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PEDIATRICS Vol. 100 No. 6 December 1997, pp. 922-930

Factors Affecting the Decision to Seek Health Care: The Voice of Adolescents

Received Jan 13, 1997; accepted May 1, 1997.

Kenneth R. Ginsburg, Adrian S. Menapace, and Gail B. Slap

From the Section of Adolescent Medicine, Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia and the Craig-Dalsimer Program in Adolescent Medicine, Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.

Objective.  To learn from teenagers why they do, or do not, seek preventive health care.

Methods.  A teen-centered methodology utilized focus groups, nominal group technique sessions, and surveys to allow adolescents to generate, prioritize, and explain their own responses. This article reports the qualitative explanations offered by youths in focus groups. In 21 groups, teenagers commented on the 15 factors that ninth graders in the School District of Philadelphia had determined most influenced their decision to seek care. Transcriptions were reviewed for consistent themes. Direct quotations are presented here to be representative of those themes.

Results.  Two key points emerged. First, adolescents are more concerned about provider characteristics than site or system characteristics. Second, they worry deeply about disease transmission in the health care setting. Teenagers suggest some simple steps that may produce significant inroads toward developing an effective working relationship with them. A few examples include: to alleviate anxiety of disease transmission, providers should wash hands and remove instruments from sterile packaging in front of patients; to reassure teenagers of competence, providers should keep diplomas and certificates displayed; and to alleviate perceptions of racism, sites should post signs that clearly explain why patients are sometimes seen out of order.

Conclusions.  Adolescents know what draws them to services and what offends them. This study documents, in the words of youths, the factors contributing to their decisions to seek care. The results allow health professionals who care for adolescents to consider what they do well and where change may be needed.

Key words: adolescents, access to health care, health care providers, HIV, focus groups, communication, confidentiality.


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