ABP Research Report

MEJO 634: Public Relations Campaigns

MARCH 2020

RESEARCH REPORT

PREPARED BY

HEALTH NUTS AMERICAN BOARD OF PEDIATRICS Bradley Barefoot, Ashley Broadwater, Jillian Daly, Maren Garner, Hope Motzenbecker

RESEARCH ON BEHALF OF AMERICAN BOARD OF PEDIATRICS

HEALTH NUTS MEET OUR TEAM

BRADLEY BAREFOOT

ASHLEY BROADWATER

JILLIAN DALY

MAREN GARNER

HOPE MOTZENBECKER

Following our initial background research, this team of public relation students from the Hussman School of Journalism and Media led our own research into how our client, the American Board of Pediatrics, could benefit from better connecting with the college demographic and understanding their preferences when it comes to pediatrics and having a primary care physician.

After completing secondary research that educated on us on the transition from pediatric care to campus health resources, our "Health Nuts" team dove into our primary research to understand the healthcare preferences of college students using an online Qualtrics survey and in-person private interviews with UNC-CH students.

MARCH 2020 -- HUSSMAN SCHOOL OF JOURNALISM AND MEDIA

EXECUTIVE SUMMARY The American Board of Pediatrics (ABP) is a nonprofit that specializes in pediatric certification and examination. Founded in 1933, the ABP is recognized worldwide for its credentials in signifying a high level of physician competence. Its mission is to “advance child health by certifying pediatricians who meet standards of excellence and are committed to continuous learning and improvement,” with a vision of “Inspiring a lifetime pursuit of learning to improve child health.”

Client Issue

While the ABP does great work serving pediatricians, children and their parents, they don't have resources to help pediatricians serve college students, whom pediatricians are qualified to serve. Many college students are unaware that they can see their pediatrician and of the resources available. The ABP needs more information regarding the health care needs of those individuals.

Methods

By using two forms of data collection -- qualitative personal interviews and a quantitative online survey -- we were able to collect sufficient information to understand college-aged adults’ attitudes and behaviors related to health care. The personal interviews helped provide more detailed information backing up the survey, giving us a well-rounded understanding.

Key Findings

College students believe that depression, anxiety and eating disorders are the most prominent mental health issues in their peers. As far as physical health issues, they said colds; the flu; and a lack of nutrition, sleep and exercise.

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College students appreciate the familiarity of their pediatrician.

They believe that their pediatricians know their personal medical history and even their families best.

However, many students go to Campus Health instead, citing reasons such as convenience and cost. In addition, many don't know seeing their pediatrician is an option.

Implications & Recommendations College students and the ABP would benefit from the ABP providing informational and supportive materials geared towards health issues affecting college students. In addition, those materials could center on the positive feelings associated with seeing a pediatrician, such as familiarity. Further, we recommend that the ABP creates graphics that talk about symptoms and resources, designs social media posts surrounding pediatricians' ability to serve college students, and collaborates with on-campus health organizations.

BACKGROUND

The American Board of Pediatrics (ABP) does a lot of great work with children and their parents. However, we see an opportunity to better connect with college-aged students, since pediatricians can see people up to 21 years old (Hardin); and students in the 1821 age range don’t know this. The ABP is seeking to learn more about this demographic and how to create a mutually-beneficial relationship with them. We see an opportunity for the ABP to learn more about the college demographic and how to better serve and communicate to them. We also believe the ABP can do this while indirectly reminding students to see their healthcare providers whether that is campus health or their pediatrician at home through an informational awareness campaign.

Audiences Our primary audiences are college students because these are the people who can provide the most insights for our research goals. By focusing on the mental and physical health needs of these patients, as well as why and where they choose to seek medical care, we could reach the goal of understanding how the ABP can best address their needs. With this, we divided our audience into three main segments: college students who are involved with health issues on campus; college students who still see their pediatrician for care; and college students who live near (< 1 hour travel time) their pediatrician, but may or may not continue to see them for care. We felt that targeting college students involved in health issue-related clubs or organizations would be most likely to support and spread health-related information promoted by the ABP, while students who still see their pediatrician may provide more information regarding deep personal connections with a primary care provider. Our last audience--students who live near their pediatrician but may or may not still see them--would provide the most insight regarding reasons to seek care from their pediatrician not related to travel restrictions. Another audience that we would have liked to have focused on is parents of college students. Parents often play a role in the transition from high school to college, how students feel about their health, and how students tend to care for their health issues.

Given more time, we could have expanded our research efforts to this audience. This is something to consider for future efforts.

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Problem/Opportunity Statement

BACKGROUND

SWOT Analysis One of the biggest strengths we found is that pediatricians want to stay certified, so there is no lack in demand as to pediatricians becoming certified and staying certified. Along with this, 90 percent of pediatricians in America are involved with the American Board of Pediatrics. This statistic is encouraging as it is a sign of respect and credibility in the medical field.

When looking for potential weaknesses, we identified a few within the ABP that could be improved. When looking at the ABP’s website and social media platforms, we noticed they were a bit outdated, and can use an update and change in branding. In addition, we were informed that the ABP could use some more updated digital materials.

Although there are some weaknesses, we have considered some solutions to aid the ABP. We believe that the ABP would benefit from improved communications across all platforms. This would help to streamline communications within the organization, as well as assist in an easier, more pleasant website and social media experience for visitors. In addition, a more consistent brand would be useful in communicating identity and familiarity with the public. Further, emphasizing the ease of MOCA-PEDS and engaging on Facebook more with their large following could yield great results. We believe that the Facebook group can help create a community bringing together parents, pediatricians and collegeaged students. Lastly, outreach to the untapped college audience is another great opportunity for the ABP to engage with more individuals.

When researching, we found a few threats that could have, and might already have a negative impact on the ABP. Some pediatricians don’t see the point of recertification, or they want to re-certify but are too busy or believe there are too many barriers.

As pediatricians are very busy people, they want to do things as efficiently as possible, and this is an aspect of recertification that could be improved. In addition, the American Academy of Pediatrics overshadows the ABP with search engine optimization; in other words, they come up first on search results. It was easier to find the AAP’s social media, and their website was the first that popped up on Google. While it is a separate entity with a different goal, this is still something that could be improved.

BACKGROUND

Research Goals Our research goals revolved around how college-aged students currently address their mental and physical health needs, what those needs are, and how the ABP could help address those needs.

Our main research questions consisted of the following:

Do students know they can continue to see their pediatrician until age 21?

Goal: Is awareness of this issue something we should address?

What information, experience, and/or issues would encourage students to see their pediatrician while in college instead of Campus Health?

Goal: How can we ensure pediatricians are available to students who may rather wait to see a pediatrician?

What health issues do college students struggle with that the ABP could attend to?

Goal: What should the ABP put on their marketing materials to college students that would help college students and encourage them to utilize their pediatricians and the ABP?

These research questions will help to guide future campaign planning.

By forming our research around these main questions, we would be able to collect sufficient information regarding college-aged students to formulate a campaign that will help the ABP inform college-aged students of how to best care for their health needs, and encourage them to seek that care in a way that is realistic, easily-accessible, and ideal for their mental and physical wellbeing. Through our survey and interview questions, we aimed to figure out our starting point in these efforts, and what kind of materials would be persuasive.

BACKGROUND

Literary Review & Initial Ideas After forming our research questions, background research of literature gave us insight for potential campaign themes. There were six different academic research pieces that we found helpful in informing future messaging on behalf of the ABP. The first research article that we found helpful was “Associations of eHealth Literacy With Health Services Utilization Among College Students: CrossSectional Study,” in the Journal of Medical Internet Research. It describes “eHealth literacy” as a concept that combines health literacy and digital literacy. This article helped us gather that by improving information of services available via digital sources (Web, mobile devices/applications, etc.), college students’ utilization of those health services may be increased (Luo 2018).. This leads us to believe that the ABP could play a role in emphasizing the need for and raising awareness of digital health information, should it be a good option for busy college students.

Luo, Y., Yang, S., Chen, A., Chiang, C. (2018). Associations of eHealth Literacy With Health Services Utilization Among College Students: CrossSectional Study. Journal of medical Internet research, 20(10), 283.

A second article, “The Role of the Pediatrician in Transitioning Children and Adolescents With Developmental Disabilities and Chronic Illnesses From School to Work or College,” discussed the importance of pediatricians helping their patients with transitions and advocacy if they’re unable to see those patients when they attend college. This article believes this is especially helpful for students who have disabilities and may need extra support. We believed this article could be helpful because if students are unable to see their pediatrician in college -- possibly because they go to school too far away -- they could still receive much-needed support from their pediatrician (Pediatrics 2000).

Committee on Children With Disabilities. (2000). The Role of the Pediatrician in Transitioning Children With Developmental Disabilities and Chronic Illnesses From School to Work or College. Pediatrics, 106, 854.

BACKGROUND

Literary Review & Initial Ideas A third article, “Transition of care for adolescents from pediatric services to adult health services,” built upon the concepts of our first article. It explained that if that transition isn’t well-managed, people with long-term health issues may fall through the cracks and not receive adequate health care services. We believe this article is helpful because it validates that transition of care in college is an important aspect to acknowledge in future messaging (Campbell 2016).

Campbell F, Biggs K, Aldiss SK, O'Neill PM, Clowes M, McDonagh J, While A, Gibson F. (2016). Transition of care for adolescents from pediatric services to adult health services. Cochrane Database of Systematic Reviews, Issue 4.

The fourth article that we referenced was “The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care,” which informed us on how pediatric primary care clinicians have unique opportunities and a growing sense of responsibility to prevent and address mental health and substance abuse problems (Pediatrics 2009). This suggests that mental health support may be necessary prior to and during the transition to college, while the patient still may see their pediatrician as their primary care physician.

The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care. (2009). Pediatrics, 124(1), 410–421. doi: 10.1542/peds.2009-1061 The fifth article of research was “Survey of Primary Care Pediatricians on the Transition and Transfer of Adolescents to Adult Health Care.” This article described how pediatricians feel that transition to adult healthcare should happen later, and emphasized the importance in young adults continuing to see their pediatricians. More research should be done on transition in healthcare (Burke 2008).

Burke, R., Spoerri, M., Price, A., Cardosi, A.-M., & Flanagan, P. (2008).

Survey of Primary Care Pediatricians on the Transition and Transfer of Adolescents to Adult Health Care. Clinical Pediatrics, 47(4), 347–354. https://doi.org/10.1177/0009922807310938

BACKGROUND

Literary Review & Initial Ideas The sixth and final article found useful background research was “Age Limit of Pediatrics.” This article described how the age limit on pediatric care is arbitrary, meaning that it is necessary for a pediatrician to completely witness a person’s growth from infancy to adulthood. This research emphasizes the importance of pediatric care for adolescents throughout their maturation, suggesting that an age limit of 21 may not represent complete maturation for some patients (Hardin).

Hardin, Amy Peykoff, and Jesse M. Hackell. “Age Limit of Pediatrics.”

Pediatrics, vol. 140, no. 3, 2017, doi:10.1542/peds.2017-2151.

These last five articles inspired a campaign test idea: Encourage pediatricians to inform patients and parents of the importance of transition of care between high school and college. This includes signs of mental health distress and how to address those issues, and information of the resources of health care available on or near college campuses. This messaging could be disseminated via pamphlet format, available in pediatric offices or other clinics that serve high school-aged patients.

RESEARCH METHODS

Each member of our group completed two in-depth interviews for a total of 10 during February 20-26, 2020.

Through our interviews, we hoped to get a closer look at health habits and health care in college students. We wanted to see, for example, what health issues they believe are prevalent on campus, if they see their pediatrician, and why they may have seeked other available medical care options.

We interviewed mostly in-state students to see their preferences with available campus medical options in comparison to their in-state pediatrician. Through these interviews, our goal was to figure out college students’ attitudes toward health and how the ABP could encourage them to seek the most suitable care for their needs. In addition, these interviews provided a way to collect qualitative data that our online survey does not allow. For example, these personal interviews yielded more detailed information on respondents’ experiences with both pediatric care and campus health, while the survey did not ask about this directly. Refer to the appendix for the full transcripts.

ONLINE SURVEYS

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IN-DEPTH INTERVIEWS

Using Qualtrics, our group created and sent out a voluntary and anonymous online survey using convenience sampling via online chat application GroupMe and popular Facebook pages. After running actively from February 14-21, 2020, the survey received a total of 72 completed responses. Through our survey, we hoped to collect basic information on respondents’ past and current health care, their preferences with pediatric care, and motivations for visits to other primary care providers while giving respondents the option to skip questions. This information would provide the foundation for understanding our respondents in a way that would allow us to make inferences about college-aged adults’ behaviors when seeking healthcare. Participant demographics showed that most respondents were in-state students (91.5%) and the majority of them were white (81.5%) and/or female (84.8%). Distribution between years at UNC-CH was evenly spread with sophomores, juniors and seniors representing 30.5% each. Observe graphs on the following page for more demographics information. Refer to the appendix for specific survey questions and data.

SURVEY DEMOGRAPHICS Gender of Respondents

In-State VS. Out-of-State Out-of-State 8.5%

Female 84.8%

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Male 15.2%

Race of Respondents Asian 13.8%

In-State 91.5%

Black 1.5%

Years of Study at UNC-CH First-Year 6.8%

Senior 30.5% Sophomore 30.5%

Junior 30.5%

Hawaiian 1.5%

White 81.5%

After conducting our interviews, we found most participants believed the most prominent mental health issues for college students are anxiety, depression and eating disorders that stem from being scared to fall short of high expectations. As far as physical health, they believe that the most prominent issues are lack of sleep, nutrition and exercise in addition to colds and the flu that are common amongst college demographics due to compromised immune systems.

"I feel like stress, anxiety and depression affect college students the most, because many of us feel overwhelmed with the amount of work we have..."

- WHITE, FEMALE IN-STATE STUDENT

Although only roughly a quarter of our interviewees still saw their pediatrician, we were able to get takeaways about the pros of seeing a pediatrician over a closer practitioner on campus or otherwise. Students still seeing their pediatrician cited receiving more “personalized care” and appreciated their knowledge of pre-documented medical and family history. Some students felt more comfortable with their pediatricians because they had grown up with them.

result

INTERVIEW RESULTS

“I could see myself going back to my pediatrician if I needed someone who was more familiar with my past health issues to assist with a current diagnosis.”

- WHITE, MALE IN-STATE STUDENT

In direct contrast, some interviewees felt that their close bond as children with their pediatrician was a hindrance to their feeling comfortable when discussing health concerns. These students appreciated both the objectivity and helpfulness of campus health resources. Some students feel more comfortable discussing mental and sexual health with new, unbiased medical practitioners at Campus Health. However, we found that most students interviewed go to Campus Health because of its convenience in close proximity to the university.

“The sexually-related healthcare that I have received on campus is something I’m not sure I’d be comfortable disclosing to my pediatrician.”

- BLACK, FEMALE OUT-of-STATE STUDENT "This woman has seen me grow up medically and that’s a large amount of trust that is kind of hard to shake.”

- BLACK, FEMALE IN-STATE STUDENT

"I see an on-campus doctor...because of convenience and cost."

- WHITE, FEMALE IN-STATE STUDENT

Did Respondents Know They Can Continue Seeing Their Pediatrician until Age 21?

SURVEY RESULTS To begin surveys, we asked the college-aged respondents a few gateway questions about their experiences with healthcare before jumping into more specific questions regarding their current medical care preferences. Roughly 93% of respondents always had health insurance growing up and nearly 100% had gone to a pediatrician. A large margin of 25.4% did not know that they could continue seeing a pediatrician until age 21.

Did Respondents Prefer Their Pediatrician Over Their Current Primary Care Provider?

25 20 15 10 5 0

Yes

Some.

No

NO 25.4%

YES 74.6%

When asked about preferring Campus Health over their pediatrician, we found that about 65% of respondents preferred their current primary care provider over their home pediatrician despite nearly 80% of our survey respondents thinking that Campus Health did not provide better medical resources than their pediatricians. This means that most survey respondents had positive long-lasting relationships with their pediatricians yet still seek out closer medical resources provided at UNC-CH that exhibit a supposed lower quality of care.

I would prefer traveling 88.5% of respondents saw the same pediatrician throughout to my pediatrician office their childhood at least â&#x20AC;&#x153;most of the time.â&#x20AC;? Since coming to over a closer practitioner. college, nearly half (49.2%) of our respondents said that they never travel to see their pediatrician even though 60.9% live within an hour of their pediatrician office. When taking Strongly Agree accessibility out of the question, exactly 75% of respondents preferred their pediatricians over other Campus Health Agree medical resources even though only 28.1% preferred their pediatricians over their current primary care physician, Neither likely due to accessibility. Only a minority of 34.4% agreed that they would prefer traveling to their pediatricianâ&#x20AC;&#x2122;s office Disagree rather than seeing a closer primary care physician.

survey Strongly Disagree

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DISCUSSION

Did Respondents Know They Can Continue Seeing Their Pediatrician until Age 21?

Our first research goal was to establish whether or not college students were aware that they could see their pediatrician up until the age of 21 and we learned that many students did not realize this.

With our research, we hoped to discover how we could best address this concern to make college students more aware of their many health care options. Our next research question asked college students what issue / experience would encourage them to seek medical help from a pediatrician. We were curious how college students viewed pediatrics and what kind of culture setting doctors could do to encourage that demographic to seek help if needed. Our third research goal was to figure out which health issues college students faced the most so that we could form our recommendations around these. The final research goal that we set was to find out how many students wait to see their pediatrician rather than just going to campus health. We sought out to discover how many students are seeking medical care and what factors would make them do so whether that be the convenience of campus health or the ease of their pediatrician. This information helped us to form our recommendations to fit our target demographic.

After conducting thorough research on our target demographic, we compiled all of this information to establish what it meant for the ABP. We had three findings that we decided were most relevant to our research and led to the development of our recommendations.

Our first key finding was that through our surveys, we learned that anxiety, depression, and eating disorders were the most commonly reported health concerns among college students. Our next realization was the significant percentage of college students liked their pediatric care because of familiarity and for a more personalized experience. The third finding that stood out to us was that students still choose to go to Campus Health because of accessibility despite some students labeling the experience as "difficult." Using all of these key findings, we developed three recommendations that we are proposing to the ABP. In order to accomplish ABPâ&#x20AC;&#x2122;s primary goal of encouraging health among college-aged students, we have carefully crafted three suggestions, using our research, that should advance this mission.

RECOMMENDATIONS

Did Respondents Know They Can Continue Seeing Their Pediatrician until Age 21?

Recommendation 1

Recommendation 2

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These campaigns are for campaign planning and they will be developed further in future work. The first recommendation that we have for the ABP would be to create visually appealing graphics that would inform college students about the early signs of anxiety, depression and eating disorders with resources to find help. These graphics would give students the information that they need to identify these issues, as well as the resources they need to seek proper help. This initiative will help college students to prioritize their personal health, and it will address the demographicâ&#x20AC;&#x2122;s largest reported health concerns. These graphics would be printable for college campuses and doctors offices, and they will also be digitally interactive so that they can be promoted on social media. These resources will allow pediatricians to help with patient transition to college or help patients who may have already transitioned to college.

With our next recommendation, we hope to address the concerns about college students' knowledge of the health care options that are available to them. We suggest that the ABP creates social media campaigns on Tik Tok and Instagram targeted at college students who have recently transitioned from high school. Because a quarter of our respondents were confused by that transition of care, we believe that a social media campaign that highlights different health care opportunities in college will be extremely beneficial. Many of our respondents were also unaware that they could still see a pediatrician until they were 21, so a paid social media campaign that highlighted their various health care options could increase the amount of students seeking help.

Recommendation 3

Our final recommendation would be to collaborate with different college campus organizations to encourage the same healthy message to: â&#x20AC;&#x153;seek medical care when you need it.â&#x20AC;? The ABP could partner with organizations such as CEED, an eating disorder help center at UNC, to promote healthy habits to students directly, as well as on social media.

This could be done through special on-campus events, social media posts, and informational content. This would help to address the research finding that college students were overwhelmed when transitioning health care providers, and it would also help the ABP to accomplish its goal of promoting health and wellness on campuses.

Having a direct voice coming from trusted organizations within the University will help to build that trust and authenticity between the ABP and college students.

CONCLUSIONS & REVIEW While conducting our primary research, we had a few limitations that are worth noting. The Hussman School of Journalism and Media is around 80 percent women, and four out of our five team members working on this campaign are also female. This ultimately had an effect on our data, as our surrounding communities are predominantly college-aged females. This resulted in most of our survey respondents and interviewees matching these demographics.

Along with this, when we initially decided who to interview, we did not consider the parents of our college-aged market. Exploring this demographic could have provided us with valuable insights about their childrenâ&#x20AC;&#x2122;s health care behaviors, as well as their personal perspectives on health care in college.

Finally, once our survey had been distributed and we were in the process of conducting interviews, we wanted to make a change to our overall campaign goal. Rather than creating a campaign focused on encouraging college students to see their pediatrician, we decided to pivot and we set a goal that promotes the relationship between the ABP and college-aged students. This informational campaign would involve the ABP encouraging mental and physical health on college campuses. With this change, gathering more data on how college students practice wellness would be beneficial, however, the data that we already assembled is still very relevant to this new goal. Now that we have addressed our recommendations for the ABP, we can begin suggesting how to implement these changes. Our team is comprised of students with significant experience in design, and feel confident that we could create a compelling graphic that would help the ABP to advance their mission. We would conduct more research on anxiety, depression, and eating disorders and how those issues affect college students in order to create the most effective graphic possible. After development, we would help the ABP to spread the graphic around UNC physically, and on university social channels. To address our second recommendation, we would also provide the ABP with specific Tik Tok and Instagram social media ideas so that they could be implemented as soon as possible. With our third recommendation, we would reach out to UNC health organizations like CEED, Healthy Heels and Embody Carolina. We would partner with these student organizations to spread the ABPâ&#x20AC;&#x2122;s mission around campus, and we would use this as a trial run to eventually also spread to other universities. Moving forward, we hope to help the ABP as much as possible to implement our recommendations.

REFERENCES Burke, R., Spoerri, M., Price, A., Cardosi, A.-M., & Flanagan, P. (2008). Survey of Primary Care Pediatricians on the Transition and Transfer of Adolescents to Adult Health Care. ​Clinical Pediatrics,​ ​47​(4), 347–354. https://doi.org/​10.1177/0009922807310938 Campbell F, Biggs K, Aldiss SK, O'Neill PM, Clowes M, McDonagh J, While A, Gibson F. (2016). Transition of care for adolescents from pediatric services to adult health services.

Cochrane Database of Systematic Reviews​, Issue 4.

Committee on Children With Disabilities. (2000). The Role of the Pediatrician in Transitioning Children With Developmental Disabilities and Chronic Illnesses From School to Work or College. ​Pediatrics​, 106, 854.

Hardin, Amy Peykoff, and Jesse M. Hackell. “Age Limit of Pediatrics.” ​Pediatrics​, vol. 140, no.

3, 2017, doi:10.1542/peds.2017-2151.

Luo, Y., Yang, S., Chen, A., Chiang, C. (2018). Associations of eHealth Literacy With Health Services Utilization Among College Students: Cross-Sectional Study. ​Journal of medical Internet research​, 20(10), 283.

The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care. (2009).

Pediatrics,​ ​124​(1), 410–421. doi: 10.1542/peds.2009-1061 APPENDIX A: Survey Questions Introduction Welcome to our voluntary and anonymous survey regarding UNC college students and their accessibility and preferences when it comes to pediatric care. As student practitioners working with the American Board of Pediatrics (ABP) through the UNC Hussman School of Journalism and Media, our team is looking to discover how ABP could better serve the collegiate community. This survey should take less than five minutes to complete; and you will have an opportunity to provide more thorough feedback at the end. Thank you!

Questions 1. Health insurance can make a significant difference in coverage options for pediatric visits. Did you grow up having health insurance? a. Yes b. No

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c. Most of the time d. I donâ&#x20AC;&#x2122;t know e. Prefer Not to Say f. Other: please explain Have you ever gone to a pediatrician? a. Yes b. No Did you know that patients may continue seeing their pediatrician until age 21? a. Yes b. No Have you ever made a primary care appointment at UNCâ&#x20AC;&#x2122;s Campus Health? a. Yes b. No c. Unsure How often did you see a pediatrician growing up? a. More than 5 times per year b. Between 3-4 times per year c. Between 1-2 times per year d. Less than once a year Growing up, where did you often go to receive medical care? Select all that apply. a. Family physician b. Urgent Care (CVS Minute-Clinic, FastMed, etc.) c. Hospital visits d. Emergency room e. If other, please explain: ___________ Growing up, did you regularly see the same pediatrician? a. Always b. Most of the time c. Sometimes d. Rarely e. Never Do you still travel to see your pediatrician for check-ups, health issues, etc. since coming to college? a. Always b. Sometimes c. Occasionally d. Never

9. If you now use Campus Health as your primary care provider, was it difficult to transfer your medical information from your previous healthcare provider to Campus Health? a. Extremely difficult b. Very difficult c. Moderately difficult d. Slightly difficult e. Not difficult at all f. No Answer/Not Applicable 10. From UNC, how long would you have to travel to see your pediatrician? a. Less than 30 minutes b. Between 30 minutes and 1 hour c. Between 1 and 2 hours d. Between 2 and 4 hours e. More than 4 hours 11. If accessible in terms of distance and cost, would you prefer to see a pediatrician over your current primary care provider? a. Yes b. Sometimes c. No d. Other, please explain: ______ Please evaluate the following statements with your own personal opinions.

12. I feel that Campus Health provides better medical resources than my pediatrician. a. Yes b. Sometimes c. No 13. Are there medical concerns you donâ&#x20AC;&#x2122;t think your pediatrician covers that a doctor here on campus could? a. Yes b. Maybe c. No 14. I prefer my pediatrician to campus health. a. Strongly Agree b. Somewhat Agree c. Neither Agree nor Disagree d. Somewhat Disagree e. Strongly Disagree 15. I prefer my pediatrician to my current medical professional.

a. Strongly Agree b. Somewhat Agree c. Neither Agree nor Disagree d. Somewhat Disagree e. Strongly Disagree 16. I would prefer traveling to my pediatrician's office rather than seeing a closer medical professional. a. Strongly Agree b. Somewhat Agree c. Neither Agree nor Disagree d. Somewhat Disagree e. Strongly Disagree Please elaborate on your pediatric care experiences if you feel the survey did not cover them. **free response question** 17. Are you an "in-state" or "out-of-state" student? a. In-state b. Out-of-state c. International student outside of the United States d. Other: ____________ Please discuss any remaining thoughts you have on your accessibility to pediatric care or its comparison to healthcare provided at UNC. **free response question** 18. What is your current year of study at UNC-CH? a. First-Year b. Sophomore c. Junior d. Senior e. Super Senior/Other 19. With what gender do you identify? a. Male b. Female c. Non-Binary or Noncomforming d. Other 20. Select one or more races with which you identify: a. White b. Black or African-American

c. American or Alaskan Native d. Asian e. Native Hawaiian or Pacific Islander f. Other: __________ 21. Are you Spanish, Hispanic, Latino or none of these? a. Spanish b. Hispanic c. Latino d. None of these Thank you for taking the time to complete this survey. Have a wonderful rest of your day!

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APPENDIX B: Interview Questions Introduction Hello, my name is ________ and thank you for agreeing to answer a few questions for me regarding pediatric and all-around health care in college students. We can ensure that your name or any names you may use in this interview will be redacted upon the completion and presentation of any information that we find. Please answer each question to the best of your ability, and according to your own thoughts and experiences. You do not have to answer every question if you don’t feel comfortable.

We’re going to start out by asking a few questions regarding health issues that affect college students.

1. What mental health issues do you believe affect college students most?

2. What physical health issues do you believe affect college students most?

We’re now going to ask a few questions regarding pediatricians and the medical care that you are seeking at this time.

3. Have you ever gone to a pediatrician/did you grow up seeing one?

4. How did you feel about your pediatrician when you were growing up at home?

5. Do you still see your pediatrician for check-ups, health issues, etc.?

6. If you do see your pediatrician still, why?

7. If you don’t see your pediatrician anymore, why not?

8. If you don’t see your pediatrician anymore, in which situations would you go home to see your pediatrician, if any? What would encourage you?

9. How far would you travel to see your pediatrician, vs. how far away is your pediatrician?

We’re going to transition to talking about your preferences in seeing your pediatrician versus another campus doctor or other medical professional.

10. How do you feel about the medical professional you see now instead?

11. What are the pros and cons of seeing your pediatrician vs. another doctor you may be currently seeing?

12. Are there medical concerns you don’t think your pediatrician covers that a doctor here on campus could?

13. Was it hard or intimidating to transfer to a campus health doctor?

Thank you for answering these questions. Your responses in this interview will be incredibly helpful to our research. Is there anything else that you would like to add to this discussion?

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APPENDIX C: INTERVIEW TRANSCRIPTS & SURVEY DATA Beginning Introduction:​ ​Hello, my name is _____________ and thank you for agreeing to answer a few questions for me regarding pediatric and all-around health care in college students.

We can ensure that your name or any names you may use in this interview will be redacted upon the completion and presentation of any information that we find. Please answer each question to the best of your ability, and according to your own thoughts and experiences. You do not have to answer every question if you don’t feel comfortable.

Wrapping Up Statement​: ​Thank you for answering these questions. Your responses in this interview will be incredibly helpful to our research. Is there anything else you would like to add to this discussion?

Interview One What mental health issues do you believe affect college students most?

Depression and anxiety are a big thing for college students. There’s just a general sense of feeling you like you can’t do something and then feeling bad about yourself and there’s this ongoing cycle that I think happens.

What physical health issues do you believe affect college students most?

Well, definitely stomach bugs and colds cause you’re in such a close environment with everyone. A physical thing I also think is definitely fatigue because my roommate doesn’t go to bed until 3 a.m. every single night because she’s doing homework and she’s over exhausted. I’ve felt that over the semester as well. I know that all of my friends are the stereotype that college students are always tired and I think that fatigue is an issue.

Have you ever gone to a pediatrician/did you grow up seeing one?

I went to a pediatrician and got a yearly check-up.

How did you feel about your pediatrician when you were growing up at home?

I really liked her. I didn’t like her giving me shots but she was cool. She gave me a lollipop and sticker at the end.

Do you still see your pediatrician for check-ups, health issues, etc.?

No. If you don’t see your pediatrician anymore, why not?

I don’t have good access to them anymore, and I see an on-campus doctor for my health problems because of convenience and cost.

If you don’t see your pediatrician anymore, in which situations would you go home to see your pediatrician, if any? What would encourage you?

I don’t know necessarily if I would go see my pediatrician. I would go see my gynecologist though. I definitely trust her more and have a better relationship with her than one on campus and feel better at an off-campus gynecology office. But I don’t know that I’d necessarily go see my pediatrician for anything.

How far would you travel to see your pediatrician, vs. how far away is your pediatrician?

My pediatrician is 3 hours away. I probably wouldn’t travel that far to go see her.

How do you feel about the medical professional you see now instead?

I like [REDACTED]. It’s kind of weird because you have to explain yourself a lot more, and that’s kind of annoying. I don’t know, I feel like I don’t have as much time with her as I did with my pediatrician. I feel like it’s more rushed and it’s more of a one-and-done than taking the time to talk about everything.

What are the pros and cons of seeing your pediatrician vs. another doctor you may be currently seeing?

Pros is that I have a really good relationship with her. She’s seen me grow up so she knows my background and my health background and can talk about everything. Cons; she's far away and expensive.

Are there medical concerns you don’t think your pediatrician covers that a doctor here on campus could?

There were medical concerns that I never brought up with my pediatrician. I’m honestly not sure if they could cover them or not. They’re eating disorder-related, and that’s something I never brought up with my pediatrician, and that’s like the main reason I go see the doctor here.

Was it hard or intimidating to transfer to a campus health doctor?

Yes. It was hard because the fear of the unknown and they’re not gonna treat me as well, and they’re not gonna be as good because they see so many people.

Is there anything else you’d like to add?

I don’t think so.

Interview Two What mental health issues do you believe affect college students most?

Anxiety and I’d say with anxiety, depression. Those are the two. If just feel like there’s a lot of stress involved in college and it’s kind of just expected that you should be sleep-deprived, that you shouldn’t be eating good, like more than ramen noodles everyday. It’s stressful in those aspects. I think a financial aspect is also very stressful for people because you’re really having to budget for the first time and sometimes people have more than you. Those are all factors that can cause someone to be anxious or depressed What physical health issues do you believe affect college students most?

The flu. That’s kind of the nature of the season. I mean any communicable disease. Well those normal sick ones, like mono, flu, strep, sinus infections. Those things come up a lot just cause you’re in such close proximity to each other. I think STIs too, if we’re being honest because college people have a lot of sex and not smartly. I think those are ones that heavily affect the college student population as a whole. Those are more like sicknesses. I don’t know if this is UNC or college in general but people just get hurt all the time because they do dumb stuff. You see someone with a broken leg because they fell because they ran on ice because they got excited that school was out, or they broke their arm getting out of an Uber because they were drunk. Those are the things I’d anticipate. People being too close and being a little too excited or drunk.

Have you ever gone to a pediatrician/did you grow up seeing one?

Yes, [REDACTED] was my pediatrician! He was a fantastic man. He was a cool guy.

How did you feel about your pediatrician when you were growing up at home?

I really liked them but I think that’s because my parents tricked me. Anytime I had to go to the pediatrician’s office or I had to go to the doctor or I was sick or had to get shots, my parents made sure I got a special treat after. We would go get ice cream or go to McDonalds, my favorite food or whatever I wanted to do. So I always liked it because of that. I never could play at the pediatrician though because they didn’t want me to get sick.

I had generally great experiences with them. [REDACTED] was the main one I saw, but it was a practice so I saw other ones. Some were not as great as others. Some would let me take my own stitches out, so that was cool. You pinch it, you pull, that kind of thing.

It wasn’t dangerous. They were really good when I was old enough on privacy for me or advocating for me so I had a good experience. Greenville Peds, an awesome place.

Do you still see your pediatrician for check-ups, health issues, etc.?

No, I aged out. I see a family practice now. I did for a while and then yeeted on over to a different town. But family practice people are nice because they have the whole lifespan.

Because I wasn’t fully an adult yet or a kid, so they’re good at finding that in-between space. I mostly see Nurse Practitioners now. Gotta rep them.

If you don’t see your pediatrician anymore, why not?

Age, accessibility. I see on-campus people here and when I’m home I’ve outgrown the pediatrician so I’m too old to go. I stopped going there I think when I was 17, so I still could go, but it was easier for me to see this family practice in this other town because they did same day appointments, like you could walk in and go. Time-wise, it was easier.

If you don’t see your pediatrician anymore, in which situations would you go home to see your pediatrician, if any? What would encourage you?

Well when I went to see the family practice people -- they’re not pediatricians but they’re like the closest thing to it -- one time I had strep and it was really bad and I’d had it for a while, but the clinic at the boarding school I went to, they said “Oh, it’s a virus!” then my fever hit 103 and my parents were like, “No,” so I went to the pediatrician when I didn’t get the care that I needed.

How far would you travel to see your pediatrician, vs. how far away is your pediatrician?

For my hometown, my pediatrician is actually 45 minutes away from where I live.

There’s pediatricians in my town, there’s pediatricians 15 minutes from where I live but I went 45 minutes just because it’s better care. From here to there, it’s about an hour and 45 minutes. I’m not totally sure because I’ve never made that trek. Oh wait, I went to Greenville. Yeah, it’s an hour and 45 minutes. Honestly, I’d go an hour. If I was already home, it’s a different story. Like if I was too sick, I would go see them.

How do you feel about the medical professional you see now instead?

This has nothing to do with [REDACTED] -- he was a great man -- but kinda as a rule now, I generally prefer nurse practitioners because that’s more because I can understand them better like, being a nursing student. I just prefer a DNP. They’re still doctors, but I just think they can communicate care much more effectively. And gynecological health.

Sometimes I see a DNP for those things. I just generally prefer nurse practitioners because they generally have better provider-patient communication.

What are the pros and cons of seeing your pediatrician vs. another doctor you may be currently seeing?

The ped knows you usually. Like [REDACTED] I saw from birth to 15 and he knew me, he knew my family, he knew our style, like we didn’t go to the doctor for a cold ever.

Like I don’t go to the doctor until I’ve had a fever for a few days, which isn’t healthy. He knew if we were coming, he knew the severity of it, he knew my parents really well, like he could joke around with me and I felt comfortable because I’d see him since I was so young. Whereas if I just went to an Urgent Care, you don’t know what you’re going to get. They may not be the most compassionate or in [REDACTED]’s case, funny, so that’d be the benefit I’d see.

Are there medical concerns you don’t think your pediatrician covers that a doctor here on campus could?

Definitely gynecological health. I don’t think that a pediatrician would be super helpful with that. I actually went to the pediatrician because I was having those problems and

they referred me out when I was 15. But like, they can’t handle that, I don’t think.

They’re not very great at mental health. I also got referred out for that. I think that those are things that are a little more outside the scope of it, at least at the practice I saw. There are just things that they are not equipped to handle. I’m sure there’s more, but those are the first two that came to mind.

Was it hard or intimidating to transfer to a campus health doctor?

I had a different situation so it wasn’t really for me. I had already made that transition before I came to college with the boarding school thing and as my siblings got older and moved out of the pediatric realm and into family practice. It wasn’t super difficult. I think going to a family practitioner whether it’s a doctor or NP, I think that’s a little smoother because they help that in-between space.

Is there anything else you’d like to add?

I prefer nurse practitioners other than [REDACTED]. Nurse practitioners are the cream of the crop.

Interview Three What mental health issues do you believe affect college students most?

I think the mental health issues that affect college students most are depression and anxiety and also a lot of body dysmorphia. That’s common, I think, in college students in large part due to social media.

What physical health issues do you believe affect college students most?

I don’t know if drugs and alcohol is a good answer but I think addiction is a big issue for college students because of the amount of drugs and alcohol that circulate throughout college campuses. And also sleep deprivation and exhaustion are big issues that college students face just because of our rigorous schedules.

Have you ever gone to a pediatrician/did you grow up seeing one?

Yes. I didn’t realize I still went to my pediatrician but yes, I technically do still see my pediatrician because she’s my doctor. She does pediatrics and internal medicine.

How did you feel about your pediatrician when you were growing up at home?

I really liked her. She was always very kind and great with me and my family. Me and my sister would go to see her together and I always felt really comfortable around her and I didnt’ have any glaring health issues growing up that we needed to deal with so it was pretty amicable interaction every time I saw her.

Do you still see your pediatrician for check-ups, health issues, etc.?

Yes. If you do see your pediatrician, why do you choose them as your primary care provider?

I’ve gone to her since I was a kid. She knows all my health stuff. She knows everything about my body and she’s basically grown up with me so I feel really comfortable around her. I don’t feel awkward talking about personal issues, especially since going back after

college, I came back with some new health issues that she had to deal with but, yeah. It was always good.

Are there situations where you would go home to see your pediatrician, if any? What would encourage you?

No. I don’t think anything would encourage me to not see a doctor here. Like, I love her but I wouldn’t go all the way home just to see her when I could go to Student Health for the convenience of it.

How far would you travel to see your pediatrician, vs. how far away is your pediatrician?

My pediatrician is 2-and-a-half hours away.

How do you feel about the medical professionals you see now instead?

I don’t feel any worse about them than I do my pediatrician but there’s definitely a level of comfort going to your pediatrician because she knows me. She knows my family and I’m not embarrassed around her but with Student Health workers seeing so many different people every time I would go in; it’s a little bit more uncomfortable just because it was a different person every time that I would have to go in. They’re not bad -- it’s just different.

What are the pros and cons of seeing your pediatrician vs. another doctor you may be currently seeing?

Pros of seeing my pediatrician are that she’s known me since I was 9 so she knows all of my pre-existing health conditions. But, I guess a con is that she is in Wilmington so it’s not always convenient to go see her.

Are there medical concerns you don’t think your pediatrician covers that a doctor here on campus could?

Yeah, I think because the doctors that I saw here, most of them were specialized in dealing with disordered eating. I think it was easier for me to go here to deal with things like that. I think when I talked with her about it, like when I went home, I had to fill her in on some stuff and that’s not really her area of expertise so it was easier to deal with that thing here specifically.

Was it hard or intimidating to transfer to a campus health doctor?

Yes. It’s very intimidating, especially if you have a personal concern that you need to take up with them. And as much as they are trained to be confidential and supportive and helpful, it is a little bit intimidating because you’re already transitioning to a campus and you’re already transitioning from high school to college on top of that. Having to deal with a doctor and having to develop that relationship is a little intimidating on top of everything else.

Is there anything else you’d like to add?

I think it’s always going to be hard to amp up the level of comfortability that students have with doctors on campus but, I mean, I think they’re doing everything within their power for us to feel comfortable so we appreciate them. There’s nothing that would really

make me uncomfortable enough to go home because I’m pretty much an open book. I don’t know if that’s the answer you wanted but, yeah.

Interview Four What mental health issues do you believe affect college students most?

Probably depression and anxiety because, I think, there’s a lot on your plate at all times and it’s kind of a shock from high school so it becomes a lot to manage at once. I think people start to realize issues that they had from before coming to the service. So, yeah, it can bring up feelings of anxiety. Anxiety because you might be overwhelmed with everything that’s being expected of you. Depression because you feel like you can’t meet those expectations -- kind of ruins your motivation.

What physical health issues do you believe affect college students most?

Probably just like people aren’t getting enough sleep so everyone’s immune systems are super compromised and nobody at UNC washes their hands so people are just getting sick from, you know, common cold. And then everyone is just really gross with each other so I know people who have gotten mono. Their immune systems are just compromised from not getting enough sleep and being generally nasty.

Have you ever gone to a pediatrician/did you grow up seeing one?

Yes, I did.

How did you feel about your pediatrician when you were growing up at home?

I felt pretty good. My pediatrician experience is kind of weird because she was friends with my parents so I always felt weird talking to her about sex and other things. It’s weird too because I’ve seen her for a long time. I’ve only recently stopped seeing her and she’s still my primary care provider but I just haven’t found a new doctor because I forget that’s up to me at this point. But, I liked her a lot. She was very personable and I was very comfortable with her because I basically saw her my whole life.

Do you still see your pediatrician for check-ups, health issues, etc.?

No. I probably should but I don’t. It probably was maybe over a year ago and I remember thinking that it was time to go. When I called the appointment, the receptionist asked me what the child’s name was. I was like, it’s me. I’m the child. The last appointment was a little awkward because she asked things that she had to ask and it’s just weird because I’ve been seeing her since I was a kid and now I’m an adult.

Why do you choose to not see your pediatrician as your primary care provider?

Going back, I felt like as I got older and had to takl about things like sex and alcohol and drug use, I felt that it became hard to talk about those things with someone who saw me as a literal kid and knew my parents. So, it just didn’t make sense anymore and also to go to the office; I felt like Buddy from ​Elf​. Everyone else in there is a child, like, playing with toys and I’m sitting in the waiting room, you know, waiting to go in. I just felt like it

was time and I had to be honest about things at my doctor’s appointments and I felt that I wasn’t able to be honest with my pediatrician because of how well she knew me as a kid.

Are there situations where you would go home to see your pediatrician, if any? What would encourage you?

Yeah, I think so because she’s a good doctor and I trust her still. I even thought about it for this summer, like, whether it’s even worth it to change my primary care provider. I would just see her for a check-up if I needed to because it’s easy to go in still and she knows who I am.

How far would you travel to see your pediatrician, vs. how far away is your pediatrician?

She is really close. From here she’s, like, 20 minutes away. It’s like seven or eight miles.

It’s kind of funny. I would travel to see her at the South Durham location but there’s another North Durham location that she works at that I would not travel to go to. The North Durham one is probably like 15 miles so I wouldn’t go more than 15 miles to go see a doctor.

How do you feel about the medical professionals you see now instead?

I find it kind of hard to build relationships with people because I’m going to be moving away from here. And I don’t go to the doctor as often as I should so it just kind of is hard to build a relationship and trust someone. I did see someone at UNC Health that I enjoyed a lot. I felt like she was pretty personable and was to the point and just really made me feel comfortable about being a young woman in my twenties. Also, recently, I went to the Voice Care Center and it was a good appointment but that doctor kind of made me feel like he was going in and out. So it’s difficult to build trust, especially in this position in my life where I’m in such a transition anyway.

What are the pros and cons of seeing your pediatrician vs. another doctor you may be currently seeing?

A pro is certainly just being able to pick up where we left off. I don’t have to explain my whole situation. She has been the one to diagnose a lot of my health issues. A con is that it feels too personal, like it feels like she knows me a little bit too well now and it’s hard to create a boundary after the fact. Like, this woman has seen me grow up medically and that’s a large amount of trust that is kind of hard to shake. When I saw other doctors, I felt like I could describe my situation on a blank slate so that was kind of cool to just start fresh with someone who doesn’t have any preconceived notions about who I am based on my medical history or the things I enjoy or people I’m around. I feel like I can get a very objective medical opinion. The con is that building that trust is very hard to do because building it before was never really an issue. It also just kind of feels like shopping around trying to find a new medical care provider.

Are there medical concerns you don’t think your pediatrician covers that a doctor here on campus could?

Yeah, I think my pediatrician never seemed to be forthcoming about sexual health. She really was a lot more open and honest about sexual health than I think other people’s pediatricians could’ve been so I really appreciated that but, I don’t know. It feels more honest and frank at Campus Health because my pediatrician was a mother and I knew her other kids so it kind of felt like I was being mothered in that way as well.

Was it hard or intimidating to transfer to a campus health doctor?

It is hard because you can’t really build relationships with people at Campus Health so I’ve seen two doctors at Campus Health that I really enjoy but every time I see them, I don’t think they fully remember me. So, that kind of sucks. They deal with a high volume of students so they don’t really have the time to get to know you. Campus Health really feels like shuffling in and out, like keeping it moving, which I don’t blame them for because they have a lot of people that they see. College students will go in for everything so, yeah. That’s kind of the challenge here, I guess.

Is there anything else you’d like to add?

I don’t know. I liked her a lot and, yeah. I think it’s just funny and getting to realize, like, oh! You get to make these decisions on your own so that’s kind of what the overwhelming thing is but other than that, yeah. Great!

Interview Five: What mental health issues do you believe affect college students most?

Definitely anxiety, and a lot of people struggle with depression as well.

What physical health issues do you believe affect college students most?

Fatigue.

Have you ever gone to a pediatrician/did you grow up seeing one?

Yes, I grew up seeing them.

How did you feel about your pediatrician when you were growing up at home?

They were nice, I just didn’t like going to a doctor.

Do you still see your pediatrician for check-ups, health issues, etc.?

No. If you do see your pediatrician still, why?

N/A If you don’t see your pediatrician anymore, why not?

The doctor only saw minors so I see Campus health now.

If you don’t see your pediatrician anymore, in which situations would you go home to see your pediatrician, if any? What would encourage you?

I would see my pediatrician if I ever had something serious because they have my whole history there.

How far would you travel to see your pediatrician, vs. how far away is your pediatrician?

Raleigh, 30 min.

How do you feel about the medical professional you see now instead?

I try to go to the same person at campus health, she's very professional and friendly and eager to help.

What are the pros and cons of seeing your pediatrician vs. another doctor you may be currently seeing?

The pros are that my pediatrician has more medical history, the cons are that they are less convenient and more time consuming.

Are there medical concerns you don’t think your pediatrician covers that a doctor here on campus could?

No Was it hard or intimidating to transfer to a campus health doctor?

Yes. Just because of comfort.

Is there anything else you’d like to add?

No.

Interview Six: What mental health issues do you believe affect college students most?

Depression (seasonal included), anxiety, ADHD, and eating disorders.

What physical health issues do you believe affect college students most?

Lack/abundance of exercise, proper nutrition, lack/abundance of sleep, exposure to common illnesses (cold, flu, etc.)

Have you ever gone to a pediatrician/did you grow up seeing one?

I grew up seeing one.

How did you feel about your pediatrician when you were growing up at home?

I loved my pediatrician.

Do you still see your pediatrician for check-ups, health issues, etc.?

No. If you do see your pediatrician still, why?

N/A If you don’t see your pediatrician anymore, why not?

I primarily use my campus’s health resources due to convenience and not having visited my pediatrician since high school.

If you don’t see your pediatrician anymore, in which situations would you go home to see your pediatrician, if any? What would encourage you?

I moved away halfway through high school from the pediatrician I grew up seeing therefore, I don’t really have a connection with them.

How far would you travel to see your pediatrician, vs. how far away is your pediatrician?

The farthest I’d go to seek care is 100 miles which is the approximate distant to my family’s house.

How do you feel about the medical professional you see now instead?

I am somewhat satisfied with the campus healthcare I have received.

What are the pros and cons of seeing your pediatrician vs. another doctor you may be currently seeing?

I think the personal relationship with a pediatrician would be beneficial to have. Each time I go to my campus health center, they do have my information on file but I usually end up seeing a different healthcare professional each time.

Are there medical concerns you don’t think your pediatrician covers that a doctor here on campus could?

No. Although the sexual related healthcare I have received on campus is something I’m not sure I’d be completely comfortable disclosing to my pediatrician.

Was it hard or intimidating to transfer to a campus health doctor?

Not at all. The health center is very helpful and full time students receive 3 free visits each semester regardless of insurance status.

Is there anything else you’d like to add?

No. Interview Seven: What mental health issues do you believe affect college students most?

- I feel like stress, anxiety and depression affect college students the most, because many of them feel overwhelmed with the amount of work they have, then that with lack of sleep and feeling like you’re not good enough contribute too.

What physical health issues do you believe affect college students most?

- Physical, I think not enough exercise and poor diet, the freshman fifteen is real.

Have you ever gone to a pediatrician/did you grow up seeing one?

- Yes, I grew up going to a pediatrician and when I was about 15 my mom said that it’s time I go to a physician so I switched. I don’t like her as much though How did you feel about your pediatrician when you were growing up at home?

- I really liked him, he was very funny, nice, and pleasant to be with.

Do you still see your pediatrician for check-ups, health issues, etc.?

- Nope, I go to a physician now, but I do go to them still for check-ups, prescriptions, and other important things.

If you do see your pediatrician still, why?

- For my physician, they know me well at this point I’ve been going to them for like 7 years, so they know me well and I get personalized care.

If you don’t see your pediatrician anymore, in which situations would you go home to see your pediatrician, if any? What would encourage you?

-

I go home to see my physician when I’m really sick, for my checkups and long-term or chronic health issues.

How far would you travel to see your pediatrician, vs. how far away is your pediatrician?

- My doctor is about 1 hour from here so I go, but any more than 2 hours I wouldn’t.

How do you feel about the medical professional you see now instead?

- N/A, still sees their physician and sees different doctors whenever they go to campus health.

What are the pros and cons of seeing your pediatrician vs. another doctor you may be currently seeing?

- My pediatrician was nicer than my physician, not a huge fan of her but I overall like both.

Are there medical concerns you don’t think your pediatrician covers that a doctor here on campus could?

- No. Was it hard or intimidating to transfer to a campus health doctor?

- I haven’t really done that, I only go to campus health for little things like a cold or a sore throat, so no.

Is there anything else you’d like to add?

- Nope!

Interview Eight: What mental health issues do you believe affect college students most?

- Probably stress and anxiety, with the amount of school work and extracurriculars, it can be a lot.

What physical health issues do you believe affect college students most?

- Probably lack of sleep if that’s physical, and not getting enough exercise. And binge drinking and a poor diet.

Have you ever gone to a pediatrician/did you grow up seeing one?

- Yes, I grew up going to one pediatrician How did you feel about your pediatrician when you were growing up at home?

- They were great, I always went to the same one and I still see her.

Do you still see your pediatrician for check-ups, health issues, etc.?

- Yes. If you do see your pediatrician still, why?

- I still see her because I’ve seen her all of my life so she really knows my health background and history. I’ve also formed a relationship with her that I don’t want to have to recreate with another doctor.

If you don’t see your pediatrician anymore, why not?

- N/A

If you don’t see your pediatrician anymore, in which situations would you go home to see your pediatrician, if any? What would encourage you?

- I still see my pediatrician, but because I live six hours away, I schedule visits during breaks or long weekends.

How far would you travel to see your pediatrician, vs. how far away is your pediatrician?

- Six hours. Anything more I would not do.

How do you feel about the medical professional you see now instead?

- N/A still sees their pediatrician and for urgent things sees a different medical professional each time they go to campus health.

What are the pros and cons of seeing your pediatrician vs. another doctor you may be currently seeing?

- They know me better than campus health Are there medical concerns you don’t think your pediatrician covers that a doctor here on campus could?

- No Was it hard or intimidating to transfer to a campus health doctor?

- N/A they only go to campus health for colds or any other sudden illness.

Is there anything else you’d like to add?

- I think more people should know that they can still go to their pediatrician beyond 18-years-old and as long as they and their pediatrician are OK with it they should continue because of the long-term relationship they have with that doctor.

Interview Nine: What mental health issues do you believe affect college students most?

- Definitely anxiety and depression, also ADHD What physical health issues do you believe affect college students most?

- I feel like upper respiratory infections are really common here because we are always passing them around to each other, and also because there’s like mold in all of the buildings.

Have you ever gone to a pediatrician/did you grow up seeing one?

- Yes, I grew up going to a pediatrician.

How did you feel about your pediatrician when you were growing up at home?

- He was chill, I liked him. I didn’t really have any special connection to him but he was a good doctor I guess.

Do you still see your pediatrician for check-ups, health issues, etc.?

- No I do not.

If you do see your pediatrician still, why?

- N/A If you don’t see your pediatrician anymore, why not?

- I guess because I graduated to an “adult” doctor.

If you don’t see your pediatrician anymore, in which situations would you go home to see your pediatrician, if any? What would encourage you?

- I guess if there was a reason that I needed somebody who extensively dealt with my health as a child for a current diagnosis. But also I didn’t have any major health concerns when I was a small child so I’m not really sure if that would be helpful.

How far would you travel to see your pediatrician, vs. how far away is your pediatrician?

- I wouldn’t travel far at all.

How do you feel about the medical professional you see now instead?

- She’s great. Really knowledgeable and personable.

What are the pros and cons of seeing your pediatrician vs. another doctor you may be currently seeing?

- I guess a pro is that my current doctor is more attuned to what I need as far as my health.

A con would be that they haven’t been seeing me as long, where my pediatrician watched me grow up.

Are there medical concerns you don’t think your pediatrician covers that a doctor here on campus could?

- I don’t think so.

Was it hard or intimidating to transfer to a campus health doctor?

- I don’t really see the campus health doctor, but my experience with the campus health doctors has been incredibly bad. I’ve had them tell me that I am less sick than I really am, and I always end up talking about my anxiety and depression with them when I wasn’t even there for that. One time a campus health doctor tried to write me a prescription for an antidepressant after I talked to him for like two minutes, and I thought “This doesn’t seem good.”

Is there anything else you’d like to add?

- I don’t really have anything else to add.

Interview Ten: What mental health issues do you believe affect college students most?

- I think maybe generalized anxiety is a mental health issue that would affect college students the most. I think UNC specifically is a super stressful environment and with other people being stressed out around it can stress others out, and I think this can lead to feelings of depression or just feeling lost because it is a big transition.

What physical health issues do you believe affect college students most?

- I think that college students are super prone to getting sick especially in their first two years at Carolina because of communal living and dining halls so the flu spreads easily and upper respiratory infections and stuff like that.

Have you ever gone to a pediatrician/did you grow up seeing one?

- Yes, I grew up seeing a pediatrician.

How did you feel about your pediatrician when you were growing up at home?

- I really liked my pediatrician. My older brother and sister also went to him and I knew him really well and I always felt comfortable with him, and I think my parents liked him too.

Do you still see your pediatrician for check-ups, health issues, etc.?

- I do not see a pediatrician anymore.

If you do see your pediatrician still, why?

- N/A If you don’t see your pediatrician anymore, why not?

- When I turned 18 my pediatrician actually retired, so I felt like it was a good time to transition to a primary physician. So I started seeing the doctor that my mom saw.

If you don’t see your pediatrician anymore, in which situations would you go home to see your pediatrician, if any? What would encourage you?

- I would go to my primary physician for any kind of medication I need prescribed. I would go to campus health for anything that’s more time-dependent, like if I had flu-like symptoms or something like that. Just for something quick.

How far would you travel to see your pediatrician, vs. how far away is your pediatrician?

- I think an hour is the furthest I would travel.

How do you feel about the medical professional you see now instead?

- She’s really reliable What are the pros and cons of seeing your pediatrician vs. another doctor you may be currently seeing?

- My pediatrician might know me and my family better, but that’s really it.

Are there medical concerns you don’t think your pediatrician covers that a doctor here on campus could?

- My physician is a lot easier to go to and she really gives me her time and attention.

Was it hard or intimidating to transfer to a campus health doctor?

- Yes. I don’t really enjoy going to campus health. I’ve opted to go to urgent care before because I thought it would be easier. The people at Campus Health aren’t always friendly and it’s just kinda tough sometimes.

Is there anything else you’d like to add?

- No.