173 - Adolescent Health Initiative: Investigating utilization, barriers, and improvements in care through community-based participatory research

Publication Number: 1162.173

Emily Shir Hall, Albert Einstein College of Medicine, Bronx, NY, United States; Maria Burdjalov, Albert Einstein College of Medicine, Bronx, NY, United States; Maura Gustin, Albert Einstein College of Medicine, Bronx, NY, United States; Lesley Coe, Albert Einstein College of Medicine, New York, NY, United States; Robinson Torres, Diego Portales University -, Santiago, Region Metropolitana, Chile; Jacqueline J. Segovia, Universidad Diego Portales, Santiago, Region Metropolitana, Chile; Jacqueline Zambrano, Universidad diego portales, santiago, Region Metropolitana, Chile; Nicolas Matías. Muñoz, Universidad Diego Portales, santiago, Region Metropolitana, Chile; Camila V. Bravo, Universidad Diego Portales, Las Condes, Region Metropolitana, Chile; Danitza E. Trujillo, Universidad Diego Portales (UDP), Santiago, Region Metropolitana, Chile; Vivian Kim, Albert Einstein College of Medicine, Boston, MA, United States; Rosy Chhabra, Montefiore Medical Center, Bronx, NY, United States

Background: Adolescents have unique healthcare needs, yet are under-prioritized in health systems. In Santiago, Chile, Community Health Centers (CHCs) lack integrated youth-centered services, contributing to issues with confidentiality, inaccessibility, and overall poor adolescent engagement. The Adolescent Health Initiative (AHI), a binational partnership between Universidad Diego Portales and Albert Einstein College of Medicine, applies community-based participatory research (CBPR) to co-design a sustainable, youth-centered care model.

Objective: To assess adolescent healthcare utilization, barriers, and preferences to design a new care model.

Design/Methods: AHI's 4 stage CBPR process involves focus group stakeholder mapping, survey creation and distribution, data analysis, and pilot program implementation. This cross-sectional descriptive study administered a 22-question survey to 115 students (grades 7-12) at two schools affiliated with CHCs.

Results: 53% of respondents relied on CHCs alone, and 23% in combination with private clinics. 84% had seen a provider in the past year, though 51% overall reported only receiving CHC services as necessary; only 26% reported routine check-ups (Fig. 1). Over half reported missing medical, mental health, or sexual and reproductive health (SRH) visits in the past year, citing school conflicts and forgetfulness as key causes. 50% expressed concern with confidentiality, especially relating to parental disclosure (Fig. 2). 30% reported prior sexual activity, yet only 9% of respondents overall received SRH services in the past year (50% of sexually active females and 40% of sexually active males). Adolescents are interested in integrated services-dental (64%), nutrition (56%), medical (51%), mental health (47%), SRH (32%)-and educational workshops. They reported convenient scheduling, greater privacy, and a nonjudgmental setting would increase CHC engagement. (Fig. 3).

Conclusion(s): Significant barriers persist in adolescent utilization of routine and preventive health services. SRH services remain underutilized, particularly among males, reflecting potential service gaps. Adolescents desire integrated, youth-centered services and education in medical care, mental health, SRH, and nutrition, delivered in confidential, nonjudgmental clinics with flexible scheduling. These findings highlight opportunities to strengthen engagement through extended clinic hours, confidentiality protocols, and educational workshops. These insights will drive AHI's pilot of a youth-centered primary care model through Santiago's CHCs, offering a scalable framework for transforming adolescent healthcare.

Types of services utilized by adolescents in the past year
Percentage of respondents who utilized each type of medical service in the past year. Most used services were medical (31.6%), mental health (12.0%), and sexual and reproductive health (9.4%).

Percentage of respondents with concerns about confidentiality, and the nature of their concerns
2a) Percentage of respondents who indicated yes, no, or unsure to the question "Do you have concerns about privacy and confidentiality at your CHC?" 50.4% of the respondents indicated they did have concerns. 2b) Percentage of respondents who indicated yes in 2a with each type of confidentiality concern, including fear of parental disclosure (64.9%), shared providers with family (28.1%), recognition by community providers (26.3%), and mistrust (21.1%).

Perceived importance of improving clinic qualities in promoting adolescent CHC utilization
Percentage of adolescent respondents who rated the importance of making changes in each of six categories to increase adolescent utilization of CHCs. Categories included non-judgmental staff, clinic design, convenient appointment scheduling, greater privacy and confidentiality, publicity of services, and community engagement. 68% of respondents indicated that improvements in privacy and confidentiality were "extremely important" in increasing adolescent CHC utilization. Ease and flexibility of appointment scheduling (50% "extremely important") as well as a respectful and non-judgemental environment (57% "extremely important") were also identified as high priorities.