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J Sch Health. 1997 Apr;67(4):144-8.

Rural school-based clinics: are adolescents willing to use them and what services do they want?

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Dept. of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston 77555-0587, USA.


Using a theoretical model of access, factors associated with rural adolescents' willingness to use primary care services through a school-based health center (SBHC) were examined. Standardized measures of health status and use were administered to 633 adolescents in grades 7-12 who resided in one rural western Maryland county. Although only 6.5% (n = 41) of the sample indicated a willingness to change their regular source of care to an SBHC, greater numbers of adolescents reported a willingness to use SBHC services, with 18%, 38%, 25%, and 16%, indicating interest in routine, acute medical, miscellaneous, and reproductive health care services, respectively. Logistic regression analysis found those adolescents who reported eligibility for free-reduced lunch and no regular source of care for illness were 3.3 and 5.4 times more likely, respectively, to use an SBHC as a primary care site than those unwilling to change their source of care. Data suggest that initially many rural adolescents appear unwilling to change their primary care site to an SBHC, but do express a willingness to use offered services.


This study examined the factors affecting use of a school-based health center (SBHC) for primary health care (PHC) and reproductive health services (RHS) among a rural population in the US in 1992. Data were obtained from 633 students in grades 7-12 and aged 11-18 years in 1 rural county in Maryland. The health needs survey assessed student willingness to use types of services and 24 specific needs for referral and medical treatment for minor illnesses, routine health maintenance, screening, health education, RHS, mental health, and miscellaneous services. 50% of the sample were aged 11-14 years, and 97% were White. 51% had private insurance. 26% were unsure of medical coverage. 28% reported serious emotional/physical problems. 17% did not have a usual source of PHC. Findings reveal that only 6.5% were willing to switch to an SBHC. 38% were unsure. Switching was significantly associated with receipt of free school lunches and not having a regular provider. Uncertainty about switching was associated with no regular source of care and lack of health insurance. 17.9% reported a willingness to use routine services. 38.1% were willing to use SBHCs for acute medical treatment. 25.3% would use miscellaneous services. 16.3% would use RHS. Teens with mothers without a high school education, teens in poor health, and teens less satisfied with health care were 2.3 times more likely to use RHS. Willingness to switch for PHC was unrelated to willingness to adopt other services. Findings reveal a disparity between support for and actual use of an SBHC.

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