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UBC Theses and Dissertations

Making space for young people's voices : adolescent and clinician perspectives on clinical encounters for sexual health Daly, Leslie Kim


Clinical care that meets young people’s needs can play a role in addressing serious inequities in terms of their sexual health. In considering the poor uptake of sexual health care and the potential disconnect between the care young people want and what they receive, this study makes a case for examining social context as a key influence in clinical encounters about sexual health. The goal of this study was to understand clinical encounters focused on promoting the sexual health of young people and the power dynamics embedded in social contexts that shape these encounters. Individual interviews and focus groups were conducted in Victoria, British Columbia, with 50 young people, aged 16 to 19, and with 22 clinicians who work with youth. The transcribed data were analyzed using critical techniques and intersectional analysis. Results indicated three dimensions of social context that shaped clinical encounters about sexual health, presenting obstacles to change: ideologies, structural barriers, and the influence of space and place. Three key discrepancies were also revealed between young people’s self-described needs and the clinical encounters they actually received. First, contrary to clinicians’ agendas focused on managing risk, young people favoured a more comprehensive approach that would accept their sexuality and indicate that positive sexuality mattered. Second, in contrast to the assumption that young people wanted clinicians as experts, young people described wanting acceptance but experiencing judgment. Third, instead of the gender-based approaches to managing sexual risks described by clinicians, young people described gender-specific strategies for managing the vulnerability of the clinical encounter. Young men often described resisting and avoiding care, or reducing exposure to vulnerability by “getting in and getting out” of the exam room. Young women sought personalized and warm relationships with clinicians. Young people’s perspectives highlighted their need to discuss sexuality with the understanding that acceptance and support are required in navigating both the dangers and pleasures of sexual activity. Sexual health care could be improved by promoting sex-positive approaches that take into account intersections of gender, sexuality, and space and place and by addressing the structural factors that limit clinical care.

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