Social-Ecological Barriers to Access to Healthcare for Adolescents: A Scoping Review

Abstract

Access to healthcare for adolescents is often overlooked in the United States due to federal and state-sponsored insurance programs such as Medicaid and the Children’s Health Insurance Program. While these types of programs provide some relief, the issue of healthcare access goes beyond insurance coverage and includes an array of ecological factors that hinder youths from receiving services. The purpose of this scoping review was to identify social-ecological barriers to adolescents’ healthcare access and utilization in the United States. We followed the PRISMA and scoping review methodological framework to conduct a comprehensive literature search in eight electronic databases for peer-reviewed articles published between 2010 and 2020. An inductive content analysis was performed to thematize the categories identified in the data extraction based on the Social-Ecological Model (SEM). Fifty studies were identified. Barriers across the five SEM levels emerged as primary themes within the literature, including intrapersonal-limited knowledge of and poor previous experiences with healthcare services, interpersonal-cultural and linguistic barriers, organizational-structural barriers in healthcare systems, community-social stigma, and policy-inadequate insurance coverage. Healthcare access for adolescents is a systems-level problem requiring a multifaceted approach that considers complex and adaptive behaviors.

Using the Social-Ecological Model to Understand the Current Perspective of Contraceptive Use in the United States: A Narrative Literature Review

“…The social-ecological model (SEM) of health promotion by McLeroy and colleagues states that health behavior and promotion are interrelated and occur around multiple levels in the individual, interpersonal, institutional, community, and policy levels [14]. SEM has been used across various health topics to identify, understand, and explain complex health issues and patterns [15,16]. This multifaceted perspective is important to understand and explicate factors that influence women's contraceptive use (see Figure 1).…”

“…health issues and patterns [15,16]. This multifaceted perspective is important to understand and explicate factors that influence women's contraceptive use (see Figure 1).…”

“…Simultaneously, barriers such as issues with confidentiality and privacy, perceived judgment or stigma, lack of clinical space, costs, inadequate health insurance, and limited information about how to access contraceptive services are persistent institutional barriers to contraceptive use [15].…”

Socio-Demographic Correlates of Barriers to Access Healthcare Services Among Children in Post-Communist Albania

“…Nevertheless, individual factors, also referred to as intrapersonal factors [13], are also associated with such individual characteristics as knowledge, attitudes, behaviour, and skills [13,14]. As a matter of fact, a fairly recent review reported that the most frequent individual level barriers to access healthcare services consist of scarce knowledge of healthcare services and negative beliefs and experiences with previous care encounters [13].…”

Acceptability and Feasibility of Peer-to-Peer Text Messaging Among Adolescents to Increase Clinic Visits and Sexually Transmitted Infection Testing: Interrupted Times-Series Analysis

“…Adolescents face barriers to accessing sexual health services, including stigma, low knowledge about STIs and available services, cost, clinic wait times, scheduling conflicts, and embarrassment [8][9][10][11]. Further, adolescents are least likely to have access to health care in the United States [12][13][14].…”