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1.  Teenagers' views on the general practice consultation and provision of contraception. The Adolescent Working Group. 
BACKGROUND: The rate of unwanted pregnancies in adolescents in the United Kingdom (UK) is one of the highest in Europe and is a major reason for the RCGP's concern at the under-use of general practitioners' (GPs') contraceptive services by young people. AIM: To discover the attitudes of 15- to 16-year-olds to the GP consultation and contraceptive services. METHOD: Questionnaires were completed as part of an evaluation of a novel sex education programme in 30 schools in 1994, and provided the data for this study. A total of 4481 teenagers (51.6% male and 48.4% female completed the questionnaires in their classrooms under conditions of complete confidentiality. RESULTS: The median consulting rate per year was two for males and three for females. Over 60% of adolescents attended the consultation with a parent. Of the males, 27.5% 'felt that the discussion with their GP could be relayed to their parents against their wishes', as did 25.1% of the females. Other difficulties with GP appointments were identified as embarrassment (63% of females and 46% of males), difficulty getting a quick appointment (44% of both males and females), and an unsympathetic GP (32% of females and 20.5% of males). CONCLUSIONS: Adolescents identify significant factors blocking them from easy access to consultation with their GP. These included lack of trust in confidentiality, lack of staff friendliness, and delay in appointment. Consideration of how these blocks can be removed will assist in providing improved contraceptive services in primary care. General practices need to consider the above factors when providing contraceptive and other services to their teenage patients.
PMCID: PMC1409956  PMID: 9519517
2.  Barriers to education of overseas doctors in paediatrics: a qualitative study in South Yorkshire 
Archives of Disease in Childhood  2006;92(3):219-223.
Objective
To explore the factors that may influence the progress of doctors who come from the Indian subcontinent to train in paediatrics in the UK.
Methods
Overseas doctors training in paediatrics in Rotherham, Sheffield and Doncaster participated in the study. Focus groups were used to collect data; two focus groups, each with 4–5 participants, were conducted at 6‐week intervals. Semistructured, one‐to‐one interviews were conducted to add more understanding and depth to issues highlighted in the focus groups. The focus groups and interviews were audiotaped; the tapes were transcribed and data were analysed using the Grounded Theory; open codes were formed and concepts identified using microanalysis, and initial theories were built.
Results
Lack of information about the National Health Service (NHS)/Royal Colleges, inappropriate communication skills, difficulties in team working, difficulties in preparing for Royal College examinations, visa and job hunting, and social and cultural isolation were identified as major barriers. Problems arose not only from difficulties with language but also from use of local and colloquial words, different accents and difficulty in communicating sensitive issues. Lack of understanding of role in teams and difficulties in working in multiprofessional setting all contributed to the problems. Cultural differences inside and outside the workplace, and social isolation were also highlighted. Induction programmes, mentoring, awareness of the issues within the teams, and courses in communication specifically directed at overseas doctors were identified as means to overcome these barriers.
Conclusions
Several intercultural factors were identified that could act as barriers to the progress of overseas doctors training in paediatrics in the UK. Increased awareness of these factors within the teams would be the first step in resolving some of the issues.
doi:10.1136/adc.2006.098939
PMCID: PMC2083415  PMID: 16935914
3.  Contraceptive medicalisation, fear of infertility and teenage pregnancy in Brazil 
Culture, Health & Sexuality  2010;13(2):201-215.
In Brazil, as in many other countries, teenage pregnancy is widely recognised as a public health problem. Buttressed by a public health science of the economics of teenage pregnancy that emphasises the postponement of parenthood as key to poverty reduction, young people's lack of appreciation for medical knowledge of contraceptives is most often credited for failed attempts to reduce teenage pregnancy. Based on a longitudinal ethnographic study conducted in Pelotas, Brazil, with young people over the course of 10 years, our study found that young women who became teenage parents did not lack medical knowledge but were, rather, highly medicalised. Not only were they intensely concerned with the ill-effects of oral contraceptives on possible future fertility, they also engaged in intricate routines of contraceptive-use as a way of testing and safeguarding their fecundity. Our analysis attends to the way these practices are shaped by the problematisation of the economics of teenage pregnancy, as well as by the gendering of cultural norms relating to the transition to adulthood. We theorise the results by considering how contraceptive medicalisation enabled some women to engage with the authority of normative society, while developing a potent off-stage critique of this authority and of what they considered to be discriminatory messages imbedded in scientific discourses on teenage pregnancy.
doi:10.1080/13691058.2010.521576
PMCID: PMC3016605  PMID: 20972914
infertility; adolescent pregnancy; medicalisation; Brazil
4.  Contraceptive medicalisation, fear of infertility and teenage pregnancy in Brazil 
Culture, health & sexuality  2011;13(2):201-215.
In Brazil, as in many other countries, teenage pregnancy is widely recognised as a public health problem. Buttressed by a public health science of the economics of teenage pregnancy that emphasises the postponement of parenthood as key to poverty reduction, young people's lack of appreciation for medical knowledge of contraceptives is most often credited for failed attempts to reduce teenage pregnancy. Based on a longitudinal ethnographic study conducted in Pelotas, Brazil, with young people over the course of 10 years, our study found that young women who became teenage parents did not lack medical knowledge but were, rather, highly medicalised. Not only were they intensely concerned with the ill-effects of oral contraceptives on possible future fertility, they also engaged in intricate routines of contraceptive-use as a way of testing and safeguarding their fecundity. Our analysis attends to the way these practices are shaped by the problematisation of the economics of teenage pregnancy, as well as by the gendering of cultural norms relating to the transition to adulthood. We theorise the results by considering how contraceptive medicalisation enabled some women to engage with the authority of normative society, while developing a potent off-stage critique of this authority and of what they considered to be discriminatory messages imbedded in scientific discourses on teenage pregnancy.
doi:10.1080/13691058.2010.521576
PMCID: PMC3016605  PMID: 20972914
infertility; adolescent pregnancy; medicalisation; Brazil
5.  Computers in the consultation: the patient's view. 
BACKGROUND. The use of computers in general practice consultations is becoming widespread. AIM. A qualitative study was undertaken to determine how patients in one practice responded to the use of computers, and the issues which particularly concerned them when doctors used computers in the consultation. METHOD. Thirty patients whose age-sex characteristics were proportional to the age-sex distribution of one practice were selected to be interviewed within two weeks of a consultation. The interviews were taped, transcribed and analysed. RESULTS: Patients had seen or used computers in many other places and accepted their role in data management. Patients with more experience of computers were more aware of their limitations, particularly with regard to the possibility of loss of confidentiality. Patients did not think the use of a computer led to a loss of the personal touch in the consultation as long as verbal skills and eye contact were maintained. However, they did expect doctors using computers to have acquired computer skills. All but one patient said they wanted to see what was on the screen, although 11 did not know they had the right to read their notes on the screen. CONCLUSION. Patients regarded the use of computers by their doctors as normal and indicative of the doctors being up to date. Most respondents were concerned about possible loss of confidentiality. This concern, and their expressed preference for computer details to be visible and shared, pose challenges to doctors' technical and communication skills.
PMCID: PMC1238955  PMID: 8068397
6.  Young people's experiences of managing asthma and diabetes at school 
Archives of Disease in Childhood  2007;92(12):1077-1081.
Purpose
To examine the experiences and concerns of young people and their parents regarding the management of medication for asthma or diabetes whilst at school.
Methods
Face‐to‐face semi‐structured interviews were conducted with 69 young people aged 8–15 years (43 with asthma and 26 with diabetes) and their parents (138 interviews in total) in their own homes. Respondents were recruited through randomly selected general practice surgeries in contrasting areas in South East England. Interviews were audio‐recorded, transcribed verbatim and analysed using established qualitative analytical procedures.
Results
Young people with asthma and diabetes discussed difficulties regarding access to and use of their medicines at school which may jeopardise optimal condition management. School medicines policies could be a further hindrance. Young people endeavour to find ways to accommodate their medication and condition related needs whilst at school, in an attempt to limit the impact of their condition upon school activities such as sport, school trips and relationships with peers. Parents expressed concern regarding the awareness and levels of support available to their sons/daughters, in particular if a crisis should develop.
Discussion
In order to ensure optimal care, there is a need for the development of protocols tailored to the needs of young people with different conditions. These should preferably be devised in partnership between the young person, their parents and the school to ensure that the flexibility and support required for optimal management are offered.
doi:10.1136/adc.2006.110536
PMCID: PMC2066080  PMID: 17855440
7.  Abstinence and Teenagers: Prevention Counseling Practices of Health Care Providers Serving High-Risk Patients in the United States 
CONTEXT
Abstinence-only education has had little demonstrable impact on teenagers’ sexual behaviors, despite significant policy and funding efforts. Given the struggle over resources to improve teenagers’ reproductive health outcomes, the views of clinicians serving teenagers at high risk for unintended pregnancy and STDs merit particular attention.
METHODS
In 2005, a qualitative study with 31 clinicians serving low-income, at-risk patients was conducted. A semistructured interview guide was used to ask clinicians about adolescent pregnancy, HIV and STD prevention counseling, and when they include abstinence. Thematic content analysis was used to examine the content of the counseling and the techniques used in different situations.
RESULTS
Providers reported offering comprehensive counseling, presenting abstinence as a choice for teenagers, along with information about contraceptives and condoms. Several providers mentioned that with young, sexually inexperienced teenagers, they discuss delaying sexual activity and suggest other ways to be affectionate, while giving information on condoms. Providers explained how they assess whether teenagers feel ready to be sexually active and try to impart skills for healthy relationships. Some described abstinence as giving teenagers a way to opt out of unwanted sexual activity. Many support abstinence if that is the patient’s desire, but routinely dispense condoms and contraceptives.
CONCLUSIONS
Overall, providers did not give abstinence counseling as a rigid categorical concept in their preventive practices, but as a health tool to give agency to teenagers within a harm reduction framework. Their approach may be informative for adolescent policies and programs in the future.
doi:10.1363/4212510
PMCID: PMC2904609  PMID: 20618752
8.  Qualitative study of interpretation of reassurance among patients attending rheumatology clinics: “just a touch of arthritis, doctor?” 
BMJ : British Medical Journal  2000;320(7234):541-544.
Objectives
To examine commonly used methods of reassurance by clinicians and explore their effect on patients.
Design
Qualitative study of tape recordings of in-depth, semistructured interviews with patients before and after consultation and of their consultations with doctors.
Setting
NHS specialist rheumatology clinics in two large British cities.
Participants
35 patients selected by consultant rheumatologists from general practitioner referral letters (28 women, 7 men; 24 with inflammatory arthropathies, 11 other rheumatological complaints).
Main outcome measures
Patients' perceptions of reassurance.
Results
Reassurance was an important part of consultations, whether the diagnosis was clear or uncertain. Clinicians tried to reduce anxiety by emphasising the mildness, early stage, or non-seriousness of the disorder and the likelihood that patients would recover. Patients interpreted reassurance in the context of their own views and perceptions. Doctors' emphasis on the mildness or earliness of the condition raised the spectre of future pain and disability rather than providing reassurance. Patients who felt that their problems were properly acknowledged felt more reassured.
Conclusions
Typical patterns of reassurance were not successful because of the differences in perspective of patients and doctors. A key to successful reassurance seemed to be the doctor's ability to acknowledge patients' perspectives of their difficulties.
PMCID: PMC27296  PMID: 10688559
9.  Exploring stimulant treatment in ADHD: narratives of young adolescents and their parents 
BMC Psychiatry  2014;14:110.
Background
Young adolescents’ and their parents’ experiences with Attention-Deficit/Hyperactivity Disorder (ADHD) and its treatment were explored to investigate beliefs and attitudes regarding use of stimulant medication, and their influence on treatment decisions.
Methods
Using in-depth qualitative interviews, 12 adolescents with ADHD aged 12 – 15 years, and their parents described their experiences of ADHD and its treatment. Twenty four interviews, 12 with adolescents and 12 with their parents elicited detailed descriptions of beliefs about ADHD, attitudes about stimulant use and the circumstances surrounding treatment decisions. Verbatim transcripts were iteratively analyzed by a team of researchers following an interpretive interactionist framework.
Results
Young people offered three themes describing ADHD: 1) personality trait, 2) physical condition or disorder, and 3) minor issue or concern. Regarding medication use, youth described 1) benefits, 2) changes in sense of self, 3) adverse effects, and 4) desire to discontinue use. Parents’ beliefs were more homogeneous than youth beliefs, describing ADHD as a disorder requiring treatment. Most parents noted benefits from stimulant use. Themes were 1) medication as a last resort, 2) allowing the child to reach his or her potential; and 3) concerns about adverse and long-term effects. Families described how responsibility for treatment decisions is transferred from parent to adolescent over time.
Conclusions
Young adolescents can have different beliefs about ADHD and attitudes about medication use from their parents. These beliefs and attitudes influence treatment adherence. Incorporating input from young adolescents when making clinical decisions could potentially improve continuity of treatment for youth with ADHD.
doi:10.1186/1471-244X-14-110
PMCID: PMC3996107  PMID: 24725829
10.  Association Between Adolescent Pregnancy And a Family History of Teenage Births 
CONTEXT
The extent to which young women’s risk of adolescent pregnancy is associated with having a mother who was a teenage parent, a sister who was a teenage parent or both is not known.
METHODS
A sample of 127 Latina and black adolescent females completed in-depth surveys at three time points between 1994 and 2000. Logistic regression analyses were used to examine whether socioeconomic factors, mothers’ parenting characteristics and certain sibling relationship qualities explain the association between a family history of teenage births and young women’s risk of pregnancy.
RESULTS
Compared with young women with no family history of teenage births, young women whose sister had had a teenage birth and those whose sister and mother both had had teenage births were significantly more likely to experience a teenage pregnancy (odds ratios, 4.8 and 5.1, respectively). Young women who had only a sister who had had a teenage birth had greater odds of pregnancy than young women who had only a mother who had had a teenage birth (4.5). Having both a mother and a sister who had had teenage births was independently associated with an elevated risk of pregnancy (3.7), even after controlling for socioeconomic and mothers’ parenting characteristics. Frequent companionship with an older sister was associated with increased odds of teenage pregnancy (4.5); frequent conflict with an older sister who had had a teenage birth was marginally associated with decreased odds of the outcome (0.3).
CONCLUSION
Pregnancy prevention interventions targeting young women according to maternal and sibling teenage birth histories may be effective.
doi:10.1363/3910807
PMCID: PMC3766634  PMID: 17565624
11.  Positive experiences of teenage motherhood: a qualitative study 
Background: Teenage pregnancy is seen as a cause for concern in the United Kingdom (UK). However, there has been little research from primary care looking at teenage motherhood and its implications.
Aim: To investigate the experiences of teenage mothers in relation to their role as mothers and their expectations of their futures.
Design of study: Qualitative study.
Setting: East Devon, England.
Methods: Nine women who had conceived their first child while still a teenager agreed to participate. Semi-structured interviews were undertaken, audiotaped, transcribed, and analysed using interpretative phenomenological analysis.
Results: The women expressed positive attitudes to being mothers and described how it had affected their lives. For some, motherhood had been the impetus to change direction and consider a career, because they had someone else for whom they were responsible. They recognised that they were still young enough to enter further education or other aspects of employment as their children grew up.
Conclusions: For the women in this study, having been a teenage mother did not mean that their life and future were all over. Motherhood and bringing up children were valued in their own right. The women were realistic about their futures, often making plans to develop their careers.
PMCID: PMC1324913  PMID: 15527606
adolescent; parental age; qualitative research; teenage pregnancy
12.  Therapeutic identification of depression in young people: lessons fromthe introduction of a new technique in general practice 
The British Journal of General Practice  2012;62(596):e174-e182.
Background
Mild-to-moderate depression in young people is associated with impaired social functioning and high rates of affective disorder in adult life. Earlier recognition of depression in young people has the potential to reduce the burden of depression in adulthood. However, depression in teenagers is underdiagnosed and undertreated.
Aim
To assess the usability and usefulness of a cognitive-behavioural-therapy-based technique for Therapeutic Identification of Depression in Young people (TIDY).
Design and setting
A qualitative study of four group practices in northwest London.
Method
Face-to-face semi-structured interviews were conducted with practitioners who had been trained in the use of the TIDY technique.
Results
Twenty-five GPs and six nurses were interviewed. The key themes that emerged from the interviews were: practitioners were ‘making sense of teenage depression’ when interpreting signs and symptoms; the training in the technique was variable in its impact on practitioners' attitudes and practice; and time factors constrained practitioners in the application of the technique.
Conclusion
The TIDY technique is usable in routine practice, but only if practitioners are allowed to use it selectively. This need for selectivity arises partly from concerns about time management, and partly to avoid medicalisation of psychological distress in young people. The perceived usefulness of the TIDY technique depends on the practitioner's prior knowledge, experience, and awareness.
doi:10.3399/bjgp12X630061
PMCID: PMC3289823  PMID: 22429434
depression; general practice; intervention, psychological; screening; teenagers
13.  Thematic Analysis of Iranian Female Adolescents’ Perceptions About HIV/AIDS: A Qualitative Study 
Background:
HIV/AIDS continues to be a major global health problem. The aim of this study was to evaluate common opinions and beliefs about HIV/AIDS among Iranian teenager girls.
Methods:
This Qualitative study (face-to-face interviews with tape recording) was conducted among fifty female teenager school students in Urmia-Iran.
Results:
The thematic analysis indicated the main information sources for HIV/AIDS among teenage girls to be their mother and teachers. The participants had little concern about the dissemination of HIV/AIDS in Iran. Using a common syringe is mentioned as the main risk factor for HIV transmission. There were some misconceptions about the at-risk group among teenage girls.
Conclusions:
Considering the misconceptions among the teenage girls, their beliefs should be reformed and reorganized in order to reduce the risk of exposure to HIV. The best practice is training life skills in the school level.
PMCID: PMC3650602  PMID: 23671782
Girls; adolescents; HIV/AIDS; Iran; qualitative study
14.  Treatment Adherence in Paediatric Inflammatory Bowel Disease: Perceptions from Adolescent Patients and Their Families 
The objective of this study was to examine patient- and parent-perceived factors that impact adherence to inflammatory bowel disease treatment using a qualitative descriptive individual interview approach. Sixteen adolescents and their parents were recruited from May through August 2007 and interviewed about medication adherence using an open-ended semi-structured interview format. Interviews were audio recorded, transcribed, and coded into themes. Parent-child dyads identified forgetting, interfering activities, parent-child conflict and oppositional behaviour, and inadequate planning for treatment as challenges to adherence. Participants reported that family support and good parent-child relationships, routines, monitoring and reminding, and organizational tools such as pill boxes facilitated treatment adherence. Other issues that emerged included immediacy of treatment effects and parent-adolescent responsibility for treatment. Patients and parents experience a number of challenges related to adherence within behavioural, educational, organizational, and health belief domains. Behavioural interventions should focus on these issues, reduction of perceived barriers, and effective transition of responsibility for treatment adherence. Future research considerations are discussed.
doi:10.1111/j.1365-2524.2010.00951.x
PMCID: PMC3052867  PMID: 21143544
Adolescent Health; Bowel Disease; Compliance; Chronic Disease Management
15.  The GAMY Project: young people’s attitudes to genetics in the South Wales valleys 
The HUGO Journal  2011;4(1-4):49-60.
This paper explores young people’s attitudes to genetics. It describes a qualitative study involving a group of teenagers in a deprived South Wales valley town over a period of 18 months. The GAMY (Genetics and Merthyr Youth) Project involved a series of interactions with participants, including 2 interviews, 4 group days and 4 genetics tasks through which these young people learned about, and then reflected upon, issues relating to genetics and health. We have gathered data about the informed attitudes of teenagers to genetics based on deliberative learning and reflection over a long period of time, and as such this paper provides useful insights into the underlying values that are guiding young people’s views and the factors that are shaping their responses to new genetic technologies. Attitudes to genetics are complex and not easily generalisable. There were low levels of familiarity with, and knowledge of, genetics from the outset. Most young people did not have pre-existing attitudes towards genetics and had given little or no thought to the topic before the project began. However, levels of awareness and general genetic literacy increased as the project progressed. This study suggests that over time young people can develop an awareness of genetics that makes sense to them; they demonstrate that they can think creatively about genetics, and they are able to engage in considering genetic and other risk factors when thinking about health and disease.
doi:10.1007/s11568-010-9148-8
PMCID: PMC3051046  PMID: 22132064
Genetics; Health; Young people; Qualitative;  Deliberation
16.  Young women's decisions to accept chlamydia screening: influences of stigma and doctor-patient interactions 
BMC Public Health  2010;10:425.
Background
An understanding of the factors that encourage young women to accept, and discourage them from accepting, STI (sexually transmitted infection) testing is needed to underpin opportunistic screening programs for the STI Chlamydia trachomatis (opportunistic screening involves healthcare professionals offering chlamydia tests to people while they are attending health services for reasons that are usually unrelated to their sexual health). We conducted a qualitative study to identify and explore: how young women would feel about being offered opportunistic tests for chlamydia?; how young women would like to be offered screening, and who they wanted to be offered screening by?; and what factors would influence young women's partner notification preferences for chlamydia (who they would notify in the event of a positive diagnosis of chlamydia, how they would want to do this).
Methods
Semi-structured interviews with 35 young women between eighteen and twenty nine years of age. The study was conducted in the Dublin and Galway regions of the Republic of Ireland. Young adults were recruited from General Practice (GP) practices, Third Level College health services, Family Planning clinics and specialist STI treatment services.
Results
Respondents were worried that their identities would become stigmatised if they accepted screening. Younger respondents and those from lower socio-economic backgrounds had the greatest stigma-related concerns. Most respondents indicated that they would accept screening if it was offered to them, however; accepting screening was seen as a correct, responsible action to engage in. Respondents wanted to be offered screening by younger female healthcare professionals. Respondents were willing to inform their current partners about positive chlamydia diagnoses, but were more ambivalent about informing their previous partners.
Conclusions
If an effort is not put into reducing young women's stigma-related concerns the population coverage of Chlamydia screening might be reduced.
doi:10.1186/1471-2458-10-425
PMCID: PMC2918556  PMID: 20642845
17.  How can adolescents' health needs and concerns best be met? 
BACKGROUND: A previous survey of letters to 'agony aunts' revealed that adolescents have many concerns about their health. AIM: To discover the views of adolescents on a range of issues including the venues where they would like to be seen, the doctors they would like to consult, and the subjects they would like to discuss. METHOD: A questionnaire was distributed to adolescents in a variety of school settings and distributed through a popular teenage magazine. RESULTS: A total of 525 replies were received. Most adolescents had visited their general practitioner (GP) in the previous year. Most would prefer to see a teenage health specialist at a venue other than their local surgery, and to have the option of a 'drop-in' service. Responders were worried about a wide range of health issues. They had strong opinions on the type of doctor they would like to consult and the style of surgery they would prefer. Concerns were expressed about confidentiality. CONCLUSION: In the short term, surgeries could be made more 'user-friendly' for adolescents. In the longer term, the authors propose liaison between GPs and paediatricians with a special interest in teenage health to provide a confidential, combined youth service, with ideas on service development based on the expressed wishes of the adolescent population.
PMCID: PMC1410117  PMID: 9474826
18.  “There is such a thing as asking for trouble”: taking rapid HIV testing to gay venues is fraught with challenges 
Sexually Transmitted Infections  2007;83(3):185-188.
Objectives
To explore the feasibility and acceptability of offering rapid HIV testing to men who have sex with men in gay social venues.
Methods
Qualitative study with in‐depth interviews and focus group discussions. Interview transcripts were analysed for recurrent themes. 24 respondents participated in the study. Six gay venue owners, four gay service users and one service provider took part in in‐depth interviews. Focus groups were conducted with eight members of a rapid HIV testing clinic staff and five positive gay men.
Results
Respondents had strong concerns about confidentiality and privacy, and many felt that HIV testing was “too serious” an event to be undertaken in social venues. Many also voiced concerns about issues relating to post‐test support and behaviour, and clinical standards. Venue owners also discussed the potential negative impact of HIV testing on social venues.
Conclusion
There are currently substantial barriers to offering rapid HIV tests to men who have sex with men in social venues. Further work to enhance acceptability must consider ways of increasing the confidentiality and professionalism of testing services, designing appropriate pre‐discussion and post‐discussion protocols, evaluating different models of service delivery, and considering their cost‐effectiveness in relation to existing services.
doi:10.1136/sti.2006.023341
PMCID: PMC2659088  PMID: 17229791
19.  “Doctor, please tell me it’s nothing serious”: an exploration of patients’ worrying and reassuring cognitions using stimulated recall interviews 
BMC Family Practice  2014;15:73.
Background
Many patients who consult their GP are worried about their health, but there is little empirical data on strategies for effective reassurance. To gain a better understanding of mechanisms for effective patient reassurance, we explored cognitions underlying patients’ worries, cognitions underlying reassurance and factors supporting patients’ reassuring cognitions.
Methods
In a qualitative study, we conducted stimulated recall interviews with 21 patients of 12 different GPs shortly after their consultation. We selected consultations in which the GPs aimed to reassure worried patients and used their videotaped consultation as a stimulus for the interview. The interviews were analysed with thematic coding and by writing interpretive summaries.
Results
Patients expressed four different core cognitions underlying their concerns: ‘I have a serious illness’, ‘my health problem will have adverse physical effects’, ‘my treatment will have adverse effects’ and ‘my health problem will negatively impact my life’. Patients mentioned a range of person-specific and context-specific cognitions as reasons for these core cognitions. Patients described five core reassuring cognitions: ‘I trust my doctor’s expertise’, ‘I have a trusting and supporting relationship with my doctor’, ‘I do not have a serious disease’, ‘my health problem is harmless’ and ‘my health problem will disappear.’ Factors expressed as reasons for these reassuring cognitions were GPs’ actions during the consultation as well as patients’ pre-existing cognitions about their GP, the doctor-patient relationship and previous events. Patients’ worrying cognitions were counterbalanced by specific reassuring cognitions, i.e. worrying and reassuring cognitions seemed to be interrelated.
Conclusions
Patients described a wide range of worrying cognitions, some of which were not expressed during the consultation. Gaining a thorough understanding of the specific cognitions and tailoring reassuring strategies to them should be an effective way of achieving reassurance. The identified reassuring cognitions can guide doctors in applying these strategies in their daily practice.
doi:10.1186/1471-2296-15-73
PMCID: PMC4008437  PMID: 24762333
20.  Perceptions of Sexual Risk Compensation Following Posttrial HIV Vaccine Uptake Among Young South Africans 
Qualitative health research  2012;22(5):668-678.
Concerns about the impact of risk compensation on advances in biomedical Human Immunodeficiency Virus (HIV) prevention technologies have been documented. We conducted an exploratory qualitative study using focus group discussions with young South African men and women (aged 18–24 years) to explore perceptions of risk compensation among young South Africans with regard to a hypothetical posttrial HIV vaccine. During the discussions participants expressed their disquiet about the potential for risk compensation and the manner in which this might manifest among young people. Discussions specifically focused on reductions in condom use, an increase in multiple partners and increased frequency of sex. The discussions also indicated contradictory feelings about HIV vaccines: appreciation for their development tempered by concerns about loss of control and undermining morality. Women were particularly concerned with the possibility of increased partner concurrency and infidelity. We suggest that concerns in HIV vaccine target populations about the impact of possible risk compensation be incorporated into strategies to for vaccine introduction once vaccines move from the hypothetical to reality.
doi:10.1177/1049732311431944
PMCID: PMC3735355  PMID: 22218269
Adolescents/youth; Africa; South; behavior change; focus groups; HIV/AIDS prevention; immunization; risk; perceptions
21.  Teen Use of a Patient Portal: A Qualitative Study of Parent and Teen Attitudes 
We conducted a qualitative study of the attitudes of teens and parents toward the use of a patient portal. We conducted two teen and two parent focus groups, one teen electronic bulletin board, and one parent electronic bulletin board. Videotapes and transcripts from the groups were independently analyzed by two reviewers for significant themes, which were then validated by two other members of the research team. Twenty-eight teens and 23 parents participated in the groups. Significant themes included issues about teens' control of their own healthcare; enthusiasm about the use of a patient portal to access their providers, seek health information, and make appointments; and concerns about confidentiality. In summary, there was considerable support among teens and parents for a patient portal as well as concerns about confidentiality. The teen portal affords an opportunity to negotiate issues of confidentiality.
PMCID: PMC2556441  PMID: 18923702
access to care; patient portal; confidentiality of teen health services
22.  Paediatric medical outpatients: are all those reviews necessary? 
The value of and need for paediatric outpatient review attendance as perceived by parents, children, consultants, and general practitioners (GPs) were assessed. One hundred and ninety one parents of 239 children over 7 years of age undergoing review were randomly selected for a semistructured interview. For each parent interviewed, an audit questionnaire was completed after case note review by another paediatrician. A random sample of the patients' GPs was surveyed by postal questionnaire. Twenty per cent of parents and 26% of GPs felt that the GP could care for the child as well as or better than the hospital, whereas only 6% of consultants felt this to be so. Regarding future attendance of the child at the hospital, 48% of parents and 32% of GPs felt the child could either be discharged or seen when parents were worried, whereas consultants felt 24% of patients should have been discharged.
PMCID: PMC1063405  PMID: 8048818
23.  A qualitative assessment of perspectives on the inclusion of adolescents in HIV vaccine trials in South Africa 
International journal of STD & AIDS  2010;21(3):10.1258/ijsa.2009.008484.
Summary
Adolescents are at high risk for HIV acquisition, and thus need to be included in HIV vaccine trials. In preparation for inclusion of adolescents in HIV vaccine trials in an urban community in Cape Town with a high antenatal HIV prevalence, the study assessed the attitudes towards the inclusion of adolescents in HIV vaccine trials. A total of 18 focus group discussions were conducted using a semistructured interview guide. The participants (n = 200) were adolescents, young adults, parents and other key informants. Participants from all groups welcomed the inclusion of adolescents in HIV vaccine trials due to their high-risk status. There were, however, concerns about sexual disinhibition, fear of side-effects, fear of HIV testing and disclosure of HIV status, mistrust of nurses and clinics. The study highlighted a number of ethical and social issues that need to be addressed before the trials.
doi:10.1258/ijsa.2009.008484
PMCID: PMC3878910  PMID: 20215620
HIV vaccine trials; adolescents; community consultation; South Africa
24.  Trust, confidentiality, and the acceptability of sharing HIV-related patient data: lessons learned from a mixed methods study about Health Information Exchanges 
Background
Concerns about the confidentiality of personal health information have been identified as a potential obstacle to implementation of Health Information Exchanges (HIEs). Considering the stigma and confidentiality issues historically associated with human immunodeficiency virus (HIV) disease, we examine how trust—in technology, processes, and people—influenced the acceptability of data sharing among stakeholders prior to implementation of six HIEs intended to improve HIV care in parts of the United States. Our analyses identify the kinds of concerns expressed by stakeholders about electronic data sharing and focus on the factors that ultimately facilitated acceptability of the new exchanges.
Methods
We conducted 549 surveys with patients and 66 semi-structured interviews with providers and other stakeholders prior to implementation of the HIEs to assess concerns about confidentiality in the electronic sharing of patient data. The patient quantitative data were analyzed using SAS 9.2 to yield sample descriptive statistics. The analysis of the qualitative interviews with providers and other stakeholders followed an open-coding process, and convergent and divergent perspectives emerging from those data were examined within and across the HIEs.
Results
We found widespread acceptability for electronic sharing of HIV-related patient data through HIEs. This acceptability appeared to be driven by growing comfort with information technologies, confidence in the security protocols utilized to protect data, trust in the providers and institutions who use the technologies, belief in the benefits to the patients, and awareness that electronic exchange represents an enhancement of data sharing already taking place by other means. HIE acceptability depended both on preexisting trust among patients, providers, and institutions and on building consensus and trust in the HIEs as part of preparation for implementation. The process of HIE development also resulted in forging shared vision among institutions.
Conclusions
Patients and providers are willing to accept the electronic sharing of HIV patient data to improve care for a disease historically seen as highly stigmatized. Acceptability depends on the effort expended to understand and address potential concerns related to data sharing and confidentiality, and on the trust established among stakeholders in terms of the nature of the systems and how they will be used.
doi:10.1186/1748-5908-7-34
PMCID: PMC3428648  PMID: 22515736
Trust; Confidentiality; Acceptability; Health information exchanges; HIV; Patient data-sharing
25.  Strategies of Asian, Hispanic, and Non-Hispanic White Parents to Influence Young Adolescents’ Intake of Calcium-Rich Foods, 2004 and 2005 
Preventing Chronic Disease  2008;5(4):A119.
Introduction
Optimal intake of dietary calcium is critical to prevent osteoporosis later in life, yet most young adolescents do not consume the recommended amount. We describe parental strategies that can influence young adolescents' calcium intake in Asian, Hispanic, and non-Hispanic white households.
Methods
A qualitative research design employed semistructured individual interviews with a convenience sample of mostly female parents self-reported as Asian (n = 48), Hispanic (n = 44), or non-Hispanic white (n = 76) having a child aged 10 to 13 years at home. Interviews were conducted in homes or community centers in 12 states. Interview data were analyzed by using qualitative data analysis software and thematic content analysis procedures.
Results
Parents monitored calcium intake by making calcium-rich foods available, preparing calcium-rich foods, and setting expectations that children would consume calcium-rich foods. As mentors, parents encouraged intake of calcium-rich foods and advised children to moderate or increase intake of specific foods. Although parents perceived modeling of calcium intake as important, some were ambivalent about its effects. We noted minimal differences by racial/ethnic groups and sex of children in reported availability of selected calcium-rich foods at home, parental modeling of intake, and mentoring behaviors.
Conclusion
Our findings suggest that interventions to help parents increase children's intake of calcium should focus on types of foods made available, giving age-appropriate encouragement and advice, and modeling proper intake.
PMCID: PMC2578790  PMID: 18793507

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