Providers' Perspectives of Counseling Parents of Adolescents about Adolescent Preventive Health

Background: Most morbidity during adolescence is preventable. Despite national recommendations that providers counsel parents about adolescent preventive health, providers do so infrequently. Objective: To explore how providers' counsel parents about adolescent preventive health. Methods: Between June-October 2009, we conducted semi-structured interviews with physicians and nurse practitioners from pediatric and adolescent outpatient clinics at the University of Pittsburgh. Participants were recruited through departmental presentations, flyers, and email. Interviews lasted 1- 1.5 hours. Participants were compensated $100. Interview transcripts were analyzed using grounded theory and the constant comparison method. Results: Seven pediatric (86% female) and 6 adolescent (67% female) providers participated. All pediatric and 4 adolescent providers were physicians. General pediatrician and adolescent specialists struggled to counsel parents about adolescent preventive health topics during the brief time allotted for visits. Lack of patient-provider continuity and sporadic parental attendance at visits were described as additional barriers to counseling. Most providers reportedly select discussion topics based on prior knowledge about the family and visit type. General pediatricians were less comfortable providing reproductive health counseling compared to adolescent providers and preferred to refer these issues to adolescent providers. General pediatricians wanted additional training in counseling about sensitive issues and additional resources, like handouts and books, to send home with families. Conclusions: Requiring parental attendance at visits and encouraging continuity between individual providers and families should be a priority. Patient-provider familiarity will improve counseling delivery. Interventions should train pediatric providers in counseling adolescents about sensitive issues and educate all providers about resources available to families.