"We Want You to Listen, Not Hear:" Youth Perceptions of Adult-Mediated Healthcare Experiences

Background and Purpose

Adolescence is characterized as a time of rapid growth and development and may be accompanied by a rise in risk-taking behavior and independence. Youth are particularly at risk for high levels of stress, decreased physical activity, unsafe sexual activity, abuse, depression, and suicide (Klein & Wilson, 2022). Considering the unique health risks adolescents face, healthcare service access and utilization can play a pivotal role in promoting positive long term health outcomes throughout adulthood. At the same time, adolescents must often rely on parents/caregivers to mediate their healthcare access. Understanding how adolescents perceive adult interactions within healthcare is important for developing interventions that increase youth access to healthcare. To contribute to future interventions, this study asked, How do youth describe mediated dynamics with adults when accessing healthcare?

Methods

We conducted nine focus groups (n=50) with youth aged 13-18 in a Western state during Summer 2022. We developed the focus group protocol using previous literature and guided by our research questions. All focus group facilitators completed a one-hour training on facilitating focus groups prior to conducting any focus groups. After receiving ethics approval from our institution, we recruited participants through email and social media. Focus groups ranged from 4-14 participants. Participants were given $30 gift cards and a box lunch. All focus groups were recorded and transcribed verbatim using Sonix. All transcripts were uploaded into Dedoose and the first author completed initial open coding focused on topic category (Gibbs, 2007). Next, the first author used axial coding which resulted in condensed and refined analytic codes (Wiliams & Moser, 2019). After this was completed, the second and third authors independently coded subsets of the data using the established initial codes. Together, the research team met weekly to develop themes from the codes, track progress, discuss analytic memos and resolve any coding conflicts.

Results

Participants described how adult-mediated healthcare interactions both enabled and constrained access to healthcare. In addition, they perceived adult-mediated healthcare interactions as supportive or unsupportive. Supportive themes included: candid trust from providers, validation from parents/caregivers, and open-ended questions from both providers and parents/caregivers. Youth perceived the following as unsupportive from both providers and parents/caregivers: minimizing healthcare needs, maintaining mental health stigma, and feeling unheard.

Conclusions and Implications

These findings suggest that providers and parents/caregivers may benefit from coaching and training in order to enact supportive roles for youth in healthcare settings. Social workers are well-positioned to provide short-term effective coaching strategies to parents/caregivers and healthcare providers across a variety of settings. This data, in concert with other research, may contribute to the development of an adult-focused intervention that aims to increase supportive environments for youth while they are accessing healthcare. In addition, this study provides additional context for social workers who work with youth in healthcare settings.