Table 3.

Themes and representative quotations related to acceptability of gonorrhea and chlamydia testing in the ED among adolescents and parents or guardians.

Themes	Representative Quotations
Barriers to GC/CT testing reported by adolescents
Embarrassment	“It’s a lot about embarrassment; they don’t want to make themselves look bad just because they have an STD.” (adolescent) “The only thing I can think of is embarrassment, but hopefully most people are logical enough to overcome that.”(adolescent)
Barriers to GC/CT testing reported by parents/guardians
Nondisclosure to parent/guardian	“I know the information is kept confidential and that’s to get teens out there more to do it, but, you know, as a parent, I also want to know if my child has something.” (parent/guardian) “...I think the parents should know so the parent can be looking out and be aware and probably help that child so.I know confidentiality means a lot, but when it comes to their adolescent, then the parent should know.” (parent/guardian)
Barriers to GC/CT testing reported by both adolescents and parents/guardians
Maintaining confidentiality	“I just think as long as their parents don’t find out or it’s just confidential with them, they would answer.” (adolescent) “They would have thoughts like if they have it, they don’t want to do it [be screened]; they might get scared of it going out and people knowing.” (adolescent) “As long as it’s OK with the adolescent, I don’t think there’s any problem.. [I]t should be confidential for them, and their parents didn’t know about it.” (parent/guardian) “I think that if you have a program, it needs to be private so that children are protected, but that yet the children need somebody to be able to go to.” (parent/guardian)
Patient cost	“I would assume my insurance would take care of it.” (adolescent) “Some people don’t have insurance.” (adolescent) “I don’t want the money aspect, but I would do anything to get rid of it.” (parent/guardian) “Might have a problem if the insurance—not sure if they will cover it, but it would be nice if they did cover it.” (parent/guardian)
Benefits of universal STI screening Benefits to GC/CT testing reported by parents/guardians
Improved education	“Education...anytime you can grab a kid and say, ‘Listen, this is your choice,’ we are big on; own it.... [I]t’s your choice and it’s your consequence.” (parent/guardian) “It might be good talking points for kids and their parents, maybe even if they don’t get screened but they got some information or if they questioned about if they could get it in the future, so it might not necessarily happened that day, but it might help in the long run.” (parent/guardian)
Improved long-term health	“That way kids who do have sex and have an STD will find out instead of waiting a year down the road and hiding something from the parents forever.” (parent/guardian) “Just to prevent long-term effects if a child does have an STD...if they’re tested, then it can be addressed; if not, it can really impact their health.” (parent/guardian)
Standardization of screening	“For the parents, not singling it out so you don’t think it’s just your kid that’s being tested, and [saying] we offer this to everybody.” (parent/guardian) “.[I]f they think people are looking down on them or they look lower class or something, they would probably think that you’re trying to call them dirty or something like that, but in all reality you are just offering them something that’s going to benefit them and their kids in the long run.” (parent/guardian)
Benefits to GC/CT testing reported by both adolescents and parents/guardians
Earlier diagnosis and treatment	“It’s a major thing and it causes major consequences if you don’t do anything about it, so I think trying to prevent it and doing everything you can to prevent it is a really good idea.” (adolescent) “...people knowing for sure and if they don’t know, then they’ll find out while they’re here so they can get treated for it right away.” (adolescent) “Catch it in time before it gets worse or before they can infect someone else.” (parent/guardian) “You could possibly know prior to maybe having symptoms.” (parent/guardian)
Convenience	“Everybody uses this [ED] as a normal doctor.” (adolescent) “It’s available if someone needs it and didn’t know how to get it.” (adolescent) “Making it easy and convenient, you’re already there and some people might not actually go to the doctor for that.” (parent/guardian) “Just getting it all done at once...getting it done if it’s offered, why not?” (parent/guardian)
Prevention of transmission	“Just making sure that stuff doesn’t go untreated and cause other problems or they’re spreading it around.” (adolescent) “I think that could prevent a lot of spread of STDs, as well as maybe, like, secondary things that could affect people later on in life.” (adolescent) “It benefits everybody all the way around, especially the kids that don’t know ‘cause there’re a lot of kids that don’t know they have something and they’re running around spreading it....” (parent/guardian) “I think if it can stop the spread of STDs, I think that’s a good idea. I mean, these kids are having sex; it’s just the way it is, you know. Burying our heads in the sand is not going to fix it.... [W]e have to be able to fix it.” (parent/guardian)
Technology use Preference for tablet-based GC/CT screening by adolescents
Screening should be offered in a private room with tablets	“I feel like no one needs to know outside, so I think being in a private room would be very important.” (adolescent) “I feel here in the treatment rooms would probably be better than triage. I think....also, depending on the condition or what they’re here for, I feel like triage can be kind of chaotic and people are kind of frazzled. Once you get here, it’s quiet, it’s calm, and I think it’s a better environment for something like that.” (adolescent)
Tablets would address concerns about broaching STI topic with clinicians	“I think it would be good because it gives the teenager, if they are embarrassed talking to doctors sometimes, you could just answer things on the iPad and then turn it in. It doesn’t actually have to come out of your mouth.” (adolescent) “I think that would help kids a lot... [I]t’s definitely between them and the doctor, but they also really identify with technology and they almost feel safer, so I think that’s a really good idea.” (adolescent)
Acceptability of tablet-based GC/CT screening by parents/guardians
Concern for lack of personal interaction	“I think somebody of authority would still need to just say, ‘Do you have questions? Does everything make sense?’” (parent/guardian) “...whereas if you have a personal interaction, sometimes you can read a key if somebody is nervous or they may be avoiding something that maybe a nurse or a doctor could say, ‘Hmm, maybe I can ask this question,’ whereas the tablets are not going to see their reaction and they wouldn’t be probed a little bit deeper....” (parent/guardian) “This iPad stuff is killing me. I always think you need to talk to a person live.” (parent/guardian)
Acceptability of tablet-based GC/CT screening by both adolescents and parents/guardians
Confidentiality	“Maybe have them on the computer or something where they don’t have to talk about it; they can just enter it.” (parent/guardian) “Some people like to do it on the computer and be alone.” (adolescent)
Adolescents’ familiarity with technology	“The people getting tested would probably be more comfortable with technology rather than a pen and paper. It just feels more familiar.” (adolescent) “I think they would like that because every time you look, they are permanently attached anyway, so that would be easy.” (parent/guardian)
GC, Gonorrhea; CT, chlamydia; STD, sexually transmitted disease; STI, sexually transmitted infection.