Background: Confidentiality protections are a key component of high-quality adolescent sexual and reproductive health (SRH) care, but many adolescents do not receive confidential SRH care. We synthesize studies reporting perspectives and experiences of adolescents, parents, and providers to identify factors that may reflect barriers or facilitators to confidential SRH care.

Methods: Given the absence of literature explicitly examining confidentiality-related barriers and facilitators, we conducted a narrative review and identified factors that could be targets for intervention or inform priority intervention settings or sub-populations to improve confidential SRH care. We present themes relevant to adolescents, parents, and providers, addressing individual-level knowledge, attitudes, and behaviors as well as clinic-level characteristics.

Results: Adolescents, parents, and providers each had low knowledge of specific confidentiality protections, and providers reported inadequate training about confidentiality. Although studies indicate that adolescents value confidential care, evidence suggests some degree of discomfort regarding spending time alone with the provider. Parental attitudes on confidentiality were mixed with many valuing their child’s rights, but also believing providers should disclose confidential information to them. Both parents and adolescents value communication about confidentiality, but reported limited provider communication and assurances of confidentiality. Lack of clinic-level policies and protocols were an important theme. Additionally, time constraints, physical space, and billing may create barriers to confidential care.

Conclusions: These findings suggest that a triadic approach that addresses the roles and interactions between adolescents, parents, and providers, combined with efforts to address clinic-level factors, may be the most effective way to improve confidential SRH care.