Brown Jonathan D, Wissow Lawrence S
Mathematica Policy Research, Inc., Washington, DC 20024, USA.
J Adolesc Health. 2009 Jan;44(1):48-54. doi: 10.1016/j.jadohealth.2008.06.018. Epub 2008 Oct 25.
Youth have concerns about sensitive health topics, such as drugs, sex, and mental health, and many wish to discuss those concerns with a primary care provider. Research has not determined whether the discussion of sensitive health topics during primary care visits is independently associated with youth perceptions of care. This study examined whether the discussion of sensitive health topics during primary care visits was associated with youth's perceptions of the provider and of participation in treatment.
Directly after visits to 54 primary care providers in 13 geographically diverse offices and clinics, youth age 11-16 years old (N = 358) reported whether the visit included the discussion of mood, behavior, getting along with others, drugs, tobacco, alcohol, sexuality, birth control, parent mood, or family problems. Youth also reported whether the provider understood their problems, eased their worries, allowed them to make decisions about treatment, gave them some control over treatment, and asked them to take some responsibility for treatment. Providers reported confidence in their ability to offer counseling for nonmedical concerns and their beliefs and attitudes toward treating nonmedical concerns.
Youth had more positive perceptions of the provider and were more likely to report taking an active role in treatment when the visit included the discussion of a sensitive health topic. Results from multivariate random effects logistic regression suggested that youth were more likely to report that the provider understood their problems (OR = 3.62, CI = 1.57-8.31), eased their worries (OR = 2.13, CI = 1.06-3.92), allowed them to make decisions about treatment (OR = 2.71, CI = 1.44-5.10), gave them some control over treatment (OR = 2.51, CI = 1.32-4.71), and asked them to take some responsibility for treatment (OR = 2.00, CI = 1.04-3.86) when the visit included the discussion of one or more sensitive health topics. The odds of each of these outcomes were also higher when the visit included the discussion of a greater number of sensitive topics. Youth also had more positive perceptions of female providers. Youth demographics, mental health status, and other provider characteristics were unrelated to youth perceptions of care.
The discussion of sensitive health topics during primary care visits may have a positive impact on youth perceptions of care. Future research is needed to understand the relationship between the discussion of sensitive health topics and health outcomes among youth.
青少年对毒品、性和心理健康等敏感健康话题存在担忧，许多人希望与初级保健提供者讨论这些担忧。研究尚未确定在初级保健就诊期间讨论敏感健康话题是否与青少年对医疗服务的认知独立相关。本研究调查了在初级保健就诊期间讨论敏感健康话题是否与青少年对提供者的认知以及参与治疗的情况相关。
在13个地理位置不同的办公室和诊所拜访了54名初级保健提供者后，11至16岁的青少年（N = 358）报告此次就诊是否包括对情绪、行为、与他人相处、毒品、烟草、酒精、性取向、节育、父母情绪或家庭问题的讨论。青少年还报告了提供者是否理解他们的问题、减轻了他们的担忧、允许他们对治疗做出决定、让他们对治疗有一定控制权以及要求他们对治疗承担一定责任。提供者报告了他们为非医疗问题提供咨询的能力信心以及他们对治疗非医疗问题的信念和态度。
当就诊包括对敏感健康话题的讨论时，青少年对提供者有更积极的认知，并且更有可能报告在治疗中发挥积极作用。多变量随机效应逻辑回归结果表明，当就诊包括对一个或多个敏感健康话题的讨论时，青少年更有可能报告提供者理解他们的问题（OR = 3.62，CI = 1.57 - 8.31）、减轻了他们的担忧（OR = 2.13，CI = 1.06 - 3.92）、允许他们对治疗做出决定（OR = 2.71，CI = 1.44 - 5.10）、让他们对治疗有一定控制权（OR = 2.51，CI = 1.32 - 4.71）以及要求他们对治疗承担一定责任（OR = 2.00，CI = 1.04 - 3.86）。当就诊包括讨论更多敏感话题时，这些结果中每一项的几率也更高。青少年对女性提供者也有更积极的认知。青少年的人口统计学特征、心理健康状况和其他提供者特征与青少年对医疗服务的认知无关。
在初级保健就诊期间讨论敏感健康话题可能会对青少年对医疗服务的认知产生积极影响。未来需要进行研究以了解在青少年中讨论敏感健康话题与健康结果之间的关系。
