Partnerships between parents and health care professionals to improve adolescent health.

INTRODUCTION: Research on partnerships between parents and health care professionals (HCPs) to improve adolescent health is limited. In this study, we have developed an empirically derived framework to guide research in this particular area. METHODS: We conducted a qualitative study using focus groups and in-depth semi-structured interviews. A total of 85 participants (51 HCPs, 17 mothers of patients of ages 12-18 years, and 17 adolescents) were recruited from three free-standing adolescent health clinics and five school-based health centers across North Carolina. We independently explored the perceptions of HCPs and mothers regarding the roles of parents, HCPs, and parent-HCP partnerships in preventing and addressing adolescent health problems. We then elicited feedback of adolescents on mother and HCP perceptions. We identified common and informative themes during content analysis using ATLAS.ti, and triangulated perspectives of HCPs, mothers, and adolescents to develop a framework for building parent-HCP partnerships to improve adolescent health. RESULTS: A general framework emerged that conceptualizes both direct and indirect strategies for building parent-HCP partnerships. Direct strategies involve strengthening relationships and/or communication between parents and HCPs in both practice and community settings. Indirect strategies involve opportunities for HCPs to influence parent-adolescent relationships and/or communication within the context of adolescent visits. For example, HCPs can discuss the importance of parental involvement and monitoring with adolescents, encourage and facilitate parent-adolescent communication, and deliver tailored parental guidance while also respecting adolescents' desires for confidential health care when appropriate. CONCLUSIONS: Interventions that directly strengthen parent-HCP relationships and/or communication, and those that indirectly support parent-HCP partnerships within the context of adolescent health care, should be designed targeting health outcomes.

Increasing adolescent vaccination: barriers and strategies in the context of policy, legal, and financial issues.

PURPOSE: To increase understanding of the policy, legal, and financial issues influencing efforts to achieve high rates of adolescent vaccination. METHODS: We conducted semistructured telephone interviews with 49 key informants in nine states, five jurisdictions, and at the national level. We elicited: (a) experiences with human papillomavirus (HPV) and meningococcal vaccine programs; (b) perspectives on policy, legal, and financing issues influencing adolescent vaccine program effectiveness; and (c) strategies to increase rates of adolescent vaccination. Common and informative themes were identified by content analyses. RESULTS: Participants reported that barriers to adolescent vaccination included: public concerns (insufficient knowledge, negative attitudes, safety concerns, controversy); practitioner concerns (insufficient knowledge or ambivalence about recommendations); delivery issues (insufficient access to or use of healthcare, vaccines not at healthcare site or part of routine care); minor consent issues; cost/financing issues; and lack of coordination in timing of vaccine recommendations, supply, and financing. Many barriers and promising strategies for overcoming them vary depending on adolescent age. For example, concerns about providing vaccines to prevent sexually transmitted diseases are less frequent with respect to older adolescents; issues of consent vary widely between 11 and 25 years of age; and financial barriers/potential solutions vary by age. We develop a framework to address policy, legal, and financial issues influencing adolescent vaccination based on adolescent age. CONCLUSIONS: A comprehensive description of factors influencing adolescent vaccination reveals variation based on age. A framework that incorporates this complexity may enhance strategies to increase rates of vaccine delivery to adolescent populations.

Parents and health care professionals working together to improve adolescent health: the perspectives of parents.

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.