Date of Award

January 2026

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Olivia N. Kachingwe

Second Advisor

Jeannette Ickovics

Abstract

Background: In order to promote positive sexual and reproductive (SRH) development and exploration among adolescents, early healthy communication with a trusted adult is critical. Historically, Black adolescents are more likely to receive abstinence-only education and experience structural barriers to care rooted in racial discrimination and disparate allocation of healthcare resources. Little is known about how parents support their children’s SRH needs and promote provider-youth communication. This study explores what role Black parents play in facilitating (or preventing) SRH communication between adolescents and their clinicians.

Methods: Twenty-four semi-structured interviews (N=24) with 11 Black adolescent-parent dyads and two additional adolescents were analyzed using a five-step reflexive thematic analysis process. Adolescents aged 11-16 and their parents aged 35-55 were recruited at a pediatric gynecology clinic. To ensure inter-coder reliability, 25% of transcripts were independently double-coded, with discrepancies resolved through frequent meetings to reach a consensus.

Results: Four themes were constructed: engaging with clinical care, cultivating a comfortable environment, facilitating problem solving, and creating communication barriers. Parents varied in clinical involvement, with some stepping back and others being actively engaged. Parents additionally prioritized making their children feel comfortable during clinical visits. Adolescent-provider communication was encouraged by parents with the goal of devising solutions to youth’s SRH challenges (e.g., irregular menstrual bleeding and irresponsible sexual activity). Parents also served as communication barriers by assuming a judgmental attitude toward SRH challenges and by restricting certain SRH topics in fear of promoting sexual risk behaviors.

Conclusion: Findings suggest that parents can play a pivotal role in facilitating clinician-child SRH communication during adolescent clinic visits, balancing parental leadership with child autonomy. Interventions that strive to improve provider-parent-child communication are needed.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 09/16/2028

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