Johanna Haraldsson: Exploring adolescent males’ consultations with general practitioners in the context of psychosocial health

Abstract

This thesis aimed to explore adolescent males’ experiences of consultations with general practitioners (GPs) with a particular focus on confidentiality in relation to poor mental health and health-compromising behaviours.

First, a model describing the covariation of poor mental-health symptoms, associated somatic symptoms, and health-compromising behaviours was developed through explorative and confirmative factor analysis (paper I). The model was then applied in a structural equation modelling approach to study whether these symptoms and behaviours influenced how adolescent males valued and experienced confidentiality as well as whether they were comfortable asking sensitive questions during their GP consultations (paper II).

Next, to gain a deeper understanding, adolescent males’ experiences with GP consultations were further explored through a qualitative lifeworld-based approach. Interviews were analysed with thematic analysis (paper III) and video observations with a phenomenological–hermeneutical method (paper IV).  

The findings revealed that by providing confidentiality, here defined as private time without parents and explaining the meaning and boundaries of professional secrecy, GPs can facilitate discussions on sensitive topics and make adolescent males feel more comfortable to raise their own concerns. This might be a fruitful approach to address any unmet health needs, which can be achieved through the split-visit consultation model.

Another finding was that the studied consultations were very complex. Due to their ongoing development, inexperience with GP consultations, and notions of masculinity, the adolescent males struggled with cognitive, emotional, and relational difficulties while negotiating their right to define the problem and be responsible for their health. The adolescent males emphasized the importance of being listened to and taken seriously, which entails that all aspects of the consultation must be adapted to their individual needs and to their lifeworld. This aligns with Larsen’s consultation model, where the GP strives to understand the patient’s experience and to connect their medical findings to the patient’s lifeworld. Given that both the split-visit consultation model and Larsen’s consultation model offer valuable frameworks for addressing essential, but different, aspects in adolescent males’ GP consultations, the thesis proposes a synthesis of the two approaches.