Gaps in transitional care: what are the perceptions of adolescents, parents and providers?

BACKGROUND: Several studies have investigated preferences and experiences of adolescents with different chronic conditions and their parents. Some have included the provider's perspective. Studies comparing the three perspectives on satisfaction with (transitional) care for different chronic conditions, however, are lacking. The main aim of this paper was to explore differences and similarities in perspectives between adolescents with chronic conditions, their parents and providers on transitional care. A secondary aim was to explore the extent to which such perspectives are disease-specific. METHODS: This quantitative study included 127 adolescents with juvenile rheumatoid arthritis (JRA), neuromuscular disorder with chronic ventilation (NMD), or diabetes Type I; 166 parents; and 19 care providers. To assess the experiences and perceptions of adolescents and parents on transitional care, we used the 'Mind the Gap' instrument. The survey for providers included a checklist of shortcomings in transitional care. RESULTS: Adolescents rate current care significantly worse than parents on opportunities to make their own decisions and be seen without parents present. Adolescents also rated providers' current social skills lower than parents. Adolescents are more satisfied than their parents about transitional care process aspects such as co-ordination and communication between providers, but both groups indicated that the care process offers most room for improvement. Providers reported other aspects such as adolescents' lack of responsibility with regard to self-care and parents' difficulties with ceding control to their children. When looking at the three disease groups - JRA, NMD, diabetes, we found only small differences. According to providers, shortcomings in the care process with respect to guidelines, protocols and co-ordination are most prevalent. CONCLUSION: Adolescents, parents and providers all report that there is room for improvement with regard to aspects of the care delivery process in transitional care. With respect to disease-specific issues we only found small differences.

Determinants of the intention of preconception care use: lessons from a multi-ethnic urban population in the Netherlands.

OBJECTIVES: To investigate the determinants of the intention of preconception care use of women in a multi-ethnic urban population. METHODS: The ASE-model-a health behaviour model-was used as an explanatory framework. A representative sample was taken from the municipal population registers of two districts in Rotterdam, the Netherlands, 2009-2010. 3,225 women (aged 15-60 years) received a questionnaire, which was returned by 631: 133 Dutch, 157 Turkish and Moroccan, and 341 Surinamese and Antillean. Descriptive, univariate and multivariate analyses were performed. RESULTS: The multiple logistic analyses showed that intention to attend preconception care was significantly higher in women with a Turkish and Moroccan background (ß 1.02, P = 0.006), a higher maternal age (ß 0.04, P = 0.008) and a positive attitude (ß 0.50, P < 0.001). Having no relationship (ß -1.16, P = 0.004), multiparity with previous adverse perinatal outcome (ß -1.32, P = 0.001), a high educational level (ß -1.23, P = 0.03), having paid work (ß -0.72, P = 0.01) and experienced barriers level (ß -0.15, P = 0.003) were associated with less intention to use preconception care. CONCLUSIONS: Modifiable determinants as attitude and barriers can be addressed to enhance preconception care attendance.