The 1990's has witnessed a concerted effort toward improving access to health care for American adolescents. Experts have produced important documents that both summarize barriers to care and propose policy changes to make care more accessible to youth. All of this work, however, comes from the perspective of adult health professionals. There has been little effort to gather information about needs and barriers from the teens themselves. While adolescents may not understand the intricacies of policy, they can provide information about how the health care system can reach them. The proposed Project asks youth to advise caregivers how best to plan and market primary, preventive health services. The overriding goal is to develop a set of recommendations for the development of services that maximize adolescent comfort, serve their primary care needs, and remove barriers to utilization. To meet these goals, all ninth grade students in the Philadelphia Public School System will participate in a staged series of group process techniques designed to answer two study questions: """"""""What characteristics of the health care system affect a teenager's decision to use it?"""""""" and """"""""How can we get teens to come for health care?"""""""" The methodology involves open focus groups, Nominal Group Technique (NGT), and Delphi Technique. Each format is selected for its particular strength in idea generation, prioritization, or clarification. Although the methods are open and friendly to the adolescent participant, the design is highly structured and produces both qualitative and quantitative data. In stage I of the Project, 100 randomly-selected students divided into ten open focus groups will help frame the questions in language that is appropriate and relevant to youth. In stage II, 200 randomly-selected students divided into 25 groups will participate in the NGT to generate and prioritize responses to each of the study questions. In stage III, all 17,000 ninth graders will be asked to complete a questionnaire in which they will rate each response from the NGT. The data from the Delphi will be analyzed using nonparametric statistics for the ordinal ratings and multivariable procedures to assess the relationships between independent variables (e.g., gender, race) and response ratings. The wide diversity within the study population reflects the demographic spectrum of Philadelphia. The large sample size will permit extensive subgroup analyses by gender, race, age, school, and socioeconomic status. This Project will elucidate what teenagers think about primary care and how they believe services can be made more accessible. This insight will help health professionals plan changes that will result in a health delivery model that attracts youth and meets their needs.
