**3. Results**

The purpose of our study was to explore the experiences of youth in a rural Central Mexican town concerning their health experiences including those at a local healthcare clinic. Here, we outline themes in accordance with Massey and colleagues' [29] framework for critical health literacy. Direct Spanish quotations are provided alongside examples. Students chose their own pseudonyms at the start of each focus group.

### *3.1. Navigating the Health System*

Although students knew the basics of how their local health clinic worked, they expressed frustration in not being able to ge<sup>t</sup> appointments or appropriate medications due to systematic issues with the center. The center utilized a token system that determined the order in which patients were seen by the doctors. Many students felt that the token system was ineffective, particularly as it disallowed them from seeing a doctor despite the fact that they had visited the clinic. Roxy (age 15, female) gave a response indicative of the frustration of many other students, stating " ... at eight in the morning they give tokens. If you make it, good! If not, oh well (O que a las ocho de la mañana dan las fichas, si alcanzaste bien si no, ni modo)." Gordito (age 14, male) explained that they do not give out many tokens a day, "they give out very few tokens, thirteen or ten (Dan muy poquitas fichas, trece o diez)." As Natalia (age 12, female) explained, if you do not ge<sup>t</sup> one of those ten tokens you have to "come (again) tomorrow (Venga hasta mañana)." The frustration with the token system was exasperated by the limited hours of the health center. The hours of the pharmacy were also limited, closing at noon, and making it difficult for students to ge<sup>t</sup> their medicine without missing school or their caretakers missing work. Halo (age 13, male) elaborated, "or sometimes they have closed, but you ring the bell and they do not open (O hay veces que tienen cerrado y tocas el timbre y no te abren)." Furthermore, even if they were able to see a doctor and make it to the pharmacy, many students expressed that the center did not have the medication they needed available: "there are almost no medications (Que no hay casi medicamentos)" (Isabela, age 14, female).

### *3.2. Patients' Rights and Responsibilities*

Patient responsibility was brought up by the youth in the context of asking clarifying questions of the doctor if information was not readily understood. Students expressed that many times they did not understand the medical language doctors used: "they talk about things we do not understand (O que hablan de cosas que nosotros no entendemos)" (Pancracio, age 15, male); "it's that you do not understand how they explain things (Es que no entiendes como te explica por sus palabras)"(Bart, age 13, male). Estrella (age 14, female) said that patients have to ask the doctors to "can you please tell us more clearly what we have, or whatever?' (Nos puede decir por favor más claro lo que tenemos o ¿equis coas?)." Axel (age 13, male) stated that when one goes to the doctor the patient has to "ask them [the doctor] what sickness you have and to please explain it. Why did I ge<sup>t</sup> sick? (T ú le vas decir qué enfermedad es esa y me la puede explicar por favor y porque esa enfermedad me dio)." The youth clearly understood that, as patients, they have the right to be spoken to at a level and in a way that they can understand. However, as will be discussed further in the theme of patient–provider relationships, barriers to communication with health professionals included fear, mistrust, and embarrassment, which seemed to stem mostly from discussion of sexual health. It may be that the youth would feel more comfortable asking these questions of their doctor if not related to their sexual health. Even so, although many students spoke about barriers to communication with their doctor, some of the same students still spoke to the importance of asking these clarifying questions.
