title: Surveillance or Engagement: Children's Conflicts During Health Maintenance Visits.
abstract: School-aged health maintenance visits seek to prevent or intervene early with health issues of lifelong importance. Little is known about what children expect to happen in these visits or how they experience them, factors related to their engagement as active collaborators in care.
  
  
  
  Thirty children (53% Latino, 27% African-American, and 20% white) ages 7 to 11 years were video recorded during a health maintenance visit and then interviewed while reviewing the videos. Interview transcripts were analyzed for understanding the purpose of the visit, feelings of comfort and discomfort, and decisions about how much to participate.
  
  
  
  Children expected doctors to be helpful, caring, and a source of important information. They anticipated visits to include immunizations, a physical examination, and praise for accomplishments, but could be surprised by questions about behavior, family function, and lifestyle. During visits, feelings varied from warmth toward providers to embarrassment, wariness, irritation, and boredom. Even when bored or irritated, children hesitated to interrupt parent-provider conversations or correct perceived provider misunderstandings, not wanting to be seen as inappropriate or rude. When asked questions they considered off topic, likely to reveal sensitive information, or that could lead to changes in their lifestyle, some were silent or answered evasively. Some said they would have spoken more freely without their parent present but valued parental support and wanted parents to make important decisions.
  
  
  
  School-aged children's limited knowledge of what to expect in health maintenance visits, uncertainty about conversational norms with adults, and desire to assert control over their lives compete with their desire to access expert advice and form bonds with providers. Engaging children in health maintenance visits might require more relationship-building and education about the visit's goals.
authors.affiliation: Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md; Department of Pediatrics, Johns Hopkins Bayview Medical Center, Baltimore, Md. Electronic address: spolk@jhmi.edu.
authors.forename: Sarah
authors.initials: S
authors.lastname: Polk
authors.affiliation: Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, Md; The Johns Hopkins Hospital, Baltimore, Md.
authors.forename: Russell
authors.initials: R
authors.lastname: Horwitz
authors.affiliation: Center for Mental Health and Pediatric Primary Care, Johns Hopkins School of Public Health, Baltimore, Md.
authors.forename: Shaina
authors.initials: S
authors.lastname: Longway
authors.affiliation: Center for Mental Health and Pediatric Primary Care, Johns Hopkins School of Public Health, Baltimore, Md.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Bonilla
authors.affiliation: Center for Mental Health and Pediatric Primary Care, Johns Hopkins School of Public Health, Baltimore, Md.
authors.forename: Kate
authors.initials: K
authors.lastname: Fothergill
authors.affiliation: Department of Psychology, University of South Florida, Tampa.
authors.forename: Marc
authors.initials: M
authors.lastname: Karver
authors.affiliation: Department of Clinical Psychology, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Salmon
authors.affiliation: Center for Mental Health and Pediatric Primary Care, Johns Hopkins School of Public Health, Baltimore, Md.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Wissow
mesh_terms: D001741:Black or African American / Q000523:psychology; D001294:Attitude to Health / Q000208:ethnology; D002648:Child; D000067576:Child Health / Q000208:ethnology; D003142:Communication; D032882:Comprehension; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008484:Medicaid; D010290:Parents; D010372:Pediatrics; D010817:Physician-Patient Relations; D014481:United States; D014741:Video Recording; D044465:White People / Q000523:psychology
keywords: disclosure; mental health; primary care; psychosocial information; stimulated recall interview