Healthy Youth Development Prevention Research Center

摘要 作为所有医疗保健服务的关键，保密在性健康服务的提供中尤为重要 (SHS)面向青少年-一个同时学习使用医疗保健系统、协商新的 亲密关系的领域，并与父母重新谈判边界。而一部小规模的文学作品 审查了法律保密保障对青少年医疗保健使用的影响，对此知之甚少 父母在促进青少年在利用卫生保健方面的转变方面的作用。同样，这一角色 在帮助青少年谈判医疗过渡方面，提供者的探索一直很少。建议数 项目(CASH：保密的青少年性健康服务)旨在审查保密服务的提供情况 为11-17岁的青少年提供性健康服务。这个项目将建立在 明尼苏达大学预防研究中心(UMN PRC；Pi Sieeving)对十字路口的理解 促进青少年发展、保健系统和性健康，并扩大青少年的工作 健康联盟项目(Pis Klein和Santelli，与美国儿科学会合作) 该署现正研究在向 年龄较大的青少年和年轻人。基于我们的集体专业知识，Cash项目将探索 从青少年的角度向青少年提供保密的SHS的细微差别和障碍， 父母和提供者。我们将调查收据中私人时间和保密性的重要性 性健康和生殖健康方面的筛查、咨询和服务。目标1将确定障碍 和推动者通过与提供者的深入定性访谈，为青少年提供机密SHS， 明尼苏达州四个县的父母和青少年(11-17岁)。我们会抽查24个初级保健服务 提供者-在城乡县和农村工作的儿科医生、家庭医生和护士从业者 在青少年怀孕率较高和较低的地区，以及48组青少年和父母 从供应商的实践中。目标2将探讨初级保健提供者视角的区域差异 通过8个全国样本的焦点小组，了解青少年的私人时间、机密性和SHS 儿科医生、家庭医生和执业护士(n=80名初级保健提供者)。目标3将 记录青少年接受适合发育的SHS的流行率(例如，筛查、教育、 咨询和服务，如疫苗、避孕套、避孕和接触前预防) 互联网调查(NIS)，对青少年/父母双亲(n=1000)进行全国概率抽样调查。国家情报局 还将探讨高质量SHS的态度、动机、障碍和促进者。拟议的研究将 产生改善青少年SHS交付的建议--包括对青少年的信息， 家长和提供者；以及重组医疗保健系统以促进提供高质量SHS的方法。

Abstract Key to all healthcare services, confidentially is particularly important in the delivery of sexual health services (SHS) to adolescents – a group that is simultaneously learning to use healthcare systems, to negotiate the new terrain of intimate relationships, and to renegotiate boundaries with parents. While a small literature has examined the impact of legal guarantees for confidentiality on adolescent healthcare use, little is known about parents’ roles in fostering adolescents’ transitions regarding the use of health care. Likewise, the role of providers in helping adolescents negotiate health care transitions has been poorly explored. The proposed project (CASH: Confidential Adolescent Sexual Health services) aims to examine the provision of confidential sexual health services to adolescents ages 11-17 years. This project would build upon the strengths of the University of Minnesota Prevention Research Center (UMN PRC; PI Sieving) in understanding the intersection of adolescent development, health care systems, and sexual health, and extend the work of the Adolescent Health Consortium project (PIs Klein and Santelli, in collaboration with the American Academy of Pediatrics) which is currently examining private time and confidentiality in the delivery of clinical preventive services to older adolescents and young adults. Grounded in our collective expertise, the CASH project will explore nuances and barriers to provision of confidential SHS to adolescents from the perspectives of adolescents, parents and providers. We would investigate the importance of private time and confidentiality in the receipt of screening, counseling, and services around sexual and reproductive health. Aim 1 would identify barriers and facilitators to confidential SHS for adolescents through in-depth qualitative interviews with providers, parents, and adolescents (11-17 years) in four counties in Minnesota. We would sample 24 primary care providers -- pediatricians, family physicians, and nurse practitioners working in urban and rural counties and in areas with higher and lower rates of adolescent pregnancy, as well as 48 sets of adolescents and parents from providers’ practices. Aim 2 would explore regional variations in perspectives of primary care providers regarding private time, confidentiality, and SHS for adolescents through 8 focus groups with a national sample of pediatricians, family physicians and nurse practitioners (n=80 primary care providers). Aim 3 would document prevalence of adolescents’ receipt of developmentally-appropriate SHS (e.g., screening, education, counseling, and services such as vaccines, condoms, contraception, and pre-exposure prophylaxis) through an internet survey (NIS) with a national probability sample of adolescent/parent dyads (n=1000 dyads). The NIS would also explore attitudes, motivations, barriers and facilitators to quality SHS. The proposed research will result in recommendations for improving delivery of adolescent SHS -- including messages for adolescents, parents, and providers; and ways for restructuring health care systems to facilitate the delivery of quality SHS.