Only about half of young people 13 to 26 years old in the United States report ever having time with their regular healthcare provider without a parent or someone else in the room, despite professional guidelines that recommend adolescents and young adults have access to confidential services and time for private discussions, according to a new study by researchers at Columbia University Mailman School of Public Health.
The findings, published in the Journal of Adolescent Health, a publication of the Adolescent Health Consortium (AHC), suggest that young people who report having private time or discussing confidentiality have more positive attitudes regarding their healthcare provider and clinical preventive services, including screening, counseling, and vaccinations.
“Discussing confidentiality and having private time with a provider are critical components of comprehensive clinical preventive services for young people, however about half of young people report never having had these with their provider,” said Ms. Stephanie Grilo, the article’s lead author and a doctoral candidate at the Columbia Mailman School. “Regular providers need to begin discussion of private time and confidentiality at earlier ages.”
Data were collected from 1918 adolescents and young adults through a 2016 national online survey. Respondents qualified if they were between the ages of 13 and 26 and spoke English or Spanish. Formative research conducted by Columbia University included focus group discussions with young people, parents, and health care providers.
The authors found that only 22 percent of 13- to 14- year old women and 14 percent of 13- to 14- year old men had ever had private time with a healthcare provider. Even among young adults, only about two-thirds of young adult women (68 percent) and men (61 percent) had ever experienced private time with their provider.
Of young women 13 to 26 years of age, 55 percent had reported ever having private time or having a discussion with their provider about confidentiality. For young men, these numbers were slightly lower, with 49 percent reporting ever having private time and 44 percent having discussed confidentiality. These percentages increased with age and higher income.
The receipt of private time was also impacted by the characteristics of providers; women providers were more likely to initiate patient discussions with young women but not necessarily with young men. The results also showed that young people who participated in risky behaviors – specifically, those who were sexually active – also reported higher percentages of receiving private time or discussing confidentiality. This suggests providers may be targeting adolescents and young adults who have initiated involvement in risk behaviors for private conversations.
The researchers also found that young people who previously received private time and/or had discussed confidentiality with their provider had more positive attitudes about their provider and clinical preventive services.
“The gap between clinical recommendations and practice means there is a need for education of parents, providers and adolescents on the importance of private time and confidentiality for adolescent and young adult care,” noted Ms. Grilo. “Private time and confidentiality can enhance preventive care for young people in the United States.”
Co-authors include: Dr. Marina Catallozzi, Dr. John Santelli, Ms. Hanying Yan, Ms. Jennifer Heitel, and Ms. Alexandra Dereix, Columbia Mailman School of Public Health; Dr. Xiaoyu Song, Icahn School of Medicine at Mount Sinai; Ms. Kristen Kaseeska, and Ms. Julie Gorzkowski, American Academy of Pediatrics; and Dr. Jonathan Klein, University of Illinois at Chicago College of Medicine.
The study was funded by the Merck Foundation.
The Adolescent Health Consortium is a collaboration to improve preventive healthcare for young people of four national medical societies: the American Academy of Pediatrics, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, and the Society for Adolescent Heath and Medicine, with researchers at Columbia University and the University of Illinois at Chicago. The project aims to improve parental, adolescent, and young adult awareness of the importance and value of preventive health care services for young people and also increase the number of young people who receive preventive healthcare services.