Identifying types of sex conversations in adolescent health maintenance visits
Identifying types of sex conversations in adolescent health maintenance visits
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DOI：
10.1071/sh15080
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发表时间：
2016-01-01
期刊：
影响因子：
1.6
通讯作者：
Shields, Cleveland G.
中科院分区：
文献类型：
--
作者：
Alexander, Stewart C.;Christ, Sharon L.;Shields, Cleveland G.
背景：医生与青少年的性行为讨论是健康维护就诊中推荐的内容，但这种讨论——如果真的有的话——可能因青少年的特点和情况，以及医生的个人信仰和培训而异。然而，在健康维护访问期间，医生与青少年性行为讨论的形式和内容知之甚少。方法：我们评估了245个医生与青少年的性对话。使用潜在类分析，我们根据13个与性相关的话题确定了对话类型，这些话题至少占所有对话的10%。结果：我们发现了四种不同类型的性对话，它们的重点不同，作为性史和风险评估的一部分的主题不同，以及在预期指导中讨论的主题不同。在所有的谈话类型中，关于伴侣性经历的询问都很典型，超过一半的人讨论了身体发育和保护行为。在所有四种类型的谈话中，性问题的讨论通常嵌入在一系列心理社会和行为主题中，建议进行保健访问。结论：在这些就诊中，性对话的出现表明，医生认为性是一个重要的问题，也是他们照顾青少年患者的责任的一部分。然而，性对话类型的巨大差异，特别是许多关键主题的明显遗漏，支持了在医学院和住院医师中教授性健康访谈技巧的重要性，并作为继续医学教育和质量改进的一部分。
Background: Physician-adolescent sexuality discussions are a recommended element in health maintenance visits, but such discussions - if they occur at all - probably vary by adolescents' characteristics and situations, and physicians' personal beliefs and training. However, little is known about the form and content of physician-adolescent sexuality discussions during health maintenance visits. Methods: We evaluated 245 physician-adolescent sexuality conversations. Using latent class analysis, we identified conversation types based on 13 sexually related topics, which occurred in at least 10% of all conversations. Results: We found four discrete types of sexuality conversations, which differed in terms of emphasis, topics addressed as part of the sexual history and risk assessment, and topics addressed in anticipatory guidance. Inquiry about partnered sexual experience was typical across all conversation types, as well as over half including discussions about body development and protective behaviours. In all four types of conversation, sexuality discussions were typically embedded in a sequence of psychosocial and behavioural topics recommended for health maintenance visits. Conclusions: The presence of sexuality conversations in the majority of these visits suggests that physicians consider sexuality to be an important issue and part of their responsibility in caring for their adolescent patients. However, the substantial variability in the types of sexuality conversations, particularly the notable omissions of many key topics, supports the importance of teaching sexual health interview skills in medical school and residency, and as part of continuing medical education and quality improvement.