Klein J D, Graff C A, Santelli J S, Hedberg V A, Allan M J, Elster A B
University of Rochester Medical Center, NY 14642-8690, USA.
Health Serv Res. 1999 Apr;34(1 Pt 2):391-404.
To demonstrate the feasibility of directly surveying adolescents about the content of preventive health services they have received and to assess the validity of adolescent self-reported recall.
DATA SOURCES/SETTING: Audiotaped encounters, telephone interviews, and chart reviews with 14-21 year olds being seen for preventive care visits at 15 pediatric and family medicine private practices, teaching hospital clinics, and health centers.
537 adolescents presenting for well visits were approached, 400 (75 percent) consented, 374 (94 percent) were audiotaped, and 354 (89 percent) completed telephone interviews either two to four weeks or five to seven months after their visits. Audiotapes were coded for screening and counseling across 34 preventive service content areas. Intraobserver reliability (Cohen's kappa) ranged from 0.45 for talking about peers to 0.94 for discussing tobacco. The sensitivity and specificity of the adolescent self-reports were assessed using the audiotape coding as the gold standard.
Almost all adolescents surveyed (94 percent) remembered having had a preventive care visit, 93 percent identified the site of care, and most (84 percent) identified the clinician they had seen. There was wide variation in the prevalence of screening, based on the tape coding. Adolescent self-report was moderately or highly sensitive and specific at two weeks and six months for 24 of 34 screening and counseling items, including having discussed: weight, diet, body image, exercise, seatbelts, bike helmet use, cigarettes/smoking, smokeless tobacco, alcohol, drugs, steroids, sex, sexual orientation, birth control, condoms, HIV, STDs, school, family, future plans, emotions, suicidality, and abuse. Self-report was least accurate for blood pressure/cholesterol screening, immunizations, or for having discussed fighting, violence, weapon carrying, sleep, dental care, friends, or over-the-counter drug use.
Adolescents' self-report of the care they have received is a valid method of determining the content of preventive health service delivery. Although recall of screening and counseling is more accurate within two to four weeks after preventive care visits, adolescents can report accurately on the care they had received five to seven months after the preventive health care visits occurred.
证明直接向青少年调查他们所接受的预防性健康服务内容的可行性，并评估青少年自我报告回忆的有效性。
数据来源/环境：对在15家儿科和家庭医学私人诊所、教学医院诊所及健康中心接受预防性保健就诊的14至21岁青少年进行录音问诊、电话访谈和病历审查。
接触了537名前来进行健康检查的青少年，400名（75%）同意参与，374名（94%）被录音，354名（89%）在就诊后两到四周或五到七个月完成了电话访谈。对录音进行编码，以涵盖34个预防性服务内容领域的筛查和咨询情况。观察者内信度（科恩kappa系数）在谈论同龄人方面为0.45，在讨论烟草方面为0.94。以录音编码为金标准评估青少年自我报告的敏感性和特异性。
几乎所有接受调查的青少年（94%）记得接受过预防性保健就诊，93%能确定就诊地点，大多数（84%）能认出他们见过的临床医生。根据录音编码，筛查的患病率差异很大。对于34项筛查和咨询项目中的24项，青少年自我报告在两周和六个月时的敏感性和特异性为中度或高度，包括讨论过：体重、饮食、身体形象、运动、安全带、自行车头盔使用、香烟/吸烟、无烟烟草、酒精、毒品、类固醇、性、性取向、节育、避孕套、艾滋病毒、性传播疾病、学校、家庭、未来计划、情绪、自杀倾向和虐待。自我报告在血压/胆固醇筛查、免疫接种方面，或在讨论打架、暴力、携带武器、睡眠、牙齿护理、朋友或非处方药使用方面最不准确。
青少年对其所接受护理的自我报告是确定预防性健康服务提供内容的有效方法。虽然在预防性保健就诊后两到四周内对筛查和咨询的回忆更准确，但青少年能够准确报告在预防性保健就诊发生五到七个月后他们所接受的护理情况。
