Parents' Perspectives on Confidentiality in Clinical Preventive Services for Adolescents

Purpose

Confidentiality is central to the delivery of high-quality adolescent clinical preventive services. Previous research documents that parents have complex and often conflicting opinions about confidentiality. This study aims to describe parents' opinions and underlying beliefs about confidentiality in adolescent preventive services.

Methods

This study examined in-depth interviews conducted with a purposive sample of 35 parents in a Midwestern state as part of a larger study of primary care clinicians (PCCs), adolescent patients from their practices, and their parents. Thematic analysis was used to identify themes.

Results

Most parents held mixed opinions of confidentiality. Examination of underlying beliefs yielded multiple themes, including parents' expectations of PCCs, parents' trust in PCCs, parents' perception of the parental role, parent–adolescent relationship qualities, parents' beliefs about adolescent autonomy development, parents' opinions about the appropriate age for confidentiality, and parents' expectations about confidentiality limits. Although all parents expected PCCs to inform them if their child was in danger of harm, opinions varied on when confidentiality should be broken. The data suggested that trust in PCCs and open parent–adolescent relationships increased support of confidentiality, whereas concerns about providing adequate support and seeing adolescents as dependent minors reduced support.

Discussion

Parents have nuanced views on confidentiality. Although most parents acknowledged the need for confidential care, particularly for adolescents who live in unsupportive homes, they also expressed hesitations around confidential care. Findings highlight the importance of PCCs routinely discussing adolescent confidentiality and its limits with parents, addressing their concerns, validating their perspectives, and answering their questions thoroughly.