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Title V Technical Assistance Meeting

 Focus Groups in Action: Iowa’s Progress

By Addie Rasmusson, MA
Community Health Consultant - Iowa Department of Public Health 

By Cori Floyd
Program Associate, Child and Adolescent Health - AMCHP 

Adolescence is a crucial time for preventive interventions, because it’s a period of significant physical, behavioral and emotional growth. How can public health professionals better engage young people and families to identify opportunities to change the perception of available services? 

As part of the Adolescent and Young Adult Health Collaborative Innovation and Improvement Network (AYAH CoIIN), the Iowa Department of Public Health focuses on strategies to encourage more adolescents to receive well-visits. In the spring of 2016, Iowa conducted focus groups with adolescents and parents of adolescents to identify levels of awareness about the existence of adolescent well-visits and their content, as well as barriers to and motivators for a well-visit. Two focus groups of parents with adolescent-aged children averaging 15 years of age (n=16) and two focus groups of youth averaging 17 years of age (n=23) were completed in Iowa. These groups presented a wealth of information that the Iowa team plans to share and incorporate in their quality improvement work. 

Parents highlighted that they took their adolescents to the doctor only for specific reasons, including the flu, broken bones, physicals for sports or camp, and chronic illnesses. They did not seem to be aware of the differences between a sports physical, an immunization visit or an adolescent well-visit. Parents also expressed value in establishing a relationship with providers through well-visits; however, the adolescent groups did not express that same perspective. The only notable benefit of the well-visit mentioned by adolescents is knowing whether or not they are healthy. 

Each group also shared what they believed providers should talk about during the well-visit (Figure 1). Interestingly, youth most valued discussion around violence prevention, substance abuse and eating disorders, while parents valued conversations around bullying, school performance, puberty and sexually transmitted diseasess. These differences can have notable impact on the well-visit experience. Using the focus groups’ results can prove valuable when structuring the well-visit experience to meet the needs of both young people and their parents. 
iowa graph.PNG

With regards to barriers, all the focus groups shared enlightening information on what hindered adolescents from receiving a well-visit. Adolescents identified being scared to go to the doctor and being too shy to discuss certain things with a provider. They also expressed concern with confidentiality and being honest about whether they are having sex, using drugs or drinking alcohol.  Additionally, parents identified barriers such as not understanding how the visit is covered by insurance (i.e., co-pays) and scheduling with a provider, especially for those living in rural areas that have to account for significant driving time. 

So with all of this information in mind, how is the Iowa team planning to move forward? Each focus group provided useful recommendations about how to advertise and incorporate the adolescent well-visit into their communities (Table 1). 
The Iowa AYAH CoIIN team plans to use each focus group’s feedback and recommendations to develop key messaging under a larger communications plan that caters to the community’s needs and concerns. The team will also distribute the focus groups’ results to health care providers across the state to help providers improve adolescent and parent interactions and identify strategies to encourage repeat visits.  

Strategies such as these that engage the community are valuable tools public health professionals can use to tackle population health issues, identify potential solutions and foster valuable partnerships with community members.