Interviewing techniques with adolescents in primary care

doi:10.1016/S1054-139X(96)00284-4

Journal of Adolescent Health

Volume 20, Issue 4, April 1997, Pages 300-305

https://doi.org/10.1016/S1054-139X(96)00284-4 Get rights and content

Purpose:

Privacy is of utmost concern to adolescents seeking advice regarding life-style and behavior choices. Lack of privacy and confidential health services are barriers to adolescents' access to health care. This study describes primary care physicians' practices with regard to inviting parent(s) to leave the room in order to interview the teen alone, and the factors associated with use of this technique.

Method:

A cross-sectional random survey of 1,630 pediatricians, internists, and family practitioners in a large metropolitan area was performed using a confidential mailed questionnaire.

Results:

The majority of the physicians were in private practice, male, board certified, Caucasian, and did not have a subspecialty. Forty-nine percent of the respondents “almost always” or“always” invite parent(s) to leave the room in order to interview the teen alone. Physicians who were female, board certified, and completed residency from 1974–94 were most likely to use this technique. Among physicians who frequently employ this strategy, the decision to interview the teen alone varied according to the clinical scenario. Using logistic regression analysis, only gender and board certification were significantly related to use of this interviewing method.

Conclusion:

A large proportion of physicians do not interview their adolescent patients alone, therefore, not affording them privacy to discuss confidential health concerns. Future research should focus on developing and validating methods to teach physicians skills to interview adolescents privately.

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Cited by (21)

Just between Us: An Integrative Review of Confidential Care for Adolescents
2018, Journal of Pediatric Health Care
Citation Excerpt :
Across studies, females and older adolescents were consistently more likely to report time alone with the provider (Denny et al., 2012; Gilbert et al., 2014; Klein et al., 1999). In a survey of pediatricians, internists, and family practice specialists (n = 1,630), 52% reported consistently spending some time alone with adolescent patients (Purcell, Hergenroeder, Kozinetz, Smith, & Hill, 1997). In a study of U.S. pediatric nephrologists (n = 66), 56% reported routinely (over 90% of the time) interviewing teens alone (Hergenroeder & Brewer, 2001).
Confidential care is recommended for all adolescents to facilitate risk behavior screening and discussion of sensitive topics. Only 40% of adolescents receive confidential care. The purpose of this integrative review is to describe research related to the practice of confidential care for adolescents. Evidence was analyzed to identify strategies to increase confidential care and improve risk behavior screening.
Whittemore and Knafl's integrative literature review process was applied.
The 26 research articles included in this review included patients', parents', and physicians' perspectives. Confidential care practice is inconsistent. Strategies to improve practice are known.
Four key elements should be considered to establish a practice culture of confidential care for adolescents. Strategies for implementing the key elements of confidential care and supporting resources for efficient use of time alone are provided.
Assessment and Identification of Deliberate Self-Harm in Adolescents and Young Adults
2012, Journal for Nurse Practitioners
Citation Excerpt :
Confidentiality and privacy should be emphasized with the caveat that certain types of behaviors such as child abuse or current suicidal intention must be reported. Purcell et al24 identified that a large portion of HCPs do not interview their patients in private. Given the correlation that DSH has with family dysfunction and abuse, the initial interview should be in private to reduce the risk of rebound abuse by a perpetrator.
Deliberate self-harm is a major public health concern among young people age 12-24 years old. Health care providers lack basic knowledge regarding the assessment and identification of deliberate self-harm, thus delaying recognition. Given the time restrictions and knowledge deficit of health care providers, a detailed physical, psychological, and psychosocial assessment is often excluded during well and acute visits. Using the evidence, this article outlines some guidelines to further providers' understanding of the essential components of assessment, which can enhance the identification of deliberate self-harm in the primary care setting.
Adolescent substance abuse confidentiality and consent
2002, Pediatric Clinics of North America
Adolescent girls' and boys' preferences for provider gender and confidentiality in their health care
1999, Journal of Adolescent Health
Purpose: To assess the influence of demographic variables and health risk status on adolescents’ preferences and actual receipt of services regarding provider gender, sharing a physician with parents, and private examinations.
Methods: Data from students participating in the Commonwealth Fund 1997 Survey of the Health of Adolescent Girls were analyzed. The weighted sample included 6748 students from grades 5-12. The influence of demographic variables and health risk status on preferences regarding physician gender, sharing a physician with parents, and parental presence during examinations and on actual physician gender, sharing a physician with parents, and receipt of confidential care was assessed for the 5067 students who indicated that they had a health check-up or physical examination within the past 2 years. Associations were examined using SAS to determine preliminary estimates of significance and correlation coefficients, and SUDAAN to generate proportions and Cochran Mantel-Haenszel Chi-squared values. A multiple logistic regression procedure in SUDAAN was used to assess interaction among demographic variables.
Results: Gender, race/ethnicity, grade level, and risk status were associated with preferences regarding provider gender and sharing a physician with parents. 50% of girls preferred a female provider; 48% had no preference. 23% of boys preferred a male provider; 65% had no preference. Most adolescents had no preference regarding whether they shared a physician with parents. Gender, race/ethnicity, grade level, and risk status were associated with preference regarding parental presence during examinations. Most younger girls preferred to have a parent present; most younger boys had no preference. Most older girls and boys preferred private examinations. For actual care situation, most adolescents were cared for by male health providers and did not share a physician with parents. 57% of girls and 66% of boys spoke privately with their health provider. Girls who had a female physician were more likely to have private time than were girls receiving care from a male physician. Gender, grade level, and risk status were associated with having private time with a physician.
Conclusions: Gender was a significant variable in adolescents’ preferences regarding health care. Preferences were also influenced by race/ethnicity, grade level, and risk status. A substantial proportion of adolescents, including those involved in health risk activities, report not having private time with their health provider.
Tips for clinicians
1999, Journal of Pediatric and Adolescent Gynecology
Adolescent pregnancy prevention in managed care
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: This project was supported in part by Ross Laboratories and Syntex Pharmaceuticals.

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Fellowship forumInterviewing techniques with adolescents in primary care

Purpose:

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J Adolesc Health

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Council on Scientific Affairs, American Medical Association: Confidential Health Services for Adolescents

JAMA

Confidentiality in health care. A survey of knowledge, perceptions, and attitudes among high school students

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Consent and confidentiality in adolescent health care

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Interviewing techniques with adolescents in primary care