ADOLESCENT & YOUNG ADULT MALE HEALTH FOCUS GROUPS: FINDINGS AND RECOMMENDATIONS
May 2017 Update
In 2015 The Partnership for Male Youth (PMY), American Sexual Health Association, Healthy Teen Network, and School-Based Health Alliance collaborated through the Young Male Well Visit Project to address the unique and unmet health care needs of adolescent and young adult (AYA) males. As documented by PMY through its Health Provider Toolkit for Adolescent and Young Adult Males, there are numerous disparities in access to and utilization of primary, reproductive, and other health care services between male and female adolescents.
The first product of the Young Male Well Visit Project was the 2015 release of an AYA male patient self-assessment tool and accompanying clinician guide to utilizing the information obtained from that tool. This is the first in a range of materials PMY intends to develop and disseminate for male youth and their families, health care providers, and youth-supporting professionals and volunteers.
The Young Male Well Visit Project was made possible (in part) by an independent grant from Merck.
AYA Male Focus Group Purpose
In 2015, as part of the Young Male Well Visit Project, Healthy Teen Network, a national adolescent health organization, and School-Based Health Alliance, a national association of school based health centers and school health professionals, conducted focus groups with AYA males to gather information relevant to creation of the above described tool, including their review of an early draft of that tool. They conducted the focus groups to gather information from AYA males of various races, ethnicities, and socioeconomic statuses about their attitudes on general health; sexual and reproductive health; sources of health information; and experiences with well visits.
Healthy Teen Network and School-Based Health Alliance conducted 10 focus groups with a total of 68 AYA males ages 14 to 24 from May to July 2015. They recruited this convenience sample of participants from several community- and school-based programs with direct access to AYA males. School-Based Health Alliance recruited participants from their school-based affiliates in California, Georgia, and Maryland. Healthy Teen Network recruited participants from community-based organizations in Maryland and the District of Columbia.
The focus group discussions addressed the following topics:
young males’ definition of health and well-being,
sources of health information,
attitudes about annual physical check-ups,
attitudes about sexual and reproductive health, including specifically the human papillomavirus vaccination.
As part of the focus group discussion, as mentioned above participants were asked to provide feedback on a draft self-assessment tool and to complete a brief survey. The survey included basic demographic questions and questions relevant to the tool. This report shares only the results of the focus group discussion and demographic information of the participants. The group discussion and survey were completely anonymous. Food and beverage were provided to participants, as well as a $15 gift card. A private Institutional Review Board approved the study. Due to its low risk level, the IRB did not require parental consent for the AYA males’ participation. All focus groups were recorded with permission of participants and transcribed verbatim. Focus group scripts were reviewed to identify trending themes for each research topic. Although the transcripts differentiated the interviewer from the participant, it was very difficult to accurately identify each individual participant. Therefore, each focus group was analyzed as one unit.
A total of 10 focus groups were held, lasting an average of 44 minutes. Participants ranged from 14 to 24 years old, with a mean age of 16.9. Most participants (66%) were African American and most resided in urban/ city areas (75%). The level of mother’s education (a proxy for AYA males’ socioeconomic status) varied among participants, but the majority reported that their mothers completed at least high school or GED (25%) or college education (27%). Of those reporting their sexual history, the majority (84%) reported ever having sexual intercourse. Participants 16 and younger were more likely not to have ever had sex than their older peers. Additionally, most participants (84%) reported having a primary care physician.
The results from the focus groups’ thematic analysis are organized below by the main topics of interest of the exploratory study.
YOUNG MALES HAD VARYING DEFINITIONS OF HEALTH AND WELL-BEING.
When asked about how they define “health”, participants used words or phrases such as “hygiene”, “being active/physically fit”, “sports”, “mental health”, “exercise”, “nutrition”, “STDs”, “pregnancy’, “violence/gang involvement”, “chronic disease such as asthma and diabetes”, “lead paint contamination”, “cigarette and marijuana smoking”, “cancer”, “HIV/AIDS”, “stress”, “PTSD/trauma”, “alcohol use”, “depression”, and “drug use”. Nutrition, being physically fit, STDs, and drug/alcohol uses were consistently reported across all focus groups as important health problems both among participants and their peers. Another recurring theme among the focus groups was hygiene. Most of the participants seemed concerned about the hygienic behaviors of their friends and their peers such as “not taking showers” and “brushing their teeth”. Some focus groups reported violence and gang related activities and its repercussion on their environment and school. For some of the participants that played sports, concussion was a common concern for them and their friends.
INTERNET PREVAILS AS LEADING HEALTH INFORMATION SOURCE.
When asked about where they go to get health information, many participants initially indicated their health care provider. However, upon further probing, it became clear that the Internet is the first place they consulted whenever something is wrong with them or when they need specific answers to certain health questions. Many consider Google as the main site for obtaining health information. Participants were split on how they decide on websites to use while on Google; while some reported that they go on the first website that appears from their Google searches, others reported looking at 3-5 websites before deciding on what website to use. Though participants reported internet searches as their top primary source of obtaining health information, they were also very aware of the accuracy of the information they obtain from these sites.
Participants said that they do not trust most of the information they get from Internet searches; therefore, they are more likely to go to their parents or health care providers for accurate diagnosis.
Family and Peers: Another main source of obtaining health information was through family members such as parents, grandparents, aunts, uncles, peers, and other older adults. Participants reported seeking additional advice from family members after their initial Internet searches to obtain specific answers or confirm the diagnosis suggested from their internet searches.
Additionally, participants reported school/community health centers, books, and social media as other places they obtain health information. Though most participants reported the use of social media for obtaining health information, participants reported low trust level on the information obtained from social media. With family members, most participants were very comfortable talking to their mother about general health questions. On the other hand, participants are more likely to seek male figures when seeking answers to sexuality questions. Many expressed seeking advice from peers that are either in similar situations or have gone through a situation similar to what they are currently facing.
Healthcare providers: Although participants place great importance and trust on the information provided by their physician or nurse, they do not have frequent contact time with them, and thus it is not a significant source of information. Participants said that their physician office would be the last place they go to if a symptom is severe. Most reported using the Internet to search and learn about their symptoms, confirm the symptoms with a parent, and then go to a clinic or physician’s office for solutions.
Time spent seeking health information: The amount of time spent with each source depended on the severity of participants’ symptoms. For example, participants reported spending as little as five minutes to over one hour while searching on Google for health information. Similar to above, reported time is also spent with family members based on severity of symptoms.
Comfort level: Participants reported that they are more likely to spend more time and talk with family members or other adults with whom they feel comfortable. Level of comfort was also determined by adults’ rapport with them. Most said they would spend at least one hour with someone they feel has their best interests at heart. All focus groups reported that they are more likely to talk with people that are nonjudgmental towards them. In addition, the amount of time they will spend with these adults is dependent on how much they trust the adult and the information the adult is giving them. With family members, level of comfort was split. While some participants expressed that their parents are very uncomfortable talking to them about sexuality questions, others expressed feeling uncomfortable about talking to their parents about their sexual problems. For example, in all groups, participants reported feeling comfortable if the parents were giving advice rather than telling them not to have sex.
Mobile app for health information: When asked about their interest in using a health mobile app, participants were split on their interest. While some of the participants wanted an app to answer their questions, some expressed no interest in obtaining an app. Many expressed that they believe their personal information is not safe on an app and that it could easily be obtained by other people. Other participants expressed that though they might initially get the app if they are experiencing certain symptoms, they are more likely to delete the app once they get the information they need. However, participants who wanted the app expressed that they want apps that have guides and solutions to different STDs, chronic diseases, and life skills. In addition, participants said they are more likely to get an app that does not take too much storage space on their devices.
MOST PARTICIPANTS HAD A POSITIVE EXPERIENCE WITH PHYSICAL CHECK-UPS.
Participants in most focus groups were familiar with physical check-ups. Most participants reported going to physical examinations. Their participation rate in physical examinations ranged from going every few months, to every few years, to when something “was wrong”. It was impossible to accurately confirm the frequency of receiving a standard check-up outside of sick visits. However, most participants felt these check-ups were important to maintain optimal health. Many consider that other young males like themselves do not get regular check-ups because either they are lazy or they are afraid of what they can find out. These were recurring themes throughout most groups.
Participants said they would motivate others to get regular physicals by telling them the importance of knowing more about their body. They would also encourage them by reminding them of the people who depend on them, if they have kids or parents they need to help. Participants in multiple groups related personal experiences of people they knew who found out too late about a chronic condition.
Although participants are open to the idea of regular check-ups, all were clear on their expectations and what makes them feel comfortable in a visit. First, most focus groups reported that it is important to know the provider. Some participants have been to the same provider since they were born, others have developed a relationship with their providers over time. They say that building a relationship is crucial to open up and trust the provider. Having an honest, friendly, and caring provider is important to boost comfort levels. Moreover, they appreciate the time providers take in getting to know them, asking about their day, or their life, rather than just focusing on the visit.
Throughout the discussion sessions, participants in most groups expressed their interest in having accurate and complete information before and during their visit. They want to know what to expect from a visit, and why certain recommendations are important.
For example, one group in particular wanted information of a step-by-step process of a typical visit, so they are aware that they will be touched and their genitalia examined. Although some acknowledged that they receive some information, the touching aspect of a physical check-up was considered the most uncomfortable aspect of the visit. The vast majority of participants expressed a preference for female providers when it came to the physical examination. Most reported feeling uncomfortable being physically examined by male providers. However, many preferred male providers when it came to some health issues. According to them, male providers were more suitable to answer questions because they were males.
Participants expressed diverse opinions when it came to following providers’ recommendations. Some believed they should always follow a physician’s advice because the doctor is knowledgeable; “that’s what they went to school for” was a common assertion. There was a great deal of trust placed on the “doctor” title. However, many acknowledged that providers sometimes do not acknowledge their needs and make recommendations on medications, vaccinations or treatment without fully explaining the condition in a way they understand. Also, Maryland-area participants expressed divergent views of the medical establishment. While some fully trust the health care providers and community clinic staff, many distrust large medical institutions and believe these institutions conduct unethical research on uninformed patients.
PARTICIPANTS ACKNOWLEDGE THEY HAVE AN IMPORTANT ROLE IN THEIR SEXUAL AND REPRODUCTIVE HEALTH.
When asked about their role in the prevention of an unintended pregnancy or sexually transmitted infections, the majority of participants across focus groups acknowledged that they play a big role. As for protection, participants in most groups mentioned condoms as the primary form of protection. Many also mentioned the pull-out method (or withdrawal) as a form of pregnancy prevention. Only a few participants mentioned that as males they should ask their partners whether they are using some type of birth control method. Participants in most groups also mentioned that males should talk to their partners to see if they have any STI. A handful of participants mentioned going to a clinic to get tested.
KNOWLEDGE ABOUT HPV INFECTION AND THE VACCINE WAS LOW.
Participants’ level of knowledge about HPV was unclear, including knowledge about the HPV vaccine and whether they had received it or not. When asked about HPV in general, most said that it sounded familiar, but they were not sure what exactly it was or the health impact of the infection. They had a similar reaction to the vaccine. Most groups reported knowing something about the vaccine, but upon asking further questions, it was likely that they were confusing the HPV vaccine with other seasonal vaccines. For example, participants reporting knowing about the vaccines also reported getting it every year at the start of the season, or getting a nasal spray, or getting it when they were born. After the group facilitators explained briefly what HPV is, most reported being motivated to get it. However, some groups were interested in some sort of incentive to get a vaccination, such as a gift card.
Focus groups were conducted with AYA males to gather information about their attitudes on general health; sexual and reproductive health; sources of health information; and experiences with well visits. Overall, all youth acknowledged that their primary source for obtaining information about their health is the internet even though they expressed distrust on the information they obtain from these sites; ultimately relying on their medical providers to provide them with accurate information. However, exposure time with their medical provider is very limited to their routine annual well visit which generally lasts about 20 minutes. This, coupled with youth’s willingness to sit down with medical professionals who are willing to educate them about their health, provides ample opportunities for medical professionals to create programs that will increase exposure time with these young males. Increased use of technology and social media by medical professionals and youth serving organizations in providing quick and accurate health information will prove beneficial in increasing health literacy among youths. In regards to general sexual health, participants seemed knowledgeable about different STIs, condom use, pregnancy prevention and testing centers, but there is a limited knowledge on HPV disease as well as the HPV vaccine. Though most participants said they have gotten the HPV vaccination, it was unclear if it was the HPV vaccine or just other vaccines in general. After explaining what the HPV vaccine is and the diseases it prevents, there was a positive attitude among the participants in obtaining the vaccine. Low levels of knowledge was common among all focus groups; thus, health professionals and medical providers need to educate youth more about the vaccine and the health problems that may be prevented by it. Based on these observations, we recommend health care providers take into consideration the following health needs of young males.
Approach to health:
When discussing health issues with young males, providers should use a more holistic approach and include discussion about nutrition, fitness, violence, substance use as well as sexual health.
Young males appreciate comprehensive and complete information explained in simple language they can understand.
Young males are more receptive to clinician’s instructions when they build some rapport with the young males they serve.
Sources of Health Information:
Young males greatly valued clinicians as a source of trustworthy information. Yet, they spend less than 30 minutes per year talking to a clinician. Clinicians should encourage open conversations during clinic visits and frequent clinical in-person or phone consults for other health issues.
Given that young males most frequently consult online sources, clinicians may provide a list of vetted and trustworthy websites young males can visit for general health information.
Also, clinicians may educate their young male patients on media literacy so they can better judge online sources of health information.
Young males reported interest in health related apps. These apps should address relevant health topics and not take too much storage space.
Although most participants went to annual check-ups, they all wanted additional education information about the visit. Clinicians should have available educational materials explaining what to expect from a physical and the importance of each aspect of the examination, including examination of genitalia, vaccines and disease prevention.
Young males reported that they are more likely to trust providers they have seen for many years. Clinician stability in a clinical setting is important to ensure continuity of care by the same person.
Some young males reported feeling judged and rushed through the visit. Clinicians should strengthen their communication skills to build rapport and encourage trust with young males.
Many young males had strong feelings about the sex of the provider. Many agreed that they feel more comfortable talking and being examined by a female provider. However, they preferred a male provider if they had to talk about “men things”. Providers should be aware of how their own sex can impact the level of comfort of their young male patients. Sexual and Reproductive Health:
Clinicians should use contact time with their patients to assess sexual health risk and emphasize healthy sexual behaviors, particularly condom use. Although most participants mentioned the condom as the main way they prevent pregnancies and STIs, some acknowledged that they do not use any protection or expressed myths regarding condom safety. Clinician can also educate about female-controlled birth control as young males reported very low knowledge on that subject.
Young males reported low knowledge about different STIs. Clinicians should provide information about different STIs, mode of transmission, treatment or cure availability and communication strategies with partners.
Most young males were not aware of HPV nor the vaccine. This vaccine was often confused with seasonal vaccines. Clinicians should provide information about vaccine schedule and a description of this vaccine in particular. Young males should be educated about the risks of HPV and the benefits of the vaccines for them and their future partners.
These focus groups provided general insights and overview on the health concerns of AYA males. Overall, there is a promising trend in young males’ action towards their general health care either through seeking out the information themselves or talking to someone who will educate them about their health. Medical providers and other organizations that serve young males need to provide more opportunity for increased exposure time between young males and their medical providers. Finally, the use of technology in promoting health literacy is greatly needed and would prove beneficial to both the young males and the adults serving them.
Source: Healthy Teen Network (2015). Volt health educator resources and opportunities (HERO) guide. Baltimore, MD. Volt is made possible (in part) by an independent grant from Merck.