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Barriers to Health Services for Adolescents

Barriers to Health Services for Adolescents. Don Langille, MD Professor Department of Community Health & Epidemiology. Barriers to Health Services for Adolescents. Most adolescent primary care delivered by physicians.

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Barriers to Health Services for Adolescents

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  1. Barriers to Health Services for Adolescents Don Langille, MD Professor Department of Community Health & Epidemiology

  2. Barriers to Health Services for Adolescents • Most adolescent primary care delivered by physicians. • Care for emotional problems, substance use and high risk sexual behaviours is particularly important. • Care should include opportunistic screening. • Adolescent access (and use) is a key challenge & SBHCs are a response to this.

  3. Barriers to Health Services for Adolescents • Availability • Accessibility • Applicability • Equity • Acceptability

  4. Barriers to Health Services for Adolescents: Availability • Services are generally available in developed countries. • May be limited by policy considerations (e.g., ECP in the US). • Individual providers may limit availability of specific services (e.g., abortion).

  5. Barriers to Health Services for Adolescents: Accessibility • Cost • Convenience factors (hours of operation, distance, transport) • Lack of knowledge of services offered

  6. Barriers to Health Services for Adolescents: Applicability • Are services offered able to meet the needs of students? • Establish these through appropriate needs assessment and ongoing review.

  7. Barriers to Health Services for Adolescents: Equity • Lack of health insurance • Refusal of service based on life circumstances (e.g., young people living on the street)

  8. Barriers to Health Services for Adolescents: Acceptability • Fear of being seen at a health facility • Lack of respect for young peoples’ health related decisions • Poor provider communication • Main issue is around parents finding out about a visit for health services (confidentiality)

  9. Barriers to Health Services for Adolescents: Confidentiality Concerns about confidentiality can cause adolescents to: • Delay seeking help • Affect choice of provider • Affect candour in responding to sensitive questions • Forego seeking help completely

  10. Barriers to Health Services for Adolescents: Confidentiality A US study published (Ford et al, JAMA, 1999) found that of students who had forgone needed health care 11.5% (95% CI 10.0-13.0) had done so because they didn’t want their parents to know.

  11. Barriers to Health Services for Adolescents: Confidentiality • A recent study (Lehrer et al, JAH 2007) found that boys with confidentiality concern as a reason for foregoing care were more at risk of depression, suicidal ideation and suicide attempt. • Girls with confidentiality concerns had had more STI, depression and suicide ideation/attempt, and lacked contraception.

  12. Confidentiality & Sexual Health Services 1997 Commonwealth Fund Survey of Health of Adolescent Girls, a nationally representative school-based survey of 6748 girls in grades 5-12(Klein, JAH, 1999) • 1/3 had missed needed care • Most common reason for missing care was not wanting parents to know

  13. Confidentiality & Sexual Health Services Reddy et al (JAMA, 2002) asked 1118 females aged <18 at Wisconsin Planned Parenthood clinics about the impact of parent notification. • 47% would stop using all PP services if parents were notified about OC use. • 6% would delay STI treatment if there were mandatory parental notification. • Authors concluded that such notification had potential to harm girls’ sexual health.

  14. Confidentiality & Sexual Health Services Jones et al (JAMA, 2005), using a sample of 80 publicly funded FP clinic in the US, asked women <18 (n=1526) seeking sexual health services how they would react if parent notification were mandatory: • 59% overall would use services. • Only 29% of the 40% whose parents were currently unaware would do so.

  15. Confidentiality & Sexual Health Services Student survey in northern Nova Scotia (Langille, 2001). Proportions of sexually active students (n=650) not having discussed sexual health with a physician due to: Males Females Embarrassment 37 56 Might tell parents 23 54 Lack of respect 21 41

  16. Confidentiality & Sexual Health Services Student survey in Cape Breton, Nova Scotia (Langille, 2007). Proportions of sexually active students (both sexes, n=379) giving reasons for first attendance: More comfortable at SBHC 63 Confidentiality maintained 63 Appropriate info available 60 Nurse non-judgmental 55

  17. Confidentiality & Sexual Health Services For Discussion: What strategies can be used to assure that issues of confidentiality are fully addressed at SBHCs?

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