205. Attitudes and Confidence In Providing Sexual Health Services for Adolescents in the Inpatient Setting

Few adolescents receive sexual and reproductive health (SRH) services at preventive visits and those with poor access or complex medical issues may not even have a preventive visit. SRH services within an inpatient setting may reach these adolescents. Thus, this study aimed to examine the relationship between clinicians’ attitudes about the appropriateness of providing SRH services and confidence in doing so within the inpatient setting among a variety of subspecialties. An online survey was distributed through the Society of Adolescent Health and Medicine (SAHM), the North American Society of Pediatric and Adolescent Gynecology (NASPAG), and the Pediatric Research for the Inpatient Setting (PRIS) network. The survey also was sent to fellowship and division directors for these subspecialties. To describe the sample, age, gender, race/ethnicity, and specialty was assessed. Participants were asked: “In addition to managing the chief complaint or reason for admission, I believe providing sexual health services in the inpatient context is appropriate.” Responses were measured on a 5-point Likert scale ranging from “strongly disagree” to “strongly agree.” Based on distribution, responses were dichotomized into “strongly agree” versus all other response options (did not strongly agree). Confidence in managing eight situations was measured (discuss healthy romantic relationships with adolescents, manage caregivers resistant to confidentiality, manage caregivers resistant to contraception, adolescents-caregiver conflict about contraception, questions about confidentiality, birth control, intrauterine devices (IUDs), and contraceptive implants). These were measured on a 4-point Likert scale from “not at all” to “very” confident and dichotomized into “confident” (very, moderately) and “not confident” (somewhat, not at all). Descriptive statistics and bivariate tests measured the association between attitudes and confidence levels. Among 669 individuals, the mean age was 40 years (median 38, range 28-70), most were females (79%), and Non-Hispanic white (66%). Respondents practiced pediatric hospital medicine (65%), adolescent medicine (14%), pediatric/adolescent gynecology (10%), or other specialties (11%). In terms of attitudes toward SRH services, 61% “strongly agreed” that providing SRH services is appropriate inpatient while 39% did not strongly agree. Over 80% of participants reported being confident to manage caregivers resistant to confidential interviews (84%), respond to questions about adolescent confidentiality (84%), and discuss healthy romantic relationships with adolescents (82%). Items with less than 60% reporting being confident were managing adolescent-caregiver conflict about contraception (58%), questions about IUDs (57%), and questions about contraceptive implants (53%). Participants who “strongly agreed” to provide SRH services while inpatient were significantly associated with reporting confidence across all eight items (p < 0.01). Over half of respondents strongly agreed that it would be appropriate to provide SRH services in addition to addressing the chief complaint. Those with positive attitudes were more likely to report confidence in providing these services. Of note, most participants reported confidence in handling confidentiality. It will be important to address clinician confidence in providing the whole range of SRH services and to address concerns about providing care in an inpatient setting.