Date of Completion


Embargo Period



adolescent, adolescent-friendly care, nurse practitioner, school-based health center, mixed methods

Major Advisor

E. Carol Polifroni

Associate Advisor

Cheryl T. Beck

Associate Advisor

Lois S. Sadler

Field of Study



Doctor of Philosophy

Open Access

Open Access


The Essential Elements of Adolescent-Friendly Care in School-Based Health Centers: A Mixed Methods Study of the Perspectives of Nurse Practitioners and Adolescents

Alison Moriarty Daley Ph.D.

University of Connecticut, 2016

The majority of the morbidity and mortality among adolescents results from preventable causes including risk-taking behaviors and injuries. Preventive care for this population therefore includes anticipatory guidance and screening aimed at reducing these risks. However, the rates of engagement in preventive care decline steadily throughout adolescence. School-based health centers (SBHCs) have been identified as an adolescent-friendly community resource for preventive care. The purpose of this study was to identify the essential elements of adolescent-friendly care in SBHCs from the perspectives of nurse practitioners (NPs) providing care to adolescents in SBHCs and adolescents, as the consumers of these services. Complex adaptive systems (CAS) provided the philosophical and theoretical foundation for this study.

An explanatory sequential mixed methods study was conducted. The first phase consisted of a Delphi technique with an expert panel of NPs (N = 21) to identify the essential elements of adolescent-friendly care in SBHCs. In the second phase, a focus group study with adolescents was conducted (N = 30) to explain the Delphi results. Data from two phases were mixed in the final phase of the study.

This study generated expert opinion regarding the essential elements of adolescent-friendly health care in SBHCs. After four Delphi rounds, consensus was reached on 98-items (49%; consensus level of .75). The results clustered into 6 essential elements: Confidentiality/ Privacy (n = 8; 42%), Accessibility, (n = 15; 46.9%), SBHC Environment (n = 4; 23.5%), Clinicians/Staff (n = 51; 58%), SBHC Clinical Services (n = 12; 37.5%) and Relationship Between the School and SBHC (n = 8; 66.7%). The adolescent focus groups provided data about what they liked about the SBHC, how the care differed from their other experiences, and explained the essential elements identified in the Delphi. Two overarching themes: Comfortable and Trusted Relationship emerged. The final phase mixed the data from the two phases. A conceptual model of adolescent-friendly care in SBHCs as a CAS is presented.

This study identified six essential elements and two overarching themes essential to the delivery of adolescent-friendly care in SBHCs. These findings contribute to a greater understanding of what adolescents, as consumers of health care services in SBHCs, need to engage in preventive care during adolescence.