A Comparison of Rural and Urban Primary Care Physicians' Comfort Level of Providing Sexual Healthcare Practices to Adolescent Patients

IntroductionHuman immunodeficiency virus (HIV) and other sexually transmitted infection (STI) rates are increasing in rural areas, and adolescents and young adults are disproportionately affected. Data is severely lacking on rural primary care physicians' prevalence and comfort level in implementing sexual healthcare practices. Research has mostly focused on metropolitan or national samples. This study compared rural and urban primary care physicians' sexual healthcare practices and comfort providing these services to adolescent patients.MethodsA total of 510 family medicine and pediatrics physicians in the U.S. were recruited from a Qualtrics panel to complete an online cross-sectional survey between July 15-August 9, 2022. Rural-urban comparisons of performing and comfort level performing sexual healthcare practices were made with a chi-square test of independence and logistic regressions.ResultsChi-square test results showed that rural primary care physicians were less comfortable than urban physicians in asking an adolescent about their sexual risk behaviors, providing sexual risk counseling to an adolescent, testing an adolescent for HIV, and ordering an acute HIV test for an adolescent. Rural-urban differences were not seen in the logistic regressions.ConclusionThis study is the first to examine the sexual healthcare practices and comfort levels of rural primary care physicians. Future research must investigate the individual, organizational, and social determinants of rural primary care physicians delivering sexual healthcare services to their adolescent patients.Policy ImplicationsMedical schools, residency programs, and healthcare systems in rural areas or rural-majority states should invest in training opportunities and clinic resources that encourage rural primary care physicians to provide sexual healthcare services for their adolescent patients.