Healthy Youth Development Prevention Research Center

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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.