15581-m-nanninga

EXPECTATIONS OF BARRIERS 35 differ in their views, including the well-known example of their views on psychosocial problems [42-44]. It might be that children in general foresee barriers more often than their parents do, because they are the ones who have to follow treatment and have to address their problems. This may be especially true for adolescents. Their developmental stage is characterized by a growth in autonomy, in self-directedness, and in the desire to solve problems on their own, which is brought about by creating distance from and less dependency on their parents and educators [45-47]. This may lead to an avoidance of interference from others, such as psychosocial care professionals, which might be reflected in the expectation of multiple barriers to care. The most frequently expected type of barrier was the expectation that treatment would be irrelevant. For parents of children this result emerged regardless of sociodemographic background. This might reflect that these parents prefer to solve problems on their own or within their informal networks. It might also mean that there is a lack of confidence in the quality of the treatment and its effectiveness [47]. Parents of adolescents of non-Dutch ethnicity more often expected this type of barriers as well as barriers regarding the relationship with the therapist and stressors and obstacles at home. It might also be that parents from some cultures expect or have experienced resistance to arranging psychosocial care for the child more often, because of a greater stigma attached to psychosocial problems and to using psychosocial care [48-50]. Barriers regarding treatment – i.e., irrelevance, problematic relationship with therapists, and demands and issues – were more frequently expected by parents of low educational level and their adolescents. These families, as compared to families with higher educational level, more often lack the skills needed to navigate the mental health care or social care systems, which might explain our finding. These families more often have limited health literacy, for example, which is a factor that has been shown to be associated with distrust of professionals and pessimism about treatment [51]. Furthermore, barriers related to treatment demands and issues were expected by parents and adolescents who already (might) had some experience with seeking psychosocial care. That is by parents of adolescents with psychosocial problems and adolescents who had used psychosocial care in the past. Also, adolescents who had psychosocial problems expected barriers regarding a problematic relationship with a therapist. It might be that seeking or using psychosocial care is actually the current reality for them. Their expectations might well be based on actual experiences, which is something parents and adolescents do not have if they are just imagining having to seek psychosocial care [52]. This explanation might also hold for our other findings, for example on the association with parental educational level, non-Dutch ethnicity and one-