1	
  

Perspectives of youths and adults improve the care of 

hospitalized adolescents in Spain1 

 
 
 

Ana M Ullán 
Department of Social Psychology 
University of Salamanca (Spain) 

 
Manuel H Belver 

Department of Education 
Complutense University of Madrid (Spain) 

 
Isabel Serrano 

Department of Psychology 
University of Salamanca (Spain) 

 
Juan Delgado 

Department of Psychology 
University of Salamanca (Spain) 

 
Marta Badía, 

Department of Psychology 
University of Salamanca (Spain) 

 
 

 

 
Corresponding author: 

 
Ana M Ullán 
Departamento de Psicología Social. Facultad de Ciencias Sociales 
Campus Miguel de Unamuno. 37007. Salamanca. Spain 
E-mail: ullan@usal.es 
Phone: 34 923 294 400 
 
 
 
	
  
	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  
Ullán,	
  A.	
  M.,	
  Belver,	
  M.	
  H.,	
  Serrano,	
  I.,	
  Delgado,	
  J.,	
  &	
  Badía,	
  M.	
  (2010).	
  Perspectives	
  of	
  
youths	
  and	
  adults	
  improve	
  the	
  care	
  of	
  hospitalized	
  adolescents	
  in	
  Spain.	
  Journal	
  of	
  
Pediatric	
  Health	
  Care,	
  In	
  Press,	
  Corrected	
  Proof.	
  DOI:	
  10.1016/j.pedhc.2010.08.005.	
  
	
  



	
   2	
  

	
  
Ullán,	
  A.	
  M.,	
  Belver,	
  M.	
  H.,	
  Serrano,	
  I.,	
  Delgado,	
  J.,	
  &	
  Badía,	
  M.	
  (2010).	
  Perspectives	
  of	
  

Youths	
  and	
  Adults	
  Improve	
  the	
  Care	
  of	
  Hospitalized	
  Adolescents	
  in	
  Spain.	
  
Journal	
  of	
  Pediatric	
  Health	
  Care,	
  In	
  Press,	
  Corrected	
  Proof.	
  

	
  
	
  



	
   2	
  

Perspectives of youths and adults to improve the care 

of hospitalized adolescents in Spain 

 

Abstract: 

Purpose: To determine and compare the preferences and priorities of youths and adults 

about the best ways to improve hospitals that would have an impact on the quality of 

life of hospitalized adolescents. 

Method: Participants in this study were 364 adolescents between 14 and 17 years of age 

(96 hospitalized) and 148 adults (96 parents of patients and 52 health professionals). All 

the participants completed a questionnaire about their preferences and priorities with 

regard to hospitalization.  

Results: A high degree of agreement among the youths and the adults was observed, 

especially in the importance assigned to agreeableness of clinical staff to improve 

adolescents' experience of hospitalization. Some discrepancies were also observed. The 

youths granted more importance to issues related to filling in time, specifically to the 

leisure technology available for patients. The adults assigned more importance to the 

organization of the hospital stay, in particular, for adolescents to be admitted with 

patients of the same age and for them to receive academic support in the hospital.  

Conclusions: Adolescents express a coherent perspective about the aspects that may 

help them to feel better in the hospital, in some ways different from the perspective of 

the adults who care for them. 

 

Key words: Adolescent, Hospitalized; Patient Participation; Episode of Care; Patient-

Centered Care; Hospital Planning 



	
   3	
  

 

Introduction 

 

Pediatric health services have changed from focusing on diagnosis and treatment of 

infectious diseases to centering on prevention and control of patients' chronic 

conditions. As a consequence of this change, the concept of health-related quality of life 

in the pediatric sphere has become increasingly relevant (Upton, Lawford, & Eiser, 

2008). However, some discrepancies have been observed between the assessments of 

well-being, health, quality of life, and quality of care made by children and adolescents 

and those of their parents or of the clinical staff. These differences have been observed 

both in samples of the general population (Jozefiak, Larsson, Wichstrom, Mattejat, & 

Ravens-Sieberer, 2008; Reinfjell, Diseth, Veenstra, & Vikan, 2006; Waters, Stewart-

Brown, & Fitzpatrick, 2003) and in samples of sick children and adolescents (Lal, et al., 

2008; Marino, et al., 2009; Shaw, Southwood, & McDonagh, 2006). The confirmation 

of these differences makes it necessary to assess the quality of life of young patients 

from diverse points of view. The same can be said about the assessment of health 

services with potential repercussions on such quality of life. Thus, proposals to 

incorporate the children's perspective in the services of health institutions are constantly 

increasing (Fernández-Castillo & López-Naranjo, 2006; Southall, et al., 2000). In the 

case of adolescent patients, there is also pressure to adapt health care to the specific 

psychosocial characteristics of this sector of the population.  

 

From a developmental viewpoint, adolescence is seen as the transition from childhood 

to adult life and it implies important biological, psychological, and social changes that 

should be taken into account when providing health services to these patients (Bennet & 



	
   4	
  

Tonkin, 2003; Hidalgo, González, & Montón, 2006).  The scientific advances of 

medicine and the social changes of the past decades have increased our awareness of the 

need to protect and promote the health of adolescents, considered a specific population 

group, that is, with particular health characteristics and needs (Alderman, Rieder, & 

Cohen, 2003). Hospital rules should take into account the perspective of adolescent 

patients (Wensing & Grol, 1998). Life expectancy of children with severe diseases has 

improved significantly. The increase in the longevity of children with chronic diseases 

has led to an increase in the number of adolescents who suffer from such diseases and, 

consequently, an increase in the demand of hospital services for this sector of the 

population (Alderman, et al., 2003). However, adolescents represent a very small 

proportion of the total number of hospitalized patients, and their preferences and 

concepts of care differ from those of the adults (Farrant & Watson, 2004; Jedeloo, Staa, 

Latour, & Exel, 2009; Joffe, Radius, & Gall, 1998; Zimmer-Gembeck, Alexander, & 

Nystrom, 1997). Identifying these preferences is useful because they can provide the 

keys to design models of care focusing on the quality of life of these patients. Some 

studies conclude that the first step to improve adolescents' health-care experience is to 

ask them about their preferences (Britto, et al., 2007). Nonetheless, adolescents, as 

health-services consumers, are admittedly hardly ever consulted and they are under-

represented in the research on the quality of these services (Blumberg & Devlin, 2006; 

Jedeloo, et al., 2009). 

  

The purpose of the present work was to determine and compare the preferences and 

priorities of a sample of adolescents and of adults—the parents of adolescent patients 

and the clinical staff—with regard to diverse aspects of the care provided to adolescent 

patients in hospitals. We wished to determine and compare these preferences and 



	
   5	
  

priorities in issues concerning potential ways to improve hospitals that could have an 

impact on the quality of life of adolescent patients.  

 

Method 

Participants 

 

The study was conducted between April and September of 2009 with two groups of 

adolescent participants and two groups of adults. The first group of adolescents was 

made up of patients between 14 and 17 years of age who were hospitalized in the 

University Hospital of Salamanca. Inclusion criteria for this group were being a patient 

between 14 and 17 years of age who was admitted in that hospital between the months 

of April and September of 2009 in any unit except for Psychiatry and Gynecology. We 

excluded the patients from these units because we considered that, due to the specific 

pathologies attended in them, these patients' problems were quite different from those of 

the adolescents hospitalized in other units. A total of 126 patients met the criteria and 96 

of them agreed to participate and completed the questionnaire. They all signed an 

informed consent form and received a present of writing material (about 6 euros value) 

at the end of the investigation. The second group of adolescents was an incidental 

sample comprising 268 students from two secondary education institutes whose 

teachers agreed to collaborate in the investigation. The students participated voluntarily, 

completing the questionnaire at the institute and they did not receive any reward for 

their participation. The first group of adults was made up of 96 fathers or mothers of 

patients who met the above-mentioned inclusion criteria. The second group of adults 

comprised 52 health professionals from the services of the above-mentioned hospital 



	
   6	
  

where adolescent patients were cared for and who agreed to complete the questionnaire 

they received from the nursing supervision of their corresponding unit. 

 

Questionnaire 

 

To collect the information, we used a questionnaire developed for this investigation. 

The questionnaire was based on previous investigations about the preferences of 

adolescents regarding their health care (Britto, et al., 2004; Britto, et al., 2007; Gusella 

& Ward, 1998; Hoffman, Freeman, & Swann, 2009; Miller, Friedman, & Coupey, 

1998). We also took into account the international recommendations for the care of 

minors in health institutions (Ullán & Belver, 2008). None of the aforementioned 

investigations of adolescents' preferences with regard to their hospital care was carried 

out in Spain. We therefore considered it necessary to develop an assessment instrument 

adapted to the situations of Spanish hospitals and, more specifically, to the 

characteristics of the care received in them by adolescent patients (Ullán, Gonzalez, & 

Manzanera, 2010). The questionnaire included 15 Likert-type items to tap the 

importance of diverse aspects for the improvement of the adolescents' stay at the 

hospital, 6 questions with various response options about their preferences concerning 

their roommate and the accompanying person at night, and one question that requested 

the participants to imagine they had to advise the hospital about how to improve the 

situation of hospitalized adolescents, selecting from among seven options the one they 

thought should be carried out first. Several versions of the questionnaire were prepared: 

one for the hospitalized adolescents, one for the nonhospitalized adolescent participants, 

one for the parents of the adolescent patients, and one for the clinical staff. The versions 

for the adolescents included data about their age, sex, and hospitalization experience; 



	
   7	
  

the parents' version included data about the age, sex, and hospitalization experience of 

their children, and the version for the clinical staff included data about their experience 

of caring for adolescents in the hospital. The complete versions of the questionnaire can 

be consulted at http://gredos.usal.es/jspui/ 

 

Analysis strategy 

 

The statistic tests were performed with the SPSS program (version 15). For the Likert-

type formatted questions, we calculated the descriptive statistics—mean and standard 

deviation—for each group of adolescents and adults. We also calculated the confidence 

intervals of the mean.  To compare the groups, we used nonparametric (Kruskal-Wallis) 

and parametric tests (ANOVA and Student's t-test), obtaining the same results. We used 

Spearman's rank correlation coefficient between the means of the responses of the four 

groups. For the questions about the most suitable roommate for adolescents and those 

concerning the recommended initiatives, we calculated the proportions of responses in 

each group and we compared the groups using the chi-square test (3x4 and 2x4 with 

Yates' correction), and subsequent z-tests to compare the proportions. 

 

Results 

 

Of the 126 patients considered eligible, 96 (76%) agreed to participate and completed 

the required information. Of them, 16 (16%) were hospitalized in a Pediatric unit and 80 

(84%) in adult units. In the group of nonhospitalized adolescents, 125 (46%) reported 

having been hospitalized at some time, and 247 (93%) said they had visited someone at 

the hospital at some time. There were no significant sex differences in any of these 



	
   8	
  

aspects. The distribution by age and sex of the adolescent participants is shown in Table 

1. Of the 148 adult participants, 52 were health professionals at the hospital where the 

investigation was conducted, and 96 were adults who accompanied the hospitalized 

adolescent patients. Of these 96 adults, 51 (52%) were the mothers of hospitalized 

patients, 32 (33%) were fathers, and 6 (6%) were relatives or legal representatives of the 

minors and were accompanying them. Of the 52 health professionals who participated 

in the investigation, 44 (88%) were nursing professionals, 3 (6%) were medical staff, 

and the rest were other professionals who worked in the hospital. Of the 52 health 

professionals who participated, 37 (74%) reported having more than 10 of years 

experience at their job, 13 (25%) reported having a lot of experience working with 

adolescents in the hospital, and 25 (47%) reported having little or very little experience 

working with adolescents in the hospital. 

  

 Participants were requested to rate the importance of 15 aspects aimed at the 

improvement of the adolescents' hospitalization on a scale ranging from 1 (not very 

important) to 5 (very important). In Table 2 are shown the mean ratings of the four 

groups for each one of the aspects listed. Clinical staff agreeableness and not delaying 

medical tests so that patients' hospitalization would be as brief as possible appear as the 

aspects with a higher mean rating in all four groups. The parents' permanent presence is 

part of a block of items with higher ratings in the groups of hospitalized adolescents and 

parents of adolescent patients, and clear medical information is part of a block of items 

with higher ratings in the groups of nonhospitalized adolescents, parents, and clinical 

staff. Friends' visits are highly rated by nonhospitalized adolescents and by clinical staff 

as important aspects to improve the experience of hospitalization. Decoration of the 

admittance rooms to adapt them to adolescents' taste was rated the lowest in all the 



	
   9	
  

groups. We calculated the correlation between the mean scores of the items of each 

group with Spearman's rank correlation coefficient (see Table 3).  The highest 

correlations were observed between the mean scores of the two groups of adolescents 

(hospitalized and nonhospitalized), followed by the correlations between the mean 

scores of the groups of adults (parents and clinical staff). The lowest, albeit statistically 

nonsignificant, correlation was the one between the mean scores of the group of parents 

and the nonhospitalized adolescents. 

 

In order to obtain more precise information about the aspects with the highest and 

lowest rating coincidence between adolescents and adults, for each group of 

adolescents, we compared the mean rating of each aspect with the mean rating of the 

same aspect made by the subjects of the two groups of adults. In Table 4 are shown the 

comparisons of the ratings performed by the hospitalized adolescents and by the two 

groups of adult participants, first listing the items whose importance was rated with a 

significantly higher score by the group of hospitalized adolescents than by the group of 

parents of adolescent patients, arranged according to the criteria of descending 

difference of means. The comparison of the ratings by hospitalized adolescents and by 

clinical staff is then presented. We observed that the hospitalized adolescents rated 

access to Internet in the hospital more highly than the group of parents. The parents 

rated the following aspects more highly than the adolescents did: fast medical tests, 

clear medical information, their own permanent presence in the hospital to accompany 

their children, adolescents' not having to share a room in the hospital with adult patients, 

and academic support for their children in the hospital.  The hospitalized adolescents 

rated having free TV in the room and access to Internet in the hospital more highly than 

did the clinical staff. Like the parents, the clinical staff generally rated the following 



	
   10	
  

aspects more highly than did the adolescents: for these patients to be admitted with 

same-age children and not with adults, clear medical information, and academic support 

for these patients. 

 

Following this same outline, in Table 5 are presented the comparison of the ratings 

made by the nonhospitalized adolescent participants and by the two groups of adults. In 

this case, we note the higher rating of nonhospitalized adolescents, compared to the 

group of parents, of visits from friends and relatives, being able to use Internet in the 

hospital, having more room for their personal belongings the room, for people to knock 

before entering, and spaces outside of the room to spend time with friends, other 

patients, or relatives. As in the case of the hospitalized adolescents, we also observed 

that this group of participants rated free TV in the room and access to Internet higher 

than the clinical staff.  

 

 

Table 6 shows the information regarding the questions about the roommate and the 

accompanying person at night that are considered the most suitable for hospitalized 

adolescents. For each response option to each question, the number (n) of people in 

each group who chose that option and the percentage (%) that this number represents of 

the total group are shown. When the differences observed among the proportions of 

responses given in each group were significant, we performed a pairwise comparison of 

the proportions of the columns with a Z-test.  It is worthwhile to note the preference 

expressed in all the groups for the adolescents to share the hospital room with patients 

of the same age. In the case of having to decide between the age criterion and that of 

similar medical problems to choose a roommate for the adolescents while in the 



	
   11	
  

hospital, all the groups preferred similar age first. The majority also expressed 

preference for the adolescents to be accompanied in the hospital at night. The parents 

were indicated as the preferred accompanying people by the majority, both by the 

adolescents and by the adult participants. 

 

 

Seven possible initiatives to improve adolescents' hospitalization were presented to the 

participants and they were asked to indicate which one they would recommend doing 

first if they had to advise the hospital. In Table 7 are shown the seven initiatives and the 

number and percentage of people from each group who chose each initiative as the one 

they would recommend implementing the first to improve adolescents' hospitalization. 

When these differences were significant, we performed a pairwise comparison of the 

proportions of the columns with a Z-test. The initiative chosen firstly in all cases by 

most of the groups, except for the nonhospitalized adolescents, was to reserve an area of 

the hospital for the admittance of adolescent patients. The nonhospitalized adolescents 

more frequently indicated as the first initiative the promotion of visits from friends and 

relatives and the creation of spaces in the hospital where the adolescents could spend 

time chatting, listening to music, etc. This latter aspect was also chosen very frequently 

by the hospitalized adolescents. The initiative of facilitating academic support to the 

adolescent patients was proposed to a greater extent by the adult participants (parents 

and clinical staff) than by the adolescents. The initiative of improving the patients' 

privacy was considered more often in the group of clinical staff than in the others. 

 

Discussion and Conclusions 

 



	
   12	
  

The adolescents of this study assigned more importance than the adults, on average, to 

issues about leisure technology in the hospital, specifically, having access to the Internet 

and free TV in the room. The adults granted more importance than the adolescents to 

issues concerning the organization of the stay in hospital, particularly, for the 

adolescents to be admitted with patients of the same age and not with adult patients, and 

for them to receive academic support from teachers in the hospital. In addition, the 

parents rated their permanent presence in the hospital, to accompany their hospitalized 

adolescent children, as more important than did the adolescent participants and the 

clinical staff. 

 

Despite these differences, the agreements are very significant, especially in some 

aspects such as the importance of the agreeableness of the clinical staff to improve 

adolescents' hospitalization. The quality of interpersonal care and of communication 

were identified as key elements in the quality of patient care (Campbell, Roland, & 

Buetow, 2000; Sitzia & Wood, 1997) and the importance granted by all the groups to 

the agreeableness of the clinical staff to improve adolescents' hospitalization is 

consistent therewith. Other investigations have also verified that young people rated 

aspects of interpersonal care highly when judging the quality of the health care received 

(Britto, et al., 2004; Farrant & Watson, 2004; Hoffman, et al., 2009; Mauerhofer, 

Bertchold, Akré, Michaud, & Suris, 2010). Moreover, our data reveal the high degree of 

agreement expressed both by adolescents and adults concerning the importance of the 

agreeableness of clinical staff to improve young patients' hospitalization experience.  In 

contrast, the same level of consensus was not observed in issues concerning how 

adolescent patients could spend time in the hospital. Boredom and the lack of 

opportunities for amusement are frequent complaints of hospitalized adolescents 



	
   13	
  

(Blumberg & Devlin, 2006; Gusella & Ward, 1998). But, according to our results, the 

adults do not grant the same importance to these aspects as the adolescents.  

 

It is noteworthy that the adolescent as well as the adult participants thought that the 

adolescent patients should share the room with patients similar to them in age or in 

pathologies. The adults granted this issue more priority than did the adolescents. If the 

room had to be shared either with someone of the same age or with the same pathology, 

the age criterion was preferred in all four groups. With regard to this, there was notable 

disagreement between the preferences of the adolescent patients, the parents, the clinical 

staff, and the rules of many hospitals that admit adolescents mainly in adult units 

(Ullán, et al., 2010). 

 

 

Our study has various limitations. First, the hospitalized adolescents who participated in 

it received health care in a single hospital. The characteristics of this hospital represent 

the average of Spanish hospitals of the same size. This hospital follows the general rule 

of admitting patients in adult units as of 14-15 years of age, as in 80% of the Spanish 

hospitals, according to the available data (Ullán, et al., 2010). It would be appropriate to 

carry out multicenter studies to confirm the results in this aspect. Second, as the diverse 

clinical conditions of the participants were not considered, it would be important to 

assess the preferences and priorities of the adolescents taking into account the 

pathologies they may suffer, their chronic or acute nature, their severity, and prognosis.  

 

As a conclusion of the study, the authors would like to mention a few aspects. First, the 

assessment of the preferences and priorities of the adolescent patients and their parents 



	
   14	
  

may contribute to defining potential ways to improve care for these patients in the 

hospital. These potential aspects for improvement are shown in Figure 1. In this case, 

those related to speeding up the diagnostic tests to prevent long stays in the hospital and 

those involving the interpersonal relations and care that the health professionals provide 

to the adolescent patients are noteworthy. Second, we underline the different ratings that 

can be made by the patients and the adults that care for them in some aspects involving 

the quality of life of the adolescent patients. This issue is also shown in Figure 1. The 

priorities and preferences of the hospitalized adolescents coincide, in some aspects, with 

those of their parents and those of the clinical staff, but in other aspects, they are 

different. The same thing occurs with the priorities and preferences of the other groups 

of participants.   

 

The different ratings of the parents and their children about aspects concerning the 

health-related quality of life in the pediatric sphere were interpreted as a consequence of 

the children’s' and parents' different perspectives of health and well-being (Upton, et al., 

2008). We can conclude this work along these same lines. The adolescents express a 

coherent perspective about the hospital and the aspects that can help them to feel better 

during their stay, in some ways, different from the adults' perspective, especially with 

reference to ways to spend time in the hospital. The design of patient-focused care 

systems obliges one to acknowledge these differences. Incorporating the adolescents' 

viewpoint into this design leads to integrating them as a part of the "strategic 

community of knowledge”  (Fayard, 2003). The authors consider that this would 

contribute to improving the quality of life of adolescents who are undergoing the 

processes of hospitalization. 

 



	
   15	
  

References 

 

Alderman,	
  M.,	
  Rieder,	
  J.,	
  &	
  Cohen,	
  M.	
  I.	
  (2003).	
  The	
  history	
  of	
  Adolescent	
  Medicine.	
  

Pediatric	
  Research,	
  54(1),	
  137-­‐147.	
  

Bennet,	
   D.	
   L.,	
   &	
   Tonkin,	
   R.	
   S.	
   (2003).	
   International	
   developments	
   in	
   adolescent	
  

health	
   care:	
   a	
   story	
   of	
   advocacy	
   and	
   achievement.	
   Journal	
   of	
   Adolescent	
  

Health,	
  33(4),	
  240-­‐251.	
  

Blumberg,	
   R.,	
   &	
   Devlin,	
   A.	
   S.	
   (2006).	
   Design	
   issues	
   in	
   hospitals:	
   The	
   adolescent	
  

client.	
  Environment	
  and	
  Behavior,	
  38(3),	
  293-­‐317.	
  

Britto,	
  M.	
  T.,	
  DeVellis,	
  R.	
  F.,	
  Hournung,	
  R.	
  W.,	
  DeFriee,	
  G.	
  H.,	
  Atherton,	
  H.	
  D.,	
  &	
  Slap,	
  

G.	
   B.	
   (2004).	
   Health	
   care	
   preferences	
   and	
   priorities	
   of	
   adolescentes	
   with	
  

chronic	
  illnesses.	
  Pediatrics,	
  114(5),	
  1272-­‐1280.	
  

Britto,	
  M.	
  T.,	
  Slap,	
  G.	
  B.,	
  DeVellis,	
  R.	
  F.,	
  Hornung,	
  R.	
  W.,	
  Atherton,	
  M.	
  S.,	
  Knopf,	
  J.	
  M.,	
  

et	
   al.	
   (2007).	
   Specialists	
   understanding	
   of	
   health	
   care	
   preferences	
   of	
  

chronically	
  ill	
  adolescents.	
  Journal	
  of	
  Adolescent	
  Health,	
  40,	
  334-­‐341.	
  

Campbell,	
   S.	
   M.,	
   Roland,	
   M.	
   O.,	
   &	
   Buetow,	
   S.	
   A.	
   (2000).	
   Defining	
   quality	
   of	
   care.	
  

Social	
  Science	
  &	
  Medicine,	
  51,	
  1611-­‐1625.	
  

Farrant,	
   B.,	
   &	
   Watson,	
   P.	
   (2004).	
   Health	
   care	
   delivery:	
   Perspectives	
   of	
   young	
  

people	
   with	
   chronic	
   illness	
   and	
   their	
   parents.	
   Journal	
   of	
   Paediatrics	
   and	
  

Child	
  Health,	
  40(4),	
  175-­‐179.	
  

Fayard,	
   P.-­‐M.	
   (2003).	
   Strategic	
   communities	
   for	
   knowledge	
   creation:	
   a	
   Western	
  

proposal	
  for	
  the	
  Japanese	
  concept	
  of	
  ba.	
  Journal	
  of	
  Knowledge	
  Management,	
  

7(5),	
  25-­‐31.	
  

Fernández-­‐Castillo,	
   A.,	
   &	
   López-­‐Naranjo,	
   I.	
   (2006).	
   Transmisión	
   de	
   emociones,	
  

miedo	
   y	
   estrés	
   infantil	
   por	
   hospitalización	
   [Transmission of emotions, 



	
   16	
  

children’s fear, and stress due to hospitalization].	
   International	
   Journal	
   of	
  

Clinical	
  and	
  Health	
  Psychology,	
  6(3),	
  631-­‐645.	
  

Gusella,	
  J.	
  L.,	
  &	
  Ward,	
  A.	
  M.	
  (1998).	
  The	
  experience	
  of	
  hospitalized	
  adolescent:	
  how	
  

well	
  do	
  we	
  meet	
  their	
  developmental	
  needs?	
  Children´s	
  Health	
  Care,	
  27(2),	
  

131-­‐145.	
  

Hidalgo,	
  M.	
   I.,	
   González,	
  M.	
   P.,	
   &	
  Montón,	
   J.	
   L.	
   (2006).	
   Atención	
   a	
   la	
   adolescencia	
  

[Care of adolescence]. Formación	
  Medica	
   Continuada	
   en	
  Atención	
   Primaria,	
  

13,	
  1-­‐49.	
  

Hoffman,	
  N.	
  D.,	
  Freeman,	
  K.,	
  &	
  Swann,	
  S.	
  (2009).	
  Healthcare	
  preferences	
  of	
  lesbian,	
  

gay,	
   bisexual,	
   transgender	
   and	
   questioning	
   youth.	
   Journal	
   of	
   Adolecent	
  

Health,	
  45,	
  222-­‐229.	
  

Jedeloo,	
  S.,	
  Staa,	
  A.	
  v.,	
  Latour,	
  J.	
  M.,	
  &	
  Exel,	
  J.	
  A.	
  v.	
  (2009).	
  Preferences	
  for	
  health	
  care	
  

and	
  self-­‐management	
  among	
  Dutch	
  adolescent	
  with	
  chronic	
  conditions:	
  a	
  Q-­‐

methodological	
   investigation.	
   International	
   Journal	
   of	
   Nursing	
   Studies,	
  

doi:10.1016/j.ijnurstu.2009.10.006	
  

Joffe,	
  A.,	
  Radius,	
  S.,	
  &	
  Gall,	
  M.	
  (1998).	
  Health	
  counselling	
  for	
  adolescents:	
  What	
  the	
  

want,	
  what	
  they	
  get,	
  and	
  who	
  gives	
  it?	
  Pediatrics,	
  82,	
  481-­‐485.	
  

Jozefiak,	
  T.,	
   Larsson,	
  B.,	
  Wichstrom,	
  L.,	
  Mattejat,	
   F.,	
  &	
  Ravens-­‐Sieberer,	
  U.	
   (2008).	
  

Quality	
   of	
   Life	
   as	
   reported	
   by	
   school	
   children	
   and	
   their	
   parents:	
   a	
   cross-­‐

sectional	
  survey.	
  Health	
  and	
  Quality	
  of	
  Life	
  Outcomes,	
  6(1),	
  34.	
  

Lal,	
   S.,	
   Adib,	
  N.,	
  Wedderburn,	
   L.,	
   Gardner-­‐Medwin,	
   J.,	
   Foster,	
  H.,	
   Chieng,	
   A.,	
   et	
   al.	
  

(2008).	
  Agreement	
  between	
  parent	
  and	
  adolescent	
  assessment	
  of	
  disability,	
  

pain	
  and	
  well-­‐being:	
  results	
  from	
  the	
  Childhood	
  Arthritis	
  Prospective	
  Study	
  

(CAPS).	
  Pediatric	
  Rheumatology,	
  6(Suppl	
  1),	
  S34.	
  



	
   17	
  

Marino,	
  B.	
  S.,	
  Tomlinson,	
  R.	
  S.,	
  Drotar,	
  D.,	
  Claybon,	
  E.	
  S.,	
  Aguirre,	
  A.,	
  Ittenbach,	
  R.,	
  et	
  

al.	
   (2009).	
   Quality-­‐of-­‐Life	
   Concerns	
   Differ	
   Among	
   Patients,	
   Parents,	
   and	
  

Medical	
   Providers	
   in	
   Children	
   and	
   Adolescents	
   With	
   Congenital	
   and	
  

Acquired	
  Heart	
  Disease.	
  Pediatrics,	
  123(4),	
  e708-­‐715.	
  

Mauerhofer,	
  A.,	
  Bertchold,	
  A.,	
  Akré,	
  C.,	
  Michaud,	
  P.	
  A.,	
  &	
  Suris,	
  J.	
  C.	
  (2010).	
  Female	
  

adolescents’	
  views	
  on	
  a	
  youth-­‐friendly	
  clinic.	
  Swiss	
  Medical	
  Weekly,	
  140(1-­‐

2),	
  18-­‐23.	
  

Miller,	
  N.	
   O.,	
   Friedman,	
   S.	
   B.,	
   &	
   Coupey,	
   S.	
  M.	
   (1998).	
   Adolescent	
   preferences	
   for	
  

rooming	
  during	
  hospitalization.	
  Journal	
  of	
  Adolescent	
  Health,	
  23,	
  89-­‐93.	
  

Reinfjell,	
  T.,	
  Diseth,	
  T.,	
  Veenstra,	
  M.,	
  &	
  Vikan,	
  A.	
   (2006).	
  Measuring	
  health-­‐related	
  

quality	
   of	
   life	
   in	
   young	
   adolescents:	
   Reliability	
   and	
   validity	
   in	
   the	
  

Norwegian	
   version	
   of	
   the	
   Pediatric	
   Quality	
   of	
   Life	
   Inventory	
   TM	
   4.0	
  

(PedsQL)	
  generic	
  core	
  scales.	
  Health	
  Qual	
  Life	
  Outcomes,	
  4,	
  61.	
  

Shaw,	
  K.	
  L.,	
  Southwood,	
  T.	
  R.,	
  &	
  McDonagh,	
  J.	
  E.	
  (2006).	
  Growing	
  up	
  and	
  moving	
  on	
  

in	
  rheumatology:	
  Parents	
  as	
  proxies	
  of	
  adolescents	
  with	
  juvenile	
  idiopathic	
  

arthritis.	
  Arthritis	
  Care	
  &	
  Research,	
  55(2),	
  189-­‐198.	
  

Sitzia,	
  J.,	
  &	
  Wood,	
  N.	
  (1997).	
  Patient	
  satisfaction:	
  a	
  review	
  of	
  issues	
  and	
  concepts.	
  

Social	
  Science	
  &	
  Medicine,	
  45(12),	
  1829-­‐1843.	
  

Southall,	
   D.	
   P.,	
   Burr,	
   S.,	
   Smith,	
   R.	
   D.,	
   Bull,	
   D.	
   N.,	
   Radford,	
   A.,	
   Williams,	
   A.,	
   et	
   al.	
  

(2000).	
   The	
   Child-­‐Friendly	
   Healthcare	
   Initiative	
   (CFHI):	
   Healthcare	
  

Provision	
  in	
  Accordance	
  With	
  the	
  UN	
  Convention	
  on	
  the	
  Rights	
  of	
  the	
  Child.	
  

Pediatrics,	
  106,	
  1054	
  -­‐	
  1064.	
  

Ullán,	
  A.	
  M.,	
  &	
  Belver,	
  M.	
  H.	
  (2008).	
  Cuando	
  los	
  pacientes	
  son	
  niños:	
  Humanización	
  y	
  

calidad	
   en	
   la	
   hospitalización	
   pediátrica	
   [When the patients are children: 

Humanization and quality in pediatric hospitalization].	
  Madrid:	
  Eneida.	
  



	
   18	
  

Ullán,	
  A.	
  M.,	
  Gonzalez,	
  R.,	
  &	
  Manzanera,	
  P.	
  (2010).	
  El	
  cudiado	
  de	
  los	
  adolescentes	
  en	
  

los	
   hospitales	
   españoles:	
   los	
   pacientes	
   invisibles	
   [Care	
   of	
   adolescents	
   in	
  

Spanish	
   hospitals:	
   The	
   invisible	
   patients].	
   Revista	
   de	
   Calidad	
   Asistencial,	
  

doi:10.1016/j.cali.2009.13.006	
  

Upton,	
   P.,	
   Lawford,	
   J.,	
   &	
   Eiser,	
   C.	
   (2008).	
   Parent-­‐child	
   agreement	
   across	
   child	
  

health-­‐related	
  quality	
  of	
  life	
  instruments:	
  a	
  review	
  of	
  the	
  literature.	
  Quality	
  

of	
  Life	
  Research,	
  17,	
  895-­‐913.	
  

Waters,	
   E.,	
   Stewart-­‐Brown,	
   S.,	
   &	
   Fitzpatrick,	
   R.	
   (2003).	
   Agreement	
   between	
  

adolescent	
  self-­‐report	
  and	
  parent	
  reports	
  of	
  health	
  and	
  well-­‐being:	
  results	
  

of	
   an	
   epidemiological	
   study.	
   Child:	
   Care,	
   Health	
   and	
   Development,	
   29(6),	
  

501-­‐509.	
  

Wensing,	
   M.,	
   &	
   Grol,	
   R.	
   (1998).	
   What	
   can	
   patients	
   do	
   to	
   improve	
   health	
   care?	
  

Health	
  Expectation,	
  1,	
  37-­‐49.	
  

Zimmer-­‐Gembeck,	
   M.,	
   Alexander,	
   T.,	
   &	
   Nystrom,	
   R.	
   (1997).	
   Adolescents	
   report	
  

their	
  need	
  for	
  and	
  use	
  of	
  healthcare	
  services.	
  Journal	
  of	
  Adolecent	
  Health,	
  21,	
  

388-­‐399.	
  

	
  

	
  

	
  

	
  

	
  



 
 
 
TABLE 1. Distribution of the sample of hospitalized and nonhospitalized adolescents by age and sex 

 
 
 
 
 
 

  Hospitalized 

adolescents 

n (%) 

Nonhospitalized 

adolescents 

n (%) 

 

N 

 

Age    χ2(3, N = 355) = 0.37, p = .94 

 14 years 25 (26.0%) 71 (26.5%) 96  

 15 years 18 (18.8%) 54 (20.1%) 72  

 16 years 25 (26.0%) 64 (23.9%) 89  

 17 years 28 (29.2%) 70 (26.1%) 98  

Sex    χ2(1, N = 364) = 0.93, p = .36 

 Girls 45 (46.9%) 141 (52.6%) 186  

 Boys 51 (53.1%) 127 (47.4%) 178  



TABLE 2. Importance of 15 aspects for the improvement of adolescents' hospitalization, rated on a scale ranging from 1 (not very important) to 5 
(very important) 
 
 
 

 Adolescents Adults 
 Hospitalized 

 
n = 96 

Nonhospitalized 
 

n = 268 

Parents of 
patients 
n = 96 

Clinical 
staff 

n = 52 
 M M M M 
Promptitude of tests so the stay in hospital will be brief** 4.5 4.3 4.8 4.6 
Agreeableness of the clinical staff 4.4 4.4 4.6 4.6 
Permanent presence of parents** 4.1 3.8 4.5 3.9 
Free TV the room** 4.0 4.1 3.8 3.0 
Access to Internet in the hospital** 4.0 3.9 3.5 3.4 
Clear medical information that the patient can understand** 4.0 4.1 4.4 4.6 
Friends' visits** 3.8 4.3 3.6 4.1 
Spaces outside of the hospital room to spend time with friends or 
other patients of the same age** 

3.7 3.9 3.6 4.0 

Rooms to listen to music, watch TV, read, etc.* 3.6 3.9 3.7 3.8 
People should always knock on the door before coming in 3.6 3.7 3.4 3.8 
The adolescent should be admitted with patients of the same age** 3.4 3.1 4.1 3.8 
The adolescent should not share the room with adult patients** 3.3 3.1 4.2 4.1 
Support teachers for the adolescent patient in the hospital** 3.0 2.6 4.2 3.8 
Room decorated according to adolescent taste 2.8 2.5 3.0 2.6 
More room for personal things in the room** 2.6 3.2 2.8 2.7 
A Kruskal-Wallis test was conducted to determine whether the group differences were significant.  
* p<.05. **p<.01. 



 
TABLE 3. Correlation coefficients of the mean ratings by the four groups of the importance of 15 
aspects for the improvement of adolescents' hospitalization 
 
 HA NHA PAP CS 

 
Hospitalized adolescents (HA) 
 

- .83** .61** .52 * 

Nonhospitalized adolescents (NHA) 
 

 - .41  .53 * 

Parents of adolescent patients (PAP) 
 

  - .80** 

Clinical Staff (CS) 
 

   - 

Note. We used Spearman's rank correlation coefficient among the mean ratings of the importance of 15 
aspects for the improvement of adolescents' hospitalization 
 
*p<.05  **p<.01 
 
 
 
 
 
 
  



 
TABLE 4. Differences in the mean scores of hospitalized adolescents (HA) and adults, parents of adolescent patients (PAP) and clinical staff 
(CS) 

 
 

  
HA-PAP 

 
tdf 

Aspects with a significantly higher mean rating in the group of hospitalized adolescents (HA) than in the  
group of parents of adolescent patients (PAP) 

  

     Access to Internet in the hospital 0.49 2.44183* 
Aspects with a significantly higher mean rating in the group of parents of adolescent patients (PAP) than 
 in the group of hospitalized adolescents (HA) 

  

      Promptitude of tests so the stay in hospital will be brief      -0.25 -2.50189* 
      Clear medical information  -0.45 -3.05186** 
      Permanent presence of parents  -0.50 -3.62188** 
       The adolescent should be admitted with patients of the same age  -0.77 -5.10184** 
     The adolescent should not share the room with adult patients -0.92 -4.92187** 
     Support teachers for the adolescent patient in the hospital -1.23 -7.08184** 
   

  
AH-CS 

 
tgl 

Aspects with a significantly higher mean rating in the group of hospitalized adolescents (HA) than in  
the group of clinical staff (CS) 

  

     Free TV the room 1.01 4.92145** 
     Access to Internet in the hospital 0.59 2.61143* 

Aspects with a significantly higher mean rating in the group of clinical staff (CS) than in the group of  
hospitalized adolescents (HA) 

  

     The adolescent should be admitted with patients of the same age -0.47 -2.68143* 
      Clear medical information  -0.65 -3.98144** 
     The adolescent should not share the room with adult patients -0.77 -3.41145** 
     Support teachers for the adolescent patient in the hospital -0.80 -3.84143** 
*p<.05 **p<.01   



 
 
TABLE 5. Differences in the mean scores of nonhospitalized adolescents (NHA) and adults, parents of adolescent patients (PAP) and clinical 
staff (CS). 
 
  

NHA-PAP 
 
tdf 

Aspects with a significantly higher mean rating in the group of nonhospitalized adolescents than in the  
group of parents of adolescent patients    

Friends' visits     0.63 5.15357** 
Access to Internet in the hospital 0.40 2.49353* 
More room for personal things in the room     0.34 2.53355* 
People should always knock on the door before coming in  0.31 2.24357* 
Spaces outside of the hospital room to spend time with friends or other patients of the same age  0.26 1.97354* 

Aspects with a significantly higher mean rating in the group of parents of adolescent patients than in the 
 group of nonhospitalized adolescents  

  

Clear medical information  -0.28 -2.45355* 
Promptitude of tests so the stay in hospital will be brief -0.49 -4.59359** 
Room decorated according to adolescent taste -0.51 -3.11353** 
Permanent presence of parents  -0.71 -5.37360** 
The adolescent should be admitted with patients of the same age -0.99 -7.34354** 
The adolescent should not share the room with adult patients -1.14 -7.28357** 
Support teachers for the adolescent patient in the hospital -1.69 -10.84355** 
   

  
NHA-CS 

 
tgl 

Aspects with a significantly higher mean rating in the group of nonhospitalized adolescents than in the  
group of clinical staff  

  

Free TV the room 1.08 6.82317** 
Access to Internet 0.50 2.54313* 
More room for personal things in the room    0.46 2.88316** 

Aspects with a significantly higher mean rating in the group of clinical staff than in the group of  
nonhospitalized adolescents 

  

Promptitude of tests so the stay in hospital will be brief -0.32 -2.22316* 
Clear medical information -0.49 -3.47313** 
The adolescent should be admitted with patients of the same age -0.69 -4.04313** 
The adolescent should not share the room with adult patients -0.99 -4.96315** 
Support teachers for the adolescent patient in the hospital 
 

-1.27 -6.34314** 

*p<.05 ** p<.01   



 
 
TABLE 6. Number and percentage of subjects who chose each one of the response options in the questions about preference for a roommate and the accompanying 
person in the hospital at night for adolescent patients 
 
 
Content of the question and response options 

Hospitalized 
adolescents 

 
n = 96 

n  (%) 

Nonhospitalized 
adolescents 

 
n = 268 

n  (%) 

Parents of 
adolescent 

patients 
n = 96 

n  (%) 

Clinical 
staff 

 
n = 52 

n  (%) 
Preferences concerning the adolescent's room in the hospital**     
 Individual 58 (60%)a  137 (51%)  61 (64%)a 

 17 (33%)  
 Shared 18 (19%)  42 (16%)  14 (15%)  26 (50%)b,c,d 

 

 Doesn't matter 20 (21%)  87 (32%)  19 (20%)  8 (15%)  
                             χ2 (6,  N = 507) = 44.4, p <.01     
If an adolescent patient must share the hospital room with another patient, is it preferable to 
share with someone of the same age or doesn't the roommate's age matter?** 

    

 With someone of the same age 83 (86%)  231 (86%)  94 (98%)c,d 
 50 (96%)  

 The roommate's age doesn't matter  13 (14%)b  36 (13%)b (9-17)
 1 (1%)  2 (4%)  

                             χ2(3, N = 510) = 15.3, p <.01     
If an adolescent patient must share the hospital room with another patient, is it preferable to 
share with someone who has similar medical problems or doesn't this aspect matter?** 

    

 With someone who has similar medical problems 54 (56%)  139 (52%)  72 (75%)a,c,d 
 25 (48%)  

 This aspect doesn't matter 42 (44%)b  127 (47%)b 
 20 (21%)  27 (52%)b 

 

                              χ2(3, N = 506) = 21.1, p <.01     
If an adolescent patient must share the hospital room, is it preferable for the roommate to 
have similar medical problems, although he/she is of a different age, or is it better for the 
roommate to have about the same age, regardless of the medical problems he/she may have?  

    

 Roommate with similar medical problems  35 (36%)  69 (26%)  24 (25%)  11 (21%)  
 Same-age roommate 61 (64%)  189 (71%)  66 (69%)  40 (77%)  
                                 χ2(3, N = 495) = 4.7, p = .19     
How would adolescent patients be better off at night in the hospital? **     
 Accompanied  90 (94%)  223 (83%)  94 (98%)c 

 51 (98%)  
 Alone 5 (5%)  38 (14%)b 

 1 (1%)  1 (2%)  
                                   χ2(3 ,N = 503) = 22.1, p <.01     
Who is the most suitable person to accompany adolescent patients at night in the hospital?      
  Parents**                          χ2(3, N = 510) = 33.6, p <.01 88 (92%)c

 193 (72%)  87 (91%)c 
 48 (92%)c 

 

  Other relatives                               χ2(3, N = 510) = 3.8, p = .29 14 (15%) 24 (9%)  11 (11%)  3 (6%)  
  Friends **                          χ2(3, N = 512) = 93.5, p <.01 7 (7%) 108 (40%)a,d 

 0 (0%)  4 (8%)  
  Professional clinical staff f           χ2(3, N = 512) = 11.4, p = .01 1 (1%) 8 (3%)  9 (9%)  1 (2%)  
Note. For each question, we include the number of people from each group who chose each response option (n), the percentage (%) that this number represents of the 



total group, and the value of χ2 , with the degrees of freedom, the sample size, and the corresponding p value to appraise the statistical significance of the differences 
in the proportions of responses of the four groups. When these differences were significant, we performed a paired comparison of the proportions of the columns 
with z-tests. The results are based on bilateral tests with a .05 level of significance. Using Bonferroni's correction, we adapted the tests for all the pairwise 
comparisons within a row for each subtable situated to the right. 
a The proportion of this cell is significantly higher than that of the group of clinical staff 
b The proportion of this cell is significantly higher than that of the group of parents of adolescent patients 
c The proportion of this cell is significantly higher than that of the group of nonhospitalized adolescents 
d The proportion of this cell is significantly higher than that of the group of hospitalized adolescents 
f More than 20% of the cells of this row had expected frequencies of less than 5 
* p < .05. **p < .01. 
 
 
 
 
 
 
 
 



 
TABLE 7. Number (n) and percentage (%) of participants of each group that indicated each one of the initiatives as the one they would recommend carrying out first to improve adolescents' 
hospitalization 

Initiatives 

 
Hospitalized  
adolescents 

n =  96 
 

n (%)   

 
Nonhospitalized 

adolescents 
n =  268 

 
n (%)   

 
Parents of adolescent 

patients 
n =  96 

 
n (%)  

 
Clinical staff 

n =  52 
 
 

n (%)  
Reserve a hospital area for patients between 14 and 18 years of age and not make 
such patients share rooms either with adults or with small children  

χ2 (3, N =512) = 47.5, p <.01 
 

40 (42%)b   54 (20%)   53 (55%)b   23 (44%)b   

Promote visits of friends and relatives and have quiet rooms reserved for such visits  
χ2 (3, N =512) = 23.9, p <.01 

 
10 (10%)   64 (24%)a,c   5 (5%)   5 (10%)   

Create spaces outside of the rooms to be used by the adolescent patients for 
chatting, reading, listening to music, playing, etc.  

χ2 (3, N =512) = 7.5, p = .06 
 

20 (21%)   65 (24%)   15 (16%)   5 (10%)   

Facilitating academic aid to the boys and girls during their hospitalization  
χ2 (3, N =512) = 10.9, p = .01 

 
12 (13%)   24 (9%)   20 (21%)b   10 (19%)   

Improving the decoration of the rooms and adapting it to adolescents' taste  
χ2 (3, N =512) = 2.6, p = .45 

 
3 (3%)   6 (2%)  4 (4%)   0 (0%)   

Program activities and alternatives to fill in time in the hospital (art workshops, 
games, etc.) and that the adolescent patients can participate in them  

χ2 (3, N =512) = 0.2, p = .97 
 

13 (14%)   33 (12%)   11 (11%)   7 (13%)   

Improve the patients' privacy in the hospital  
χ2 (3, N =512) = 2.7, p = .44 

 
11 (11%)  32 (12%)   10 (10%)   10 (19%)   

Note. For each question, we include the number of people from each group who chose each response option (n), the percentage (%) that this number represents of the total group, and the value 
of χ2 , with the degrees of freedom, the sample size, and the corresponding p value to appraise the statistical significance of the differences in the proportions of responses of the four groups. 
When these differences were significant, we performed a paired comparison of the proportions of the columns with z-tests. The results are based on bilateral tests with a .05 level of 
significance.  



 
a The proportion of this column is significantly higher than that of the column of hospitalized adolescents 
b The proportion of this column is significantly higher than that of the column of nonhospitalized adolescents 
c The proportion of this column is significantly higher than that of the column of parents of adolescent patients 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 




	Title page.pdf
	manuscript.pdf
	Table 1.pdf
	Table 2.pdf
	Table 3.pdf
	Table 4.pdf
	Table 5.pdf
	Table 6.pdf
	Table 7.pdf
	figure 1