Understanding Primary Care Providers' Perceptions and Practices in Implementing Confidential Adolescent Sexual and Reproductive Health Services
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 facili...
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| Veröffentlicht in: | Journal of adolescent health 2020-10, Vol.67 (4), p.569-575 |
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| container_title | Journal of adolescent health |
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| creator | Sieving, Renee E. Mehus, Christopher Catallozzi, Marina Grilo, Stephanie Steiner, Riley J. Brar, Pooja Gewirtz O'Brien, Janna R. Gorzkowski, Julie Kaseeska, Kristen Kelly, Emily Denight Klein, Jonathan D. McRee, Annie-Laurie Randazzo, Lia Santelli, John |
| description | 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.
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.
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.
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. |
| doi_str_mv | 10.1016/j.jadohealth.2020.03.035 |
| format | Article |
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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.
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.
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.</description><identifier>ISSN: 1054-139X</identifier><identifier>EISSN: 1879-1972</identifier><identifier>DOI: 10.1016/j.jadohealth.2020.03.035</identifier><identifier>PMID: 32389456</identifier><language>eng</language><publisher>NEW YORK: Elsevier Inc</publisher><subject>Adolescent sexuality ; Communication ; Confidentiality ; Counseling ; Decision making ; Health behavior ; Health services ; Health status ; Interviews ; Life Sciences & Biomedicine ; Medical personnel ; Medical referrals ; Medical screening ; Nurse practitioners ; Openness ; Parents & parenting ; Pediatricians ; Pediatrics ; Primary care ; Psychology ; Psychology, Developmental ; Public, Environmental & Occupational Health ; Reproductive health ; Science & Technology ; Sexual behavior ; Social Sciences ; Teenage pregnancy ; Teenagers</subject><ispartof>Journal of adolescent health, 2020-10, Vol.67 (4), p.569-575</ispartof><rights>2020 Society for Adolescent Health and Medicine</rights><rights>Copyright © 2020 Society for Adolescent Health and Medicine. All rights reserved.</rights><rights>Copyright Elsevier BV Oct 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>23</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000573018200020</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c507t-9ea43c2db855e0b1f67627251781731f17b57b8f477710fac01452127b7e9a003</citedby><cites>FETCH-LOGICAL-c507t-9ea43c2db855e0b1f67627251781731f17b57b8f477710fac01452127b7e9a003</cites><orcidid>0000-0003-1841-3770 ; 0000-0003-4809-5144 ; 0000-0001-6588-5995</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jadohealth.2020.03.035$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,315,782,786,887,3554,27933,27934,28257,28258,31008,46004</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32389456$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sieving, Renee E.</creatorcontrib><creatorcontrib>Mehus, Christopher</creatorcontrib><creatorcontrib>Catallozzi, Marina</creatorcontrib><creatorcontrib>Grilo, Stephanie</creatorcontrib><creatorcontrib>Steiner, Riley J.</creatorcontrib><creatorcontrib>Brar, Pooja</creatorcontrib><creatorcontrib>Gewirtz O'Brien, Janna R.</creatorcontrib><creatorcontrib>Gorzkowski, Julie</creatorcontrib><creatorcontrib>Kaseeska, Kristen</creatorcontrib><creatorcontrib>Kelly, Emily Denight</creatorcontrib><creatorcontrib>Klein, Jonathan D.</creatorcontrib><creatorcontrib>McRee, Annie-Laurie</creatorcontrib><creatorcontrib>Randazzo, Lia</creatorcontrib><creatorcontrib>Santelli, John</creatorcontrib><title>Understanding Primary Care Providers' Perceptions and Practices in Implementing Confidential Adolescent Sexual and Reproductive Health Services</title><title>Journal of adolescent health</title><addtitle>J ADOLESCENT HEALTH</addtitle><addtitle>J Adolesc Health</addtitle><description>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.
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.
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.
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.</description><subject>Adolescent sexuality</subject><subject>Communication</subject><subject>Confidentiality</subject><subject>Counseling</subject><subject>Decision making</subject><subject>Health behavior</subject><subject>Health services</subject><subject>Health status</subject><subject>Interviews</subject><subject>Life Sciences & Biomedicine</subject><subject>Medical personnel</subject><subject>Medical referrals</subject><subject>Medical screening</subject><subject>Nurse practitioners</subject><subject>Openness</subject><subject>Parents & parenting</subject><subject>Pediatricians</subject><subject>Pediatrics</subject><subject>Primary care</subject><subject>Psychology</subject><subject>Psychology, Developmental</subject><subject>Public, Environmental & Occupational Health</subject><subject>Reproductive health</subject><subject>Science & Technology</subject><subject>Sexual behavior</subject><subject>Social Sciences</subject><subject>Teenage pregnancy</subject><subject>Teenagers</subject><issn>1054-139X</issn><issn>1879-1972</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>AOWDO</sourceid><sourceid>ARHDP</sourceid><sourceid>7QJ</sourceid><recordid>eNqNUdGK1DAULaK46-ovSMEHBZnxJm2a9EVYi7oLCy7qgm8hTW93M3SSMWlH_Qp_2VtnnFVfFC4kN_eck3s4WZYzWDJg1YvVcmW6cINmGG-WHDgsoaASd7JjpmS9YLXkd-kOolywov50lD1IaQVErRjcz44KXqi6FNVx9v3KdxjTaHzn_HV-Gd3axG95YyJSE7Zunj7NLzFa3Iwu-JQTlEbGjs5iyp3Pz9ebAdfox1mhCb4nEjVmyE-7MGCy1OUf8OtELzP5PW5i6CYS2GJ-9tMEjeN21nuY3evNkPDR_jzJrt68_ticLS7evT1vTi8WVoAcFzWasrC8a5UQCC3rK1lxyQWTismC9Uy2QraqL6WUDHpjgZWCMy5bibUBKE6ylzvdzdSusZtXjGbQm51_HYzTf068u9HXYatrqHilOAk82wvE8HnCNOq1I6fDYDyGKWleAoNa1dX815O_oKswRU_2CFXWpapUXRBK7VA2hpQi9odlGOg5db3St6nrOXUNBZUg6uPfzRyIv2K-1f6CbeiTdegtHmAAIGQBTHG6cWjcaOakmzD5kajP_59K6Fc7NFJ2W4dR7xmdi2hH3QX3bzs_AIhM5ns</recordid><startdate>20201001</startdate><enddate>20201001</enddate><creator>Sieving, Renee E.</creator><creator>Mehus, Christopher</creator><creator>Catallozzi, Marina</creator><creator>Grilo, Stephanie</creator><creator>Steiner, Riley J.</creator><creator>Brar, Pooja</creator><creator>Gewirtz O'Brien, Janna R.</creator><creator>Gorzkowski, Julie</creator><creator>Kaseeska, Kristen</creator><creator>Kelly, Emily Denight</creator><creator>Klein, Jonathan D.</creator><creator>McRee, Annie-Laurie</creator><creator>Randazzo, Lia</creator><creator>Santelli, John</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier BV</general><scope>17B</scope><scope>AOWDO</scope><scope>ARHDP</scope><scope>BLEPL</scope><scope>DTL</scope><scope>DVR</scope><scope>EGQ</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7TS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-1841-3770</orcidid><orcidid>https://orcid.org/0000-0003-4809-5144</orcidid><orcidid>https://orcid.org/0000-0001-6588-5995</orcidid></search><sort><creationdate>20201001</creationdate><title>Understanding Primary Care Providers' Perceptions and Practices in Implementing Confidential Adolescent Sexual and Reproductive Health Services</title><author>Sieving, Renee E. ; 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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.
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.
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.
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.</abstract><cop>NEW YORK</cop><pub>Elsevier Inc</pub><pmid>32389456</pmid><doi>10.1016/j.jadohealth.2020.03.035</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-1841-3770</orcidid><orcidid>https://orcid.org/0000-0003-4809-5144</orcidid><orcidid>https://orcid.org/0000-0001-6588-5995</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent sexuality Communication Confidentiality Counseling Decision making Health behavior Health services Health status Interviews Life Sciences & Biomedicine Medical personnel Medical referrals Medical screening Nurse practitioners Openness Parents & parenting Pediatricians Pediatrics Primary care Psychology Psychology, Developmental Public, Environmental & Occupational Health Reproductive health Science & Technology Sexual behavior Social Sciences Teenage pregnancy Teenagers |
| title | Understanding Primary Care Providers' Perceptions and Practices in Implementing Confidential Adolescent Sexual and Reproductive Health Services |
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