Saberi Parya, Ming Kristin, Dawson-Rose Carol
Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA, USA.
Adolesc Health Med Ther. 2018 Apr 24;9:65-75. doi: 10.2147/AHMT.S158759. eCollection 2018.
Given the consistent associations between younger age and numerous suboptimal clinical outcomes, there is a critical need for more research in youth living with human immunodeficiency virus (YLWH) and tailoring of health care delivery to the unique and complex needs of this population. The objective of this study was to examine the facilitators of and barriers to engagement in care among YLHW at the system and provider/staff level, as well as the barriers to using technology-based forms of communication with YLWH to improve retention and engagement in care.
We conducted in-depth qualitative interviews with health care providers and staff members at the clinics and organizations serving YLWH in the San Francisco Bay Area.
We interviewed 17 health care providers and staff members with a mean of 8 years of experience in providing clinical care to YLWH. Interviewees noted various facilitators of and barriers to engagement in care among YLWH, including the environment of the clinic (e.g., clinic location and service setting), provision of youth-friendly services (e.g., flexible hours and use of technology), and youth-friendly providers/staff (e.g., nonjudgmental approach). With regard to barriers to using technology in organizations and clinics, interviewees discussed the challenges at the system level (e.g., availability of technology, clinic capacity, and Health Insurance Portability and Accountability Act compliance), provider/staff level (e.g., time constraints and familiarity with technology), and youth level (e.g., changing of cellular telephones and relationship with provider/staff).
Given the need for improved clinical outcomes among YLWH, our results can provide guidance for clinics and institutions providing care for this population to enhance the youth-friendliness of their services and examine their guidelines around the use of technology.
鉴于年轻与众多不良临床结局之间存在持续关联，对于感染人类免疫缺陷病毒的青年（YLWH）开展更多研究以及根据该人群独特且复杂的需求调整医疗服务至关重要。本研究的目的是在系统和提供者/工作人员层面检查 YLHW 参与护理的促进因素和障碍，以及使用基于技术的沟通方式与 YLWH 交流以提高护理留存率和参与度的障碍。
我们对旧金山湾区为 YLWH 提供服务的诊所和组织中的医疗保健提供者和工作人员进行了深入的定性访谈。
我们采访了 17 名医疗保健提供者和工作人员，他们平均有 8 年为 YLWH 提供临床护理的经验。受访者指出了 YLWH 参与护理的各种促进因素和障碍，包括诊所环境（如诊所位置和服务设置）、提供适合青年的服务（如灵活的工作时间和技术使用）以及友善的提供者/工作人员（如无评判的态度）。关于在组织和诊所中使用技术的障碍，受访者讨论了系统层面的挑战（如技术可用性、诊所容量以及符合《健康保险流通与责任法案》）、提供者/工作人员层面的挑战（如时间限制和对技术的熟悉程度）以及青年层面的挑战（如更换手机和与提供者/工作人员的关系）。
鉴于需要改善 YLWH 的临床结局，我们的结果可为为该人群提供护理的诊所和机构提供指导，以提高其服务对青年的友好程度并审查其围绕技术使用的指南。
