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Kenneth R. Ginsburg, MD, MSEd; Gail B. Slap, MD, MS; Avital Cnaan, PhD; Christine M. Forke; Catherine M. Balsley, EdD; Dionne M. Rouselle, MD

JAMA. 1995;273(24):1913-1918.

Abstract
Objective.
—To have adolescents, rather than adults, identify characteristics of health care providers and sites that affect their decision to seek care.

Design.
—Five stages conducted over a 10-month period: (1) focus groups to frame the study questions; (2) nominal group technique to generate student responses; (3) three surveys to assess response importance; (4) one survey to link the most important responses with the decision to seek care; and (5) focus groups to explain the variables associated with the decision to seek care.

Setting.
—The Philadelphia (Pa) School District.

Participants.
—The study population consisted of all ninth graders from 39 of Philadelphia's 42 public high schools. The 6821 students who returned the final survey comprised the study sample (69% of in-school youth).

Results.
—In the final survey, students used a Likert scale (1 to 5) to describe the impact of 31 ideas on their decision to seek care. The most important characteristics were provider hand washing, clean instruments, honesty, respect toward teens, cleanliness, know-how, carefulness, experience, seronegativity for the human immunodeficiency virus, equal treatment of all patients, and confidentiality. There was little variation in the order of the items by sex, race, or socioeconomic status. Factor analysis showed that the most important of four identified latent factors related to infection control and provider competency.

Conclusion.
—Four of the top 10 characteristics that affect an adolescent's decision to seek care involve cleanliness and infection control. These findings offer providers and planners straightforward, modifiable factors that teens believe influence their decision to seek care.

(JAMA. 1995;273:1913-1918)

Author Affiliations
From the Craig-Dalsimer Program in Adolescent Medicine, Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine (Drs Ginsburg, Slap, Rouselle and Ms Forke), Philadelphia; Section of Adolescent Medicine, Division of General Pediatrics (Drs Ginsburg and Slap), and Division of Biostatistics and Epidemiology, Department of Pediatrics (Dr Cnaan), Children's Hospital of Philadelphia (Pa); and the Office of Student Services, School District of Philadelphia (Pa) (Dr Balsley). Dr Rouselle is now with the Department of Obstetrics and Gynecology, University of Pittsburgh (Pa).

Footnotes
Dr Ginsburg is the recipient of the 1994 Young Investigator Award of the Society for Adolescent Medicine.

Reprint requests to the Section of Adolescent Medicine, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104 (Dr Ginsburg).

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