Management of Adolescent–Parent Dyads’ Discordance for Willingness to Participate in a Reproductive Health Clinical Trial

Abstract

The objective of this study is to understand the resolution of discordance between adolescent-parent dyads about participation in research. Adolescent (14-17 years) and parent dyads were recruited from NYC pediatric clinics to assess attitudes toward research participation. A subset of dyads participated in videotaped discussions about participation in a hypothetical study. Videos from dyads that held strongly discordant opinions about participation ( n = 30) were content-coded and analyzed using a thematic framework approach. Strategies used to resolve discordance included asserting authority, granting autonomy, or recognizing inaccurate assumptions using a variety of communication behaviors. Missed opportunities to enroll initially discordant dyads may be avoided by allowing time for adolescents and parents to elicit information, clarify a situation, or convince the other.

Adolescent–Parent Dyadic Retention in an Interview Study and Changes in Willingness to Participate in a Hypothetical Microbicide Safety Study

“…24 In the context of a clinical trial in which the parent would need to provide permission for the adolescent to participate, our analysis of interviews at baseline shows that for the most part adolescent-parent conflict resolves quickly. 22 The results of the current study demonstrate that adolescents and parents become more concordant in their WTP over time. Taken together, these findings, are consistent with developmental research that suggests that most adolescent-parent conflict is over every day mundane issues, and that serious conflict is rare.…”

“…Taken together, these findings, are consistent with developmental research that suggests that most adolescent-parent conflict is over every day mundane issues, and that serious conflict is rare. 25 This also suggests that when a dyad is not able come to a resolution quickly, 22 it may be wise to wait and offer them another opportunity at a later time, given the tendency to become concordant over time.…”

“…Adolescent (aged 14–17 years) and parent dyads were recruited in English and/or Spanish to participate in a study assessing their willingness to participate in a hypothetical safety trial of a topical microbicide gel for sexually transmitted infections/human immunodeficiency virus (STIs/HIV) prevention in adolescents. Study procedures 14,19–22 included simultaneous individual interviews of the adolescent and parent and a return visit one-year later for the same interview at an academic medical center.…”

Adolescent and Parent Perceptions about Participation in Biomedical Sexual Health Trials

“…All patterns of discordance were found, but in general, it was more common for adolescents to be willing to participate than for parents to be willing to have their adolescent enroll. However, extreme discordance was rare and was generally resolved quickly once the adolescents and their parents engaged in conversation about whether the adolescent would participate 55 . In the case of all dyads who eventually agreed that the adolescent would participate in the study, adolescents convinced their parents in favor of participation.…”

A reflection on ethical and methodological challenges of using separate interviews with adolescent-older carer dyads in rural South Africa

“…Adolescents may agree to participate out of obedience to or respect for their caregivers [19, 20]. For example, in a study to understand the resolution of discordance between adolescent-parent dyads about participation in research, Francis and colleagues [24] report that sometimes one individual in the dyad asserted authority over his/her partner about the decision for participation.…”