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      Changes in public attitudes towards confidential adolescent sexual and reproductive health services in Lithuania after the introduction of new legislation: findings from the cross-sectional surveys conducted in 2005 and 2012

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          Abstract

          Background

          In Lithuania, the right to confidentiality in healthcare for adolescents over the age of 16 was guaranteed in 2010 through the adoption of new legislation. This study sets out to explore changes in Lithuanian residents’ attitudes towards confidentiality protection in adolescent sexual and reproductive healthcare (SRH) by comparing data from surveys administered in 2005 and 2012.

          Methods

          For both surveys, the participants were random samples of the Lithuanian residents aged 16 to 74. A 23-item questionnaire was used in 2005 and complemented with 2 items in 2012. Linear regression analysis was employed to estimate absolute differences in prevalence of belief in whether or not adolescents would find confidentiality important when consulting a physician on SRH issues. A log-binomial regression model was fitted to estimate the relative changes (prevalence ratio) of the independent variables.

          Results

          The total number of respondents was 1054 (response rate 83 %) in 2005 and 1002 (response rate 80 %) in 2012. The proportion of respondents who reported a belief that adolescents would find confidentiality important when seeing a physician for SRH issues increased significantly from 62 % in 2005 to 73 % in 2012. Regardless of their belief in the importance of confidentiality, in 2012 respondents more often indicated positive outcomes on the relations between the physician and the minor patient, such as increased trust of the adolescent in the physician and more frequent visits to physicians. However, study participants who believed that adolescents would find confidentiality important in 2012 were less optimistic about potential positive outcomes of further legal consolidation of adolescents’ right to confidentiality than in 2005. Younger respondents were the most optimistic about potential outcomes if laws were enacted to further protect adolescent confidentiality.

          Conclusions

          This study uncovers the dynamics of public attitudes towards the socially and ethically sensitive issue of adolescent SRH. Our study suggests that legislation could be a factor prompting changes in public opinion, but not sufficient in and of itself for its social acceptance.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12913-015-1027-5) contains supplementary material, which is available to authorized users.

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          Most cited references25

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          Effect of mandatory parental notification on adolescent girls' use of sexual health care services.

          Mandatory parental notification for adolescents to obtain prescribed contraceptives is a controversial issue. Recently, legislation that would prohibit prescribed contraceptives for adolescents without parental involvement was introduced in 10 states and the US Congress. To determine the effect of mandatory parental notification for prescribed contraceptives on use of sexual health care services by adolescent girls. Girls younger than 18 years and seeking services at all 33 Planned Parenthood family planning clinics in Wisconsin (n = 1118) were surveyed during the spring of 1999. A response rate of 85% was achieved, yielding a sample of 950 girls. Percentages of girls who reported that they would stop using all sexual health care services, delay testing or treatment for human immunodeficiency virus (HIV) or other sexually transmitted diseases (STDs), or discontinue using specific (but not all) services because of parental notification. Fifty-nine percent (n = 556) indicated they would stop using all sexual health care services, delay testing or treatment for HIV or other STDs, or discontinue use of specific (but not all) sexual health care services if their parents were informed that they were seeking prescribed contraceptives. Eleven percent indicated they would discontinue or delay STD tests or treatment, even though the survey made it clear that mandatory parental notification would occur only for prescribed contraceptives. Analyses comparing girls of different ages and races and from urban vs rural clinics showed that, although the 17-year-olds and African American girls were significantly less likely to stop using sexual health care services with mandatory parental notification, roughly half of the 17-year-olds (56%) and African American girls (49%) indicated that they would stop using all sexual health care services, delay testing or treatment for HIV or other STDs, or discontinue use of specific (but not all) services with mandatory parental notification. Mandatory parental notification for prescribed contraceptives would impede girls' use of sexual health care services, potentially increasing teen pregnancies and the spread of STDs.
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            Influence of physician confidentiality assurances on adolescents' willingness to disclose information and seek future health care. A randomized controlled trial.

            Adolescents' concerns about privacy in clinical settings decrease their willingness to seek health care for sensitive problems and may inhibit their communication with physicians. To investigate the influence of physicians' assurances of confidentiality on adolescents' willingness to disclose information and seek future health care. Randomized controlled trial. Three suburban public high schools in California. The 562 participating adolescents represented 92% of students in mandatory classes. After random assignment to 1 of 3 groups, the adolescents listened to a standardized audiotape depiction of an office visit during which they heard a physician who assured unconditional confidentiality, a physician who assured conditional confidentiality, or a physician who did not mention confidentiality. Adolescents' willingness to disclose general information, willingness to disclose information about sensitive topics, intended honesty, and likelihood of return visits to the physician depicted in the scenario were assessed by anonymous written questionnaire. Assurances of confidentiality increased the number of adolescents willing to disclose sensitive information about sexuality, substance use, and mental health from 39% (68/175) to 46.5% (178/383) (beta=.10, P=.02) and increased the number willing to seek future health care from 53% (93/175) to 67% (259/386) (beta=.17, P<.001). When comparing the unconditional with the conditional groups, assurances of unconditional confidentiality increased the number of adolescents willing to return for a future visit by 10 percentage points, from 62% (122/196) to 72% (137/190) (beta=.14, P=.001). Adolescents are more willing to communicate with and seek health care from physicians who assure confidentiality. Further investigation is needed to identify a confidentiality assurance statement that explains the legal and ethical limitations of confidentiality without decreasing adolescents' likelihood of seeking future health care for routine and nonreportable sensitive health concerns.
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              Confidential Health Care for Adolescents: position paper for the society for adolescent medicine.

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                Author and article information

                Contributors
                +370 686 46242 , ljaruseviciene@gmail.com
                Apolinaras.Zaborskis@lsmuni.lt
                smante@centras.lt
                gedijaru@yahoo.com
                Jeffrey.Lazarus@regionh.dk
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                4 September 2015
                4 September 2015
                2015
                : 15
                : 360
                Affiliations
                [ ]Department of Family Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
                [ ]Institute of Health Systems Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
                [ ]Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania
                [ ]Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
                [ ]Centre for Health and Infectious Disease Research (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
                Article
                1027
                10.1186/s12913-015-1027-5
                4560918
                0ca85553-d888-4859-82c5-4f3e515d609d
                © Jaruseviciene et al. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 26 June 2014
                : 27 August 2015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                Health & Social care
                Health & Social care

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