(PS2-26) Why I’m Here Matters: Sexual Health and Other Presenting Concerns Underlying College Students’ Worst Healthcare Experiences

Abstract Text: Past negative healthcare experiences (e.g., healthcare institutional betrayal, medical trauma) have been associated with anticipated healthcare avoidance (HAV) (Gigler et al., 2022). The recent COVID-19 pandemic and political changes have strained the national healthcare system and disrupted care, particularly among those seeking sexual and reproductive health services (Cooley-Strickland et al., 2023). Given the tightening restrictions on abortion services, sex education, and gender-affirming care in multiple US states, this research aimed to a] describe the most prevalent presenting concerns (PC) of college students during their worst healthcare experience (WHE; i.e., what % are sexual-health related) and b] consider differences in HAV among those whose PC type was sexual health-related versus other PCs. Qualitative descriptions of 955 college students’ (56.3% White, 63% female) worst healthcare experiences were obtained via Qualtrics. Data were collected from 2020-2023. PC was coded from open-ended WHE descriptions by two independent researchers; 12 PC categories emerged. Sexual health PC’s were reported by 3.6% of the sample (n = 52). The remaining PCs were categorized as: 21.0% acute injury, 25.0% acute illness, 1.8% allergy, 6.6% chronic illness, 6.6% routine care, 3.6% dental care, 4.2% mental health, and 10.1% other; 17.4% reported no WHE. HAV was assessed using a well-utilized 3-item measure (e.g., Rastegar et al.., 2025).
A one-way ANOVA found a significant effect of PC on HAV [F(10, 944) = 2.24, p = 0.014] with a small effect size (eta2 = 0.023). Post hoc Tukey tests revealed the sexual health PC group differed significantly in HAV from those with no WHE (p < 0.001, m diff = 2.09) as well as those with an acute injury PC (p < 0.01, m diff = .76) or routine care PC (p < 0.05, m diff = .86).
Of note, most college students could pick and describe a “worst healthcare experience.” Furthermore, a variety of PC’s underlie college students’ WHEs, with acute injury and illness being the most common. Importantly, as predicted, sexual health PCs were differentially associated with a greater likelihood of future HAV as compared to other PCs precipitating a WHE. Individuals presenting with sexual-health concerns may particularly benefit from trauma-informed healthcare (TIC). While TIC practices are generally recommended (Greenwald et al., 2023; O’Malley et al., 2023) to reduce avoidance behavior, providers need additional implementation support to routinely enact these (Levya et al., 2020; Kannan et al., 2014). Finally, research focused explicitly on negative healthcare experiences associated with recent sexual health service restrictions could be critical to improving care quality, reducing HAV, and improving long-term health outcomes in emerging adults.