Developing quality measures for adolescent care: validity of adolescents' self-reported receipt of preventive services.
ABSTRACT To demonstrate the feasibility of directly surveying adolescents about the content of preventive health services they have received and to assess the validity of adolescent self-reported recall.
Audiotaped encounters, telephone interviews, and chart reviews with 14-21 year olds being seen for preventive care visits at 15 pediatric and family medicine private practices, teaching hospital clinics, and health centers.
537 adolescents presenting for well visits were approached, 400 (75 percent) consented, 374 (94 percent) were audiotaped, and 354 (89 percent) completed telephone interviews either two to four weeks or five to seven months after their visits. Audiotapes were coded for screening and counseling across 34 preventive service content areas. Intraobserver reliability (Cohen's kappa) ranged from 0.45 for talking about peers to 0.94 for discussing tobacco. The sensitivity and specificity of the adolescent self-reports were assessed using the audiotape coding as the gold standard.
Almost all adolescents surveyed (94 percent) remembered having had a preventive care visit, 93 percent identified the site of care, and most (84 percent) identified the clinician they had seen. There was wide variation in the prevalence of screening, based on the tape coding. Adolescent self-report was moderately or highly sensitive and specific at two weeks and six months for 24 of 34 screening and counseling items, including having discussed: weight, diet, body image, exercise, seatbelts, bike helmet use, cigarettes/smoking, smokeless tobacco, alcohol, drugs, steroids, sex, sexual orientation, birth control, condoms, HIV, STDs, school, family, future plans, emotions, suicidality, and abuse. Self-report was least accurate for blood pressure/cholesterol screening, immunizations, or for having discussed fighting, violence, weapon carrying, sleep, dental care, friends, or over-the-counter drug use.
Adolescents' self-report of the care they have received is a valid method of determining the content of preventive health service delivery. Although recall of screening and counseling is more accurate within two to four weeks after preventive care visits, adolescents can report accurately on the care they had received five to seven months after the preventive health care visits occurred.
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ABSTRACT: BACKGROUND School-based health centers (SBHC) can provide equitable and comprehensive care for adolescents; yet, few studies have described how patterns of health service utilization differ among groups. The purpose of this study was to investigate differences in utilization and perceptions of SBHC care among adolescents.METHODS This study sample included 414 adolescent respondents to the Healthy Schools, Healthy Communities User Survey. Three outcome measures represented utilization of care, while 4 represented perceptions of care. Multivariate logistic regressions modeled the effects of user characteristics on outcome measures.RESULTSThere were few notable and significant differences in either utilization or perceptions of care, based on sociodemographic or health status characteristics.CONCLUSIONSSBHCs can eliminate differences in utilization based on sociodemographic characteristics. However, null findings show that they fall short in delivering comprehensive care to high-risk adolescents, and may not be capitalizing on opportunities to offer targeted services. Results showing positive perceptions of care suggest that adolescents would be amenable to additional counseling or education services offered at SBHCs. To foster positive health outcomes among adolescents, SBHC administrators should regularly evaluate their scope of services and support quality improvement efforts.Journal of School Health 08/2014; 84(8). DOI:10.1111/josh.12178 · 1.66 Impact Factor
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ABSTRACT: Although school health centers (SHCs) may improve access to reproductive health care services and contraception, published data on SHC service use and reproductive health impact are limited. Reproductive health indicators among students at four urban high schools in a single building with an SHC in 2009 were compared with students in a school without an SHC, using a quasi-experimental research design (N = 2,076 students, 1,365 from SHC and 711 from comparison school). The SHC provided comprehensive reproductive health education and services, including on-site provision of hormonal contraception. Students in the SHC were more likely to report receipt of health care provider counseling and classroom education about reproductive health and a willingness to use an SHC for reproductive health services. Use of hormonal contraception measured at various time points (first sex, last sex, and ever used) was greater among students in the SHC. Most 10th-12th graders using contraception in the SHC reported receiving contraception through the SHC. Comparing students in the nonintervention school to SHC nonusers to SHC users, we found stepwise increases in receipt of education and provider counseling, willingness to use the SHC, and contraceptive use. Students with access to comprehensive reproductive health services via an SHC reported greater exposure to reproductive health education and counseling and greater use of hormonal contraception. SHCs can be an important access point to reproductive health care and a key strategy for preventing teen pregnancy. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.Journal of Adolescent Health 03/2015; 56(3):338-44. DOI:10.1016/j.jadohealth.2014.10.269 · 2.75 Impact Factor