title: Accessing General and Sexual Healthcare: Experiences of Urban Youth.
abstract: Urban adolescents face many barriers to health care that contribute to health disparities in rates of sexually transmitted infections (STIs) and unintended pregnancy. Designing interventions to increase access to health care is a complex process that requires understanding the perspectives of adolescents. We conducted six focus groups to explore the attitudes and beliefs about general and sexual health care access as well as barriers to care among urban, economically disadvantaged adolescents. Participants first completed a written survey assessing health behaviors, health care utilization, and demographics. The discussion guide was based on the Theory of Planned Behavior and its constructs: attitudes, subjective norms, and perceived behavioral control. Transcripts of group discussions were analyzed using directed content analysis with triangulation and consensus to resolve differences. Fifty youth participated (mean age 15.5 years; 64% female; 90% African American). Many (23%) reported missed health care in the previous year. About half (53%) reported previous sexual intercourse; of these, 35% reported no previous sexual health care. Youth valued adults as important referents for accessing care as well as multiple factors that increased comfort such as good communication skills, and an established relationship. However, many reported mistrust of physicians and identified barriers to accessing care including fear and lack of time. Most felt that accessing sexual health care was more difficult than general care. These findings could inform future interventions to improve access to care and care-seeking behaviors among disadvantaged youth.
authors.affiliation: Emergency and Urgent Care, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, 64108 USA.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Miller
authors.affiliation: Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, USA.
authors.forename: Joi
authors.initials: J
authors.lastname: Wickliffe
authors.affiliation: Center for Fire, Rescue & EMS Health Research, National Development & Research Institutes, Overland Park, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Jahnke
authors.affiliation: Palliative Medicine, Children's Mercy Hospital, Kansas City, USA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Linebarger
authors.affiliation: Emergency and Urgent Care, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, 64108 USA.
authors.forename: Denise
authors.initials: D
authors.lastname: Dowd
keywords: Access; Adolescent; Evaluation; Health Care Disparities; Health Care Quality
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