Results of Teen Focus Group - Health Information Providers for Teenagers
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Background
The leading causes of death among teens aged 13-18 in the National Network of Libraries of Medicine South Central Region (NN/LM SCR), are unintentional injury, suicide and homicide. According to the Centers for Disease Control and Prevention (CDC), other health issues facing teens are illegal drugs and alcohol, sexual activity, eating disorders, mental health concerns and addictions.
To learn more about the health information needs of teenagers, two focus groups were conducted in March and April of 2005. The goal was to determine the challenges and needs of those who help teenagers find health information in order to assist the Regional Medical Library staff to address those needs by creating classes or other program elements.
One focus group was held March 23, 2005 in Houston, TX, and the other was held April 25, 2005 in New Orleans, LA. Participants included public and school librarians, school nurses, health educators, and staff from teen homeless shelters, clinics, and teen health support organizations. The focus groups were conducted by NN/LM SCR staff, and assistance was provided by the staffs of Louisiana State University Health Sciences Center Libraries-New Orleans and Ochsner Clinic Foundation Medical Library and Archives.
Questions that were asked to focus group participants were:
- What are some difficulties you encounter when talking with teens about health information?
- What difficulties do teenagers encounter when trying to get health information?
- Where do you search for health information for teenagers?
- Which websites do teenagers use when looking for health information?
- If we developed a training class on providing health information to children and teens, what types of information should we include?
- Based on your experience, what do librarians need to keep in mind when dealing with teenagers who have health information questions?
Process
Transcripts of the focus groups were analyzed, and statements were organized into the eight issues listed below:
- Teen Information Needs
- Teens' Barriers to Finding Health Information
- Providers' Challenges to Providing Health Information
- Teens: Where and How They Get Health Information
- Providers: Where and How They Get Health Information
- How Providers Give Information to Teens
- Strategies for Reaching Teens
- Suggestions for New Classes
An important tool of focus group evaluation is the non-verbal agreement evinced by focus group members about particular topics (nods and other body language). These are noted by an observer. Another element is the enthusiasm the speakers have for their topics - the emphasis that they themselves place on a particular subject. Much of this can be found by reviewing the language in the transcripts. Quotes that were notable for summing up an issue or a topic are available in a separate PDF document, Selections from Transcripts of Focus Groups.
The main themes that arose during discussion of the above issues are shown below in decreasing order of importance.
Conclusions
The conclusions drawn from the focus group are related to the initial goals of the study: to find information that will help to create a class or other program to address the challenges of providing teenagers with health information. In regards to this goal, the most significant information learned from these focus groups were:
- Learning to listen to teenagers, and taking the time to elicit the real health question that they are asking, is a critical skill that many people working with teenagers are lacking.
- Service providers have difficulty addressing many important health topics in public schools or other publicly funded education programs due to political pressure to not discuss certain "hot button" topics such as birth control and protection from sexually transmitted diseases (STDs). They appreciate places where they can send teens for good quality information on these subjects.
- An educational program on providing teen health information would be of interest to many school counselors and school nurses as an in-service program for their entire faculty.
Using these results, the Regional Medical Library now has plans to create a class for school teachers during their in-service days rather than a class for school or public librarians as originally planned. The class will include a strong reference interview component, with special exercises for active listerning skills with teenagers. The Consumer Health Outreach Coordinator will work closely with school nurses, librarians and counselors to develop this class, and will use the themes and issues identified in the focus groups as the subjects for the class. Due to limitations set by institutions, the class cannot suggest to teachers how to answer "hot button" issues; however many health websites with excellent health information on teen issues will be recommended.
If you have questions about the information in this report, please contact Karen Vargas, Consumer Health Outreach Coordinator, NN/LM SCR at karen.vargas@exch.library.tmc.edu
- Sexual Education
- Pregnancy
- Parenting
- Abortion
- Abstinence
- Relationships
- Sex Education
- Birth control
- Birth control negotiation skills
- Communicable Diseases
- STDs
- AIDS/HIV
- Communicable diseases
- Mental Health
- Health condition research
- Personal or family
- Homework
- Violence
- Dating violence
- Sexual assault
- Teen violence
- Addictions
- Drugs
- Alcohol
- Tobacco
- Addictions
- Nutrition
- Nutrition
- Obesity
- Eating disorders
- Accurate and complete information
- Understanding of risk (it won't happen to me)
- Their bodies
- Sleep
- Child abuse
- Exercise
- Asthma
- Birth defects
Teens' Barriers to Finding Health Information:
- Internet filtering on school and public library computers
- Poor ability to discern credible information
- Deliberately misleading information ("stealth" websites and hotline phone numbers)
- Shame
- Shame/ guilt/ emotionally difficult to talk about
- Don't want to be seen in bookstore section labeled "Gay Studies"
- Fear of what others are thinking
- Ignorance about what is in school/public library
- Social or political opinions causing information to be withheld
- Pervasive conservativeness of society limiting information given to teens
- Abstinence based programs may not answer questions teens have or address issues they have
- Adults/librarians who censor reading materials for teens
- Literacy level
- No home computers
- Age limit of 18 for videos in some public libraries
- Access to bad information/ street myths
- Lack of (or fear of no) confidentiality
- Poor Internet search skills
- Moralizing from adults giving information
- No specific information in teen area of public library; must send teens to adult area for health information (no comfort level, embarrassment, no teen librarian)
- Librarians/information professionals who do not treat teens well, or with whom teens are uncomfortable
- Security guard/adult asks teens what they want when they enter clinic
- Poor or foster child falling through cracks, doesn't know where to go for information
- Older librarians not comfortable with computers, won't help with prescription databases, Internet, etc.
- Health information not specific to needs
- Health information not available to marginalized teens (gay, lesbian, bisexual and transgender)
- Health class cancelled (now some health information covered in biology)
- Feelings of isolation
Providers' Challenges to Providing Health Information:
- Restrictions placed on ability to give complete information
- Restrictions on talking about sexual education/birth control in schools
- Hard to find groups to talk to teens in shelters that are not under the "abstinence-only" guidelines
- Abstinence-only limits what can be told to teens
- Hard for schools to buy non-fiction materials on controversial health issues due to parental and administrative concerns
- Teen health websites (Teenwire, Go Ask Alice) removed from public library web links (harder for teens to get information without having to ask in person)
- Pervasive conservativeness of society limiting information given to teens (political climate)
- Fear that by giving information on behavior to teens, you are condoning it
- School authorities pulling books off shelves without following procedure
- Teen health information in adult section of library (due to community requests to take it out of teen section)
- Poor relationship between adults and teens
- Definitions/language/vocabulary different for teens than adults (definition of sex very different)
- Difficulty listening to teens clearly (active listening)
- Lack of comfort in discussing difficult issues with teens
- Health care providers who do not like working with teens
- Teens will not go to adults who can help them
- Getting teens to listen
- Teens who think they know everything so they won't listen
- Teens think they are invincible, so they don't listen
- Getting their attention to begin with
- Health information misinformation/myths
- Shortage of materials
- Lack of low literacy materials
- Little up-to-date drug information for teens available in books or on U.S. Drug Enforcement Administration website
- Confidentiality (teens are afraid to talk to an adult for fear it will get back to parents)
- Parents' denial/ Need for parental education
- Shame (limiting what they will tell you)
- Multi-layering of health issues (violence, STDs, drugs, addictions)
- Unhelpful or misleading library websites for teens
- Books expressing negative views towards homosexuality
- Librarians not allowed to interpret medical information
- Sometimes too busy at circulation or reference desk to focus on teen, to help in detail
- Ignorance about purpose of school/public library leads people to call for wrong reasons
Teens: Where and How They Get Health Information:
- Computers/ websites
- Computer at home
- Computer at library
- Computers at school
- WebMD
- Google, Ask Jeeves
- School assignment (public or school library)
- Asking questions within an organized health program
- Asking trusted adult
- Start with general question, and then get specific. Or don't know what they want to ask, need to have a discussion to figure out what they are asking.
- Brochures
- Health center
- Send someone in their place
- Public library - librarian won't tell parents
- Search the web by typing whatever they're looking for .com (pregnancy.com)
- Not MedlinePlus, not library website, not Go Ask Alice, not CDC
- Not the public library
- Not necessarily using computer when available at clinic
- Hide info about themselves with a question about homework assignment
- They know where sex education section in public library is, and they share with each other
- Share information with friends (health information books are not returned)
- Whisper private medical question to librarian
- Skip adult reference (even adults do this) and go to teen area
Providers: Where and How They Get Health Information (for themselves or for teens):
- Computer online sources
- Centers for Disease Control and Prevention
- Databases
- WebMD
- Merck online
- Amazon (for reviews and book suggestions)
- Teenwire
- MedlinePlus
- Books
- Videos/DVDs
- Medical directory from Harris County
- Confer with experts
- Journals like Booklist (for reviews)
- Public library (using unfiltered access as incentive for teens)
- Brochures
How Providers Give Information to Teens:
- Groups
- Medical students doing health education groups
- Educational seminars
- Group educational sessions
- Issues groups (violence, narcotics)
- Family and group therapy
- One on one (clinical setting, in context)
- Health programs/programming
- Health programming in libraries (cannot group teens with children; can group teens with adults)
- In schools (e.g. )Baby, Think it Over
- Programs at community centers or clinics
- Long term programs (8-10 weeks)
- Brochures (with teen language and graphics)
- Order library books based on class assignment, request, or usage figures
- Train how to evaluate website
- Visit the schools (demonstrate databases, websites, library resources)
- Visit other locations where juveniles are captive audience
- Refer them to books
- E-reference
- Educational games
- Send to expert (or clinic) for more information
- Refer them to public library website and links
- Team working together (social worker, doctor, psychiatrist)
- Listen to them, where they are
- Resource line, phone hotline
- School homework
- Write books to help teens
- Speak in classes or for teachers
- Develop respect from teens based on personal interest in them
- Announcements on school public address system
- Book displays
Strategies for Reaching Teens:
- Ask teens for suggestions, suggestion box, publicize that you will order the books they request
- Get parents to watch where teens go on the Internet
- Use incentives (points system)
- Student peer program or support group
- Need to talk in child's language, not clinical language
- Active listening
- Comfortable environment (furniture, space)
- Teen advisory board
- Programs to get their attention
- Create shame-free environment
- Email reference with doctors on teen website combined with doctors meeting teens once a month to get to know them
- Interacting with teens
- Teach adults how to listen actively before giving information
- Teach customer service: ask teens whether or not their question was answered, or if they found what they were looking for
- Re-educate adults about adolescents: where they are, how to make them feel welcome, how sensitive they are, how to make them feel respected
- Don't underrate their intelligence or their vocabulary. Show them how to look up medical words.
- Teach adults how to get teens to share sensitive or uncomfortable information; how to break down barriers of age or discomfort
- Do not engage in information overload - just answer question
- Teach adults not to moralize
- Understand how teens ask questions (they start with general inquiries, then work up to specific)
- Learn how to use teens' language
- Outreach (what, when, where, who)
- Clarify basic issues for teens, since health class is no longer in curriculum
- Train the trainer
- Teach during teacher inservice days - they often have health information component; plan in Spring for following Fall, send out flyers saying "we're available for in-services."
- Understand different needs for classes in healthcare setting, library setting, and school setting
- Offer presentations at library conferences
- Teach classes in schools, because health class is waived in a lot of schools
- Teach directly to students - go through counseling departments
- Computer skills
- Teach adults (including librarians, teachers) how to use health websites and databases
- Demonstrate a place where one enters zip code and retrieves list of providers
- Provide training in basic computer skills and search skills
- Teach parents how to track what teens are viewing on the Internet
- Resources
- Include helplines, centers, clinics, etc.
- Provide information on books that present opposing viewpoints on issues, like abortion
- Provide list of accurate, clear, unbiased sites
- Recommend books to buy for schools, and why (collection development)
- Marketing your library
- Market your library and its programs as a resource for teen health information
- Make the information palatable to parents as well as teens
- Decorate/publicize the program in a way that teens feel welcome
- Evaluation of websites
- Teach evaluation of websites: ability to discern misleading information and bias
- Teach adults (including librarians, teachers) to evaluate websites
- Let teens know about public librarian confidentiality rules
- Teach adults when you must break confidentiality rules (safety of child)
Suggestions for new health topics:
- Sexual issues
- STDs
- Mental health issues
- Definitions
- Violence
- Where do you go or call
- Suicide prevention
- Basic health information
- Child abuse
