Understanding Primary Care Providers' Perceptions and Practices in Implementing Confidential Adolescent Sexual and Reproductive Health Services

Renee E. Sieving, Christopher Mehus, Marina Catallozzi, Stephanie Grilo, Riley J. Steiner, Pooja Brar, Janna R. Gewirtz O'Brien, Julie Gorzkowski, Kristen Kaseeska, Emily Denight Kelly, Jonathan D. Klein, Annie Laurie McRee, Lia Randazzo, John Santelli

Research output: Contribution to journalArticlepeer-review


Purpose: Substantial gaps exist between professional guidelines and practice around confidential adolescent services, including private time between health-care providers and adolescents. Efforts to provide quality sexual and reproductive health services (SRHS) require an understanding of barriers and facilitators to care from the perspectives of primary care providers working with adolescents and their parents. Methods: We conducted structured qualitative interviews with a purposive sample of pediatricians, family physicians, and nurse practitioners (n = 25) from urban and rural Minnesota communities with higher and lower rates of adolescent pregnancy. Provider interviews included confidentiality beliefs and practices; SRHS screening and counseling; and referral practices. Results: The analysis identified two key themes: (1) individual and structural factors were related to variations in SRH screening and counseling and (2) a wide range of factors influenced provider decision-making in initiating private time. A nuanced set of factors informed SRHS provided, including provider comfort with specific topics; provider engagement and relationship with parents; use of adolescent screening tools; practices, policies, and resources within the clinic setting; and community norms including openness with communication about sex and religious considerations regarding adolescent sexuality. Factors that shaped providers’ decisions in initiating private time included adolescent age, developmental stage, health behaviors and other characteristics; observed adolescent-parent interactions; parent support for private time; reason for clinic visit; laws and professional guidelines; and cultural considerations. Conclusions: Findings suggest opportunities for interventions related to provider and clinic staff training, routine communication with adolescents and their parents, and clinic policies and protocols that can improve the quality of adolescent SRHS.

Original languageEnglish (US)
Pages (from-to)569-575
Number of pages7
JournalJournal of Adolescent Health
Issue number4
StatePublished - Oct 2020

Bibliographical note

Funding Information:
This research was supported by Cooperative Agreement Number (U48DP005022-04-05; R. Sieving, PI) funded by the Centers for Disease Control and Prevention , Prevention Research Center Program and by funds from the Maternal and Child Health Bureau , Health Resources and Services Administration, U.S. Department of Health and Human Services ( T71MC00006 ; R. Sieving, PI).

Publisher Copyright:
© 2020 Society for Adolescent Health and Medicine

Copyright 2020 Elsevier B.V., All rights reserved.

Fingerprint Dive into the research topics of 'Understanding Primary Care Providers' Perceptions and Practices in Implementing Confidential Adolescent Sexual and Reproductive Health Services'. Together they form a unique fingerprint.

Cite this