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Background
Poverty affects approximately 1 in 7 children in the US. Although social determinants of health (SDOH) have been shown to have a detrimental effect on children's health status, medical providers often focus on recommending lifestyle changes without considering social implications that may pose a challenge for patients.
Objective
To examine the processes used and barriers experienced by providers when addressing adolescent hypertension and to identify how SDOH influences exam room messaging to families.
Study Design, Setting, Participants
Semi-structured private phone interviews (n = 12) were conducted with medical providers (MD, DO, PA, NP) who treat adolescents in North Carolina. Participants were recruited through North Carolina Pediatric Society listserv, Federally Qualified Health Centers, three academic medical centers, and three major healthcare systems. The interview guide was content and face validated prior to use.
Measurable Outcome/Analysis
Interviews were audio-recorded and transcribed verbatim. Content analysis of member-checked transcripts revealed main themes and consensus was reached between four reviewers.
Results
Main themes included variation in monitoring blood pressure in adolescents, level of comfort associated with HTN diagnosis and management, approaches to weight and diet-related chronic disease discussions, SDOH data collection and influence on provider messaging, and resources desired. Providers had variable approaches to managing hypertension with greater comfort in recommending lifestyle changes than prescribing medications. Collection methods related to SDOH varied and these factors were used differently among providers with most considering access to food and safe space to exercise in their messaging to families.
Conclusions
Management of adolescent hypertension is challenging because providers must consider clinical symptoms and unmet social needs when making recommendations to their patients. Altering messages to meet families where they are and providing referrals to appropriate community resources supports patients in their efforts to make changes. Providers identified barriers and opportunities for improvement which should be further investigated to improve overall patient care.
Funding
None
Article info
Identification
Copyright
© 2022 Published by Elsevier Inc.
