School-based health centers. Students' access, knowledge, and use of services
P. M. Keyl, M. P. Hurtado, M. M. Barber and J. Borton
Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD, USA.
OBJECTIVE: To examine students' knowledge, barriers to access, and use of
services at two school-based health centers. DESIGN: In-person survey.
SETTINGS: Two urban public schools in Baltimore, Md. PARTICIPANTS: One
hundred forty-nine middle school and 131 high school African-American
students. The response rate was 84%. MAIN OUTCOME MEASURES: Knowledge about
center operations and services, reported barriers to access to the center,
and reported use of the center. RESULTS: Knowledge about center operations
and services was generally high. However, knowledge was low with respect to
the need for an appointment for non-emergency visits (40% correct) and the
availability of dental service referrals (51% correct). One fifth of
students incorrectly reported their enrollment status. Boys were more
likely to report that they knew about the availability of sports physical
examinations (odds ratio, 3.7), and girls were more likely to report that
they knew about reproductive services (odds ratio, 3.0). The most
frequently identified barriers to access were difficulty in obtaining a
teacher's permission to leave class (55%), requiring parental permission
for enrollment (31%), and concern about confidentiality (26%). Barriers to
access were reported more frequently by students in the middle school than
by students in the high school. Seven eighths of enrolled students reported
that they had used the center in the past year, but only a third would use
it if they woke up on a Monday with a bad cough and needed to see a
physician or nurse. CONCLUSIONS: Despite increasing the availability of
primary care services by locating health centers in schools, some barriers
to access remain. School-based health centers could more actively promote
awareness of their operation and services among students and their parents.
