Predictors of Preference for School-Based Health Center Services Among Urban High School Youth

Understanding adolescents' health care preferences is of critical importance to support optimal use. School-Based Health Centers (SBHCs) are an important setting for adolescents to seek care, yet little is known about their perceptions of and preference for SBHC services. The purpose of this study was to test whether health literacy and greater trust in SBHC providers predicted a preference for receiving health care services at an SBHC. In addition, we tested whether this preference was associated with three categories of reasons for using or not using these services (accessibility, confidentiality, and trust). We conducted a cross-sectional survey in a sample of students at 15 New York City (NYC) high schools with onsite health care services. We assessed health literacy (knowledge of sexually transmitted infections [STIs], awareness of health care rights, health literacy, and communication efficacy) and level of trust in the SBHC and reasons why students would and would not use the SBHC, as well as their preference for receiving specific health care services at the SBHC. In total, 1,382 of 1,601 students who participated met inclusion criteria for this analysis. Multivariable models showed that a stronger preference for receiving services at an SBHC was (1) predicted by greater trust in SBHC providers and higher health literacy and (2) independently predicted by greater perceived accessibility, confidentiality, as well as trust in SBHC services. Our findings show a need for increased outreach efforts within school settings with an SBHC to enhance students' awareness of the SBHC's comprehensive services.