Abstract
Objectives
Confidential counseling is a critical condition of the healthcare quality in adolescent medicine. This study aimed at assessing knowledge, attitudes and practice of primary healthcare pediatricians and gynecologists regarding adolescents’ rights to confidentiality.
Methods
A cross-sectional study was conducted in a sample of 152 pediatricians and gynecologists who are employed at 13 primary healthcare centers in Belgrade, Serbia, in 2017–2018. Data were collected by a self-administered questionnaire purposefully constructed for this study. The questionnaire examined knowledge and attitudes toward adolescents’ right to confidentiality as well as whether participating physicians practice confidential health care with adolescents.
Results
Physicians scored 4 out of 7 on a knowledge scale, but they overall supported adolescents’ right to confidential health care (average attitude score was 71 out of 95). On average, physicians scored 21 out of 30 on practice of confidentiality scale. Multivariate analysis showed that better knowledge and stronger positive attitudes toward duty of confidentiality were associated with consistent practice of confidential health care.
Conclusions
Knowledge about adolescents’ rights to confidentiality and attitudes toward keeping adolescents’ information confidential influence the practice of providing confidential services.
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References
Ajzen I (1991) The theory of planned behavior. Organ Behav Hum Decis Process 50(2):179–211. https://doi.org/10.1016/0749-5978(91)90020-T
American Academy of Pediatrics (2016) Confidentiality protections for adolescents and young adults in the health care billing and insurance claims process. J Adolesc Health 58(3):374–377. https://doi.org/10.1016/j.jadohealth.2015.12.009
American Medical Association (2014) Code of medical ethics. opinion 5.055: confidential care for minors. American Medical Association, 2014. https://journalofethics.ama-assn.org/article/ama-code-medical-ethics-opinion-adolescent-care/2014-11. Accessed 20 Apr 2020
Armitage CJ, Conner M (2001) Efficacy of the theory of planned behaviour: a meta-analytic review. Br J Soc Psychol 40(4):471–499. https://doi.org/10.1348/014466601164939
Bartholomew TP, Carvalho T (2005) General practitioners’ competence and confidentiality determinations with a minor who requests the oral contraceptive pills. J Law Med 13:191–203. https://doi.org/10.1080/13548500601043467
Beeson T, Mead KH, Wood S et al (2016) Privacy and confidentiality practices in adolescent family planning care at federally qualified health centers. Perspect Sex Reprod Health 48(1):17–24. https://doi.org/10.1363/48e7216
Brittain AW, Briceno AC, Pazol K et al (2018) Youth-friendly family planning services for young people: a systematic review. Am J Prev Med 55(5):725–735. https://doi.org/10.1016/j.amepre.2018.06.010
Buljugic B, Bjegovic V, Santric M (2015) Patients’ rights in Serbia in comparison with EU practice: Biljana Buljugic. Eur J Public Health 25(suppl_3):ckv176-104. https://doi.org/10.1093/eurpub/ckv176.104
Carlisle J, Shickle D, Cork M, McDonagh A (2006) Concerns over confidentiality may deter adolescents from consulting their doctors. A qualitative exploration. J Med Ethics 32:133–137. https://doi.org/10.1136/jme.2004.011262
Coker TR, Sareen HG, Chung PJ et al (2010) Improving access to and utilization of adolescent preventive health care: the perspectives of adolescents and parents. J Adolesc Health 47:133–142. https://doi.org/10.1016/j.jadohealth.2010.01.005
Darroch J, Woog V, Bankola A, Ashford L (2016) Adding it up: costs and benefits of meeting the contraceptive needs of adolescents. Guttmacher Institute, New York
Delva W, Wuillaume F, Vansteelandt S et al (2007) Sexual behaviour and contraceptive use among youth in Balkans. Eur J Contracept Reprod Health Care 12:309–315. https://doi.org/10.1080/13625180701673855
Deneyer M, Devroey D, De Groot E et al (2011) Informative privacy and confidentiality for adolescents: the attitude of the Flemish paediatrician anno 2010. Eur J Pediatr 170(9):1159–1163. https://doi.org/10.1007/s00431-011-1427-4
Flanagan KF, Cunningham SD, Lewis JB et al (2019) Factors associated with pregnant adolescents’ access to sexual and reproductive health services in New York City. Sex Reprod Healthc 19:50–55. https://doi.org/10.1016/j.srhc.2018.12.003
Garside R, Ayres R, Owen MR et al (2000) General practitioners’ attitudes to sexual activity in under-sixteens. J R Soc Med 93(11):563–564. https://doi.org/10.1177/014107680009301103
Gilbert AL, McCord AL, Ouyang F et al (2018) Characteristics associated with confidential consultation for adolescents in primary care. J Pediatr 199:79–84. https://doi.org/10.1016/j.jpeds.2018.02.044
Godin G, Kok G (1996) The theory of planned behavior: a review of its applications to health-related behaviors. Am J Health Promot 11(2):87–98. https://doi.org/10.4278/0890-1171-11.2.87
Godin G, Bélanger-Gravel A, Eccles M, Grimshaw J (2008) Healthcare professionals’ intentions and behaviours: a systematic review of studies based on social cognitive theories. Implement Sci 3(1):36. https://doi.org/10.1186/1748-5908-3-36
Gore F, Bloem P, Patton GC et al (2011) Global burden of disease in young people aged 10–24 years: a systematic analysis. Lancet 377(9783):2093–2102. https://doi.org/10.1016/S0140-6736(11)60512-6
Harrison JA, Mullen PD, Green LW (1992) A meta-analysis of studies of the Health Belief Model with adults. Health Educ Res 7(1):107–116. https://doi.org/10.1093/her/7.1.107
Institute of Public Health of Serbia “Dr Milan Jovanović Batut” (2018) Health statistical yearbook of Republic of Serbia 2017. Belgrade, 2018
Irwin CE Jr, Adams SH, Park MJ et al (2009) Preventive care for adolescents: few get visits and fewer get services. Pediatrics 123:e565–e572. https://doi.org/10.1542/peds.2008-2601
Jaruseviciene L, Levasseur G, Liljestrand J (2006) Confidentiality for adolescents seeking reproductive health care in Lithuania: the perceptions of general practitioners. Reprod Health Matters 14(27):129–137. https://doi.org/10.1016/S0968-8080(06)27224-0
Jaruseviciene L, Lazarus JV, Zaborskis A (2011) Confidentiality and parental involvement in adolescent sexual and reproductive health care: a cross-sectional study of Lithuanian general practitioners. Scand J Public Health 39(5):484–491. https://doi.org/10.1177/1403494810396554
Jeremic Stojkovic V, Matejic B, Turza K (2018) Serbian primary care physicians’ perspectives on adolescents’ right to confidentiality in sexual and reproductive healthcare—a qualitative interview study. Fam Pract 36(3):317–324. https://doi.org/10.1093/fampra/cmy067
Jeremic Stojkovic V, Cvjetkovic V, Matejic B (2020a) Physicians’ attitudes toward adolescent confidentiality services: scale development and validation. Zdr Varst 59(2):99–107. https://doi.org/10.2478/sjph-2020-0013
Jeremic Stojkovic V, Matejic B, Cvjetkovic S, Gazibara T (2020b) Barriers to confidentiality protection in adolescent health care: a survey of Serbian primary healthcare paediatricians and gynaecologists. Central Eur J Paediatr 16(1):30–38. https://doi.org/10.5457/p2005-114.254
Lehrer JA, Pantell R, Tebb K, Shafer M (2007) Forgone health care among U.S. adolescents: Associations between risk characteristics and confidentiality concern. J Adolesc Health 40(3):218–226. https://doi.org/10.1016/j.jadohealth.2006.09.015
McKee MD, Rubin SE, Campos G, O’Sullivan LF (2011) Challenges of providing confidential care to adolescents in urban primary care: clinician perspectives. Ann Fam Med 9(1):37–43. https://doi.org/10.1370/afm.1186
Michaud PA, Jansen D, Schrier L et al (2019) An exploratory survey on the state of training in adolescent medicine and health in 36 European countries. Eur J Pediatr 178(10):1559–1565. https://doi.org/10.1007/s00431-019-03445-1
O’ Donnell L, O’ Donnell CR, Stueve A (2001) Early sexual initiation and subsequent sex-related risks among urban minority youth: the Reach for Health Study. Fam Plann Perspect 33:268–275. https://doi.org/10.2307/3030194
Pérez-Cárceles MD, Pereñiguez JE, Osuna E et al (2006) Primary care confidentiality for Spanish adolescents: fact or fiction? J Med Ethics 32(6):329–334. https://doi.org/10.1136/jme.2005.011932
Resnick MD, Litman TJ, Blum RW (1992) Physician attitudes toward confidentiality of treatment for adolescents: findings from the Upper Midwest Regional Physicians Survey. J Adolesc Health 13(7):616–622. https://doi.org/10.1016/1054-139X(92)90377-N
Resnick MD, Catalano RF, Sawyer SM et al (2012) Seizing the opportunities of adolescent health. Lancet 379(9826):1564–1567. https://doi.org/10.1016/s0140-6736(12)60472-3
Riley M, Ahmed S, Reed BD, Quint EH (2015) Physician knowledge and attitudes around confidential care for minor patients. J Pediatr Adolesc Gynecol 28:234–239. https://doi.org/10.1016/j.jpag.2014.08.008
Ross LF (1997) Health care decision-making by children: is it in their best interest? Hastings Cent Rep 27:41–45. https://doi.org/10.2307/3527717
Salter EK (2017) Conflating capacity & authority: why we’re asking the wrong question in the adolescent decision-making debate. Hastings Cent Rep 47(1):32–41. https://doi.org/10.1002/hast.666
United Nations (2015) General assembly resolution A/RES/70/1. Transforming our world, the 2030 agenda for sustainable development. [cited 2020 April 24]. http://www.un.org/ga/search/view_doc.asp?symbol=A/RES/70/1&Lang=E
World Health Organization (2018) Situation of child and adolescent health in Europe. WHO Regional Office for Europe. http://www.euro.who.int/__data/assets/pdf_file/0007/381139/situation-child-adolescent-health-eng.pdf?ua=1
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Ethics Committee of the University of Belgrade Faculty of Medicine, reference number: 29/VI-1) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Jeremic Stojkovic, V., Cvjetkovic, S., Matejic, B. et al. Adolescents’ right to confidential health care: knowledge, attitudes and practice of pediatricians and gynecologists in the primary healthcare sector in Belgrade, Serbia. Int J Public Health 65, 1235–1246 (2020). https://doi.org/10.1007/s00038-020-01454-8
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DOI: https://doi.org/10.1007/s00038-020-01454-8