Teenage Pregnancy Research Report - 3p Consulting

adolescents highlight the effectiveness of working withyoung people from a strength-based model where it isacknowledged that:• Every individual, family, group and community hasstrengths, and the focus is on these strengths ratherthan pathology;• The community is a rich source of resources;• Interventions are based on client self-determination;• Collaboration is central with the practitioner-clientrelationship as primary and essential;• Outreach is employed as a preferred mode ofintervention; and• All people have the inherent capacity to learn, growand change. 18It is these elements of forming a relationship, preferablywith one person, being listened to, being respected forthe choices that have been made, and not being treatedas a “welfare” issue mean that young people are morelikely to access assistance and feel included both whilethey are pregnant and when they become parents.Bronfenbrenner’s socio-ecological model provides oneway of understanding factors that influence adherencewith clinic appointments. 19 The model posits that a child’sdevelopment/behaviour is influenced by interactions withothers (e.g. family), experiences in various settings (e.g.school, hospital) and larger systems (e.g. social/politicalclimate). Studies in other chronic illness groups regardingbarriers to clinic attendance have identified factors atthe micro and macro levels. For example, research hasshown a relationship between clinic attendance andindividual/developmental level factors such as forgettingand health beliefs. 20 Family factors including parentalsupervision regarding appointment-making have alsobeen identified. Interactions with the healthcare systemappear to also be a contributor to poor clinic attendance,including dissatisfaction with clinical care (e.g. poorcommunication, multiple physicians providing medicalcare), long waiting periods, and provider behaviours(e.g. explaining all components of the visit, answeringquestions). Furthermore, even the time of the appointmentcan influence clinic non-attendance, with adolescentsmissing fewer appointments in the afternoon comparedto the morning. Finally, societal and/or cultural factorsmay place adolescents at higher risk for non-adherencewith clinic appointments. For example, beliefs regardingmistrust of the healthcare system, socio-economic status(e.g. transportation issues, lack of insurance), presence/absence of social support, and past negative experienceswith medical teams play a key role in determining themotivation to attend routine appointments.62