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The Promise and Potential of Adolescent Engagement in Health

      See Related Article p. 334
      Patient engagement has gained widespread attention over the last decade because it has been shown to improve quality of care, patient experience, and cost reductions [
      • James J.
      Health policy brief: Patient engagement.
      ]. Up until now, most of the research in this field has focused on adults. In this issue of the Journal of Adolescent Health, Sebastian et al. make an important contribution to the consumer engagement field of study for adolescents [
      • Sebastian R.A.
      • Ramos M.M.
      • Stumbo S.
      • et al.
      Measuring youth health engagement: Development of the Youth Engagement with Health Services Survey.
      ]. They have developed a new Youth Engagement in Health Scale that incorporates health access and self-efficacy measures. The authors found that greater engagement by adolescents in their health is positively associated with experience with care and receipt of anticipatory guidance, particularly sexual health risk-reduction counseling.
      In addition to the authors' recommendation calling for further testing of the Youth Engagement in Health Scale instrument in other adolescent populations and practice settings, there continues to be a need for new research conceptualizing and developing engagement measures appropriate for adolescents of different ages, genders, income levels, racial or ethnic backgrounds, and presence of chronic conditions. Such efforts would benefit from considering the continuum of adolescent engagement related to direct care and to adolescent involvement as staff members, peer health educators, advisory group members, and other leadership and policymaking roles.
      Adolescents' engagement even in direct care has been limited. In fact, past research has shown that most adolescents ages 12–17 years do not have time alone with their providers [
      • Irwin C.E.
      • Adams S.H.
      • Park M.J.
      • Newacheck P.W.
      Preventive care for adolescents: Few get visits and fewer get services.
      ]. Clearly, this significantly impedes the development of health literacy and, ultimately, engagement. Adolescent involvement in providing input to improve the delivery of care to their peers and to formulate health care policies is unusual but often found in practices specializing in the care of adolescents.
      The authors note that incorporating transition readiness might be appropriate as a next step for improving the measurement of adolescent engagement. Recently, a new transition readiness assessment tool was developed by Got Transition, the federally funded program operated by The National Alliance to Advance Adolescent Health, as part of the “Six Core Elements of Health Care Transition (2.0)” [

      Transition Readiness Assessment for Youth. Available at: www.gottransition.org. Accessed June 18, 2014.

      ]. This self-care assessment tool asks youth to rank transition importance and confidence and includes a set of 23 questions about knowledge and skills related to health needs and using health care. It is intended for use at age 14 and can be repeated annually until the youth or parent and/or caregiver (in the case of youth with significant intellectual disabilities) achieves a level of self-efficacy appropriate to manage an adult approach to care. This new self-care assessment tool has not yet been validated.
      Recognizing that the adolescent period is a critical stage when health behaviors are established, when chronic conditions increase dramatically, and when service utilization declines precipitously, it is critical for health plans and practices to discover effective approaches for engaging adolescents and improving their experience with care. Involving adolescents in the development and application of new patient engagement tools will be key.

      References

        • James J.
        Health policy brief: Patient engagement.
        Health Aff. February 14, 2013;
        • Sebastian R.A.
        • Ramos M.M.
        • Stumbo S.
        • et al.
        Measuring youth health engagement: Development of the Youth Engagement with Health Services Survey.
        J Adolesc Health. 2014; 55: 334-340
        • Irwin C.E.
        • Adams S.H.
        • Park M.J.
        • Newacheck P.W.
        Preventive care for adolescents: Few get visits and fewer get services.
        Pediatrics. 2009; 123: e565-e572
      1. Transition Readiness Assessment for Youth. Available at: www.gottransition.org. Accessed June 18, 2014.

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