James Cook University ISSN 1445-6354
Purpose: The purpose of the study was to gain understanding of the health issues and needs of rural adolescents by listening to their voices and elicit their personal perspectives. Rural counties in the US are defined as having 6 to 19.9 persons per
Method: Focus groups interviews were conducted with 65 adolescents aged between 13 and 19 years old, from four rural counties in the U.S. These counties are medically underserved with one Primary Care physician per 3,500 population. Grounded theory analysis was utilized to identify overarching themes.
Findings: Thematic content analysis revealed two themes of health issues: making healthy choices and lack of pro-social, health promoting role-models, and four themes of health needs: privacy, reliable information, accessible healthcare, and prioritizing
health. The findings that speak to the complexity of adolescent health go beyond the inability to access healthcare and may provide important information that can help mitigate some of the obstacles to adolescents accessing healthcare in rural settings. A main contributor to adolescents' health choices is the lack of positive role-models. Adolescents look for role-models in their parents, siblings, peers and adults in their communities. The absence of positive role-models means adolescents lack guidance at an age when they are highly impressionable. Contrary to general perceptions that adolescents do not want to affiliate with their parents, adolescents in this study desired connection with their parents and adults in general. Adolescents in the study called for 'frank' discussions with adults about stress management, consequences of substance abuse, realities of adolescent pregnancy and sexual health. It is through open dialogue and frank conversations with adults that adolescents believe they would best obtain the type of credible, realistic health information they need. Common features of rural settings such as familiarity and close-knit communities, though integral in developing a sense belonging, can be an impediment to privacy. Lack of exposure and resources to educate residents of rural communities may enhance biases against the mentally and physically ill. Biases can lead to the stigma associated with seeking healthcare that in-turn leads to distancing and fear promotion, making it difficult, and at times impossible, for adolescents to seek the health care they need.
Conclusion: Barriers to developmentally necessary healthcare and health information that all adolescents need are compounded by the unique rural socio-environment and the involvement of multiple systems - family, school, peers and healthcare providers - rooted within communities that may hinder adolescents from becoming thriving, contributing citizens. It is crucial that adults in rural communities seek to hear, strengthen, and empower young people through education, sharing of personal experiences and struggles, focusing adolescents' time and energies on positive, pro-health activities, and providing positive role-models. Attaining and maintaining good health is a lifelong process. Learning how to be healthy takes time and effort. Communities that lack
recreational resources for adolescents to have positive "downtime to unwind," engage with others in the community and re-energize do a disservice to adolescents who want to be active and thriving. The lack of healthy forms of recreation and community engagement can lead to boredom, and engagement in activities that may not be the safest or healthiest.