Family Practice Vol. 17, No. 2, 156-158
© Oxford University Press 2000
Teenagers' views on general practice consultations and other medical advice
Department of General Practice, University of Wales College of Medicine, Llanedeyrn Health Centre, Llanedeyrn, Cardiff CF3 7PN,
a University of Exeter, Department of Child Health, Church Lane, Exeter EX2 5SW,
b 25 Middleway, Hampstead Garden Suburb, London NW11 6SH and
c Department of Community Child Health, Royal Free Hospital, Pond St, London NW3 2QC, UK.
Jacobson LD, Mellanby AR, Donovan C, Taylor B, Tripp JH and Members of the Adolescent Working Group, RCGP. Teenagers' views on general practice consultations and other medical advice. Family Practice 2000; 17: 156–158.
Received 4 May 1999; Revised 15 October 1999; Accepted 26 October 1999.
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Abstract |
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Background. The provision of health services for teenagers is of current interest in relation to primary care.
Objectives. The main objective of the study was to look at satisfaction with the teenager's last consultation and any reasons for dissatisfaction. A further objective was to look at common teenage health concerns to identify how many teenagers had been concerned about them, where they sought advice, and to look at ratings of this advice.
Method. Questionnaires were completed as part of a continuing evaluation of a novel sex education programme in 38 schools in 1997 and provided the data. The particular items reported in this study were related to satisfaction with the last GP consultation and reasons for dissatisfaction, health concerns and who (if anybody) was approached to address these concerns, and comments on services used. 5152 teenagers (51.8% male and 47.8% female) completed the questionnaires in a school lesson under conditions of complete confidentiality.
Results. Over 86% of adolescents were apparently satisfied with their last consultation with a GP, although several possible reasons were identified for any dissatisfaction. Health concerns were identified and sources of help were considered and compared; no obvious levels of relative dissatisfaction with services were noted. A large number of teenagers identified apparent concerns but did not seek help for these concerns.
Conclusions. Adolescents are largely satisfied with the services available in primary care. A number of teenagers do not seek help for their own individual concerns. Encouraging teenagers to attend when they perceive a health problem may help provide a more sensitive primary care service.
Keywords. Teenagers, GP consultations, primary care services.
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Introduction |
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Today there is much interest in teenage health and primary care services.1–3 Many reports of teenage opinions on services indicate that present services could be improved.4–10 It is suggested that ‘satisfied’ teenagers will use primary care services appropriately.1,7 This study was undertaken to look at levels of satisfaction with the teenager's last consultation, and at reasons for any dissatisfaction. This element can be regarded as comparative and follows data collected in a recently published study using similar methodology.10
No previous studies have looked at the comparative role of GP services, school nurse, clinics or ‘other’ services. A further aim of this study was to look at some teenage health problems and identify how many teenagers were concerned about them, where they sought advice, and to examine ratings of this advice.
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Method |
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Data have been collected from successive years of National Curriculum Year 11 students (age 15–16 years) from 1990 onwards evaluating a novel school sex education programme. This evaluation included the completion of a long questionnaire in a school lesson. The methodology has been consistent over many years, and has been described in detail elsewhere.10
The data in this study were collected from 5152 students aged 15–16 years during March and April 1997, 51.8% males and 47.8% females; 22 (0.4%) did not give their sex. The students were from 38 schools in rural, semi-urban and urban areas of England outside major conurbations. The data examined levels of satisfaction with the last GP consultation, and asked for reasons for any dissatisfaction. The questionnaire also looked at consultations with family doctors and others about a range of medical problems. The medical problems chosen reflect teenagers' own concerns; these included questions on spots/acne, diet, smoking, pregnancy and sexually transmitted diseases (STDs).1,4,6
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Results |
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One per cent of students were withdrawn from the questionnaire lesson, and 14% were not at school at the time of the questionnaire sessions, mostly due to other school activities. All gender comparisons reported are statistically significant (P < 0.001) using parametric statistics.
GP consultations
Most answered that it was easy to tell the doctor about their problem (82.4% overall), slightly more so for males (85.9%) compared with females (78.9%). Most (87.0%) answered that they were satisfied with the help or advice that they were given, 87.7% of males and 86.4% of females.
The two most common categories for dissatisfaction reported by the remaining 13% of the sample were insufficient information provided by the GP and lack of improvement in the condition following the consultation, together comprising more than half the dissatisfaction for both genders. Other reasons given were perceived lack of care (9% of males and 22% of females), embarrassment (1% of males and 3% of females) or a consultation with a male doctor (1% of the female sample).
Specific health problems
Nearly 50% of individuals reported at least one health concern, more females than males (58.0 and 42.3%, respectively). Most (63%) expressed worry over one item only. The most common overall concern related to skin/acne (>30% of males and females). The second was diet, a major concern for 9.6% of males and 28.4% of females. Overall, pregnancy was the third major concern, affecting 6% of males and 23.3% of females. Smoking was a concern for nearly 10%, slightly more males (11.2%) than females (8.2%). Finally, STDs were a worry for just over 9% of both sexes. Table 1
gives the responses from those who identified problems to where, if anywhere, they looked for help.
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Respondents were asked to give ratings along four-point Likert-like scales for any help received. Table 2
lists the ‘good’ and ‘very good’ responses for each service used. A small proportion did not make any comment on the services they had used.
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Discussion |
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These results support previous findings that most teenagers are satisfied with the help and advice they receive, particularly in general practice consultations. Relatively few teenagers were withdrawn by parents; proportions of absent teenagers are similar to previous similarly conducted studies.10,11 The study clearly reflects opinions given by a large number of teenagers in rural, semi-rural and urban areas of England outside major conurbations.
The level of dissatisfaction seen in this study of <14% compares favourably with previous reported levels of 20% of teenage respondents in other studies.1,2,4–7,12 There is no obvious explanation for this finding, although 14% dissatisfaction is still higher than the usual reported figure of 10% for adult patients.13 A lack of information, and perceived lack of care (especially as reported by females) figure highly as sources of dissatisfaction with GP consultations.
Nearly 50% of teenagers reported at least one health concern, and many did discuss these concerns with someone. The majority attended their GP, although pregnancy concerns were often dealt with through a clinic. Most were satisfied with the care they received from the GP, school nurse, clinic or ‘other’ sources of primary care. Nonetheless, many teenagers who identified health worries did not seek help from available services, in particular many with concerns over sexual health. This has worrying implications for health service aims to improve teenage health in general, and sexual health in particular.1–3,14
An aim of primary care should be to encourage attendance for all teenagers when they have health concerns. This study suggests that there is a continuing need to change teenagers' perceptions and skills as well as improving services. This suggests further investigation to discover how to make primary care services sensitive to requests for appropriate information from teenagers with health concerns.
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References |
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1 Jacobson L, Wilkinson C. A review of teenage health: time for a new direction. Br J Gen Pract 1994; 44: 420–424.[Web of Science][Medline]
2
Macfarlane A, Macpherson A. Primary health care and adolescence (editorial). Br Med J 1995; 311: 825–826.
3
Walker Z, Townsend J. The role of general practice in promoting teenage health: a review of the literature. Fam Pract 1999; 16: 164–172.
4 Bewley B, Higgs R, Jones A. Adolescent patients in an inner London general practice: their attitudes to illness and health care. J R Coll Gen Pract 1984; 34: 543–546.[Web of Science][Medline]
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Macfarlane A, McPherson A, McPherson K, Ahmed L. Teenagers and their health. Arch Dis Child 1987; 62: 1125–1129.
6 Epstein R, Rice P, Wallace P. Teenagers' health concerns: implications for primary health care professionals. J R Coll Gen Pract 1989; 39: 247–249.[Web of Science][Medline]
7 Jacobson L, Wilkinson C, Pill R, Hackett P. Communication between teenagers and British general practitioners: a preliminary study of the teenage perspective. Ambul Child Health 1996; 1: 291–301.
8 Kari J, Donovan C, Li J, Taylor B. Adolescents' attitudes to general practice in North London. Br J Gen Pract 1997; 47: 349.
9 Donovan C, Mellanby A, Jacobson L, Taylor B, Tripp J. Members of the Adolescent Working Party, RCGP. Teenagers' views on the GP consultation and their provision of contraception. Br J Gen Pract 1997; 47: 715–718.[Web of Science][Medline]
10 Jones R, Finlay F, Simpson N, Kreitman T. How can adolescents' health needs and concerns best be met? Br J Gen Pract 1997; 47: 631–634.[Web of Science][Medline]
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Mellanby A, Phelps F, Crichton N, Tripp J. School sex education: an experimental programme with educational and medical benefit. Br Med J 1995; 311: 414–417.
12 Balding J. Young People in 1987. Exeter HEA Schools Health Education Unit, University of Exeter, 1988.
13 Rees Lewis J. Patient views on quality in general practice: literature review. Social Sci Med 1994; 39: 655–670.
14
Jacobson L, Wilkinson C, Pill R. Teenage pregnancy in the United Kingdom in the 1990s: the implications for primary care. Fam Pract 1995; 12: 232–236.
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