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• W2910809205 abstract "Young women with depressive symptoms may have unique sexual health care needs that are not met by current clinic systems. The goal of this study was to identify facilitators and barriers to addressing pregnancy/STI risk among depressed young women in diverse clinic systems. We conducted in-person semi-structured qualitative interviews with 28 participants from seven diverse clinics in the New England region of the U.S., including community health centers, comprehensive health and social support programs, and a school-based health center. Participants represented varied clinic roles: behavioral health clinician (n=9), nurse practitioner (n=7), nurse (n=3), medical doctor (n=3), administrative associate (n=2), practice manager (n=2), family planning counselor (n=1), and medical assistant (n=1). Interview questions addressed how depression and sexual risk are identified and managed, and what facilitators and barriers affect the provision of ideal sexual health care to depressed young women. Interviews were audio-recorded and transcribed. Transcripts were coded by two members of the research team. Immersion/crystallization and template organizing approaches were used to identify themes across interviews. Themes were identified that represented facilitators of and barriers to providing sexual health care to high-risk depressed young women at five socioecological levels: patient, provider, clinic, organization/community, and society. At the patient level, facilitators of care included trust in providers (“I think it's important for the patients…[to] feel that they can relate to their providers because they'll be more comfortable talking to you…and open up to you more”) and patients’ motivation; barriers included the patient’s experiences of stigma and medical mistrust, and the adverse effects of the patient’s depression on executive function. Facilitators of care at the provider level included frequent patient-provider communication and providers’ comfort with the topic of sexual health; barriers included providers’ preconceptions about high-risk depressed young women, and lack of time in a clinic visit to build trust with the patient (“I don't think that's an adequate amount of time to address all of the issues that adolescents have, especially ones that are dealing with depression”). At the clinic level, facilitators of care included integration of care and use of a team-based care approach; barriers included lack of scheduling flexibility, and confidentiality and space constraints. Facilitators of care at the organization/community level included training and support for providers; barriers included a lack of support from clinic leadership and funding constraints (“I think that it all boils down to money”). At the societal level, facilitators of care included supportive policies and funding streams; barriers included policy and societal stigma about mental health and young women’s sexuality. Optimizing sexual health care to high-risk depressed young women necessitates attention to factors on all socioecological levels to remove barriers and bolster existing facilitators of care. Improving sexual health care for high-risk depressed young women through the integration of mental health care and sexual health care in clinic systems has the potential to improve sexual health care for all young women." @default.
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• W2910809205 date "2019-02-01" @default.
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• W2910809205 title "236. Facilitators And Barriers To Providing Sexual Health Care To High-Risk Depressed Young Women: A Qualitative Study of Diverse Clinic Systems" @default.
• W2910809205 doi "https://doi.org/10.1016/j.jadohealth.2018.10.253" @default.
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