Factors Associated with Sexual Health Care Access and Utilization Among Black Youth in King County: A Qualitative Pilot Study

Abstract

Chlamydia and Gonorrhea infections most commonly affect 15–24-year-olds and can cause significant and permanent health problems if left untreated. Confidentiality concerns, stigma, and inaccessible services have been cited as barriers to sexual health care among youth. There are also racial and ethnic disparities among Black youth who also have the highest rates of Chlamydia and Gonorrhea infections, even when accounting for similar sexual behaviors. Our team recently conducted a large quantitative analysis that showed 20% of Black youth with Medicaid received Chlamydia and Gonorrhea testing in an emergency department, even though prior studies suggest that receiving sexual health services in these settings is not ideal. To better understand the barriers and facilitators that lead to emergency departments utilization for Chlamydia and Gonorrhea testing among Black youth, our team will conduct a qualitative analysis based on the Health Belief Conceptual Model. However, prior to implementing a larger qualitative study, a pilot study will be conducted to identify and address potential issues which could compromise the success of the larger study. For our pilot study, we recruited two youth who received Chlamydia and/or Gonorrhea testing in a pediatric emergency department or urgent care within the past year. After completing the interview, these youth gave feedback on best practices for study recruitment and perceptions of the interview guide design. Overall, there were two primary issues identified during the pilot. The first included difficulty with recruitment, likely due to starting with an overall small sample frame, but mistrust of the health care system among Black youth, particularly with regards to research needs to be explored. We also encountered problems regarding protecting the anonymity of youth whose multiple intersectionalities could be compromised given our small population size. The team will expand our sample size across multiple hospital systems to ensure confidentiality and anonymity is maintained. Among the pilot study participants, they reported no concerns regarding the survey design, understanding of questions, or length of interview. Results from this pilot will be used to improve our study design and methodology prior to initiating the larger qualitative study.