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School-based health centers. Students' access, knowledge, and use of services.

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.