- Email: [email protected]
Parents and Health Care Professionals Working Together to Improve Adolescent Health: The Perspectives of Parents
Journal of Adolescent Health 44 (2009) 191–194
Adolescent health brief
Parents and Health Care Professionals Working Together to Improve Adolescent Health: The Perspectives of Parents Carol A. Ford, M.D.a,b,*, Amy F. Davenport, M.P.H.a, Andrea Meier, Ph.D.c, and Annie-Laurie McRee, M.P.H.b a School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina c School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Manuscript received January 9, 2008; manuscript accepted June 26, 2008
b
Abstract
One proposed strategy to improve adolescent health and health care is to create working partnerships among adolescent health care professionals (HCPs) and families. In this pilot qualitative study we interviewed 17 mothers to explore their perceptions of the role of parents, HCPs, and parent–HCP partnerships in addressing adolescent health issues. Ó 2009 Society for Adolescent Medicine. All rights reserved.
Keywords:
Adolescent; Adolescent health services; Parenting education; Parent–child relations; Health care quality; Adolescent medicine
Introduction
Sample selection
Improvements in adolescent health and health care continue to be needed. A mid-course review of Healthy People 2010 objectives that are critical to adolescent health has revealed little or no improvement on most objectives [1]. A recent study of quality of ambulatory health care delivered to children in the United States revealed that documented adherence to indicated clinical services was lowest for adolescent preventive care [2]. One proposed strategy to improve adolescent health and health care is to create working partnerships among adolescent health care professionals (HCPs) and families [3]. The primary objective of this formative research was to explore parent perceptions of the roles of parents, HCPs, and parent–HCP partnerships in improving adolescent health and health care.
The goal of our sampling strategy was to recruit a diverse sample of parents of adolescent children in North Carolina (NC) with a recent health care visit. We selected eight clinical sites that primarily serve adolescent patients within the NC Multi-site Adolescent Research Consortium for Health (NC MARCH) primary-care based research network (PBRN) to purposefully assure diversity based on type of site (freestanding vs. school-based health center [SBHC]), region (coastal planes, piedmont, mountains), population density (urban, suburban, rural), and racial/ethnic characteristics; participants were recruited from these sites.
Methods This was an exploratory pilot project using qualitative methodology. The project was approved by the Institutional Review Board of the Office of Human Research Ethics at the University of North Carolina at Chapel Hill. *Address correspondence to: Carol A. Ford, MD, Associate Professor of Pediatrics and Internal Medicine, Director, NC MARCH, University of North Carolina at Chapel Hill, CB 7225, Chapel Hill, NC 27599-7225. E-mail address: [email protected]
Recruitment Procedures for recruiting parents varied depending on whether the clinic was free-standing or a SBHC, because parents were usually present in free-standing clinics and absent in SBHCs. Criteria for eligibility included being the mother or primary female caregiver to a child or adolescent 12–18 years of age living at home, recently seen by a health care provider and being able to communicate in English. In freestanding clinics, mothers or female adults who were present with a patient registering to be seen for any reason received written information about the study. If interested in participating, they were asked to complete a screening survey to
1054-139X/09/$ – see front matter Ó 2009 Society for Adolescent Medicine. All rights reserved. doi:10.1016/j.jadohealth.2008.06.017
192
C.A. Ford et al. / Journal of Adolescent Health 44 (2009) 191–194
determine eligibility and to provide contact information. Those eligible to participate were contacted by a member of the research team and invited to participate. In SBHCs, students registering to be seen for any reason were told about the study. If the student gave permission, clinic staff contacted the mother or primary female caregiver to discuss the study, to determine interest, and to determined eligibility. The clinic staff provided a list of eligible interested participants with contact information to the research team, who then recruited participants. The research staff obtained verbal informed consent from all participants, who received a $25 gift certificate from a statewide-department store at completion of the study. Interviews We initially planned focus groups; however two parents attended the first group and one parent attended the second, so we modified procedures and began conducting individual semi-structured telephone interviews. Focus groups followed standard procedures. The sessions were audio-taped and later transcribed, and the data were included in our study. Semistructured interviews followed standard procedures, with written notes recorded by the interviewer [4]. Content The content of the focus group and interview guides were designed to elicit and explore participants’ perspectives on the roles of parents, HCPs, and parent–HCP partnerships in improving adolescent health and health care. Guides were revised and finalized based on iterative review by parents. This study summarizes responses to the following questions: What can parents do to keep teens healthy and address health problems? What can HCPs do to keep teens healthy and address health problems? How can parents and HCPs work together to keep teens healthy and address health problems? Data analyses All data were reviewed independently by at least two members of the research team. We conducted content analyses and thematic coding using Atlas.ti to identify common and interesting themes.
What can parents do to keep teens healthy and address health problems? When asked what parents can do to keep teens healthy and address health problems, the most common themes reported by our participants included keeping teens busy and parental monitoring (Table 1). As one participant reported: We try to monitor their friends. We know how they look, and who they’re going out with. We try to pay attention to the way they act. If it doesn’t seem right, we have to pay attention.
Many participants discussed the importance of parent– teen communication. One-third discussed the importance of parents being able to ask for and accept help from HCPs when they needed it. What can HCPs do to keep teens healthy and address health problems? When asked what HCPs can do to keep teens healthy and address health problems, the most common theme focused on the importance of teenagers being able to openly communicate with clinicians (Table 2) so that HCPs get an accurate assessment of an adolescent’s behaviors and health. For example: My daughter might be able to talk to a doctor or a nurse, if she can’t talk to me. She might be able to talk to a doctor about anything and not feel stupid. They (doctors) have to be respectful, open to discussing rather than just discounting things. You run into doctors that won’t listen, or they just want to write a teenager off. They can’t have that kind of attitude. They need to see beyond the obvious. They have to be sure that they don’t shame the child or make them feel uneasy or bad. I don’t think at this point I have to worry about the sexual issues and stuff, but they (doctors) should be open, try not to be judgmental, but to guide the teen. Table 1 Parent perspectives: What parents can do to keep teens healthy and address health problems? (N ¼ 17) Theme
No. (%)*
Example
Monitor teen
10 (59)
Monitor what they do, eat, sleep, TV time; monitor their feelings, how they are behaving; monitor friends Keep them busy, involved in activities, scheduled Provide good food, opportunities for sports; provide health insurance; provide good example Talk, listen, give encouragement. Take to clinic, doctor, dentist; contact school nurse/nutritionist; parent may need help, might not know everything let kids hear from experts, support health/sex education in schools Ask questions, learn about adolescent health issues
Results
Keep teen busy
8 (47)
Participants
Provide something
8 (47)
Communicate Asks for/ accept help
8 (47) 6 (35)
Get informed
2 (29)
On average, participants had two children (mean 2.2, range one to four), and most (92%) of their children between 11 and 18 years of age had health insurance. Based on selfreport, 10 participants were black, five were white, and two were Latina. Their highest level of education was approximately evenly distributed between high school diploma (four participants), some college (four), and college graduation (six). Almost all participants (82%) were employed part- or full-time.
* Number (%) of participants who mentioned theme.
C.A. Ford et al. / Journal of Adolescent Health 44 (2009) 191–194
193
Table 2 Parent perspectives: Role of health care professionals (HCPs) (N ¼ 17) and parent-HCP partnerships Theme
No. (%)*
Example
‘‘What can HCPs do to keep teens healthy and address health problems?’’ Communication 6 (35) Sit down and listen to my child, don’t discount them, see beyond the obvious; be respectful, do not judge; don’t shame them; be respectful of privacy; have a sense of humor, be easy going and relaxed; find out things that are going on that parents might not know about Encourage/reinforce healthy behavior 5 (29) Tell them what they are doing right, when they are doing a good job Make referrals 3 (18) Tell me where I need to take my child Support primary prevention programs 3 (18) Become involved in primary prevention programs (e.g. support groups), give classes for teens Provide treatment 1 (5) Give medication ‘‘How can parents and HCPs work together.?’’ HCP–parent communication about individual children 12 (70) Let me know what is going on, what I need to worry about with my child without breaking confidentiality; what I need to be talking to my child about; discuss health education targeted to my child; let me ask questions HCP–parent health education and outreach programs 7 (41) General health education programs for parents, health fairs, go into schools and talk, talk with school boards, workshops for parents, classes, help-lines, internet bulletin boards * Number (%) of participants who mentioned theme.
A few participants explicitly commented that they thought it was helpful for clinicians to learn about things that parents might not know about but that might impact their child’s health. How can parents and HCPs work together? When asked how parents and HCPs can work together to keep teens healthy and address health problems, the clear majority (70%) of participants discussed parent–HCP communication (Table 2). Several parents discussed the importance of HCP taking the initiative in communicating with parents while also respecting the adolescent patients’ confidentiality. One participant stated: Keep an open line of communication (with the parent) as much as possible without breaking confidentiality. If the child wants their confidentiality, keep it, but if it’s not a confidential issue that they (doctor and parent) should let each other know what’s going on. Keep an open door there. Or encourage the child to talk to the parent if there is an issue. Basically, communication within reason and if the child does want confidentiality— encourage the child to talk to the parent.
Many parents, especially those recruited from SBHCs, suggested that HCPs’ give general adolescent health information to parents using public forums or information technology. Just get the word out. If doctors and nurses are in the schools and reach the parents, set up workshops with parents, workshops for the teens, getting people together and communicating like that.it could help.
Discussion New and novel ideas for improving partnerships between parents and adolescent health care professionals emerged from this exploratory study. First, mothers in this study
reported that many activities typically considered the ‘‘work of parenting’’ are an important part of parents’ roles in protecting adolescent health, such as parental monitoring, providing a positive role model, and working to keep parent– teen communication open. The value of HCPs’ explicitly acknowledging and encouraging parenting activities shown by research to improve adolescent health outcomes warrants further investigation [5,6]. Second, HCPs may have an important role in assisting parents to recognize when they should ask for help, and encouraging parental acceptance of help when offered. As one parent stated: The most important thing is that the parents do not fool themselves, that they don’t go around with their heads in the sand thinking ‘it can not happen to my child’. because it certainly can, even in the best of circumstances.
Research to increase our understanding of care seeking by parents on behalf of their adolescent children may lead to interventions that facilitate parents connecting their adolescent children to needed health care [7–9]. Third, communication between HCPs and parents of adolescents is clearly an area that warrants investigation. An increased understanding of parent–HCP communication within the developmental context of adolescent health may lead to parent–targeted interventions to improve use and quality of adolescent health services [10] as well as health outcomes. Our exploratory work suggests that this may be feasible for both routine and sensitive health issues, such as health issues related to sexual behaviors. Furthermore, our results suggest that it is worthwhile exploring strategies to communicate with parents both inside and outside of clinical settings Finally, nearly one-third of the mothers we talked with discussed the importance of HCPs recognizing and acknowledging what adolescents are doing well. Even though traditional medical care is typically problem focused, strategies for strengths-based counseling are emerging. The impact of
194
C.A. Ford et al. / Journal of Adolescent Health 44 (2009) 191–194
HCPs’ positively reinforcing adolescent characteristics and behaviors that promote health is of interest. There are important limitations to this small exploratory study. Results are not representative and should not be generalized. We have not conducted research to determine whether other mothers would have similar views or to explore barriers to parent–HCP partnerships. Our study is limited by exclusion of fathers, who may have different perspectives on parent and HCP roles in addressing adolescent health issues. Our study may also be limited by its focus on parents of children recently seen by a HCP, who may have different perspectives than parents of adolescent children who are not connected to health care. Finally, parents’ perspectives on parent–HCP partnerships may substantially differ from those of HCPs. Despite these limitations, our results begin to address an important gap in the existing literature. Creative strategies to align parents and HCPs in partnerships to improve adolescent health and health care are needed. Future research to better define the challenges and opportunities for parents and HCPs to collaboratively work within the context of developmentally appropriate adolescent health care has the potential to assure that adolescents’ health issues are addressed.
Acknowledgments This work was supported by the Agency for Health care Research and Quality 1 R03 HS016021-01.
References [1] Park MJ, Brindis CD, Chang F, et al. A midcourse review of Healthy People 2010 critical health objectives for adolescents and young adults. J Adoles Healt 2008;42:329–34. [2] Mangione-Smith R, DeCristofaro AH, Setodji CM, et al. The quality of ambulatory care delivered to children in the United States. N Engl J Med 2007;357:1515–23. [3] Centers for Disease Control and Prevention. Division of Adolescent and School Health: Health Resources and Services Administration, Maternal and Child Health Bureau, Office of Adolescent Health, National Adolescent Health Information Center University of California at San Francisco. Improving the Health of Adolescents and Young Adults: A Guide for States and Communities. Atlanta: Centers for Disease Control and Prevention, 2004. [4] Patton MQ. Qualitative Evaluation and Research Methods. Second Edition. Thousand Oaks, California: Sage, 1990. [5] Yang H, Stanton B, Li X, et al. Dynamic association between parental monitoring and communication and adolescent risk involvement among African-American adolescents. J Natl Med Assoc 2007;99: 517–24. [6] Ellis DA, Podolski CL, Frey M, et al. The role of parental monitoring in adolescent health outcomes: Impact on regimen adherence in youth with type 1 diabetes. J Pediatr Psychol 2007;32:907–17. [7] Nicoteri JA, Arnold EC. The development of health care-seeking behaviors in traditional-age undergraduate college students. J Am Acad Nurse Pract 2005;17:411–5. [8] McKee MD, Karasz A, Weber CM. Health care seeking among urban minority adolescent girls: The crisis at sexual debut. Ann Fam Med 2004;2:549–54. [9] Wildman BG, Stancin T, Golden C, et al. Maternal distress, child behaviour, and disclosure of psychosocial concerns to a paediatrician. Child Care Health Dev 2004;30:385–94. [10] Hutchinson JW, Stafford EM. Changing parental opinions about teen privacy through education. Pediatrics 2005;116:966–71.
Adolescent health brief
Parents and Health Care Professionals Working Together to Improve Adolescent Health: The Perspectives of Parents Carol A. Ford, M.D.a,b,*, Amy F. Davenport, M.P.H.a, Andrea Meier, Ph.D.c, and Annie-Laurie McRee, M.P.H.b a School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina c School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Manuscript received January 9, 2008; manuscript accepted June 26, 2008
b
Abstract
One proposed strategy to improve adolescent health and health care is to create working partnerships among adolescent health care professionals (HCPs) and families. In this pilot qualitative study we interviewed 17 mothers to explore their perceptions of the role of parents, HCPs, and parent–HCP partnerships in addressing adolescent health issues. Ó 2009 Society for Adolescent Medicine. All rights reserved.
Keywords:
Adolescent; Adolescent health services; Parenting education; Parent–child relations; Health care quality; Adolescent medicine
Introduction
Sample selection
Improvements in adolescent health and health care continue to be needed. A mid-course review of Healthy People 2010 objectives that are critical to adolescent health has revealed little or no improvement on most objectives [1]. A recent study of quality of ambulatory health care delivered to children in the United States revealed that documented adherence to indicated clinical services was lowest for adolescent preventive care [2]. One proposed strategy to improve adolescent health and health care is to create working partnerships among adolescent health care professionals (HCPs) and families [3]. The primary objective of this formative research was to explore parent perceptions of the roles of parents, HCPs, and parent–HCP partnerships in improving adolescent health and health care.
The goal of our sampling strategy was to recruit a diverse sample of parents of adolescent children in North Carolina (NC) with a recent health care visit. We selected eight clinical sites that primarily serve adolescent patients within the NC Multi-site Adolescent Research Consortium for Health (NC MARCH) primary-care based research network (PBRN) to purposefully assure diversity based on type of site (freestanding vs. school-based health center [SBHC]), region (coastal planes, piedmont, mountains), population density (urban, suburban, rural), and racial/ethnic characteristics; participants were recruited from these sites.
Methods This was an exploratory pilot project using qualitative methodology. The project was approved by the Institutional Review Board of the Office of Human Research Ethics at the University of North Carolina at Chapel Hill. *Address correspondence to: Carol A. Ford, MD, Associate Professor of Pediatrics and Internal Medicine, Director, NC MARCH, University of North Carolina at Chapel Hill, CB 7225, Chapel Hill, NC 27599-7225. E-mail address: [email protected]
Recruitment Procedures for recruiting parents varied depending on whether the clinic was free-standing or a SBHC, because parents were usually present in free-standing clinics and absent in SBHCs. Criteria for eligibility included being the mother or primary female caregiver to a child or adolescent 12–18 years of age living at home, recently seen by a health care provider and being able to communicate in English. In freestanding clinics, mothers or female adults who were present with a patient registering to be seen for any reason received written information about the study. If interested in participating, they were asked to complete a screening survey to
1054-139X/09/$ – see front matter Ó 2009 Society for Adolescent Medicine. All rights reserved. doi:10.1016/j.jadohealth.2008.06.017
192
C.A. Ford et al. / Journal of Adolescent Health 44 (2009) 191–194
determine eligibility and to provide contact information. Those eligible to participate were contacted by a member of the research team and invited to participate. In SBHCs, students registering to be seen for any reason were told about the study. If the student gave permission, clinic staff contacted the mother or primary female caregiver to discuss the study, to determine interest, and to determined eligibility. The clinic staff provided a list of eligible interested participants with contact information to the research team, who then recruited participants. The research staff obtained verbal informed consent from all participants, who received a $25 gift certificate from a statewide-department store at completion of the study. Interviews We initially planned focus groups; however two parents attended the first group and one parent attended the second, so we modified procedures and began conducting individual semi-structured telephone interviews. Focus groups followed standard procedures. The sessions were audio-taped and later transcribed, and the data were included in our study. Semistructured interviews followed standard procedures, with written notes recorded by the interviewer [4]. Content The content of the focus group and interview guides were designed to elicit and explore participants’ perspectives on the roles of parents, HCPs, and parent–HCP partnerships in improving adolescent health and health care. Guides were revised and finalized based on iterative review by parents. This study summarizes responses to the following questions: What can parents do to keep teens healthy and address health problems? What can HCPs do to keep teens healthy and address health problems? How can parents and HCPs work together to keep teens healthy and address health problems? Data analyses All data were reviewed independently by at least two members of the research team. We conducted content analyses and thematic coding using Atlas.ti to identify common and interesting themes.
What can parents do to keep teens healthy and address health problems? When asked what parents can do to keep teens healthy and address health problems, the most common themes reported by our participants included keeping teens busy and parental monitoring (Table 1). As one participant reported: We try to monitor their friends. We know how they look, and who they’re going out with. We try to pay attention to the way they act. If it doesn’t seem right, we have to pay attention.
Many participants discussed the importance of parent– teen communication. One-third discussed the importance of parents being able to ask for and accept help from HCPs when they needed it. What can HCPs do to keep teens healthy and address health problems? When asked what HCPs can do to keep teens healthy and address health problems, the most common theme focused on the importance of teenagers being able to openly communicate with clinicians (Table 2) so that HCPs get an accurate assessment of an adolescent’s behaviors and health. For example: My daughter might be able to talk to a doctor or a nurse, if she can’t talk to me. She might be able to talk to a doctor about anything and not feel stupid. They (doctors) have to be respectful, open to discussing rather than just discounting things. You run into doctors that won’t listen, or they just want to write a teenager off. They can’t have that kind of attitude. They need to see beyond the obvious. They have to be sure that they don’t shame the child or make them feel uneasy or bad. I don’t think at this point I have to worry about the sexual issues and stuff, but they (doctors) should be open, try not to be judgmental, but to guide the teen. Table 1 Parent perspectives: What parents can do to keep teens healthy and address health problems? (N ¼ 17) Theme
No. (%)*
Example
Monitor teen
10 (59)
Monitor what they do, eat, sleep, TV time; monitor their feelings, how they are behaving; monitor friends Keep them busy, involved in activities, scheduled Provide good food, opportunities for sports; provide health insurance; provide good example Talk, listen, give encouragement. Take to clinic, doctor, dentist; contact school nurse/nutritionist; parent may need help, might not know everything let kids hear from experts, support health/sex education in schools Ask questions, learn about adolescent health issues
Results
Keep teen busy
8 (47)
Participants
Provide something
8 (47)
Communicate Asks for/ accept help
8 (47) 6 (35)
Get informed
2 (29)
On average, participants had two children (mean 2.2, range one to four), and most (92%) of their children between 11 and 18 years of age had health insurance. Based on selfreport, 10 participants were black, five were white, and two were Latina. Their highest level of education was approximately evenly distributed between high school diploma (four participants), some college (four), and college graduation (six). Almost all participants (82%) were employed part- or full-time.
* Number (%) of participants who mentioned theme.
C.A. Ford et al. / Journal of Adolescent Health 44 (2009) 191–194
193
Table 2 Parent perspectives: Role of health care professionals (HCPs) (N ¼ 17) and parent-HCP partnerships Theme
No. (%)*
Example
‘‘What can HCPs do to keep teens healthy and address health problems?’’ Communication 6 (35) Sit down and listen to my child, don’t discount them, see beyond the obvious; be respectful, do not judge; don’t shame them; be respectful of privacy; have a sense of humor, be easy going and relaxed; find out things that are going on that parents might not know about Encourage/reinforce healthy behavior 5 (29) Tell them what they are doing right, when they are doing a good job Make referrals 3 (18) Tell me where I need to take my child Support primary prevention programs 3 (18) Become involved in primary prevention programs (e.g. support groups), give classes for teens Provide treatment 1 (5) Give medication ‘‘How can parents and HCPs work together.?’’ HCP–parent communication about individual children 12 (70) Let me know what is going on, what I need to worry about with my child without breaking confidentiality; what I need to be talking to my child about; discuss health education targeted to my child; let me ask questions HCP–parent health education and outreach programs 7 (41) General health education programs for parents, health fairs, go into schools and talk, talk with school boards, workshops for parents, classes, help-lines, internet bulletin boards * Number (%) of participants who mentioned theme.
A few participants explicitly commented that they thought it was helpful for clinicians to learn about things that parents might not know about but that might impact their child’s health. How can parents and HCPs work together? When asked how parents and HCPs can work together to keep teens healthy and address health problems, the clear majority (70%) of participants discussed parent–HCP communication (Table 2). Several parents discussed the importance of HCP taking the initiative in communicating with parents while also respecting the adolescent patients’ confidentiality. One participant stated: Keep an open line of communication (with the parent) as much as possible without breaking confidentiality. If the child wants their confidentiality, keep it, but if it’s not a confidential issue that they (doctor and parent) should let each other know what’s going on. Keep an open door there. Or encourage the child to talk to the parent if there is an issue. Basically, communication within reason and if the child does want confidentiality— encourage the child to talk to the parent.
Many parents, especially those recruited from SBHCs, suggested that HCPs’ give general adolescent health information to parents using public forums or information technology. Just get the word out. If doctors and nurses are in the schools and reach the parents, set up workshops with parents, workshops for the teens, getting people together and communicating like that.it could help.
Discussion New and novel ideas for improving partnerships between parents and adolescent health care professionals emerged from this exploratory study. First, mothers in this study
reported that many activities typically considered the ‘‘work of parenting’’ are an important part of parents’ roles in protecting adolescent health, such as parental monitoring, providing a positive role model, and working to keep parent– teen communication open. The value of HCPs’ explicitly acknowledging and encouraging parenting activities shown by research to improve adolescent health outcomes warrants further investigation [5,6]. Second, HCPs may have an important role in assisting parents to recognize when they should ask for help, and encouraging parental acceptance of help when offered. As one parent stated: The most important thing is that the parents do not fool themselves, that they don’t go around with their heads in the sand thinking ‘it can not happen to my child’. because it certainly can, even in the best of circumstances.
Research to increase our understanding of care seeking by parents on behalf of their adolescent children may lead to interventions that facilitate parents connecting their adolescent children to needed health care [7–9]. Third, communication between HCPs and parents of adolescents is clearly an area that warrants investigation. An increased understanding of parent–HCP communication within the developmental context of adolescent health may lead to parent–targeted interventions to improve use and quality of adolescent health services [10] as well as health outcomes. Our exploratory work suggests that this may be feasible for both routine and sensitive health issues, such as health issues related to sexual behaviors. Furthermore, our results suggest that it is worthwhile exploring strategies to communicate with parents both inside and outside of clinical settings Finally, nearly one-third of the mothers we talked with discussed the importance of HCPs recognizing and acknowledging what adolescents are doing well. Even though traditional medical care is typically problem focused, strategies for strengths-based counseling are emerging. The impact of
194
C.A. Ford et al. / Journal of Adolescent Health 44 (2009) 191–194
HCPs’ positively reinforcing adolescent characteristics and behaviors that promote health is of interest. There are important limitations to this small exploratory study. Results are not representative and should not be generalized. We have not conducted research to determine whether other mothers would have similar views or to explore barriers to parent–HCP partnerships. Our study is limited by exclusion of fathers, who may have different perspectives on parent and HCP roles in addressing adolescent health issues. Our study may also be limited by its focus on parents of children recently seen by a HCP, who may have different perspectives than parents of adolescent children who are not connected to health care. Finally, parents’ perspectives on parent–HCP partnerships may substantially differ from those of HCPs. Despite these limitations, our results begin to address an important gap in the existing literature. Creative strategies to align parents and HCPs in partnerships to improve adolescent health and health care are needed. Future research to better define the challenges and opportunities for parents and HCPs to collaboratively work within the context of developmentally appropriate adolescent health care has the potential to assure that adolescents’ health issues are addressed.
Acknowledgments This work was supported by the Agency for Health care Research and Quality 1 R03 HS016021-01.
References [1] Park MJ, Brindis CD, Chang F, et al. A midcourse review of Healthy People 2010 critical health objectives for adolescents and young adults. J Adoles Healt 2008;42:329–34. [2] Mangione-Smith R, DeCristofaro AH, Setodji CM, et al. The quality of ambulatory care delivered to children in the United States. N Engl J Med 2007;357:1515–23. [3] Centers for Disease Control and Prevention. Division of Adolescent and School Health: Health Resources and Services Administration, Maternal and Child Health Bureau, Office of Adolescent Health, National Adolescent Health Information Center University of California at San Francisco. Improving the Health of Adolescents and Young Adults: A Guide for States and Communities. Atlanta: Centers for Disease Control and Prevention, 2004. [4] Patton MQ. Qualitative Evaluation and Research Methods. Second Edition. Thousand Oaks, California: Sage, 1990. [5] Yang H, Stanton B, Li X, et al. Dynamic association between parental monitoring and communication and adolescent risk involvement among African-American adolescents. J Natl Med Assoc 2007;99: 517–24. [6] Ellis DA, Podolski CL, Frey M, et al. The role of parental monitoring in adolescent health outcomes: Impact on regimen adherence in youth with type 1 diabetes. J Pediatr Psychol 2007;32:907–17. [7] Nicoteri JA, Arnold EC. The development of health care-seeking behaviors in traditional-age undergraduate college students. J Am Acad Nurse Pract 2005;17:411–5. [8] McKee MD, Karasz A, Weber CM. Health care seeking among urban minority adolescent girls: The crisis at sexual debut. Ann Fam Med 2004;2:549–54. [9] Wildman BG, Stancin T, Golden C, et al. Maternal distress, child behaviour, and disclosure of psychosocial concerns to a paediatrician. Child Care Health Dev 2004;30:385–94. [10] Hutchinson JW, Stafford EM. Changing parental opinions about teen privacy through education. Pediatrics 2005;116:966–71.