Perspectives on Confidential Care for Adolescent Girls

Abstract

PURPOSE We wanted to obtain perspectives of mothers and daughters on facilitators of and barriers to with adolescent girls' timely access to risk-appropriate reproductive care. METHODSWe conducted 5 separate focus groups with Latina and black mothers and their adolescent daughters. All participants resided in impoverished neighborhoods of New York City. Participants addressed mothers' roles in helping girls initiate gynecologic care, perceived role of physicians in daughters' sexual health, including the provision of confi dential care, and perceived need for girls' gynecologic care. Data were analyzed using qualitative data analysis methods.RESULTS Mothers see themselves as their daughters' primary protectors against daughters' poor reproductive outcomes. Many believe that confi dential care promotes risky behavior and undermines mothers' efforts to protect girls. Mothers endorse facilitating gynecologic care and entering alliances with physicians but see the need for care as arising only after girls' sexual debut. Unfortunately, maternal awareness of sexual activity is low. Adolescent girls express considerable discomfort around reproductive health care and negotiating maternal involvement, and they fear breaches in confi dentiality.CONCLUSIONS A lack of trust in health care clinicians and the mother's gatekeeper role are key barriers to girls' transition to reproductive care. Consistently including a confi dential component to health care visits in early adolescence, with preparation for both mothers and daughters, may reduce the distrust and discomfort.

Predictors of lifestyle behaviors, trust of health care provider, and utilization of health services among adolescents living in a rural area.

“…These qualitative reports suggested higher levels of trust of HCP among adolescents with chronic illnesses were related to the adolescents' faith in their parents' trust of HCP (Broome & Richards, 2003;Klostermann et al, 2005). The difference in levels of trust of HCP between adolescents who received preventative or acute health services and those that received chronic illness care (Blake, Robley, & Taylor, 2012;Britto et al, 2004) seemed to be related to adolescents' interest in keeping knowledge of risk-taking behaviors from parents (Cogswell, 1985;Ingram & Salmon, 2007;McKee, O'Sullivan, & Weber, 2006). It seems likely that adolescents living in the rural United States would also report lower levels of trust of HCPs when receiving preventative and acute health services.…”

“…Parents expect all information disclosed by the adolescent to the HCP to be shared with the parent (McKee, O'Sullivan, et al, 2006). Evidence suggests that while most HCPs support providing confidential care to adolescents (Akinbami, Gandhi, & Cheng, 2003;Lovett & Wald, 1985;Resnick, Litman, & Blum, 1992), the office staff report otherwise (Akinbami et al, 2003).…”

“…A lack of trust of the HCP was frequently reported by adolescents as a reason for not utilizing health services (BrelandNoble et al, 2010;Charman, Harms, & Myles-Pallister, 2010;Elliott & Larson, 2004;Scott & Davis, 2006). In health care, trust has been demonstrated to influence many situations including adolescent patients' willingness to seek care (Breland-Noble et al, 2010;Charman et al, 2010), to disclose sensitive information (Blake et al, 2012;Farrant & Watson, 2004;Leonard, Markham, Bui, Shegog, & Paul, 2010), to submit to treatment (McKee, O'Sullivan, et al, 2006;Renker, 2006;Sayles, Macphail, Newman, & Cunningham, 2010), to participate in research (Broome & Richards, 2003), to adhere to prescribed treatments (Brown, 2007), to continue a HCP relationship (Hudson, Nyamathi, & Sweat, 2008), and to recommend a HCP to others (Ingram & Salmon, 2007).…”

“…Many rural areas lack pediatric or adolescent specialists (MacDowell et al, 2010) and as a result, frequently adolescents and their family members all receive treatment from the same provider and office staff. This becomes complicated when parents expect all information disclosed by the adolescent to the HCP to be shared with the parent (McKee, O'Sullivan, et al, 2006). Evidence suggests that while most HCPs support providing confidential care to adolescents (Akinbami et al, 2003;Lovett & Wald, 1985;Resnick et al, 1992), office staff report otherwise (Akinbami et al, 2003).…”

“…In this study, trust of HCP was defined as a patient's accepted vulnerability to the HCP's possible but not expected ill will, made up of four overlapping domains: fidelity, competence, honesty, and global trust (Hall et al, 2002). Among five previous quantitative studies, trust of HCP was measured among adolescents using one or two investigator-developed survey items (Chandra, 2006;Cheng, 1993;Farrant & Wilson, 2004;McKee, O'Sullivan, & Weber, 2006;Ingram & Salmon, 2007). In this study, use of the Wake Forest Trust in Physician…”