Renee E Sieving1, Christopher Mehus2, Marina Catallozzi3, Stephanie Grilo4, Riley J Steiner5, Pooja Brar6, Janna R Gewirtz O'Brien6, Julie Gorzkowski7, Kristen Kaseeska7, Emily Denight Kelly8, Jonathan D Klein9, Annie-Laurie McRee6, Lia Randazzo4, John Santelli4. 1. School of Nursing, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota. Electronic address: sievi001@umn.edu. 2. School of Nursing, University of Minnesota, Minneapolis, Minnesota; Institute for Translational Research in Children's Mental Health, University of Minnesota, Minneapolis, Minnesota. 3. 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. 4. Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York. 5. Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia. 6. Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota. 7. Department of Healthy Resilient Children Youth and Families, American Academy of Pediatrics, Itasca, Illinois. 8. School of Nursing, University of Minnesota, Minneapolis, Minnesota. 9. Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois.
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.
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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Authors: Trang Quyen Nguyen; Carol A Ford; Jay S Kaufman; Peter A Leone; Chirayath Suchindran; William C Miller Journal: Am J Public Health Date: 2006-05-02 Impact factor: 9.308
Authors: Annika M Hofstetter; Danielle C Ompad; Melissa S Stockwell; Susan L Rosenthal; Karen Soren Journal: JAMA Pediatr Date: 2016-05-01 Impact factor: 16.193
Authors: Renee E Sieving; Christopher Mehus; Janna R Gewirtz O'Brien; Riley J Steiner; Shuo Wang; Marina Catallozzi; Julie Gorzkowski; Stephanie A Grilo; Kristen Kaseeska; Annie-Laurie McRee; John Santelli; Jonathan D Klein Journal: J Adolesc Health Date: 2021-11-24 Impact factor: 7.830
Authors: Renee E Sieving; Annie-Laurie McRee; Christopher Mehus; Janna R Gewirtz O'Brien; Shuo Wang; Pooja Brar; Marina Catallozzi; Julie Gorzkowski; Stephanie Grilo; Kristen Kaseeska; John Santelli; Riley J Steiner; Jonathan D Klein Journal: Pediatrics Date: 2021-07-12 Impact factor: 9.703