What does it mean to be youth-friendly? Results from qualitative interviews with health care providers and clinic staff serving youth and young adults living with HIV

Parya Saberi, Kristin Ming, Carol Dawson-Rose, Parya Saberi, Kristin Ming, Carol Dawson-Rose

Abstract

Purpose: Given the consistent associations between younger age and numerous suboptimal clinical outcomes, there is a critical need for more research in youth living with human immunodeficiency virus (YLWH) and tailoring of health care delivery to the unique and complex needs of this population. The objective of this study was to examine the facilitators of and barriers to engagement in care among YLHW at the system and provider/staff level, as well as the barriers to using technology-based forms of communication with YLWH to improve retention and engagement in care.

Patients and methods: We conducted in-depth qualitative interviews with health care providers and staff members at the clinics and organizations serving YLWH in the San Francisco Bay Area.

Results: We interviewed 17 health care providers and staff members with a mean of 8 years of experience in providing clinical care to YLWH. Interviewees noted various facilitators of and barriers to engagement in care among YLWH, including the environment of the clinic (e.g., clinic location and service setting), provision of youth-friendly services (e.g., flexible hours and use of technology), and youth-friendly providers/staff (e.g., nonjudgmental approach). With regard to barriers to using technology in organizations and clinics, interviewees discussed the challenges at the system level (e.g., availability of technology, clinic capacity, and Health Insurance Portability and Accountability Act compliance), provider/staff level (e.g., time constraints and familiarity with technology), and youth level (e.g., changing of cellular telephones and relationship with provider/staff).

Conclusion: Given the need for improved clinical outcomes among YLWH, our results can provide guidance for clinics and institutions providing care for this population to enhance the youth-friendliness of their services and examine their guidelines around the use of technology.

Keywords: HIV; barriers; health care provider; technology; young adults; youth.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

References

    1. CDC HIV Among Youth. 2015. [Accessed February 16, 2018]. Avaiable from: .
    1. Zanoni BC, Mayer KH. The Adolescent and young adult HIV cascade of care in the United States: exaggerated health disparities. Aids Patient Care St. 2014;28(3):128–135.
    1. Gardner EM, McLees MP, Steiner JF, del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52(6):793–800.
    1. Horberg MA, Hurley LB, Klein DB, et al. The HIV care cascade measured over time and by age, sex, and race in a large national integrated care system. AIDS Patient Care STDS. 2015;29(11):582–590.
    1. Saberi P, Mayer K, Vittinghoff E, Naar-King S, Adolescent Medicine Trials Network for HIVAI Correlation between use of antiretroviral adherence devices by HIV-infected youth and plasma HIV RNA and self-reported adherence. Aids Behav. 2015;19(1):93–103.
    1. Fortenberry JD, Martinez J, Rudy BJ, Monte D, AIDS ATNH. Linkage to care for HIV-positive adolescents: a multisite study of the adolescent medicine trials units of the adolescent trials network. J Adolescent Health. 2012;51(6):551–556.
    1. MacDonell K, Naar-King S, Huszti H, Belzer M. Barriers to medication adherence in behaviorally and perinatally infected youth living with HIV. Aids Behav. 2013;17(1):86–93.
    1. United Nations Children’s Fund . Towards an AIDS-Free Generation– Children and AIDS: Sixth Stocktaking Report. New York, NY: UNICEF; 2013.
    1. Saberi P, Yuan P, John M, Sheon N, Johnson MO. A pilot study to engage and counsel HIV-positive African American youth via telehealth technology. Aids Patient Care St. 2013;27(9):529–532.
    1. Muessig KE, Nekkanti M, Bauermeister J, Bull S, Hightow-Weidman LB. A systematic review of recent smartphone, Internet and Web 2.0 interventions to address the HIV continuum of care. Curr HIV/AIDS Rep. 2015;12(1):173–190.
    1. Allison S, Bauermeister JA, Bull S, et al. The intersection of youth, technology, and new media with sexual health: moving the research agenda forward. J Adolescent Health. 2012;51(3):207–212.
    1. Schwandt TA. The SAGE Dictionary of Qualitative Inquiry. 4th ed. Los Angeles: SAGE; 2015.
    1. Burla L, Knierim B, Barth J, Liewald K, Duetz M, Abel T. From text to codings: intercoder reliability assessment in qualitative content analysis. Nurs Res. 2008;57(2):113–117.
    1. Strauss AL. Qualitative Analysis for Social Scientists. Cambridge; New York, NY: Cambridge University Press; 1987.
    1. Hayward J. Origin of ‘Obama phone’ was 1984 with goal of service to low-income Americans. Hum Events. 2012;68(38)
    1. Brittain AW, Williams JR, Zapata LB, Pazol K, Romero LM, Weik TS. Youth-friendly family planning services for young people: a systematic review. Am J Prev Med. 2015;49(2 Suppl 1):S73–S84.
    1. Alberti PM, Steinberg AB, Hadi EK, Abdullah RB, Bedell JF. Barriers at the frontline: assessing and improving the teen friendliness of South Bronx medical practices. Public Health Rep. 2010;125(4):611–614.
    1. French RS. The experience of young people with contraceptive consultations and health care workers. Int J Adolesc Med Health. 2002;14(2):131–138.
    1. Hayter M. Reaching marginalized young people through sexual health nursing outreach clinics: evaluating service use and the views of service users. Public Health Nurs. 2005;22(4):339–346.
    1. Perry C, Thurston M. Meeting the sexual health care needs of young people: a model that works? Child Care Health Dev. 2008;34(1):98–103.
    1. Brindis CD, Loo VS, Adler NE, Bolan GA, Wasserheit JN. Service integration and teen friendliness in practice: a program assessment of sexual and reproductive health services for adolescents. J Adolescent Health. 2005;37(2):155–162.
    1. Peremans L, Hermann I, Avonts D, Van Royen P, Denekens J. Contraceptive knowledge and expectations by adolescents: an explanation by focus groups. Patient Educ Couns. 2000;40(2):133–141.
    1. Russell ST, Lee FC. Practitioners’ perspectives on effective practices for Hispanic teenage pregnancy prevention. Perspect Sex Reprod Health. 2004;36(4):142–149.
    1. Shah DR, Galante JM, Bold RJ, Canter RJ, Martinez SR. Text messaging among residents and faculty in a university general surgery residency program: prevalence, purpose, and patient care. J Surg Educ. 2013;70(6):826–834.
    1. Kuhlmann S, Ahlers-Schmidt CR, Steinberger E. TXT@ WORK: pediatric hospitalists and text messaging. Telemed E Health. 2014;20(7):647–652.
    1. Drolet BC. Text messaging and protected health information what is permitted? JAMA. 2017;317(23):2369–2370.
    1. Smith AUS. Smartphone Use in 2015. 2015. [Accessed November 2, 2015]. Available from:
    1. Lenhart A. Teens. Social Media and Technology Overview 2015. 2015. [Accessed August 27, 2017]. Available from:
    1. Greenwood S, Perrin A, Duggan M. Social Media Update 2016. 2016. [Accessed October 16, 2017]. Available from:
    1. Lester RT, Ritvo P, Mills EJ, et al. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. Lancet. 2010;376(9755):1838–1845.
    1. Pop-Eleches C, Thirumurthy H, Habyarimana JP, et al. Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. AIDS. 2011;25(6):825–834.
    1. Smillie K, Van Borek N, van der Kop ML, et al. Mobile health for early retention in HIV care: a qualitative study in Kenya (WelTel Retain) Afr J AIDS Res. 2014;13(4):331–338.
    1. Smillie K, Van Borek N, Abaki J, et al. A qualitative study investigating the use of a mobile phone short message service designed to improve HIV adherence and retention in care in Canada (WelTel BC1) J Assoc Nursesin AIDS Care. 2014;25(6):614–625.
    1. Salesforce State of the Connected Patient. 2015. [Accessed February 24, 2015]. Available from: .
    1. Gros DF, Yoder M, Tuerk PW, Lozano BE, Acierno R. Exposure therapy for PTSD delivered to veterans via telehealth: predictors of treatment completion and outcome and comparison to treatment delivered in person. Behav Ther. 2011;42(2):276–283.
    1. Leon A, Caceres C, Fernandez E, et al. A new multidisciplinary home care telemedicine system to monitor stable chronic human immunodeficiency virus-infected patients: a randomized study. PLoS One. 2011;6(1):e14515.
    1. Morland LA, Raab M, Mackintosh MA, et al. Telemedicine: a cost-reducing means of delivering psychotherapy to rural combat veterans with PTSD. Telemed J E Health. 2013;19(10):754–759.

Source: PubMed

3
Subscribe