Barriers and facilitators to conducting adolescent health risk assessments in primary care

Adolescence represents an important time for prevention and early intervention of health issues, which if not addressed, could lead to chronic conditions in adulthood. Health risk assessments (HRAs) with adolescents improve health status, yet many barriers exist to conducting HRAs. This qualitative study examined factors that facilitate or hinder adolescent HRA administration. Focus groups with healthcare teams were audio-recorded, transcribed verbatim, and content analyzed with Atlas.ti. Sixty-five subjects participated in eight focus groups in four Florida cities. Provider, patient, parent, practice and process barriers and facilitators were found. Provider facilitators included communication style, comfort level discussing sensitive topics, and cultural competence. Patient characteristics that hinder HRAs included low literacy, low health literacy, constraints faced by younger adolescents, privacy concerns, and teen's general apathy towards health issues. Parental concerns about confidentiality and parents infringing on privacy were reported barriers. Process barriers included time constraints, slowed workflow, multiple or critical health issues, and conducting non-English HRAs. Process facilitators included reducing time constraints, information technology, culturally competent tools appropriate for teens, and billing systems to recoup costs. Practice barriers included clinic layout and pressure to return student patients to class. Practice characteristics that facilitate HRAs included experienced staff, longer appointment times, and access to appropriate resources. Long-term and close patient-provider relationships also facilitate HRAs. The use of HRAs in primary care can be expanded and improved by addressing barriers and facilitators to administration. Adolescent health interventions can potentially reduce risks for adult chronic diseases, thus improving health status and reducing healthcare costs.