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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
Barriers to Health Services for Adolescents

Don Langille, MD

Professor

Department of Community Health & Epidemiology

barriers to health services for adolescents2
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.
barriers to health services for adolescents3
Barriers to Health Services for Adolescents
  • Availability
  • Accessibility
  • Applicability
  • Equity
  • Acceptability
barriers to health services for adolescents availability
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).
barriers to health services for adolescents accessibility
Barriers to Health Services for Adolescents: Accessibility
  • Cost
  • Convenience factors (hours of operation, distance, transport)
  • Lack of knowledge of services offered
barriers to health services for adolescents applicability
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.
barriers to health services for adolescents equity
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)
barriers to health services for adolescents acceptability
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)
barriers to health services for adolescents confidentiality
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
barriers to health services for adolescents confidentiality10
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.

barriers to health services for adolescents confidentiality11
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.
confidentiality sexual health services
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
confidentiality sexual health services13
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.
confidentiality sexual health services14
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.
confidentiality sexual health services15
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

confidentiality sexual health services16
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

confidentiality sexual health services17
Confidentiality & Sexual Health Services

For Discussion:

What strategies can be used to assure that issues of confidentiality are fully addressed at SBHCs?