“It’s on Me”: Perspectives of College Students Without Complex Medical Needs Learning to Manage Their Health Care

Abstract

Objective:

Most of the transition literature has examined adolescents and young adults with special health care needs, though many youth will eventually transition to adult health care providers, regardless of medical complexity. This study addressed this gap by examining transition needs and experiences specifically within a college student sample of emerging adults without complex medical needs.

Methods:

One hundred eight college students (M_age = 20.93 years, SD = 1.14) completed interviews and questionnaires regarding transition. The most difficult and easiest aspects of health care self-management were thematically coded. Differences in questionnaires were assessed across sources of transition education.

Results:

Fifty-two percent of college students reported receiving education about managing health care from medical providers versus 95% from caregivers. Notably, 57% desired more support. Those receiving medical provider education reported higher responsibility. Students reported most difficulty managing health insurance. Results were similar across racial and ethnic groups and genders.

Conclusions:

Gaps in transition preparation include low rates of medical provider education and support regarding health insurance. College students receiving education from medical providers reported greater health care responsibility. Provider-led transition education is needed for college students without complex medical needs.

Implications for Impact Statement

This study suggests that college students without complex medical conditions experience gaps in transition preparation. Although half reported talking to their medical provider about transitioning to adult care, many desired more support, with the greatest difficulty reported in learning to manage health insurance.

Get full access to this article

View all access options for this article.

References

Asarnow

J. R.

Kolko

D. J.

Miranda

, & Kazak

A. E.

(2017). The pediatric patient-centered medical home: Innovative models for improving behavioral health. American Psychologist, 72(1), 13–27. 10.1037/a0040411

Becker

S. J.

(2015). Direct-to-consumer marketing: A complementary approach to traditional dissemination and implementation efforts for mental health and substance abuse interventions. Clinical Psychology: Science and Practice, 22(1), 85–100. 10.1111/cpsp.12086

Betz

C. L.

Lobo

M. L.

Nehring

W. M.

, & Bui

(2013). Voices not heard: A systematic review of adolescents’ and emerging adults’ perspectives of health care transition. Nursing Outlook, 61(5), 311–336. 10.1016/j.outlook.2013.01.008

Blum

R. W. M.

Garell

Hodgman

C. H.

Jorissen

T. W.

Okinow

N. A.

Orr

D. P.

, & Slap

G. B.

(1993). Transition from child-centered to adult health-care systems for adolescents with chronic conditions. A position paper of the Society for Adolescent Medicine. The Journal of Adolescent Health, 14(7), 570–576. 10.1016/1054-139X(93)90143-D

Burke

Spoerri

Price

Cardosi

A.-M.

, & Flanagan

(2008). Survey of primary care pediatricians on the transition and transfer of adolescents to adult health care. Clinical Pediatrics, 47(4), 347–354. 10.1177/0009922807310938

Calamidas

E. G.

, & Crowell

T. L.

(2018). A content analysis of college students’ health behaviors. American Journal of Health Education, 49(3), 133–146. 10.1080/19325037.2018.1428699

Cohen

(1988). Statistical power analysis for the behavioral sciences (2nd ed.). Erlbaum Associates.

Davidson

L. F.

Doyle

, & Silver

E. J.

(2017). Discussing future goals and legal aspects of health care: Essential steps in transitioning youth to adult-oriented care. Clinical Pediatrics, 56(10), 902–908. 10.1177/0009922817706142

Eaton

C. K.

Davis

M. F.

Gutierrez-Colina

A. M.

LaMotte

Blount

R. L.

, & Suveg

(2017). Different demands, same goal: Promoting transition readiness in adolescents and young adults with and without medical conditions. Journal of Adolescent Health, 60(6), 727–733. 10.1016/j.jadohealth.2017.01.002

10.

Gabriel

McManus

Rogers

, & White

(2017). Outcome evidence for structured pediatric to adult health care transition interventions: A systematic review. The Journal of Pediatrics, 188, 263–269.e15. 10.1016/j.jpeds.2017.05.066

11.

Gale

R. C.

Erhardt

Bounthavong

Reardon

C. M.

Damschroder

L. J.

, & Midboe

A. M.

(2019). Comparison of rapid vs in-depth qualitative analytic methods from a process evaluation of academic detailing in the Veterans Health Administration. Implementation Science, 14(1), Article 11. 10.1186/s13012-019-0853-y

12.

Gilleland

Amaral

Mee

, & Blount

(2012). Getting ready to leave: Transition readiness in adolescent kidney transplant recipients. Journal of Pediatric Psychology, 37(1), 85–96. 10.1093/jpepsy/jsr049

13.

Guest

Bunce

, & Johnson

(2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18(1), 59–82. 10.1177/1525822X05279903

14.

Gutierrez-Colina

A. M.

Davis

Eaton

C. K.

LaMotte

Cushman

Quast

Blount

R. L.

, & Suveg

(2020). The role of executive functioning in health self-management and the transition to adult health care among college students. Journal of American College Health, 70(3), 830–836. 10.1080/07448481.2020.1775605

15.

Hargreaves

D. S.

Elliott

M. N.

Viner

R. M.

Richmond

T. K.

, & Schuster

M. A.

(2015). Unmet health care need in U.S. adolescents and adult health outcomes. Pediatrics, 136(3), 513–520. 10.1542/peds.2015-0237

16.

Kelly

A. M.

Kratz

Bielski

, & Rinehart

P. M.

(2002). Implementing transitions for youth with complex chronic conditions using the medical home model. Pediatrics, 110(6 Pt 2), 1322–1327. 10.1542/peds.110.S3.1322

17.

Kuckartz

, & Rädiker

(2019). Analyzing qualitative data with MAXQDA. Springer. 10.1007/978-3-030-15671-8_11

18.

Lebrun-Harris

L. A.

McManus

M. A.

Ilango

S. M.

Cyr

McLellan

S. B.

Mann

M. Y.

, & White

P. H.

(2018). Transition planning among U.S. youth with and without special health care needs. Pediatrics, 142(4), Article e20180194. 10.1542/peds.2018-0194

19.

Lotstein

D. S.

Kuo

A. A.

Strickland

, & Tait

(2010). The transition to adult health care for youth with special health care needs: Do racial and ethnic disparities exist? Pediatrics, 126(Suppl. 3), S129–S136. 10.1542/peds.2010-1466F

20.

Mahmoud

J. S. R.

Staten

Hall

L. A.

, & Lennie

T. A.

(2012). The relationship among young adult college students’ depression, anxiety, stress, demographics, life satisfaction, and coping styles. Issues in Mental Health Nursing, 33(3), 149–156. 10.3109/01612840.2011.632708

21.

McHugh

M. L.

(2012). Interrater reliability: The kappa statistic. Biochemia Medica, 22(3), 276–282. 10.11613/BM.2012.031

22.

McManus

White

Barbour

Downing

Hawkins

Quion

Tuchman

Cooley

W. C.

, & McAllister

J. W.

(2015). Pediatric to adult transition: A quality improvement model for primary care. Journal of Adolescent Health, 56(1), 73–78. 10.1016/j.jadohealth.2014.08.006

23.

McManus

White

Schmidt

Barr

Langer

Barger

, & Ware

(2020). Health care gap affects 20% of United States population: Transition from pediatric to adult health care. Health Policy OPEN, 1, Article 100007. 10.1016/j.hpopen.2020.100007

24.

Parasuraman

S. R.

Anglin

T. M.

McLellan

S. E.

Riley

, & Mann

M. Y.

(2018). Health care utilization and unmet need among youth with special health care needs. Journal of Adolescent Health, 63(4), 435–444. 10.1016/j.jadohealth.2018.03.020

25.

Park

M. J.

Scott

J. T.

Adams

S. H.

Brindis

C. D.

, & Irwin

C. E.

Jr. (2014). Adolescent and young adult health in the United States in the past decade: Little improvement and young adults remain worse off than adolescents. Journal of Adolescent Health, 55(1), 3–16. 10.1016/j.jadohealth.2014.04.003

26.

Santo

, & Okeyode

(2021). National ambulatory medical care survey: 2018 national summary tables. National Center for Health Statistics.

27.

Sawicki

G. S.

Lukens-Bull

Yin

Demars

Huang

I.-C.

Livingood

Reiss

, & Wood

(2011). Measuring the transition readiness of youth with special healthcare needs: Validation of the TRAQ—Transition Readiness Assessment Questionnaire. Journal of Pediatric Psychology, 36(2), 160–171. 10.1093/jpepsy/jsp128

28.

Sawyer

S. M.

Blair

, & Bowes

(1997). Chronic illness in adolescents: Transfer or transition to adult services? Journal of Paediatrics and Child Health, 33(2), 88–90. 10.1111/j.1440-1754.1997.tb01005.x

29.

Schuiteman

Chua

K.-P.

Plegue

M. A.

Ilyas

, & Chang

(2020). Self-management of health care among youth: Implications for policies on transitions of care. Journal of Adolescent Health, 66(5), 616–622. 10.1016/j.jadohealth.2020.01.009

30.

Seigers

D. K.

, & Carey

K. B.

(2010). Screening and brief interventions for alcohol use in college health centers: A review. Journal of American College Health, 59(3), 151–158. 10.1080/07448481.2010.502199

31.

Sharkey

C. M.

Bakula

D. M.

Gamwell

K. L.

Mullins

A. J.

Chaney

J. M.

, & Mullins

L. L.

(2017). The role of grit in college student health care management skills and health-related quality of life. Journal of Pediatric Psychology, 42(9), 952–961. 10.1093/jpepsy/jsx073

32.

Telfair

Myers

, & Drezner

(1994). Transfer as a component of the transition of adolescents with sickle cell disease to adult care: Adolescent, adult, and parent perspectives. Journal of Adolescent Health, 15(7), 558–565. 10.1016/1054-139X(94)90139-T

33.

Tessier

(2012). From field notes, to transcripts, to tape recordings: Evolution or combination? International Journal of Qualitative Methods, 11(4), 446–460. 10.1177/160940691201100410

34.

White

P. H.

, & Cooley

W. C.

(2018). Supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics, 142(5), Article e20182587. 10.1542/peds.2018-2587

35.

White

Schmidt

McManus

, & Irwin

(2018). Incorporating health care transition services into preventive care for adolescents and young adults: A toolkit for clinicians. Got Transition. https://www.gottransition.org/resource/?clinician-toolkit-preventive-care

36.

Wong

C. A.

Asch

D. A.

Vinoya

C. M.

Ford

C. A.

Baker

Town

, & Merchant

R. M.

(2015). Seeing health insurance and HealthCare.gov through the eyes of young adults. Journal of Adolescent Health, 57(2), 137–143. 10.1016/j.jadohealth.2015.04.017

37.

Wood

D. L.

Sawicki

G. S.

Miller

M. D.

Smotherman

Lukens-Bull

Livingood

W. C.

Ferris

, & Kraemer

D. F.

(2014). The Transition Readiness Assessment Questionnaire (TRAQ): Its factor structure, reliability, and validity. Academic Pediatrics, 14(4), 415–422. 10.1016/j.acap.2014.03.008

38.

Zhang

Lin

Pforsich

, & Lin

V. W.

(2020). Physician workforce in the United States of America: Forecasting nationwide shortages. Human Resources for Health, 18(1), Article 8. 10.1186/s12960-020-0448-3