Providing adolescent sexual health care in the pediatric emergency department: views of health care providers.
OBJECTIVE
The purpose of this study was to explore health care providers' (HCPs') attitudes and beliefs about adolescent sexual health care provision in the emergency department (ED) and to identify barriers to a health educator-based intervention.


METHODS
We conducted focused, semistructured interviews of HCPs from the ED and adolescent clinic of a children's hospital. The interview guide was based on the theory of planned behavior and its constructs: attitudes, subjective norms, perceived behavioral control, and intention to facilitate care. We used purposive sampling and enrollment continued until themes were saturated. Interviews were recorded and transcribed. Transcripts were analyzed using directed content analysis.


RESULTS
Twenty-nine interviews were required for saturation. Participants were 12 physicians, 12 nurses, 3 nurse practitioners, and 2 social workers; the majority (83%) were female. Intention to facilitate care was influenced by HCP perception of (1) their professional role, (2) the role of the ED (focused vs expanded care), and (3) need for patient safety. Health care providers identified 3 practice referents: patients/families, peers and administrators, and professional organizations. Health care providers perceived limited behavioral control over care delivery because of time constraints, confidentiality issues, and comfort level. There was overall support for a health educator, and many felt the educator could help overcome barriers to care.


CONCLUSIONS
Despite challenges unique to the ED, HCPs were supportive of the intervention and perceived the health educator as a resource to improve adolescent care and services. Future research should evaluate efficacy and costs of a health educator in this setting.
From the *Division of Emergency Medical Services, Children's Mercy Hospital, Kansas City, MO; †Pediatrics/Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; ‡Department of Psychology, University of Wisconsin, Stevens Point, WI; and §Department of Psychology and ∥School of Nursing, University of Missouri, Kansas City, MO.
Melissa K
MK
Miller
Cynthia J
CJ
Mollen
Donna
D
O'Malley
Rhea L
RL
Owens
Genevieve A
GA
Maliszewski
Kathy
K
Goggin
Patricia
P
Kelly
D000293:Adolescent; D001291:Attitude of Health Personnel; D003219:Confidentiality; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010564:Personnel, Hospital; D060728:Reproductive Health; D018456:Reproductive Medicine