'I Didn't Even Know You Cared About That Stuff'

Youths' Perceptions of Health Care Provider Roles in Addressing Bullying

Judith A. Vessey, PhD, MBA, RN, FAAN; Rachel L. DiFazio, PhD, RN, PPCNP-BC, FAAN; Tania D. Strout, PhD, RN, MS

Disclosures

J Pediatr Health Care. 2017;31(5):536-545. 

In This Article

Results

Three focus groups of middle school students from diverse communities across the New England region of the United States provided the initial data. Groups ranged in size from seven to eight participants. A fourth group of two hospitalized youths with ongoing chronic health conditions was added to reach data saturation. The study period was September through November 2015. The participants (N = 24) ranged in age from 12 to 16 years, with a mean of 12.3 years. Participants were 22.7% male, 63.6% White, 13.6% African American/Black, 18.2% Asian/Pacific Islander, and 4.5% of more than one race; ad 22.7% were of Hispanic ethnicity. The median income of participants' communities ranged from $28,000 to $131,000, with a median of $75,640 (U.S. Census Bureau, 2014).

Themes

Three primary themes emerged from the data that addressed health care providers' role in addressing bullying: (a) Not sure that's part of their job, (b) That's way too personal, and (c) They couldn't help anyway. Exemplar codes, categories, and themes are provided in the Table.

Theme 1: Not sure that's part of their job. When asked, "[W]ho would you seek help from if you or a friend were bullied?" the participants were quick to identify friends, school counselors, older siblings, and parents as individuals that they believed would be empathetic and knowledgeable. When specifically probed to whether they would seek help from their nurse practitioner or pediatrician, the participants were visibly flummoxed. They noted that their health care providers often made general conversation about school but did not specifically ask about bullying, as noted in this quotation: "Like my doctor goes, 'How's school?' and I'm like, 'Good,' and she doesn't get that personal like are you getting bullied." They clearly had not considered the possibility that health care providers had a substantive role in addressing bullying. More commonly, youths viewed bullying as a school and community issue rather than a health care concern. After giving the idea some thought, the following response captured the participants' shared views:

I don't even think it's like a question that people think to bring up to their doctors because people think doctors are for more like mental illness and physical illnesses. They don't think of it as a help for that type of thing.

The participants did endorse health care providers' role as helping with "mental illness" and were quick to identify bullying's psychosocial sequelae—including fear, sadness, depression, self-harm, and school avoidance—but they did not classify these outcomes as mental health concerns. The participants saw the health care provider as having a primary role only if bullying sequelae rose to the level of suicide ideation, as noted by this quotation: "I think that if you're getting to the point in bullying that you're trying to hurt yourself or commit suicide."

Theme 2: That's way too personal. Youths were queried about what would make them more or less comfortable in talking about bullying with their nurse practitioners or physicians. The lack of a patient–provider relationship was the first identified barrier, as noted by this quotation: "Some kids don't feel okay talking to their doctors because they don't know them personally because it [bullying] is like outside of the doctor's office you don't see them…" The second concern was that they would be made to feel uncomfortable, as noted by this quotation: "…like maybe if your stress was up or something. I don't think that a lot of kids feel comfortable talking to their doctor about that." Study participants clearly endorsed the notion that an indirect approach for initiating the conversation should be used. One participant stated, "If it was like casual…you didn't go there just to talk about bullying and stuff like that." Another added, "I think maybe if it was on paper or not physically just talking to them. I think it makes it uncomfortable because you might not know what to say."

The use of technology, such as an electronic tablet, also was endorsed by participants. They supported the idea that an electronic screening tool could be completed at a health visit and that this modality might afford more privacy than a paper version or direct questioning by a provider.

The role parents play in mediating health care encounters between youths and providers was viewed both positively and negatively. Although many youths stated that they were comfortable talking about sensitive topics with their parents in attendance, others expressed significant reluctance and had concerns about provider–patient confidentiality, as noted by these quotations: "I don't know how many kids are actually going to answer those questions [about bullying]…because doctors can tell your parents…if something is happening like bullying, they're probably going to tell your parents," and "I'd rather talk to the doctor first (without parents present)."

Theme 3: They couldn't help anyway. Lastly, youths were concerned that even if they discussed bullying with their health care provider, that the provider would not be in a position to help. They perceived health care providers' roles as primarily limited to assisting in the case of physical injury, as noted in this quotation: "…if they are getting physically bullied they may help you." Second, youths viewed bullying as a school- or community-related issue, as noted in this quotation: "…but I don't know how much say they would have, if it's connected to school or wherever else you may go."

Lastly, they doubted that providers had the necessary compendium of resources to offer meaningful help, as noted in this quotation:

I think that you know that if something's going to be done, it makes you feel more comfortable that you know that what you're doing is going to be successful. Like if you just talk to someone and they're not going to do anything about it, it doesn't really matter.

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