RE, McRee AL. Opportunities to Improve Adolescent Sexual and Reproductive Health Services in Primary Care Clinics. Clin Pediatr (Phila) 2022:99228221142691. [PMID: 36475405 DOI: 10.1177/00099228221142691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Primary care providers are well positioned to address the sexual and reproductive health (SRH) needs of adolescents; however, gaps often exist in the delivery of quality SRH services in primary care. Our objective was to identify specific opportunities to improve the delivery of adolescent SRH services in primary care. We conducted in-depth interviews with 25 primary care providers from various disciplines across rural and urban areas of Minnesota and conducted thematic analysis of transcribed data. Participants identified salient opportunities in three areas: (1) training and resources for providers (e.g., related to minor consent laws or addressing sensitive subjects), (2) practices and procedures (e.g., time-alone procedures and policies for confidential screening and sharing test results), and (3) education for adolescents (e.g., knowing their rights and accessing confidential SRH services). Study findings provide actionable opportunities to improve delivery of adolescent SRH services in primary care.
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Affiliation(s)
- Christopher J Mehus
- Department of Family Social Science and Center for Applied Research and Educational Improvement, University of Minnesota, St. Paul, MN, USA
| | | | - Amy L Gower
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Jonathan D Klein
- Department of Pediatrics, University of Illinois Chicago, Chicago, IL, USA
| | - John S Santelli
- Department of Population & Family Health and Pediatrics, Columbia University, New York, NY, USA
| | - Renee E Sieving
- Department of Pediatrics, School of Nursing, University of Minnesota, Minneapolis, MN, USA
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Hammarström S, Bernhardsson S, Nilsen P, Elisson J, Frostholm E, Lindroth M. Ask me, listen to me, treat me well and I shall tell: a qualitative study of Swedish youths' experiences of systematic assessment of sexual health and risk-taking (SEXIT). Sex Reprod Health Matters 2022; 30:2146032. [PMID: 36476113 PMCID: PMC9733687 DOI: 10.1080/26410397.2022.2146032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Sexual ill health among young people, in terms of sexually transmitted infections (STIs), unintended pregnancy, transactional sex and sexual violence, is a global public health concern. To that end, the SEXual health Identification Tool (SEXIT) was developed. The purpose of this study was to explore the visitors' experiences of a youth clinic visit when SEXIT was used. A purposively selected sample of 20 participants (16-24 years of age) was recruited from three Swedish youth clinics using SEXIT. Participants were interviewed individually in March and April 2016, and data were analysed using inductive qualitative content analysis. The analysis resulted in four main categories describing the participants' experiences of using SEXIT: "Issues of concern" includes descriptions of the items in SEXIT as important; "Enabling disclosure" describes how SEXIT serves as an invitation to talk and facilitates disclosure of negative experiences; "Road to change" captures experiences of the conversation with the healthcare professional; and "Managing power imbalance" describes experiences regarding the response and attitudes of the healthcare professional as well as the participants' fears of being judged. The categories are connected by the overarching theme "Ask me, listen to me, treat me well and I shall tell". This study contributes knowledge on young people's experiences of a tool-supported dialogue on sexual health and risk-taking initiated by the healthcare professional. Structured questions in a written format, as a basis for dialogue, are appreciated and experienced as a functioning way of addressing sexual ill health and risk-taking at Swedish youth clinics.
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Affiliation(s)
- Sofia Hammarström
- Academic Researcher, Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, Linköping, Sweden; Development Manager, Region Västra Götaland, Knowledge Centre for Sexual Health, Gothenburg, Sweden; Faculty of Health and Society, Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden. Correspondence:
| | - Susanne Bernhardsson
- Associate Professor, Region Västra Götaland, Research and Development Primary Health Care, Gothenburg, Sweden; Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per Nilsen
- Professor, Department of Health, Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, Linköping, Sweden
| | - Jennie Elisson
- Registered Midwife, Region Västra Götaland, Mölnlycke Youth Clinic, Mölnlycke, Sweden
| | - Ellinor Frostholm
- Registered Midwife, Region Västra Götaland, Youth Clinics Central Administration, Gothenburg, Sweden
| | - Malin Lindroth
- Associate Professor, Faculty of Health and Society, Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden
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Rea S, Zynda A, Allison B, Tolleson-Rinehart S. Adolescent Perceptions of Technology-Based Sexual and Reproductive Health Services: A Systematic Review. J Adolesc Health 2022; 71:533-544. [PMID: 35717326 DOI: 10.1016/j.jadohealth.2022.05.012] [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: 09/15/2021] [Revised: 02/28/2022] [Accepted: 05/06/2022] [Indexed: 10/31/2022]
Abstract
Technology-based services, including telehealth, text messaging, and the internet are increasingly popular methods for adolescents and young adults (AYA) to access sexual and reproductive health (SRH) information and healthcare. This systematic review examined AYA perceptions of privacy and confidentiality of technology-based SRH services. The PubMed, Scopus, and PsycINFO were systematically searched in May 2021 to capture relevant qualitative or quantitative articles from the past 10 years. Included studies had AYA (i.e., mean age, 13-26-years with <10% of the sample outside this range), technology-based services for SRH, and outcomes of perceived privacy or confidentiality. Twenty-eight articles were included (N = 8638 AYA). Most studies utilized the internet and mobile apps to address human immunodeficiency virus infection (HIV), sexually transmitted infections, and general SRH topics. Most AYA reported that these services were private and confidential, with minimal differences across SRH topic addressed. More interactive services had greater concerns (e.g., family or friends seeing notifications). Most AYA considered technology-based SRH to be confidential and private. As technology will likely remain an integrated part of healthcare delivery, improving the privacy and confidentiality of these services can facilitate AYA's independent and autonomous engagement in SRH care, and potentially improve their SRH outcomes.
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Affiliation(s)
- Samantha Rea
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina.
| | - Aaron Zynda
- Department of Kinesiology, Michigan State University, East Lansing, Michigan
| | - Bianca Allison
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Sue Tolleson-Rinehart
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Agbenyo JS, Nzengya DM, Mwangi SK. Perceptions of the use of mobile phones to access reproductive health care services in Tamale, Ghana. Front Public Health 2022; 10:1026393. [PMID: 36339214 PMCID: PMC9633860 DOI: 10.3389/fpubh.2022.1026393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/06/2022] [Indexed: 01/28/2023] Open
Abstract
Introduction Africa has one of the world's highest populations of young people. In addition, Africa has one of the highest proportions of young people facing the worst health challenges. Although previous scholars have reported that young people were using mobile phones to fill in the gaps in accessing reproductive health services, among other health services, there was little comprehensive research on the perception of young people in Tamale, Ghana, on the use of mobile phones to access reproductive health services. This study analyzed the perceptions on mobile phone use to access reproductive health services among young people in Tamale, Ghana. Methods The research used a quantitative method design from a target population of 72,706 young people from selected peri-urban, low-income, middle income and high-income residential areas in Tamale Metropolis, Ghana. The sample size used was 397 young people. Participants were selected using a stratified multistage sampling strategy. Descriptive statistics were used to analyse the data. Results A total of 86% of the respondents agree that the use of mobile phones helps to overcome cultural challenges that young people in Tamale encounter in accessing reproductive health care. Also, 84.6% of the respondents agree that the use of mobile phones helps them to overcome inadequate access to reproductive health information and services. The use of mobile phones helps to overcome the negative attitude of health providers toward young people in need of reproductive health services was agreed by most of the respondents [strongly agree (35.4%) and agree (49.4%)]. Conclusion This study informed highly positive perceptions and attitudes toward the use of mobile phones to access Reproductive Health Services in Tamale, Ghana. There is, therefore the need for the health sector to reform its mode of prescriptions of medication, consultation, and service delivery to leverage on the advantages that mHealth presents.
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24
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Abstract
This study examines current minor consent laws for sexually transmitted infection/HIV services and related confidentiality protections in all 50 states and the District of Columbia.
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Affiliation(s)
- Kimberly M. Nelson
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Alexandra Skinner
- Department of Health Law, Policy, & Management, Boston University School of Public Health, Boston, Massachusetts
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25
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Macharia P, Pérez-Navarro A, Sambai B, Inwani I, Kinuthia J, Nduati R, Carrion C. An Unstructured Supplementary Service Data–Based mHealth App Providing On-Demand Sexual Reproductive Health Information for Adolescents in Kibra, Kenya: Randomized Controlled Trial. JMIR Mhealth Uhealth 2022; 10:e31233. [PMID: 35436230 PMCID: PMC9055479 DOI: 10.2196/31233] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/07/2021] [Accepted: 02/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Adolescents transitioning from childhood to adulthood need to be equipped with sexual reproductive health (SRH) knowledge, skills, attitudes, and values that empower them. Accessible, reliable, appropriate, and friendly information can be provided through mobile phone–based health interventions.
Objective
This study aims to investigate the effectiveness and impact of an Unstructured Supplementary Service Data (USSD)–based app in increasing adolescents’ knowledge about contraceptives, gender-based stereotypes, sexually transmitted infections (STIs), abstinence, and perceived vulnerability, and helping adolescents make informed decisions about their SRH.
Methods
A randomized controlled trial (RCT) methodology was applied to investigate the potential of a USSD-based app for providing on-demand SRH information. To be eligible, adolescents aged 15 to 19 years residing in Kibra, Kenya, had to have access to a phone and be available for the 3-month follow-up visit. Participants were randomly assigned to the intervention (n=146) and control (n=154) groups using sequentially numbered, opaque, sealed envelopes. The primary outcome was improved SRH knowledge. The secondary outcome was improved decision-making on SRH. The outcomes were measured using validated tools on adolescent SRH and user perceptions during the follow-up visit. A paired sample t test was used to compare the changes in knowledge scores in both groups. The control group did not receive any SRH information.
Results
During the RCT, 54.9% (62/109) of adolescents used the USSD-based app at least once. The mean age by randomization group was 17.3 (SD 1.23) years for the control group and 17.3 (SD 1.12) years for the intervention group. There was a statistically significant difference in the total knowledge scores in the intervention group (mean 10.770, SD 2.012) compared with the control group (mean 10.170, SD 2.412) conditions (t179=2.197; P=.03). There was a significant difference in abstinence (P=.01) and contraceptive use (P=.06). Of the individuals who used the app, all participants felt the information received could improve decision-making regarding SRH. Information on STIs was of particular interest, with 27% (20/62) of the adolescents seeking information in this area, of whom 55% (11/20) were female. In relation to improved decision-making, 21.6% (29/134) of responses showed the adolescents were able to identify STIs and were likely to seek treatment; 51.7% (15/29) of these were female. Ease of use was the most important feature of the app for 28.3% (54/191) of the responses.
Conclusions
Adolescents require accurate and up-to-date SRH information to guide their decision-making and improve health outcomes. As adolescents already use mobile phones in their day-to-day lives, apps provide an ideal platform for this information. A USSD-based app could be an appropriate tool for increasing SRH knowledge among adolescents in low-resource settings. Adolescents in the study valued the information provided because it helped them identify SRH topics on which they needed more information.
Trial Registration
Pan African Clinical Trial Registry PACTR202204774993198; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=22623
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26
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Allison BA, Rea S, Mikesell L, Perry MF. Adolescent and Parent Perceptions of Telehealth Visits: A Mixed-Methods Study. J Adolesc Health 2022; 70:403-413. [PMID: 34756777 DOI: 10.1016/j.jadohealth.2021.09.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/23/2021] [Accepted: 09/21/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Telehealth presents unique benefits and challenges for adolescents and their parents. This study aimed to explore adolescent and parent perceptions of privacy, confidentiality, and therapeutic alliance during telehealth video visits. METHODS This was a cross-sectional convergent parallel mixed-methods study. English-speaking parents and 13- to 17-year-old adolescents who completed a video visit at eight academic-affiliated pediatric primary care practices in the Southeastern U.S. were recruited between September 2020 and January 2021. Online surveys were administered and analyzed using descriptive and bivariable analysis. Subsequent semi-structured qualitative interviews were conducted and analyzed using thematic analysis. RESULTS Forty-eight adolescents and 104 parents completed surveys. Fourteen adolescents and 20 parents were interviewed. Mean ages of adolescents and parents were 15 and 46 years, respectively, and most participants identified as female, non-Hispanic, and white. Seventy-seven percent of adolescents reported very private telehealth visits. Most privacy concerns were related to the location of the visit in the patient's home or family members overhearing. Adolescents reported that alone time with their provider increased comfort in discussing sensitive issues, although only 31% of adolescents reported having time alone with their provider during their telehealth visit. Neither adolescents nor parents reported concerns about confidentiality. Interviews suggested that adolescent autonomy and independence in accessing health care may explain the positive relationship observed between therapeutic alliance and privacy. CONCLUSIONS Adolescents and parents describe telehealth as convenient, useful, private, and confidential. Providers should strive to maximize privacy and the therapeutic alliance during video visits, including encouraging alone time and supporting adolescent autonomy and independence.
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Affiliation(s)
- Bianca A Allison
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Samantha Rea
- University of North Carolina at Chapel Hill Gillings School of Public Health, Chapel Hill, North Carolina
| | - Lisa Mikesell
- Rutgers University School of Communication and Information, New Brunswick, New Jersey
| | - Martha F Perry
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Sieving RE, Mehus C, Gewirtz O'Brien JR, Steiner RJ, Wang S, Catallozzi M, Gorzkowski J, Grilo SA, Kaseeska K, McRee AL, Santelli J, Klein JD. Correlates of Sexual and Reproductive Health Discussions During Preventive Visits: Findings From a National Sample of U.S. Adolescents. J Adolesc Health 2022; 70:421-428. [PMID: 34838444 PMCID: PMC9066357 DOI: 10.1016/j.jadohealth.2021.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/03/2021] [Accepted: 10/07/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE This study examines characteristics of healthcare delivery, providers, and adolescents associated with provider-adolescent discussions about sexual and reproductive health (SRH) during preventive visits. METHODS Data were from a 2019 national internet survey of U.S. adolescents ages 11-17 years and their parents. Adolescents who had a preventive visit in the past 2 years (n = 853) were asked whether their provider discussed each of eight SRH topics at that visit: puberty, safe dating, gender identity, sexual orientation, whether or not to have sex, sexually transmitted infections including human immunodeficiency virus, birth control methods, and where to get SRH services. Eight multivariable logistic regression models were examined (one for each SRH topic as the outcome), with each model including modifiable healthcare delivery and provider characteristics, adolescent beliefs, behaviors, and demographic characteristics as potential correlates. RESULTS Provider-adolescent discussions about SRH topics at the last preventive visit were positively associated with face-to-face screening about sexual activity for all eight topics (range of adjusted odds ratios [AORs] = 3.40-9.61), having time alone with the adolescent during that visit (seven topics; AORs = 1.87-3.87), and ever having communicated about confidentiality with adolescents (two topics; AORs = 1.88-2.19) and with parents (one topic; AOR = 2.73). Adolescents' perception that a topic was important to discuss with their provider was associated with provider-adolescent discussions about seven topics (AORs = 2.34-5.46). CONCLUSIONS Findings that provider-adolescent discussions about SRH during preventive visits were associated with modifiable practices including time alone between providers and adolescents and screening about sexual activity can inform efforts to improve the delivery of adolescent SRH services within primary care.
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Affiliation(s)
- Renee E Sieving
- School of Nursing, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
| | - Christopher Mehus
- Center for Applied Research and Educational Improvement, College of Education and Human Development, University of Minnesota, Minneapolis, Minnesota
| | | | - Riley J Steiner
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shuo Wang
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Marina Catallozzi
- Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University Medical Center, New York, New York; Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Julie Gorzkowski
- Department of Healthy Resilient Children, Youth and Families, American Academy of Pediatrics, Itasca, Illinois
| | - Stephanie A Grilo
- Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Kristen Kaseeska
- Department of Healthy Resilient Children, Youth and Families, American Academy of Pediatrics, Itasca, Illinois
| | - Annie-Laurie McRee
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - John Santelli
- Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Jonathan D Klein
- Department of Pediatrics, University of Illinois at Chicago, Chicago Illinois
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28
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Brault MA, Curry LA, Kershaw TS, Singh K, Vash-Margita A, Camenga DR. Supporting Patient-centered Communication on Adolescent Sexual and Reproductive Health-Perspectives to Build an Appointment Planning Tool. J Pediatr Adolesc Gynecol 2021; 34:725-731. [PMID: 33989800 PMCID: PMC10712738 DOI: 10.1016/j.jpag.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/02/2021] [Accepted: 04/25/2021] [Indexed: 12/25/2022]
Abstract
STUDY OBJECTIVE Input from adolescents and healthcare providers is needed to develop electronic tools that can support patient-centered sexual and reproductive (SRH) care. This study explores facilitators and barriers to patient-centered communication in the context of developing an electronic appointment planning tool to promote SRH communication in clinic settings. DESIGN In-depth interviews were conducted to explore what constitutes adolescent-friendly SRH care and communication, as well as on the design of the appointment planning tool. Interviews were coded iteratively, and analyzed using the software Atlas.TI v8. SETTING An adolescent primary care clinic, and a pediatric and adolescent gynecology clinic. PARTICIPANTS Adolescent girls (N=32; ages 14-18) and providers who care for adolescent girls (N=10). MAIN OUTCOME MEASURES Thematic analyses explored facilitators/barriers to SRH communication and care and preferences for the tool. RESULTS Facilitators identified by adolescents and providers included: direct patient/provider communication; adolescent-driven decision-making regarding care and contraceptive choice; supplementing clinic visits with electronic resources; and holistic care addressing physical, mental, and social needs. Barriers identified by participants included: limited time for appointments; limited adolescent autonomy in appointments; and poor continuity of care when adolescents cannot see the same provider. Given the complexity of issues raised, adolescents and providers were interested in developing an appointment planning tool to guide communication during appointments, and contributed input on its design. The resulting Appointment Planning Tool app pilot is in progress. CONCLUSIONS Qualitative interviews with adolescents and providers offer critical insights for the development and implementation of mobile health (mHealth) tools that can foster patient-centered care.
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Affiliation(s)
- Marie A Brault
- Department of Social and Behavioral Sciences, 60 College Street, PO Box 208034, Yale School of Public Health, New Haven, CT, 06520-8034, USA.
| | - Leslie A Curry
- Global Health Leadership Initiative, 100 Church Street South, Yale School of Public Health, New Haven, CT, 06519, USA; Department of Health Policy and Management, 60 College Street, PO Box 208034, Yale School of Public Health, New Haven, CT, 06520-8034, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, 60 College Street, PO Box 208034, Yale School of Public Health, New Haven, CT, 06520-8034, USA
| | - Karen Singh
- Department of Social and Behavioral Sciences, 60 College Street, PO Box 208034, Yale School of Public Health, New Haven, CT, 06520-8034, USA
| | - Alla Vash-Margita
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Farnham Memorial Building, Yale School of Medicine, New Haven, CT, 06520, USA
| | - Deepa R Camenga
- Department of Emergency Medicine, 464 Congress Avenue, Suite 260, Yale School of Medicine, New Haven, CT, 06519, USA
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29
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Sieving RE, McRee AL, Mehus C, Gewirtz O'Brien JR, Wang S, Brar P, Catallozzi M, Gorzkowski J, Grilo S, Kaseeska K, Santelli J, Steiner RJ, Klein JD. Sexual and Reproductive Health Discussions During Preventive Visits. Pediatrics 2021; 148:e2020049411. [PMID: 34253569 PMCID: PMC9125413 DOI: 10.1542/peds.2020-049411] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To quantify adolescent- and parent-perceived importance of provider-adolescent discussions about sexual and reproductive health (SRH), describe prevalence of provider confidentiality practices and provider-adolescent discussions about SRH topics during preventive visits, and identify missed opportunities for such conversations. METHODS We used data from a national Internet survey of 11- to 17-year-old adolescents and their parents. Data were weighted to represent the noninstitutionalized US adolescent population. Adolescents who had a preventive visit in the past 2 years and their parents reported on perceived importance of provider-adolescent discussions about SRH topics: puberty, safe dating, gender identity, sexual orientation, sexual decision-making, sexually transmitted infections and HIV, methods of birth control, and where to get SRH services. Adolescents and parents reported whether they had ever discussed confidentiality with the adolescent's provider. Adolescents reported experiences at their most recent preventive visit, including whether a provider spoke about specific SRH topics and whether they had time alone with a provider. RESULTS A majority of adolescents and parents deemed provider-adolescent discussions about puberty, sexually transmitted infections and HIV, and birth control as important. However, fewer than one-third of adolescents reported discussions about SRH topics other than puberty at their most recent preventive visit. These discussions were particularly uncommon among younger adolescents. Within age groups, discussions about several topics varied by sex. CONCLUSIONS Although most parents and adolescents value provider-adolescent discussions of selected SRH topics, these discussions do not occur routinely during preventive visits. Preventive visits represent a missed opportunity for adolescents to receive screening, education, and guidance related to SRH.
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Affiliation(s)
| | | | - Christopher Mehus
- Center for Applied Research and Educational Improvement, College of Education and Human Development, University of Minnesota, Minneapolis, Minnesota
| | | | | | - Pooja Brar
- Department of Family Studies and Community Development, Towson University, Towson, Maryland
| | - Marina Catallozzi
- Department of Pediatrics, Vagelos College of Physicians and Surgeons
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University and Columbia University Irving Medical Center, New York, New York
| | | | - Stephanie Grilo
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University and Columbia University Irving Medical Center, New York, New York
| | | | - John Santelli
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University and Columbia University Irving Medical Center, New York, New York
| | - Riley J Steiner
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan D Klein
- Department of Pediatrics, University of Illinois at Chicago, Chicago Illinois
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30
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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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Chernick LS, Stockwell MS, Gonzalez A, Mitchell J, Ehrhardt A, Bakken S, Westhoff CL, Santelli J, Dayan PS. A User-Informed, Theory-Based Pregnancy Prevention Intervention for Adolescents in the Emergency Department: A Prospective Cohort Study. J Adolesc Health 2021; 68:705-712. [PMID: 32948403 PMCID: PMC8527994 DOI: 10.1016/j.jadohealth.2020.07.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Female adolescents seeking emergency department (ED) care are at high risk of unintended pregnancy, primarily because of contraceptive nonuse; yet, few ED patients follow up for reproductive care when referred. The objective of this cohort study was to determine the feasibility, acceptability, adoption, fidelity, and potential efficacy of a personalized and interactive ED-based pregnancy prevention mobile health intervention (Emergency Room Interventions to improve the Care of Adolescents [Dr. Erica]). METHODS We conducted a prospective cohort study with sexually active female ED patients aged 14-19 years who were not using highly effective contraceptives. Dr. Erica consists of a 10-week, automated, two-way texting intervention based on an evidence-based sexual health curriculum, the Social Cognitive Theory, and motivational interviewing techniques. At 12 weeks, we conducted follow-up via online survey and phone call to measure feasibility, acceptability, adoption, fidelity, and preliminary efficacy data (contraception initiation). RESULTS We screened 209 female ED patients to enroll 42. The average age was 17.5 years (standard deviation ± 1.4); the majority were Hispanic (n = 37, 88%) and had a primary provider (n = 40, 95%). One participant opted out (1/42, 2%), and a total of 35 participants (83%) completed follow-up. Although interactivity diminished with time, 83% of participants (35/42) replied to one or more text. Ninety-four percent of participants (29/31) liked the messages, and 83% (25/30) would recommend the program. Hormonal contraceptives were initiated by 46% of participants (16/35). CONCLUSIONS Dr. Erica was feasible and acceptable among female adolescent ED patients and demonstrated high fidelity and adoption. The intervention also showed potential to increase highly effective contraceptive use among high-risk females.
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Affiliation(s)
- Lauren S. Chernick
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, New York,Address correspondence to: Lauren S. Chernick, M.D., M.Sc., Department of Emergency Medicine, Columbia University Medical Center, 3959 Broadway, CHN 1-116, New York, NY 10032
| | - Melissa S. Stockwell
- Department of Child and Adolescent Health, Columbia University Medical Center, New York, New York,Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York
| | - Ariana Gonzalez
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, New York
| | - Jameson Mitchell
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, New York
| | - Anke Ehrhardt
- Department of Psychology, Columbia University Medical Center, New York, New York
| | - Susanne Bakken
- Department of Nursing and Bioinformatics, Columbia University Medical Center, New York, New York
| | - Carolyn L. Westhoff
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York,Department of Obstetrics-Gynecology, Columbia University Medical Center, New York, New York
| | - John Santelli
- Department of Child and Adolescent Health, Columbia University Medical Center, New York, New York,Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York
| | - Peter S. Dayan
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, New York
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Fields EL, Hussen SA, Malebranche DJ. Mind the Gap: HIV Prevention Among Young Black Men Who Have Sex with Men. Curr HIV/AIDS Rep 2021; 17:632-642. [PMID: 32914329 PMCID: PMC7483045 DOI: 10.1007/s11904-020-00532-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Young Black men who have sex with men (YBMSM) suffer profound health inequities in new HIV diagnoses and clinical outcomes. While the evolution of HIV prevention options has become increasingly biomedical, inequities in access and uptake of these modalities persist. RECENT FINDINGS Studies suggest that while YBMSM display interest and acceptability of varied HIV prevention options, uptake lags due to the lingering effects of intersectional oppression from racism and sexual prejudice, HIV stigma, institutional and provider bias, and unresolved health policy barriers. Promising avenues to address these barriers have yet to be fully explored. We have the tools to effectively prevent HIV transmission and acquisition among YBMSM, but we have not yet effectively implemented these tools for this priority population. To end the epidemic, we must tailor and adapt HIV prevention strategies to meet the unique intersecting needs, identities, and social contexts of YBMSM.
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Affiliation(s)
- Errol L Fields
- Division of Adolescent/Young Adult Medicine, Johns Hopkins School of Medicine, 200 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Sophia A Hussen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - David J Malebranche
- Department of General Medicine, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA.
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Did You Get My Snap? Snapchat as a Health Education Tool for Hospitalized Adolescents. J Adolesc Health 2021; 68:411-413. [PMID: 32674962 DOI: 10.1016/j.jadohealth.2020.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Given the popularity of Snapchat with teens, we used this tool to disseminate reproductive health information to adolescent patients. METHODS We developed a unique Snapcode linked to educational materials located on a cloud service and accessible via the Snapchat app. The Snapcode was printed on a business card and distributed to hospitalized adolescents. We tracked card distribution and how often the materials were accessed through our cloud service and through Snapchat. RESULTS A total of 236 cards were distributed to teens with 117 unique scans and 122 views of the PDF. Of the teens who received the card (N = 236), 49.5% of teens used the Snapcode to access reproductive health education. CONCLUSIONS Snapchat is a promising way to distribute educational materials to adolescents in a discrete manner on a platform many teens use. This mechanism demonstrates a way for providers to use Snapchat as a tool to provide education to hospitalized adolescents.
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Pampati S, Andrzejewski J, Steiner RJ, Rasberry CN, Adkins SH, Lesesne CA, Boyce L, Grose RG, Johns MM. "We Deserve Care and we Deserve Competent Care": Qualitative Perspectives on Health Care from Transgender Youth in the Southeast United States. J Pediatr Nurs 2021; 56:54-59. [PMID: 33186863 PMCID: PMC7941262 DOI: 10.1016/j.pedn.2020.09.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/28/2020] [Accepted: 09/28/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Transgender populations experience health inequities that underscore the importance of ensuring access to high quality care. We thematically summarize the health care experiences of transgender youth living in the southeast United States to identify potential barriers and facilitators to health care. DESIGN AND METHODS Transgender youth recruited from community settings in an urban area of the southeast United States participated in individual interviews (n = 33) and focus groups (n = 9) about protective factors. We conducted a thematic analysis of data from 42 participants who described their experiences seeking and receiving health care. RESULTS Participants reported a wide range of gender identities. The individual interview sample was majority Black (54.5%) and the mean age was 21.7 years and focus group participants were all white and the mean age was 16.8 years. Participants described numerous barriers to health care, including limited availability of gender affirming care, logistical challenges, such as gatekeeping and cost, concerns about confidentiality in relation to sexual behavior and gender identity, and inadequate cultural competency among providers regarding gender-affirming care. Facilitators included intake procedures collecting chosen pronouns and names and consistent use of them by providers, and open communication, including active listening. CONCLUSIONS Findings underscore the need for a multi-component approach to ensure both transgender- and youth-friendly care. PRACTICE IMPLICATIONS Providers and office staff may benefit from transgender cultural competency trainings. In addition, clinic protocols relating to confidentiality and chosen name and pronoun use may help facilitate access to and receipt of quality care.
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Affiliation(s)
- Sanjana Pampati
- Oak Ridge Institute for Science and Education (ORISE), TN, United States of America.
| | - Jack Andrzejewski
- Oak Ridge Institute for Science and Education (ORISE), TN, United States of America
| | - Riley J Steiner
- Centers for Disease Control and Prevention, Division of Reproductive Health, GA, United States of America
| | - Catherine N Rasberry
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, GA, United States of America
| | - Susan H Adkins
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, GA, United States of America
| | | | | | - Rose Grace Grose
- Department of Community Health Education, Colorado School of Public Health at the University of Northern Colorado, CO, United States of America
| | - Michelle M Johns
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, GA, United States of America
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Hardin HK, Alchami H, Lee D, Jones MS. Unmet health need and perceived barriers to health care among adolescents living in a rural area. CHILDRENS HEALTH CARE 2020; 50:108-123. [PMID: 33424079 PMCID: PMC7787257 DOI: 10.1080/02739615.2020.1833333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study investigated the perceived health care needs, unmet health need, and barriers to health care in 224 rural-dwelling adolescents. A cross-sectional, descriptive design was used to survey adolescents attending a public high school in a low-resource, rural Indiana community. One in five adolescents reported an unmet health need. The most common barriers to health care were related to access, apathy, anxiety, and parenting issues. Implications include confidentiality protocols in family healthcare practices, school-based health centers, and intervention research targeting adolescents' communication skills and healthcare consumer skills.
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Affiliation(s)
- Heather K. Hardin
- Case Western Reserve University, Frances Payne Bolton School of Nursing
| | - Hana Alchami
- Case Western Reserve University, Frances Payne Bolton School of Nursing
| | - David Lee
- Case Western Reserve University, Frances Payne Bolton School of Nursing
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Sieving RE, Mehus C, Catallozzi M, Grilo S, Steiner RJ, Brar P, Gewirtz O’Brien JR, Gorzkowski J, Kaseeska K, Kelly ED, Klein JD, McRee AL, Randazzo L, Santelli J. Understanding Primary Care Providers' Perceptions and Practices in Implementing Confidential Adolescent Sexual and Reproductive Health Services. J Adolesc Health 2020; 67:569-575. [PMID: 32389456 PMCID: PMC9062682 DOI: 10.1016/j.jadohealth.2020.03.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Substantial gaps exist between professional guidelines and practice around confidential adolescent services, including private time between health-care providers and adolescents. Efforts to provide quality sexual and reproductive health services (SRHS) require an understanding of barriers and facilitators to care from the perspectives of primary care providers working with adolescents and their parents. METHODS We conducted structured qualitative interviews with a purposive sample of pediatricians, family physicians, and nurse practitioners (n = 25) from urban and rural Minnesota communities with higher and lower rates of adolescent pregnancy. Provider interviews included confidentiality beliefs and practices; SRHS screening and counseling; and referral practices. RESULTS The analysis identified two key themes: (1) individual and structural factors were related to variations in SRH screening and counseling and (2) a wide range of factors influenced provider decision-making in initiating private time. A nuanced set of factors informed SRHS provided, including provider comfort with specific topics; provider engagement and relationship with parents; use of adolescent screening tools; practices, policies, and resources within the clinic setting; and community norms including openness with communication about sex and religious considerations regarding adolescent sexuality. Factors that shaped providers' decisions in initiating private time included adolescent age, developmental stage, health behaviors and other characteristics; observed adolescent-parent interactions; parent support for private time; reason for clinic visit; laws and professional guidelines; and cultural considerations. CONCLUSIONS Findings suggest opportunities for interventions related to provider and clinic staff training, routine communication with adolescents and their parents, and clinic policies and protocols that can improve the quality of adolescent SRHS.
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Affiliation(s)
- Renee E. Sieving
- School of Nursing, University of Minnesota, Minneapolis, Minnesota,Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota,Address correspondence to: Renee E. Sieving, Ph.D., R.N., University of Minnesota School of Nursing, 5-140 Weaver Densford Hall, 308 Harvard Street S.E., Minneapolis, MN 55455. (R.E. Sieving)
| | - Christopher Mehus
- School of Nursing, University of Minnesota, Minneapolis, Minnesota,Institute for Translational Research in Children’s Mental Health, University of Minnesota, Minneapolis, Minnesota
| | - Marina Catallozzi
- Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University Medical Center, New York, New York,Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Stephanie Grilo
- Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Riley J. Steiner
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pooja Brar
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | | | - Julie Gorzkowski
- Department of Healthy Resilient Children Youth and Families, American Academy of Pediatrics, Itasca, Illinois
| | - Kristen Kaseeska
- Department of Healthy Resilient Children Youth and Families, American Academy of Pediatrics, Itasca, Illinois
| | | | - Jonathan D. Klein
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Annie-Laurie McRee
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Lia Randazzo
- Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - John Santelli
- Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
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Hardin HK, Moore SM, Moore SE, Uli NK. Associations between Trust of Healthcare Provider and Body Mass Index in Adolescents. Compr Child Adolesc Nurs 2020:1-12. [PMID: 32574088 PMCID: PMC7755707 DOI: 10.1080/24694193.2020.1783028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 06/10/2020] [Indexed: 02/07/2023]
Abstract
Adolescent obesity continues to be a serious concern around the world, placing young people at risk for chronic conditions and early death. Research has shown that social relationships are important in making health behavior changes, such as following health-care recommendations for eating and physical activity. Specifically, the trust of health-care providers has been shown to be important in making health behavior change. Evidence suggests that obese young adults are less trusting of health-care providers than their healthy weight peers, but it is not known if this also applies to obese adolescents. The purpose of this secondary analysis study was to determine relationships between the trust of health-care providers and body mass index percentile in adolescents. Participants were 224 adolescents aged 14-19 years attending a public high school in the Midwestern United States. The Wake Forest Physician Trust scale measured the trust of health-care providers. Height and weight were collected at a school screening; body mass index percentile categories were determined according to age- and sex-adjusted body mass index percentiles. One-way analysis of variance and post hoc Tukey tests showed trust scores varied significantly between body mass index percentile categories of girls. Results suggest it may be necessary for health-care providers to make additional efforts to build trust with obese adolescent girls than with other groups of adolescents.
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Affiliation(s)
- Heather K Hardin
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Shirley M Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Scott E Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Naveen K Uli
- School of Medicine, Case Western Reserve University
- Director of Pediatric Endocrinology, Rainbow Babies and Children's Hospital, Cleveland Medical Center, Cleveland, OH, USA
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Fields EL, Gayles TA. Considerations for Addressing Low HIV Testing Rates Among Adolescent Men Who Have Sex With Men. Pediatrics 2020; 145:peds.2019-3996. [PMID: 32047099 PMCID: PMC8188268 DOI: 10.1542/peds.2019-3996] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2019] [Indexed: 01/18/2023] Open
Affiliation(s)
- Errol L. Fields
- Johns Hopkins School of Medicine, Department of Pediatrics,
Division of General Pediatrics and Adolescent Medicine, Baltimore, MD
| | - Travis A. Gayles
- Montgomery County Department of Health and Human Services,
Rockville, MD
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