# Adolescents talk about insufficient prevention through their general practitioner: A qualitative study

Elodie Million, Léa Fabre, Bruno Falissard, François Carbonnel, Béatrice Lognos, Agnès Oude-Engberink

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Elodie Million, Léa Fabre, Bruno Falissard, François Carbonnel, Béatrice Lognos, et al.. Adolescents talk about insufficient prevention through their general practitioner: A qualitative study. BJGP Open, 2025, pp.BJGPO.2025.0054. 10.3399/BJGPO.2025.0054. hal-05363504

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BJGP OPEN

Adolescents talk about insufficient prevention through
their general practitioner: A qualitative study

Million, Elodie; Fabre, Léa; Falissard, Bruno; Carbonnel, François; Lognos, Béatrice; Oude-Engberink, Agnès

DOI: https://doi.org/10.3399/BJGPO.2025.0054

To access the most recent version of this article, please click the DOI URL in the line above.

Received 11 March 2025

Revised 10 August 2025

Accepted 03 October 2025

© 2025 The Author(s). This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License (http://creativecommons.org/licenses/by/4.0/). Published by BJGP Open. For editorial process and policies, see: https://bjgpopen.org/authors/bjgp-open-editorial-process-and-policies

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**Author Accepted Manuscript**

This is an 'author accepted manuscript': a manuscript that has been accepted for publication in BJGP Open, but which has not yet undergone subediting, typesetting, or correction. Errors discovered and corrected during this process may materially alter the content of this manuscript, and the latest published version (the Version of Record) should be used in preference to any preceding versions
## Article title:

# Adolescents talk about insufficient prevention through their family doctor: A qualitative study

## Authors

Elodie Million*, M.D.ª,ᵇ,ᶜ, Léa Fabre*, M.D.ª, Bruno Falissard, PhD.ᵈ, François Carbonnel, PhD.ª,ᶜ,ᵉ, Béatrice Lognos**, PhD.ª,ᵇ,ᶜ, Agnès Oude-Engberink**, M.D.ª,ᶜ,ᵉ.

## Corresponding author:

Elodie Million

ORCID: 0000-0001-5693-6594

Correspondence details: 38 rue Louis Martin Berthoud 34080 Montpellier, FRANCE

elodie.million@umontpellier.fr

<footnote>ªDepartment of General Practice, University of Montpellier, Montpellier, France.</footnote>

<footnote>ᵇPauline Lautaud University Multiprofessional Health Centre, Saint-Georges-d'Orques, France.</footnote>

<footnote>ᶜDesbrest Institute of Epidemiology and Public Health (IDESP), UMR UA11 INSERM, University of Montpellier, Montpellier, France.</footnote>

<footnote>ᵈCESP, INSERM U1018, Université Paris-Saclay, France</footnote>

<footnote>ᵉAvicenne University Multiprofessional Health Centre, Cabestany, France.</footnote>

<footnote>* Both authors contributed equally to the study.</footnote>

<footnote>** Both authors contributed equally to the study.</footnote>
**Data availability statement:**

Data are available on request from the principal author.

**Funding statement:** No funding

**Conflict of interest disclosure:** The authors declare no conflict of interest.

**Ethics approval statement:**

The study was approved by a National Ethics Committee (CNGE 260123431).

**Patient consent statement:** All study participants provided informed consent

**Permission to reproduce material from other sources:** NA

**Clinical trial registry:** No

**Acknowledgements of support and assistance:**

Thank you to the adolescents in our study for their participation and the wealth of their responses.

Thanks to Pr Hervé Maisonneuve for his invaluable help in writing this article.
1 **Title:**

2 Adolescents talk about insufficient prevention through their general practitioner: A qualitative study

3

4 **Abstract**

5 **Background:** Adolescence is a period of empowerment and vulnerability that

6 requires the early identification of risky behaviors to prevent them. Several

7 prevention areas, including sexual health, mental health, substance use and

8 addiction, diet, physical activity, orthopedic disorders, vaccinations, screen

9 use, and social relationships, need to be addressed. Prevention plays an

10 important role in primary care all over the World. Consultation between an

11 adolescent and his or her general practitioner (GP) can be complex. While

12 there are professional recommendations, they rarely address all prevention

13 areas.

14 **Aim:** This study aims to understand the prevention experience of adolescents during

15 consultations with GPs.

16 **Design and settings:** This qualitative study used semi-structured interviews

17 with French adolescents between 11 and 24 years old.

18 **Method:** Analysis was conducted based on grounded theory and triangulated for the

19 identification of conceptualizing categories.

20 **Results:** Twelve interviews led to identify of three conceptualizing categories: (1)

21 Prevention in adolescents is primary and multifaceted. (2) limited preventive

22 involvement by the general practitioner: adolescents obtain information from other

23 sources with varying influence on their behavior. (3) Adolescents tend to justify GPs'

24 limited preventive engagement.
**Conclusion:** Adolescents trust their GP. Despite the use of different prevention sources, not all recommended topics are discussed with adolescents. Leveraging the experiences of adolescents, we can confirm that GP has to be more involved in prevention during consultation with adolescents. These consultations are complex, and it is necessary to offer support tools for GP and other primary healthcare professionals, based on the needs of adolescents.

**Key Words:**

Adolescent; Prevention; General Practitioner; Primary Health Care; Qualitative

Research

34

**How this fits in:**

Primary healthcare professionals, and GPs in particular, should address all areas of prevention when consulting with adolescents but it can be complex and difficult to manage. For adolescents in our study, the preventive adolescent's health approach is primary, multifaceted, but the GP isn't very involved. Adolescents are looking for reassurance about their normality and need to talk about prevention with their GP. GP has an important role to play, particularly in the most intimate issues (sexual health, mental health or violence), which were not discussed in all families.

43

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50

Accepted Manuscript - BJGP Open - BJGPO:2025.0054
## 51 Introduction

Adolescence is a period of empowerment and vulnerability that requires the early identification of risky behaviors. This identification enables a preventive approach to be implemented with the aim of reducing morbidity and mortality ¹⁻⁴. Numerous areas of prevention need to be addressed: sexual health, mental health, substance abuse and addiction, diet, physical activity, orthopedic disorders, vaccinations, screen use, and social relations⁵⁻⁹. Healthcare professionals should ideally address all these areas of prevention when consulting with adolescents. Prevention plays an important role in primary care all over the World, particularly in Europe and North America¹⁰⁻¹². There are recommendations and many tools on prevention for adolescents in primary care consultation⁷,⁸,¹³,¹⁴. However, these recommendations essentially focus on a single theme as nutrition¹⁵⁻¹⁷, mental ⁴,¹⁸⁻²⁰ or sexual health²¹⁻²⁴. Adolescents have expectations regarding the health professionals²⁵,²⁶ but there is a lack of literature on their expectations regarding prevention: Tools and recommendations about prevention should yet be based on adolescents' needs. We plan to create a digital tool to help with prevention during consultations with adolescents. This tool will be available to doctors and healthcare professionals who see adolescents in consultation. Before creating the tool, it was necessary to ask adolescents about their experience of prevention through their GP. We have chosen to focus on consultations with GPs because they are the most frequently consulted by French adolescents. In this way, the tool can be adapted to the needs expressed by adolescents. We conducted a qualitative study using semi-structured interviews to understand the prevention experience of adolescents during consultations with their GP. Our aim was to suggest methods to improve this prevention.
75 **Methods**

76 **Study design:**

77 We conducted a qualitative study of French adolescents. Semi-structured interviews
78 were conducted by one researcher (LF). LF received specific training in qualitative
79 interviews and analysis by an expert in qualitative research (EM). LF used an interview
80 guide focused on lived experiences, developed by two experts in qualitative research
81 (AOE, EM) and pre-tested on a sample of three adolescents of different ages (21, 20
82 and 12 years old). These three interviews were included in the analysis. The guide
83 was based on literature data, using open-ended questions to gain an in-depth
84 understanding of the adolescent's experiences; there were no modifications after the
85 test interviews (Table 1).

86 [Table 1 here]

87 **Participants:**

88 French adolescents, living in Occitanie region, between 11 and 24 years old, were
89 recruited following requests from the principal investigator (LF) and sampled using the
90 snowball sampling method. The association between direct solicitation and
91 recruitment by snowball sampling method allowed us to diversify the purposive
92 sample, which was otherwise too homogenous. A purposive sample (i.e., a targeted
93 sampling of adolescents who were competent to answer the research questions) was
94 sought with maximum variation in personal experience such as age, gender, and
95 educational background.

96
97 **Data collection:**

98 Individual in-depth interviews took place at home or by videoconference. the location
99 of the interviews was chosen by adolescent. The interview began with a written
100 information sheet and questionnaire to collect the participants' characteristics,
101 followed by the investigator obtaining the interviewees' written consent to participate
102 in the study and their agreement to audio recording. The written consent of parents of
103 children under 18 years of age was recorded too. The recording was destroyed
104 immediately after verbatim transcription. We have kept the transcripts for analysis. The
105 participants were informed of the study objectives and that they could stop the
106 interview at any time without giving a reason.

107 **Data analysis:**

108 The recorded interviews were transcribed verbatim. The text was then analyzed using
109 floating reading and annotation: the verbatims were read several times, with notes
110 added in the margins and in a separate document. Continuous comparisons enable
111 the identification of conceptual categories, based on a grounded theory model²⁷(Table
112 2). We aimed to explore and understand the experiences of the adolescents rather
113 than develop a theory²⁷⁻²⁹. No analytical software was used. The analysis was carried
114 out when the interviews were completed, until data saturation was reached. Two
115 further interviews were required to confirm this saturation³⁰. Two researchers [LF and
116 EM] triangulated the data employing inductive content analysis, using a process of
117 constant comparison between the text and categories. This strict methodology
118 ensured the internal validity of the study.

119 [Table 2 here]
120 **Ethics:**

121 The study was approved by a National Ethics Committee (CNGE 260123431). We

122 have created a paper document listing validated prevention websites in France. This

123 document was offered to the adolescents at the end of the interviews.

124 **Results**

125 **Participants:**

126 Fifteen young people were contacted to propose participation in this study. All had

127 initially agreed to be interviewed. Three adolescents changed their minds and refused

128 to take part in the interview when a date have to be found. Twelve interviews were

129 conducted between May 2023 and the end of January 2024: ten made it possible to

130 reach data saturation and 2 additional interviews were carried out to confirm it. Seven

131 girls and five boys interviewed were between the ages of 12 and 22 (median age of

132 16 years). The average length of the interviews was 37 minutes. Seven interviews

133 were conducted at the participants' homes and 5 by videoconference.

134 [Table 3 here]

135 **Conceptualizing categories:**

136 3 conceptual categories were identified from verbatims.

137 [Table 4 here]

138

139
140 **1- Prevention in adolescents is primary and multifaceted.**

141 **Prevention for adolescents is mainly primary. It takes many forms, both personalized and collective, with the aim of helping them to modify their health-risk behavior.**

144 For adolescents, **prevention was a means of limiting the onset of hereditary or acquired diseases.** Prevention addressed several themes to understand the possible consequences of the adolescent's behavior on his or her health. The daily prevention themes (sleep, nutrition, hearing/vision and dental health) were designed to enable immediate action, sometimes with family support, with the aim of achieving good health with long-term consequences.

150 P1 "prevention is something that is done to prevent us from doing bad things".

151 P2 "I'd like to have [...] information on how to eat well or how to lead a healthy life, [...] I'd like someone to talk to me about that!"

153

154 Primary prevention could be achieved through **massive behavioral prevention messages aimed at the general population.** Adolescents remembered television campaigns during the COVID-19 epidemic, protection campaigns against sexually transmitted infections, or massive campaigns against domestic violence or road accidents. Adolescents described a wide range of prevention media (intervention in schools, television, photographs on pack of cigarettes), some of which were inappropriate or shocking depending on the age at which they were exposed to them.

161 P1 "... prevention against smoking [...] it's massive, it's everywhere, [...] on cigarette packets, on bus stops, streetcar stops, on TV... everywhere!"

163
164 **Screening was described by adolescents as another means of prevention.**
165 They described individual screening when testing for sexually transmitted infections
166 with a sexual partner, essentially to consider condom withdrawal, or individual
167 screening for cancers when there were family risk factors.

168 "I can think of 'cancer', but I think there are other diseases that can be
169 screened for, and I don't think enough is done [...]"

170
171 For adolescents, **prevention meant identifying risk situations**, especially those
172 involving violence and mental health. These situations of violence or psychological
173 suffering had to be identified as early as possible to limit their future impact.
174 Adolescents described the transition from high school to higher education as a period
175 that promotes psychological suffering and fragility in young people: detection should
176 therefore be commonplace, systematic and widespread during this period of change,
177 in order to overcome the societal taboo associated with these themes. GPs should
178 systematically identify young people's mental health problems and offer them easier
179 access to free consultations with psychologists.

180 "I'm thinking of a questionnaire, that's good! [...] that we send to all the
181 mailboxes, [...] "Help for students" and a little questionnaire with answers "... Are
182 you adapting to your new life?", "Are you encountering any problems?""

183
184 The adolescents identified **the notion of public health in the prevention
185 approach**. When it came to vaccinations, the adolescents perceived an external
186 obligation to carry them out, imposed by families and legislation with the overall health
187 objective of eradicating certain diseases. However, they had no control over their own
188 vaccinations: it was the family who took them and the doctor who vaccinated them.
189 Adolescents found a collective interest in tackling topics that are taboo in society
190 (addiction, mental health, violence): it enabled them to be attentive to those around
191 them and to share prevention information.

192 P7 "It wouldn't be useful for me, but maybe I could share it with others. So [...] it's
193 still useful to talk about it".

194

195 2- Limited preventive involvement by the attending physician: adolescents seek
196 information from other sources, with varying influence on their behavior.

197 GPs have little involvement in adolescent health prevention. Adolescents
198 therefore experience prevention via multiple channels with varying impact on
199 their behavior: school, various digital medias, family and peers. Whatever the
200 source of the prevention message, the influence of peers and the young
201 person's personal experience have a strong impact on behavior change.

202 Adolescents seldom consulted their GP, and the prevention they could
203 provide seemed rare. Even if the GP was a reliable source of information for the
204 adolescents, the information given was not widely accepted. Adolescents were
205 looking for reassurance about their normality and their identification with the group of
206 healthy young people. The GP therefore had an important role to play in addressing
207 the most intimate issues (sexual health, mental health or violence), which were not
208 discussed in all families.

209 P5 "Always give as much information as possible about the body and how
210 adolescents function - future adults, in fact! And reassure them as much as
211 possible"
212 P7 "for the doctor, because since he's studied so hard[...], well, he's in a position
to tell me everything I need to know!"

214

215 **In the school environment, prevention varied**: during general courses in high
216 school, during interventions by outside professionals (road safety) or during higher
217 education. Adolescents had an ambivalent experience of prevention in the school
218 environment: too redundant, even if repetition led to better assimilation; student
219 posture conducive to memorization of prevention messages, but no new information
220 over time.

221 P0 "as a health student, I'm aware of this, but "just a little", [...] people who do
222 ordinary studies, [...] they don't know the subject, so there's even more risk for
223 them".

224

225 **Audiovisual and digital media were important sources of information for**
226 **adolescents**: TV commercials and reports, social networks and websites. These
227 preventive messages were effective because of their visual impact, ease of access
228 and the daily use of these digital tools by young people. Adolescents appreciated peer
229 testimonials, particularly on topics considered taboo in society or families (violence,
230 sexual or mental health). However, adolescents were concerned about the unreliability
231 of the witnesses and the irrelevance of the solutions offered in these non-expert
232 testimonials.

233 P5 "But they warn us on the Internet, they warn us with flashes on TV, they give
us little reminders".

234
P5 "On social networks, [...] young adolescents or young adults say 'Oh, but I didn't know. I thought I was the only one and that I was the weird one'".

237

238 **Some families were a source of information in adolescent prevention.** Some 239 subjects related to everyday life (sleep) were easily broached, while others, more 240 taboos in society, were difficult to discuss (sexual health, mental health). When one of 241 the parents worked in the medical-social field, all preventive topics were discussed 242 more frequently, and the adolescent felt less taboo.

243 P4 "Families talk a lot about this, these open subjects, it's not taboo. You can talk 244 about anything, etc. [but] there will be subjects that are completely closed.

245

246 In adolescence, **identification with the peer group was important, and this** 247 **influenced the adolescent's personal behavior.** However, the adolescents 248 interviewed pointed out that personal awareness could be stronger than the effect of 249 the group: the young person reflected on the group's behavior and might not imitate it 250 if he or she perceived it as inappropriate.

251 P1 "I don't know what I would have done if all my group of friends had told me 252 'Don't use a condom, it's rubbish, etc.'. I don't know [...]. For example, as [...] 253 almost all my friends smoke. I don't smoke. But anything to do with casino [...], 254 sports betting, they've dragged me into it, so [...] it depends".

255

256 Whatever the prevention channel used, **the youth's individual experience and** 257 **age always strongly influenced the impact of prevention on his or her behavior.** 258 Prevention messages and themes had to be tailored to each adolescent and 259 discussed in understandable, age-appropriate language, especially when it came to
260 sexuality and addictions. In the event of a personal pathology or a pathology affecting
261 a close relative, the adolescent was made aware of the health risks associated with
262 these pathologies.

263 "P3 "Well, that's good, but I don't really care (laughs)! I mean, it's okay, I'm not old
264 enough!" [sexuality]

265 P9 "As for hearing, well, you realize that when you play music too loudly, it can
266 hurt your ears a bit"

267

268 3- Adolescents tend to justify GPs' limited preventive engagement

269 GPs don't talk much about prevention in their consultations, but adolescents
270 make excuses for this: a GP consultation is short, stereotyped, too infrequent
271 and without room for prevention, the GP lacks knowledge and time, the
272 presence of a third party or the professional's good knowledge of the young
273 person's environment makes prevention pointless.

274 Consultations with their GPs were not conducive to prevention
275 messages. Adolescents were ambivalent about the possibility of
276 suitable subjects other than the initial reason for consulting the
277 doctor, which hindered prevention. They did not feel entitled to question
278 the doctor directly on topics they wished to discuss but declared the doctor
279 "irrelevant" if he or she spontaneously broached topics unrelated to the
280 initial reason for consultation. Moreover, consultations with the GP were
281 stereotyped, leaving little room for anything other than the initial reason for
282 consultation: questioning, examination and prescription of appropriate
283 therapies.
P2 "it's not really the subject, [...] And it's complicated to take a subject to something else [...]. I don't think I'd necessarily be able to ask".

For adolescents, a GP didn't think to mention prevention in his consultation because he wasn't familiar with recent recommendations. Adolescents justified this lack of knowledge by citing the numerous prevention topics to be addressed and the time-consuming ongoing training required of the doctor. Adolescents felt that certain areas of prevention did not fall within the GP's remit, and so he or she would not discuss them in a consultation: it would be more appropriate to discuss vision with an ophthalmologist, contraception or sexuality with a gynecologist...

P2 "There's a lot of prevention to be done and it must take a lot of work"

For adolescents, prevention and the GP's time were not compatible: short consultation times not conducive to prevention, considered time-consuming; loss of chance for other "really" sick patients if the doctor wasted time talking about prevention; too long time between two consultations with the GP, rendering ineffective prevention messages forgotten by adolescents.

P4 "if he takes a lot of time for people who don't necessarily have a problem, well then... Bah it's a waste of time".

Being the GP could complicate the preventive approach to the adolescent. Familiarity with the adolescent and the family justified the GP's failure to address certain issues, especially those relating to sporting activities. On the other hand, some more intimate topics required a closer relationship with the practitioner, so that the adolescent could confide in him or her: sexuality, addictions or mental health. The
308 parents were often present at the consultation with the adolescent. This third party
309 made communication between the GP and the adolescent more difficult: lack of
310 listening to the adolescent, direct communication to the third party by the doctor. This
311 impaired communication was not conducive to preventive discourse.

312 P8 "Imagine I smoke, I can't see talking about it with her or even alcohol [...] I'm
313 not close enough to talk about it!"

314
315 Adolescents justified the limits of primary prevention by GP in certain areas.

316 Doctors might fear a feeling of judgment or stigmatization on the part of the adolescent:
317 for example, nutrition or sports activities in the case of overweight, or prevention
318 messages concerning drug use, which were only addressed if the adolescent indicated
319 that he or she was taking them.

320 P3 "No, [...] maybe in my head, I'll think 'if he's talking about it, it means he thinks
321 I'm doing it'." [addiction]

322
323
324 Discussion

325 • Summary

326 Three conceptualizing categories were identified from the twelve interviews: (1)
327 Prevention in adolescents is primary and multifaceted. (2) limited preventive
328 involvement by the general practitioner: adolescents obtain information from other
329 sources with varying influence on their behavior. (3) Adolescents tend to justify GPs'
330 limited preventive engagement.
332 • Strengths and limitations:

333 Our study contributes to optimizing adolescent preventive care, offering novel

334 insights

335 about prevention by a primary health care professional as no previous study has

336 addressed this topic in the same way. The strength of our study lies in its

337 methodological rigor and compliance with the recommendations of the COREQ grid³⁰:

338 maximum variation in the sample, triangulation of the analysis with a researcher who

339 is an expert in qualitative research, iterative adaptation of the interview guide,

340 concurrent analysis and triangulation of the analysis with an expert in qualitative

341 research. Some comments from participants might only apply to specific prevention

342 areas: it should be a limitation. The method was based on the researcher's

343 reformulations during the interviews, the triangulation of the analysis and the constant

344 comparison analysis method. This methodological rigour led to the identification of

345 more general conceptual categories that took into account the lived experience of the

346 participants in our study as a whole. If an adolescent perceived prevention through

347 one or more areas only : the result was considered relevant because it explains their

348 perception of prevention during consultations. The interviewer (LF) was not an expert

349 in qualitative research but received targeted training from experts (EM and AOE) to

350 conduct interviews and the analysis of verbatims. This rigorous qualitative method

351 contributes to the internal and external validity of this study.

352

353 • Comparison with existing literature

354 For adolescents, prevention should be primary. GPs interviewed in a previous study

355 conducted by our team also recommended primary prevention as early as possible to

356 limit the negative consequences of risky behavior³¹. Adolescents described GP as
uninvolved in their prevention. Studies have asked GPs about this subject: GP described an adolescent world that was difficult to understand, and consultations that were too complex. GPs' justifications for their lack of involvement in prevention were in line with the excuses given by adolescents: GP consultations are too short, too stereotyped, and adolescents don't feel legitimate in imposing subjects. However, GPs, like primary care professionals, could be privileged interlocutors for adolescents on the subject of prevention, especially if the relationship and communication were of good quality ³¹,³². Adolescents in our study said that they rarely consulted their GP. During these consultations, prevention was rare. The literature confirms that adolescents consult few doctors, whatever their speciality⁶. However, in France, GPs are the doctors most frequently consulted by adolescents, even if these consultations are rare⁵. GPs therefore have an essential role to play in health prevention after adolescents. The Vergne study confirmed that during consultations, GPs talked about prevention, even if the initial reason for consultation was unrelated for 13-24 year-olds⁶.

Our study confirms that GPs are not the only media for adolescent's prevention. Adolescents are exposed to prevention messages through family, school, audiovisual prevention campaigns, but above all peer groups and social networks. Identification with peers is important for adolescents: this need for identification can influence their decisions, including regarding risky behavior, so any preventive action must take this into account if it is to be effective³³⁻³⁶. The family environment played a role in prevention among their adolescents: in primary prevention as well as in relaying prevention messages from the GP or national and school prevention campaigns. Good parental habits influenced children's behavior, mainly regarding everyday issues such
as nutrition, sport and sleep³⁷. GPs must therefore take this parental influence into account in their preventive support for adolescents. So, the place of family doctor is a facilitating factor. Parents could be helpful in the preventive approach, but also a hindrance, as in the case of vaccination recommendations: parents may promote vaccination and accompany their adolescent towards GPs' office, or on the contrary, may oppose vaccination because of their own hesitations or erroneous beliefs³⁸,³⁹.

However, a 2019 study showed that early intervention with parents about parent-adolescent communication helped to reduce risky behavior and alcohol consumption among adolescents⁴⁰.

Participants reported that most prevention content for adolescents targeted only a few themes: essentially sexual health, taking toxic substances or nutrition. A 2017 study confirmed that GP does not cover all the recommended topics⁶. GPs, as other primary care professionals, have an important role to play in optimizing prevention among adolescents by complementing the messages of prevention media³⁷,⁴¹.

Adolescents recognise the important role of the GP in prevention in intimate areas such as sexual and mental health. But they know little about the GP's skills, have difficulty in spontaneously broaching the subject or are uncomfortable with the idea of the GP broaching it themselves. A clear and direct message from the GP on all prevention issues could facilitate discussion on these topics. The adolescent could be reassured about the GP's knowledge and skills. Adolescents were looking for better ways of detecting and dealing with de psychological suffering. The literature confirms the existence of effective mental health prevention measures⁴,⁴²⁻⁴⁴. Adolescents identified the period of entry into higher education as particularly risky in terms of mental health, which is confirmed by the literature⁴⁵. Primary healthcare professionals
407 are relevant for enhancing the identification and prevention of mental health issues
408 among adolescents: recommendations exist in different countries¹⁰,⁴⁶,⁴⁷. Schools and
409 families must also be involved in the prevention of mental health problems in
410 adolescents⁴³,⁴⁸⁻⁵¹. As Patel V. reminded us in a 2007 Lancet article: Mental health of
411 young people is « a global public-health challenge »²⁰.

412

413 Adolescents we interviewed had expectations regarding the prevention of their GPs.
414 A qualitative study carried out by our team among GPs proposed recommendations in
415 line with these expectations³¹: prevention for adolescents during consultation must be
416 opportunistic, personalized, multiple and based on the relationship of trust that the GP
417 develops through monitoring the child and family.

418 For adolescents, prevention messages and themes had to be tailored to each
419 adolescent. These needs for personalisation apply regardless of the professional
420 involved in prevention : primary care health professionals, teachers, national
421 authorities, etc. The influence of the teenager's personal experience on the perception
422 and consequences of prevention messages has been described in numerous
423 international studies: the influence of adolescent personality on smoking prevention⁵²,
424 the influence of adolescents' psychosocial skills on substance abuse prevention⁵³, the
425 influence of family medical history on adolescent health risks⁵⁴. Taking into account
426 the specific characteristics of adolescents in terms of their personal skills, their family,
427 friends, cultural environment, and their past experiences is essential to the
428 effectiveness of prevention measures, which must be personalised¹⁰,⁵⁵,⁵⁶. Adolescents
429 in our study expect age-appropriate prevention. In our study, we choose a large broad
430 definition of adolescence, from 11 to 24 years of age. The needs of 12 year olds at
431 secondary school, who have rarely experienced sexual relations and live with their
432 parents, are bound to be different from those of 23 year olds already immersed in the world of work or studying at university. It is therefore necessary for health professionals to identify and communicate prevention messages that are adapted to the age of the adolescent, but also to his or her life history¹,⁵⁷. Adolescents in our study did not always identify them as prevention relays because they were unfamiliar with their functions. Prevention is an important part of the role of the GP and primary care, as confirmed by numerous studies and international recommendations⁶,¹⁰,³¹,⁵⁸.

439 The literature shows that parents and adolescents expect to receive information from primary care professionals⁵⁹ and that they trust their healthcare professional if he or she is honest, respectful, empathetic and respect confidentiality⁶⁰. GPs, as family doctors, have a legitimate role to play in this preventive mission. This preventive mission is facilitated by knowledge of the adolescent's socio-familial environment and the relationship GPs have developed with the child and then the adolescent¹²,³¹,³³.

445

446

447 GPs interviewed in the previous study conducted by our team recommended 448 consultation aids to optimize the preventive approach, based on pre-consultation 449 questionnaires, digital tools and dedicated long consultations³¹. These strategies may 450 help facilitate more open dialogue with adolescents³¹,⁶¹, who may not feel empowered 451 to raise sensitive topics with their GPs. This proposal would be particularly interesting 452 and complementary to the proposal made by the adolescents in our study to 453 systematize, normalize and better address mental disorders in young people.

454 • Implications for research and practice:

455 Adolescents perceived that GPs were not sufficiently involved in adolescent preventive care. Additionally, they found that preventive messages from other media

456
457 were too narrowly focused on specific themes. GPs need to invest more and better
458 in their prevention work with adolescents, because they have the advantage of a
459 special relationship with the adolescent, which makes it easier to discuss more
460 intimate subjects. The development of a digital prevention tool for primary care
461 professionals could help GP to optimize consultations with adolescents and
462 implement a preventive approach covering all recommended themes. Our study will
463 enable us to refine the content of this tool to meet the expectations of adolescents.

464 ADDITIONAL INFORMATION

465 • Funding:

466 This research did not receive any specific grant from funding agencies in the public,
467 commercial, or not-for-profit sectors.

468 • Ethical approval:

469 The study was approved by a National Ethics Committee (CNGE 260123431).

470 • Competing interest :

471 Authors declare no conflict of interest

472 • Acknowledgements

473 Thanks to the adolescents in our study for their participation and the wealth of their
474 responses.

475 Thanks to Pr Hervé Maisonneuve for his invaluable help in writing this article.

476 • List of abbreviations

477 GP: General practitioner
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672
<caption>Table 1: Interview guide</caption>

When I say, " prevention " what comes to mind?

*Probing questions: And for "prevention campaign"? Prevention in the field of health?*

Can you tell me about the last consultation with GP in which you discussed prevention?

*Probing questions: How did you react in this situation? What emotions did you feel? What did you think?*

What other health topics do you talk about with your GP?

*Probing questions: How did you react in this situation? What emotions did you feel? What did you think?*

In prevention among young people, GP are advised to talk about several topics: Sport / Vaccination / Contraception and sexuality / Addiction / Nutrition / Mental Health / Social relations / Sexually transmitted infections / General risk factors / Hearing/Vision/Teeth / Violence / Sleep / General prevention. What do you think?

*Probing question: How were these other fields discussed with you? How did you feel?*

In everything you've just told me, what aspect do you think is the most important?
<table><caption>Table 2 : Data Analysis²⁹</caption><thead><tr><th></th><th></th></tr></thead><tbody><tr><td><strong>Accurate transcription of the recordings</strong></td><td><ul><li>Transcription of interviews</li><li>Progressive analysis of interviews</li></ul></td></tr><tr><td><strong>Floating reading</strong></td><td><ul><li>Identification of the most relevant elements of the verbatim reading and annotation</li></ul></td></tr><tr><td><strong>Open coding</strong></td><td><ul><li>Coding as close as possible to the text to preserve meaning</li><li>Division text into meaning chunks through focused reading</li><li>Name first themes</li></ul></td></tr><tr><td><strong>Axial Coding</strong></td><td><ul><li>Back and forth between the data that is already analyzed and the data recorded in the new verbatim text being analyzed</li><li>Assembling meaningful and similar elements or elements relating to the same lexical field using an inductive approach between different verbatims</li></ul></td></tr><tr><td><strong>Categorization</strong></td><td><ul><li>Horizontal coding: Grouping themes for a first categorization</li><li>Continuous comparisons between conceptualized categories under construction and the emerging conceptualized categories of the following verbatims</li><li>Increase in the level of generalization categories until theoretical saturation</li></ul></td></tr><tr><td><strong>Meaning of the phenomenon</strong></td><td><ul><li>Arranging conceptualized categories according to their logical inter-relationships to construct the meaning of a phenomenon</li></ul></td></tr></tbody></table>
<table><caption>Table 3 : Characteristics of the participants</caption><thead><tr><th></th><th>Sexe</th><th>Age</th><th>Life environment</th><th>educational background / Work</th></tr></thead><tbody><tr><td>P0</td><td>F</td><td>21</td><td>Semi-rural</td><td>University</td></tr><tr><td>P1</td><td>M</td><td>20</td><td>Urban</td><td>University</td></tr><tr><td>P2</td><td>F</td><td>22</td><td>Urban</td><td>Work</td></tr><tr><td>P3</td><td>F</td><td>12</td><td>Rural</td><td>Middle School</td></tr><tr><td>P4</td><td>M</td><td>17</td><td>Semi-rural</td><td>University</td></tr><tr><td>P5</td><td>F</td><td>19</td><td>Semi-rural</td><td>University</td></tr><tr><td>P6</td><td>M</td><td>14</td><td>Rural</td><td>Middle School</td></tr><tr><td>P7</td><td>F</td><td>16</td><td>Rural</td><td>High School</td></tr><tr><td>P8</td><td>F</td><td>18</td><td>Urban</td><td>University</td></tr><tr><td>P9</td><td>M</td><td>12</td><td>Semi-rural</td><td>Middle School</td></tr><tr><td>P10</td><td>M</td><td>14</td><td>Semi-rural</td><td>Middle School</td></tr><tr><td>P11</td><td>F</td><td>14</td><td>Semi-rural</td><td>Middle School</td></tr></tbody></table>

Abreviations: F : Female / M : Male
<table><caption>Table 4: Conceptual categories</caption><thead><tr><td>Category</td><td>Subcategory</td></tr></thead><tbody><tr><td>Prevention in adolescents is primary and multifaceted</td><td>A way to limit the onset of disease, by modifying behaviors<br>Massive, sometimes inappropriate behavioral prevention messages<br>Screening: another means of prevention prevention meant identifying risk situations the notion of public health in the prevention approach</td></tr><tr><td>Little prevention by the attending physician: adolescents seek information from other sources, with varying influence on their behavior.</td><td>Adolescents seldom consulted their GPs, and the prevention they could provide seemed rare<br>In the school environment, prevention varied<br>Audiovisual and digital media were important sources of information for adolescents<br>Some families were a source of information in teenage prevention identification with the peer group was important<br>the youth's individual experience and age always strongly influenced the impact of prevention</td></tr><tr><td>Adolescents excuse GPs' lack of prevention</td><td>Adolescents were ambivalent about the possibility of suitable subjects other than the initial reason for consulting the family doctor<br>a GP didn't think to mention prevention in his consultation because he wasn't familiar with recent recommendations<br>prevention and the GP's time were not compatible<br>Being the family doctor could complicate the preventive approach to the teenager<br>Adolescents justified the limits of primary prevention by GPs in certain areas</td></tr></tbody></table>