Young People's Perceived Barriers in Talking about Sexuality with Their Parents vs. with Healthcare Providers: A Mixed-method Study

Abstract

ABSTRACT Introduction While most parents and healthcare providers understand the importance of educating young people about their emerging sexuality, about 20% of parents and 65% of providers never talk about sex with their children/young patients. Little prior research has asked young people directly what they perceive to be the greatest barriers to sexuality communication. Objective To center the voices of emerging adults in their perceived barriers to sexuality communication in the patient-provider and parent-child context. Methods Using data from a survey of 1193 young adults (mean age = 19.23, 72% female), we applied concept mapping to a corpus of over 2,400 qualitative responses to two questions: 1) What, if anything, makes it difficult to talk to your parents about sexuality or your sexual health? 2) What, if anything, makes it difficult to talk to your doctors, therapists, or mental health professionals about sexuality or your sexual health? These data were split into single-concept statements and grouped by similarity by seven researchers of varying demographic and academic backgrounds. Conceptual groupings were derived statistically via multidimensional scaling (MDS) and hierarchical cluster analyses. We then explored how perceived barrier clusters differed across demographic and cultural factors, including socioeconomic status, gender and sexual minority status, race and acculturation, religion and religiosity. Results MDS and cluster analyses revealed a best-fit solution of 8 conceptual groups for perceived barriers talking about sexuality with healthcare providers, but only 4 groups of barriers in talking with parents. That is, young people's descriptions of barriers in talking to healthcare providers were discrete, specific, and shared across participants when considering difficulties talking to clinicians about sex, but more diffuse and idiosyncratic when considering talking to their parents. Younger participants were more likely to endorse awkwardness across contexts. Those with lower parental SES were more likely to perceive mismatch with their provider's communication style or demeanor. Gender typicality and sexual orientation were generally associated with resilience and relative lack of barriers to communication across contexts. Those more assimilated to their heritage/home culture, and Evangelical Christians, were more likely to identify shame as a barrier in talking to parents, but not providers. Conclusions Our findings suggest greater specificity and agreement among young people as to what makes it difficult to talk to healthcare providers about their sexuality. A common qualitative theme was recognition of the need to talk to healthcare providers about sex, but not one's parents. Thus, young people may be ready to jump directly into interventions to build skills to talk to providers, but may need to be convinced of the benefits of open communication about sexuality with their parents to get them on board. Moreover, as barriers differed across identity groups, these findings reinforce the need to tailor sexual health communication to patient characteristics. Disclosure No