Adolescents' Self-Reported Recall of Anticipatory Guidance Provided During Well-Visits at Nine Medical Clinics in San Diego, California, 2009-2011

Abstract

Purpose: Anticipatory guidance (AG) is recommended for adolescent well care. AG recall is important in the event sequence that might lead to behavioral change, reduced health risk, and improved health. We assessed factors influencing adolescents' self-reported recall of specific AG topics.

Methods: Through convenience sampling of nine clinics in San Diego, California, 872 adolescents (429 aged 11-13 years; 443 aged 14-17 years) who had received well visits completed standardized surveys between 2009 and 2011. Adolescents were asked to report recall of either 17 or 23 age-appropriate AG topics that were analyzed in five categories (health maintenance; social/emotional, safety/violence; smoking/substance abuse, and puberty/sexual health); a summary score for all categories was developed. Summary scores' associations with demographic variables, visit characteristics (including having time without parents present [private time]), clinic procedures, and lead physician attitudes were assessed.

Results: AG recall was independently associated with adolescents having private time with clinicians, completing previsit questionnaires, reporting the well visit was helpful, and the well visit lasting at least 10 minutes. Higher summary recall scores were observed among adolescents who received care in clinics providing AG at both sick and well visits and having policies encouraging private time. Clinic electronic medical record use for AG prompts was associated with recall of fewer topics.

Conclusions: To increase adolescents' AG recall and potentially foster behavior change, our results suggest medical providers should adopt procedures advocated by professional societies, including assuring adolescents receive private time during visits, increasing visit time during well visits, using patient-completed questionnaires, and providing AG during all visits.

Keywords: Adolescents; Anticipatory guidance; Clinic characteristics; Clinical preventive services; Community health centers; Electronic medical record; Evidence-based practices; Patient privacy; Primary medical care; Vaccine; Well visits.