TY - JOUR
T1 - Understanding Primary Care Providers' Perceptions and Practices in Implementing Confidential Adolescent Sexual and Reproductive Health Services
AU - Sieving, Renee E.
AU - Mehus, Christopher
AU - Catallozzi, Marina
AU - Grilo, Stephanie
AU - Steiner, Riley J.
AU - Brar, Pooja
AU - Gewirtz O'Brien, Janna R.
AU - Gorzkowski, Julie
AU - Kaseeska, Kristen
AU - Kelly, Emily Denight
AU - Klein, Jonathan D.
AU - McRee, Annie Laurie
AU - Randazzo, Lia
AU - Santelli, John
N1 - Funding Information:
This research was supported by Cooperative Agreement Number (U48DP005022-04-05; R. Sieving, PI) funded by the Centers for Disease Control and Prevention , Prevention Research Center Program and by funds from the Maternal and Child Health Bureau , Health Resources and Services Administration, U.S. Department of Health and Human Services ( T71MC00006 ; R. Sieving, PI).
Publisher Copyright:
© 2020 Society for Adolescent Health and Medicine
PY - 2020/10
Y1 - 2020/10
N2 - 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.
AB - 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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U2 - 10.1016/j.jadohealth.2020.03.035
DO - 10.1016/j.jadohealth.2020.03.035
M3 - Article
C2 - 32389456
AN - SCOPUS:85084392214
SN - 1054-139X
VL - 67
SP - 569
EP - 575
JO - Journal of Adolescent Health
JF - Journal of Adolescent Health
IS - 4
ER -