Added: Brittania Carwile - Date: 10.02.2022 09:40 - Views: 48188 - Clicks: 1265
Try out PMC Labs and tell us what you think. Learn More. PURPOSE We wanted to explore the context of help seeking for reproductive and nonreproductive health concerns by urban adolescent girls.
Before the onset of sexual activity, most girls meet health needs within the context of the family, relying heavily on mothers for health care and advice. Many new needs and concerns emerge at sexual debut. Core values shaping these processes include privacy, a close relationship with the mother, and a perception of sexual activity as dangerous. No girl was able to meet her specific reproductive health needs within the mother-daughter relationship. Some find nonmaternal sources of personalized health care and advice for reproductive health needs, but many do not. Difficulty balancing these values often in inadequate support and care.
Adolescence is marked by the emergence of sexual behaviors that may lead to sexually transmitted infections STIstheir sequelae, and unplanned pregnancy. Reproductive health services promote sexual health by providing access to contraception, STI screening, and counseling. Despite the need for such services, many youth acknowledge considerable delay between the onset of sexual activity and initiation of risk-appropriate services 1, 2 and report missing needed care. Formal care seeking for reproductive health needs is apt to be influenced by informal care seeking and lay referral, yet studies of these processes, especially for vulnerable urban youth, have rarely been reported.
In this study we used in-depth interviews to understand the barriers related to seeking reproductive health care in inner-city adolescent girls by exploring sources of advice and strategies for seeking help. Participants were adolescent girls attending 2 Bronx, NY, public high schools serving a largely minority, multiethnic, low-income community.
All 65 young women in 5 classrooms were invited to participate, and 26 returned ed parental consents. Those present on interviewing days 22 of 26 furnished an informed consent before being interviewed privately, in English or Spanish, by 1 of 2 trained female, ethnic minority research assistants.
Consistent with our approval from the Board of Education, detailed notes were taken, with transcripts typed immediately to obtain nearly verbatim records. To understand the familial and social context of illness and care seeking, data were collected on both nonsexual and sexual health needs.
Participants generated narratives on 3 types of health problem: pain, a cold, and a reproductive health issue. Structured prompts were used to elicit narratives. Prompts were derived from the Illness Self Regulation Model, 8, 9 which provided a framework for systematic exploration of cause, consequence, timeline, course, prevention, and treatment for each health concern.
Additional prompts explored lay consultation, formal treatment seeking, and the rationale for each. The analysis team included the principal investigator a family physiciana psychologist coinvestigator, and a sociologist not involved in developing the study hypotheses or methods. The team underwent a reflexivity exercise 10 deed to expose preconceptions and expectations regarding findings.
The analysis focused on unmet need and variables contributing to or modifying it. Team members independently coded transcripts to identify themes. A tentative coding scheme emerged that included dimensions of the self-regulation model, such as cause, perceived consequences, and treatment seeking.
Coding differences were explored in group meetings. Once consensus was achieved, a final coding scheme was developed and applied using NVivo software QSR International Pty Ltd to facilitate the retrieval of text passages.
After coding 8 interviews, we developed a theoretical model comparing patterns of help seeking for girls who were successful in meeting their health needs with patterns for girls who were not. The fit of this model was tested and refined by exploration of the remaining 14 interviews, including an explicit search for disconfirming cases.
Three interviews were conducted in Spanish. Participants were in grades 9 through Fifteen reported that they had been sexually active.
A variety of health issues were described, including acute illnesses, orthopedic problems, grief, and puberty issues. For such problems, initial health seeking took place entirely within the family. I complained to my friend, but, you know, she could only tell me that she hoped I felt better. We found that the care and advice the mothers provided during illness was an important context for expressing highly valued closeness between mothers and daughters. Always my mom, not my dad. Privacy also emerged as a key value shaping how girls sought health advice and care.
Though providing reliable information may be important, me-care is valued because it provides much more than information. My mom is very interested in my health and she fixes me. Sexual debut is a crisis point for girls.
Faced with new needs, girls must find new sources of advice and care for reproductive health problems while continuing to protect the mother-daughter relationship. Girls used a variety of strategies in the context of important values of familism and privacy. Balancing the desired outcomes of privacy and relationship with mother and meeting reproductive health needs. A variety of new needs associated with sexual activity were described, including the need for information, screening, and family planning and the need for diagnosis and treatment of symptoms. Concern about harming the mother-daughter relationship reflected that girls were concerned with issues of social mobility.
She wants me to wait. She wants me to have the house … you know, the house, the husband, the 3. Despite the identification of mothers as the best sources of care and advice in general, girls were unable to turn to their mothers to meet reproductive health needs. Girls consistently used a strategy of selective disclosure of information related to sexual activity and the health needs associated with it. Though a few feared punishment, selective disclosure was more often used to avoid damaging familial relationships. Yet the girls felt ambivalent about selective disclosure. Most girls sought nonmaternal sources of advice for sexual health problems.
Commonly mentioned confidants included female friends, sisters, other female relatives, and occasionally other female adults. The qualities of a trusted confidant include a perceived ability to relate to the issue, a close relationship with the confidant, and privacy. By contrast, in a few cases, older female family members were important sources of advice.
She knows me … and she knows about pregnancy. Facing new needs, some girls turned to health care clinicians. The quality of these relationships varied substantially. Of sexually active girls, 6 of 15 had established close, trusting relationships. The qualities sought in professional caregivers were similar to the qualities valued of confidants and familial caregivers, including closeness, ability to relate, and privacy. We have things in common. She has teenage daughters. I think she communicates with me and most doctors should do that.
Unmet need was reported for 10 of the 15 sexually experienced girls in our sample. Among these are fears of pregnancy, infections, and infertility that were not addressed in health care settings, as well as inadequate birth control. Girls often reported intense distress associated with unmet need. I smoked, I drank, did not think about these things. I was unsure of what to do or how to treat my body. Of the 6 with close relationships, only 1 described a major unmet need—delay in evaluation for a feared STI.
By contrast, of the 9 girls who had no such relationships, all had ongoing unmet need. Interestingly, older girls aged 16 years or older were more likely to describe trusting relationships 6 of 9whereas none of the younger girls had such relationships. Patterns of care seeking, ly located within the family, shift dramatically at sexual debut.
Frightening new sexual health needs challenge ly established familial health-seeking strategies. Girls cope by being selective in disclosing information perceived to be harmful to family relationships, especially with their mothers, or to threaten privacy. Girls want personalized care modeled on the emotional and physical care received from their mothers.
They extend their search for this type of advice and care to mother alternatives, such as older female family members. Girls experienced their sexual health needs as intimately tied to personhood and individuality, to their emotional needs, and to their adult futures. Peers provide support but not adequate help, and relationships with health care clinicians are often absent or too shallow to be a source of the desired personalized care.
Those who find sources of personalized reproductive health advice and care, including trusting continuity relationships with health care clinicians, are able to address reproductive health needs. For those who fail to establish this type of relationship, sexual health needs are very likely to remain unmet. Tolman et al 17 recently published an ambitious effort to construct a comprehensive model of adolescent sexual health.
Her model moves away from an exclusive focus on risky sexual behavior and stresses the importance of gender norms in promoting or undermining sexual health. According to Tolman et al, encompassing the individual and relational aspects of sexuality are broader social and dominant cultural conceptions. These conceptions include the view of female sex as passive, devoid of desire, and subordinate to male needs.
Two decades later, the inner-city girls in our study focused on danger, and narratives describing pleasure were rare. We hypothesize that the urban girls in our study have internalized the safe sex message, ever more common in the era of AIDS acquired immunodeficiency syndromeas well as the fears of early pregnancy consistently heard from their mothers.
They remain essentially mired in negative constructions of female sexuality. The level of distress experienced by the young women in our sample related to reproductive health was striking. The pervasive view of sexual activity as dangerous warrants attention from clinicians. From this sample, it appears that awareness of the risks of unprotected sexual activity is very high.
In providing comprehensive care appropriate to the needs of young women, clinicians need to elicit the often unspoken fears related to reproductive health that are sources of distress and empower girls to manage the risk associated with sexual activity.
Future research should attempt to assess and quantify systematically the distress associated with unmet reproductive health needs and seek to identify not only predictors of distress but also effective strategies to minimize it. Limitations are introduced by the interview methods. That the interviews were not audiotaped perhaps resulted in less than exact reconstruction of the narrative; however, the interviewers used extensive notes and immediate transcription to minimize this limitation. About one third of our potential sample volunteered to participate.Seeking girls in need
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