507 - Perceptions of the Provider-Patient Relationship Following the COVID Transition to Telehealth Visits

Poster Board #: 507
Publication #: EP-100.507

Background: The COVID-19 pandemic caused a sudden shift in care delivery models from in-person to telehealth. There is no known published literature on adolescent perceptions of telehealth.


Objective: The aims of this exploratory study are: (1) to describe adolescent patients’ perceptions of the therapeutic alliance with providers during video visits (VVs), and (2) to describe adolescent perceptions of privacy during VVs.


Design/Methods: This was a cross-sectional study of English-speaking adolescent patients aged 13-17 years old who had a VV between September 2020 and December 2020 at 8 academic-affiliated pediatric primary care practices. Data collection will end February 2020. Online surveys included questions on demographics, technology use, privacy, and a modified Working Alliance Inventory (WAI) (range 14-70) to capture perceived therapeutic alliance. Descriptive and bivariable statistical analyses (2-sample t-test for continuous variables, or Fischer’s exact test for categorical variables) were performed using StataSE 16. The institutional IRB approved the study.


Results: Of 270 eligible adolescents, 86 consented, and 22 completed surveys (8% response rate) (Figure 1). Mean age was 15 years. The majority were cisgender female, non-Hispanic, White, and living with 3-4 person households (Table 1). After dichotomizing WAI score, high WAI score [i.e., ≥61.88 (mean)] was significantly associated with the VV not being their first meeting with the provider (p=0.04). The remainder of the variables had similar distributions across WAI score (all p>0.05). Only 27% of adolescents reported some time alone with their provider during their last VV. However, WAI score was not correlated with reported time alone during the VV (p=1.00). 75% of adolescents reported "very private" VV (Table 2), though nearly 100% of adolescents reported “very private” in-person visits. Perceived level of privacy during VV was statistically associated with mean WAI score (p=0.015).

Conclusion(s): In this preliminary analysis, adolescents perceived telehealth as a private and therapeutic method of accessing health care. Higher perceived therapeutic alliance was associated with repeated visits with the provider or high levels of perceived privacy. However, only a quarter of adolescents reported having private time during their last VV, which may limit their access to confidential services. Future research should evaluate how adolescents define adequate privacy during VVs, and how to train providers to ensure private and confidential VVs.

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Authors/Institutions: Bianca A. Allison, University of North Carolina, Chapel Hill, North Carolina, United States; Samantha Rea, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, United States; Lisa Mikesell, Rutgers School of Communication, New Brunswick, New Jersey, United States; Ashleigh Kozel, University of North Carolina School of Nursing, Chapel Hill, North Carolina, United States; Elizabeth M. Walters, University of North Carolina, Durham, North Carolina, United States; Martha Perry, UNC School of Medicine, Chapel Hill, North Carolina, United States