Parental Knowledge and Attitudes of Confidential Sexually Transmitted Infections (STI) Services for Teens

Teens' access to confidential services for sexually transmitted infections (STI's) has been assured over time by privacy protections established through statutory and policy routes. Yet, the STI epidemic among youth persists, in part , because many STI's are largely asymptomatic, remain undetected and continue to be transmitted unknowingly. Also, many teens are reluctant to obtain STI services due to embarrassment, fear of disclosure, lack of knowledge about STI diagnosis/treatment, and confidential STI services. How do we bridge the gap between availability and apparent lack of utilization by teens in need of confidential services to prevent STI's and their long term sequelae? One strategy that has been overlooked is the engagement of parents in a partnership with the teen and the provider to effectively guide the developing adolescent towards becoming a responsible and confident adult consumer of health services, especially regarding STI prevention and care including confidential services. Before developing the parental component to a broad-based effort aimed at decreasing the STI rate, especially C. trachomatis, it is important to examine parental knowledge and attitudes towards confidential STI health services for teens and how these might influence parental intention to facilitate their adolescent's accessing appropriate preventive care for STIs. We propose a multi-method research design in 2 phases. Phase 1 comprises a qualitative format (focus groups and 1:1 semi-structured interviews) designed to yield data on parental knowledge and attitudes about confidential STI related health care services for teens. Findings from Phase 1 will then inform Phase 2, a quantitative cross-sectional survey of a random sample of ethnically diverse parents of 12-17 yo teens designed to examine the following questions. First, how does parental knowledge and attitudes about STI confidential care for teens vary according: (a) the adolescent's age and gender; and (b) the specific parental characteristics, e.g., gender, race/ethnicity, insurance status, education, religiosity. Secondly, how does parental knowledge and attitudes about confidential care for teens affect parental behavioral intentions to facilitate their teen's gaining knowledge and skills to be able to access STI preventive confidential services. This research would inform investigations how to strengthen the role of parents and encourage partnerships between health care providers and parents to ultimately improve the health outcomes for teens.

Hypotheses:

1. Parental knowledge of confidential care for adolescents will increase parental intention to facilitate confidential care
2. Parental knowledge of STI's will be positively associated with their perceptions of their teen's susceptibility to/ severity of STI
3. Parental knowledge or suspicion that their adolescent is having sex will be associated with perceptions that their teen is susceptibility to STIs
4. Parental knowledge of STI's and/or knowledge/ suspicion adolescent is having sex will be associated with parental intention to facilitate confidential care
5. Perceived susceptibility/severity of their teen to STI will be associated with a greater intention to facilitate confidential care
6. Perceived benefits of confidential care will be associated with an greater intention to facilitate confidential care
7. Perceived risks/barriers to confidential care (e.g., logistical/billing; busy practice, no policy/time for provider to see teen alone; perceived increase risky teen behavior due to such sexual health discussions) will be negatively associated with intention to facilitate confidential care
8. Perceived self-efficacy will be associated with an greater intention to facilitate confidential care
9. Past behavior/experiences regarding confidential care for parent and/or adolescent will be associated with intention to facilitate confidential care

Specific Aims:

i. To examine parental knowledge and attitudes of confidential health services related to STI care for adolescents

1. To examine how parental knowledge and attitudes of confidentiality regarding STI and related health care services vary according to parent characteristics
2. To examine how parental knowledge and attitudes of confidentiality regarding STI and related health care services vary according to child characteristics

ii. To examine how parental knowledge and attitudes toward confidential STI care affects the parent's behavioral intentions to support their adolescent's access to confidential care

iii. To identify key mechanisms that will form the basis of an intervention to improve parent-health care provider partnerships by giving parents knowledge and skills to help them facilitate their adolescent's access to confidential STI services as needed