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Waller D, Kang M, Gibson S, Brooks F, Medlow S, Steinbeck K, Perry L. Development and implementation of Australian State, territory, and national policy on the health and wellbeing of adolescents and young adults: An exploration of policy actor perspectives using the Consolidated Framework for Implementation Research. Aust N Z J Public Health 2024; 48:100112. [PMID: 38198902 DOI: 10.1016/j.anzjph.2023.100112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 09/20/2023] [Accepted: 11/21/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVES Government policies that support the health and wellbeing of young people (aged 10 to 25) can have important individual and societal impacts. The aim of this study was to explore policy actor perspectives on the development and implementation of Australian government policies focussed on the health and wellbeing of young people. METHODS We utilised a qualitative research design consisting of semi-structured interviews with policy actors with experience working with Australian youth health policies. Our interview guide and analyses were informed by the Consolidated Framework for Implementation Research (CFIR). We interviewed 19 participants from various national, state, and territory bodies. RESULTS Several specific barriers and facilitators to policy development and implementation were identified using the Consolidated Framework for Implementation Research. Key policy development barriers were limited available resources (e.g. staffing and funding) and low relative priority within health and political systems. Key policy implementation barriers were limited available resources, limited policy compatibility with health services, cosmopolitanism issues related to interagency collaboration, and a lack of policy evaluation. Meaningful engagement of young people could also be improved. CONCLUSIONS Although Australian youth health policies are perceived as evidence-based and comprehensively developed, the ability to promote implementation remains stalled. IMPLICATIONS FOR PUBLIC HEALTH The development of policy implementation plans, monitoring and evaluation mechanisms, funding and resources, and a strong commitment to removing barriers to working across multiple departments and systems is required to improve outcomes for young people.
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Affiliation(s)
- Daniel Waller
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, 2006, Australia; The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, 2145, Australia.
| | - Melissa Kang
- The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, 2145, Australia
| | - Sally Gibson
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, 2006, Australia
| | - Fiona Brooks
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, 2007, Australia; Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, 0627, New Zealand
| | - Sharon Medlow
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, 2006, Australia; The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, 2145, Australia
| | - Katharine Steinbeck
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, 2006, Australia; The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, 2145, Australia
| | - Lin Perry
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, 2007, Australia
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Bosakova L, Dankulincova Veselska Z, Filakovska Bobakova D. How to improve the system of care for adolescents with emotional and behavioural problems from the perspective of care providers: a concept mapping approach. Health Res Policy Syst 2024; 22:9. [PMID: 38225655 PMCID: PMC10789000 DOI: 10.1186/s12961-023-01096-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/18/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Emotional and behavioural problems (EBP) are the most common mental health issues during adolescence, and their incidence has increased in recent years. The system of care for adolescents with EBP is known to have several problems, making the provision of care less than optimal, and attention needs to be given to potential improvements. We, therefore, aimed to examine what needs to be done to improve the system of care for adolescents with EBP and to assess the urgency and feasibility of the proposed measures from the perspective of care providers. METHODS We used Concept mapping, a participatory mixed-method research, based on qualitative data collection and quantitative data analysis. A total of 33 stakeholders from 17 institutions participated in our study, including psychologists, pedagogues for children with special needs, teachers, educational counsellors, social workers and child psychiatrists. RESULTS Respondents identified 43 ideas for improving of the system of care for adolescents with EBP grouped into 5 clusters related to increasing the competencies of care providers, changes at schools and school systems, support for existing services, transparency of the care system in institutions and public administration, and the adjustment of legislative conditions. The most urgent and feasible proposals were related to the support of awareness-raising activities on the topic of EBP, the creation of effective screening tools for the identification of EBP in adolescents, strengthening the role of parents in the process of care, comprehensive work with the family, creation of multidisciplinary support teams and intersectoral cooperation. CONCLUSIONS Measures which are more accessible and responsive to the pitfalls of the care system, together with those strengthening the role of families and schools, have greater potential for improvements which are in favour of adolescents with EBP. Care providers should be invited more often and much more involved in the discussion and the co-creation of measures to improve the system of care for adolescents with EBP.
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Affiliation(s)
- Lucia Bosakova
- Department of Health Psychology and Research Methodology, Faculty of Medicine, P.J. Safarik University in Kosice, Tr. SNP 1, Kosice, 040 01, Slovakia.
- Olomouc University Society and Health Institute (OUSHI), Palacky University in Olomouc, Univerzitni 22, Olomouc, 771 11, Czech Republic.
| | - Zuzana Dankulincova Veselska
- Department of Health Psychology and Research Methodology, Faculty of Medicine, P.J. Safarik University in Kosice, Tr. SNP 1, Kosice, 040 01, Slovakia
| | - Daniela Filakovska Bobakova
- Department of Health Psychology and Research Methodology, Faculty of Medicine, P.J. Safarik University in Kosice, Tr. SNP 1, Kosice, 040 01, Slovakia
- Olomouc University Society and Health Institute (OUSHI), Palacky University in Olomouc, Univerzitni 22, Olomouc, 771 11, Czech Republic
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Siderius L, Perera SD, Gelander L, Jankauskaite L, Katz M, Valiulis A, Hadjipanayis A, Reali L, Grossman Z. Digital child health: opportunities and obstacles. A joint statement of European Academy of Paediatrics and European Confederation of Primary Care Paediatricians. Front Pediatr 2023; 11:1264829. [PMID: 38188915 PMCID: PMC10766845 DOI: 10.3389/fped.2023.1264829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024] Open
Abstract
The advancement of technology and the increasing digitisation of healthcare systems have opened new opportunities to transform the delivery of child health services. The importance of interoperable electronic health data in enhancing healthcare systems and improving child health care is evident. Interoperability ensures seamless data exchange and communication among healthcare entities, providers, institutions, household and systems. Using standardised data formats, coding systems, and terminologies is crucial in achieving interoperability and overcoming the barriers of different systems, formats, and locations. Paediatricians and other child health stakeholders can effectively address data structure, coding, and terminology inconsistencies by promoting interoperability and improving data quality and accuracy of children and youth, according to guidelines of the World Health Organisation. Thus, ensure comprehensive health assessments and screenings for children, including timely follow-up and communication of results. And implement effective vaccination schedules and strategies, ensuring timely administration of vaccines and prompt response to any concerns or adverse events. Developmental milestones can be continuously monitored. This can improve care coordination, enhance decision-making, and optimise health outcomes for children. In conclusion, using interoperable electronic child health data holds great promise in advancing international child healthcare systems and enhancing the child's care and well-being. By promoting standardised data exchange, interoperability enables timely health assessments, accurate vaccination schedules, continuous monitoring of developmental milestones, coordination of care, and collaboration among child healthcare professionals and the individual or their caregiver. Embracing interoperability is essential for creating a person-centric and data-driven healthcare ecosystem where the potential of digitalisation and innovation can be fully realized.
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Affiliation(s)
- Liesbeth Siderius
- Rare Care World Foundation, Loosdrecht, Netherlands
- Youth Health Care, Almere, Netherlands
| | | | - Lars Gelander
- Centre of Child Health Services, Regionhälsan, Region Västra Götaland, Borås, Sweden
| | - Lina Jankauskaite
- Department of Pediatrics, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Coordinating Center for Rare and Undiagnosed Diseases, Lithuanian University of Health Sciences Hospital Kauno Klinikos, Kaunas, Lithuania
| | - Manuel Katz
- Patient Safety Department, Meuhedet Health Services, Tel Aviv, Israel
- Goshen Foundation, Jerusalem, Israel
| | - Arunas Valiulis
- Clinic of Children’s Diseases, Institute of Clinical Medicine, Medical Faculty of Vilnius University, Vilnius, Lithuania
- European Academy of Paediatrics, Brussels, Belgium
| | - Adamos Hadjipanayis
- European Academy of Paediatrics, Brussels, Belgium
- Medical School, European University Cyprus, Nicosia, Cyprus
- Department of Paediatrics, Larnaca General Hospital, Larnaca, Cyprus
| | - Laura Reali
- Primary Care Pediatrician, Italian National Health System (INHS), ASL Rm1, Rome, Italy
| | - Zachi Grossman
- European Academy of Paediatrics, Brussels, Belgium
- Department of Pediatrics, Adelson School of Medicine, Ariel University Pediatrics, Ariel, Israel
- Department of Pediatrics, Maccabi Health Care Services Pediatrics, Tel Aviv, Israel
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Omidimorad A, Nazari M, Bahmanziari N, Soleymani MH, Barakati SH, Ardalan G, Aminaee T, Taghizadeh R, Motlagh ME, Heidarzadeh A. Priority strategic directions in adolescent health in Iran based on the WHO's Global Accelerated Action for the Health of Adolescents. Int J Adolesc Med Health 2023; 35:313-321. [PMID: 37624369 DOI: 10.1515/ijamh-2023-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/30/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVES In line with the World Health Organization's Global Accelerated Action for the Health of Adolescents (AA-HA!) guidance, the goal of the current research was to identify critical strategies for adolescents' health and to determine the role and distribution of responsibilities among the leading players in the field of adolescent health in Iran. METHODS The current qualitative and applied study is part of the Ministry of Health and Medical Education's "Adolescent, Youth and School Health" plan to develop the "National Adolescent Health Plan Document" in 2020. First, stakeholder analysis was done, then a pool of nationally appropriate strategies was selected from the list of priority strategies recommended by the WHO in the AA-HA! through several group sessions. After that, the experts selected priority strategies based on the criteria of feasibility, acceptability, effectiveness, guaranteed resources, coordination with other plans and temporal priority, scoring, and executive priorities. Eventually, the priority strategies were assigned to different players/stakeholders in the field over several sessions bearing in mind the methods of implementation and the target groups. RESULTS The experts identified 58 priority strategies/actions for adolescent health under the seven priority areas of positive development, sexual protection, reproductive health, mental health, substance abuse, self-harm, violence, unintentional injury, communicable and non-communicable diseases, nutrition, and physical activity. CONCLUSIONS The highest identified priority areas were in the areas of vaccination; special health care package for service providers; training and education to promote health literacy and self-care, life skills, sexual awareness, and prevention/protection against violence; community-based mental health services, planning for adolescents' spare time, substance use prevention.
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Affiliation(s)
- Afsaneh Omidimorad
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Maryam Nazari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Najmeh Bahmanziari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Haddad Soleymani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Tahereh Aminaee
- Youth and School Health Unit, The Population, Family and School Health Office, Ministry of Health and Medical Education, Tehran, Iran
| | - Rahim Taghizadeh
- Health Promotion, Maastricht University, Maastricht, The Netherlands
| | | | - Abtin Heidarzadeh
- Medical Education Research Center, Department of Community Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Wahlström E, Golsäter M, Holmström IK, Larm P, Harder M. In search of factors related to migration affecting children's health - an analysis of documents guiding health visits within the Swedish school health services. Arch Public Health 2023; 81:103. [PMID: 37312228 DOI: 10.1186/s13690-023-01125-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/04/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Migration affects the health of children worldwide. Therefore, school nurses who encounter these children as part of their everyday practice need support from guidelines on how to promote the health of children who have migrated or whose parents have migrated. Yet knowledge regarding such content in guidelines of school nursing practice is sparse. Therefore, this study aims to investigate how municipal and regional guidelines and health questionnaires used in health visits in the Swedish school health services include factors related to migration that affect children's health. METHODS A document analysis of municipal and regional guidelines and health questionnaires guiding school nurses' practice in health visits was conducted during the autumn of 2020. In total, 687 guidelines and health questionnaires were analyzed using deductive content analysis. RESULTS The results show that municipal and regional guidelines and health questionnaires used in health visits in the Swedish school health services include content on many factors related to migration that affect children's health. Yet the content was limited, and none was found on factors related to discrimination based on ethnicity or origin. CONCLUSION Guidance related to promoting the health of children who have migrated or whose parents have migrated should include all factors affecting these children's health. Therefore, to strengthen school nurses' evidence-based practice, guideline development might be needed, although guidelines and health questionnaires exist and include content on many factors related to migration affecting the health of children in order to provide equitable healthcare for all children, regardless of country of origin.
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Affiliation(s)
- Emmie Wahlström
- ChiP Research Group, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden.
| | - Marie Golsäter
- CHILD-Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Child Health Services and Futurum, Region Jönköping County, Jönköping, Sweden
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Peter Larm
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Maria Harder
- ChiP Research Group, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden
- Child Health Care Services, Region Västmanland, Västerås, Sweden
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Rachamin Y, Nerlich SE, Jäger L, De Gani SM, Favre O, Senn O. Adolescents' self-reported health status, behaviours and health issues addressed during routine school doctor consultations in Switzerland: an observational study. Swiss Med Wkly 2023; 153:40078. [PMID: 37243976 DOI: 10.57187/smw.2023.40078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND We aimed to investigate the self-reported health status and behaviours of 7th-grade adolescents, associations with gender and educational track, as well as health issues addressed during routine school doctor consultations in Switzerland. METHODS Data on health status and behaviours, specifically general well-being, stimulant and addictive substance use, bullying/violence, exercise, nutrition and health protection, and puberty/sexuality, were drawn from routinely collected self-assessment questionnaires from 1076 (of a total of 1126) students from 14 schools in the Swiss canton of Zug in 2020. Data on health issues addressed in school doctor consultations were collected by nine school doctors (for 595 individual consultations). Multilevel logistic regression analyses were used to investigate the association of gender and educational track with unfavourable health status or behaviours. RESULTS Although 92% (n = 989) of the students reported being happy or satisfied overall, 21% (n = 215) often or almost always felt sad, and 5-10% had repeatedly been seriously physically hurt (n = 67), sexually harassed with words (n = 88) or experienced uncomfortable physical contact (n = 60). Female gender and a lower educational track were associated with unfavourable health status. In 90% (n = 533) of the school doctor consultations, at least one topic of disease prevention or health promotion was addressed, whereby the topics addressed depended strongly on the individual school doctors. CONCLUSIONS Our findings revealed that unfavourable health status and behaviours were prevalent among adolescents but the health topics addressed in school doctor consultations were not tailored to students' self-reported health issues. A school-based approach that strengthens adolescents' health literacy and provides opportunities for patient-centred counselling has the potential to improve the current and future health of adolescents and, ultimately, adults. To realise this potential, it is essential for school doctors to be sensitised and trained to address students' health concerns. Emphasis should be placed on the importance of patient-centred counselling, the high prevalence of bullying, and gender and educational differences.
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Affiliation(s)
- Yael Rachamin
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Campus Stiftung Lindenhof Bern (SLB), Bern, Switzerland
| | - Sofia Elena Nerlich
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Levy Jäger
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | | | - Olivier Favre
- Department of Child and Adolescent Health, Office of Public Health, Canton of Zug, Zug, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
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Park M, Budisavljević S, Alemán-Díaz AY, Carai S, Schwarz K, Kuttumuratova A, Jobe LB, Hülsen V, Lee YE, Scott E, Whitehead R, Weber MW. Child and adolescent health in Europe: Towards meeting the 2030 agenda. J Glob Health 2023; 13:04011. [PMID: 36655877 PMCID: PMC9850873 DOI: 10.7189/jogh.13.04011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Childhood and adolescence are critical stages for a healthy life. To support countries in promoting health and development and improving health care for this age group, the WHO Regional Office for Europe developed the European strategy for child and adolescent health 2015-2020, which was adopted by all countries. This paper reports progress in the strategy's implementation until 2020. Methods A survey was sent to all ministries of health of the 53 Member States of the WHO European Region. Responses were received from 45 Member States. Results are presented in this paper. Results The European Region made overall progress in recent years, but increasing levels of overweight and obesity among children, adolescent mental health and low breastfeeding rates are recognized as key national challenges. Although forty-one countries adopted a national child and adolescent health strategy, only eight countries involve children in their review, development and implementation stages. Two-thirds of countries have a strategy for health-promoting schools and a school curriculum for health education. One-third of countries do not have legislation against marketing of unhealthy foods and beverages to children. Most countries reported routine assessment for developmental difficulties in children, but less than a quarter collected and reported data on children who are developmentally on track. There are major gaps in data collection for migrant children. Hospitalization rates for young children vary five-fold across the region, indicating over-hospitalization and access problems in some countries. Only ten countries allow minors access to health care without parental consent based on their maturity and only eleven countries allow school nurses to dispense contraceptives to adolescents without a doctor's prescription. Conclusions This paper shows the progress in child and adolescent health made by countries in Europe until 2020 and key areas where additional work is needed to move the 2030 agenda forward. The survey was undertaken before the COVID-19 pandemic and the war in Ukraine. Both will likely exacerbate many of the observed problems and potentially reverse some gains reported. A renewed commitment is needed.
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Affiliation(s)
- Minhye Park
- WHO Regional Office for Europe, Copenhagen, Denmark
| | | | | | - Susanne Carai
- WHO Regional Office for Europe, Copenhagen, Denmark,Universitat Witten/Herdecke, Witten, Germany
| | | | | | - Lei B Jobe
- WHO Regional Office for Europe, Copenhagen, Denmark
| | | | - Yae Eun Lee
- WHO Regional Office for Europe, Copenhagen, Denmark
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Nikander K, Kosola S, Vahlberg T, Kaila M, Hermanson E. Associating school doctor interventions with the benefit of the health check: an observational study. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2021-001394. [PMID: 36053658 PMCID: PMC8889353 DOI: 10.1136/bmjpo-2021-001394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/02/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The benefits of school doctor interventions conducted at routine general health checks remain insufficiently studied. This study explored the associations of school doctor interventions with the doctor-evaluated and parent-evaluated benefits of routine health checks. METHODS Between August 2017 and August 2018, we recruited a random sample of 1341 children from grades 1 and 5 from 21 Finnish elementary schools in 4 municipalities. Doctors routinely examined all children, who were accompanied by parents. The doctor-reported interventions were categorised into six groups: instructions and/or significant discussions, prescriptions, laboratory tests and/or medical imaging, scheduling of follow-up appointments, referrals to other professionals and referrals to specialised care. Doctors evaluated the benefit of the appointment using predetermined criteria, and parents provided their subjective perceptions of benefit. Interventions and reported benefit were compared using multilevel logistic regression. RESULTS Doctors reported 52% and parents 87% of the appointments with interventions beneficial. All interventions were independently associated with doctor-evaluated benefit (ORs: 1.91-17.26). Receiving any intervention during the appointment was associated with parent-evaluated benefit (OR: 3.25, 95% CI 2.22 to 4.75). In analyses of different interventions, instructions and/or significant discussions (OR: 1.71, 95% CI 1.20 to 2.44), prescriptions (OR: 7.44, 95% CI 2.32 to 23.91) and laboratory tests and/or medical imaging (OR: 3.38, 95% CI 1.34 to 8.55) were associated with parent-evaluated benefit. Scheduled follow-up appointments and referrals to other professionals showed no significant association with parent-evaluated benefit. CONCLUSIONS Doctors and parents valued the appointments with interventions. Parents especially appreciated immediate help and testing from the doctor. TRIAL REGISTRATION NUMBER NCT03178331.
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Affiliation(s)
- Kirsi Nikander
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland .,School and Student Healthcare, Department of Social Services and Healthcare, City of Helsinki, Helsinki, Finland.,Doctoral School in Health Sciences, Doctoral Program in Population Health, University of Helsinki, Helsinki, Finland
| | - Silja Kosola
- Pediatric Research Center, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tero Vahlberg
- Faculty of Medicine, Department of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland
| | - Minna Kaila
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Elina Hermanson
- Pikkujätti Medical Center for Children and Youth, Helsinki, Finland
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Rocco I, Tamburis O, Pecoraro F, Luzi D, Corso B, Minicuci N. Quality of child healthcare in European countries: common measures across international databases and national agencies. Eur J Public Health 2021; 31:679-687. [PMID: 34480552 PMCID: PMC8504999 DOI: 10.1093/eurpub/ckab086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The evaluation of child healthcare is not yet widely explored, especially from a cross-country comparison perspective. The routine adoption of measures by national assessment agencies is under-investigated. Though the guiding principles developed at international level call for a child-centric multi-dimensional evaluation of child care, its feasibility is hampered by the availability of robust and harmonized data. METHODS To explore the data availability, international databases (IDBs) were scrutinized and measures dealing with child health-related issues were collated. In parallel, an ad hoc questionnaire was administrated to 30 Country Agents (CAs) to gather measures routinely adopted at local level. To facilitate the comparison of measures, a three-level conceptual map was developed. RESULTS The IDBs yielded at 207 measures that pertained mainly to non-health determinants of health, whereas the 352 measures obtained from CAs focused on process and outcome. A set of 33 common measures that related to immunization, morbidity and mortality were identified. CONCLUSIONS A limited set of measures used both in IDBs and at national level identify common areas of concerns that certainly capture crucial issues with child prevention and health outcomes. However, they are far from satisfying a child-centric multi-dimensional approach to the evaluation of child well-being and well-becoming. There is room for improvement at both international and national levels. IDBs should include and harmonize measures that concern the provision of child-centric services and encompass physical, social and mental development. At the national level, efforts towards the inclusion of measures that concern non-health determinants of health should be pursued.
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Affiliation(s)
- Ilaria Rocco
- Departement of Biomedical sciences, Neuroscience Institute, National Research Council, Padova, Italy
| | - Oscar Tamburis
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, Naples, Italy
| | - Fabrizio Pecoraro
- Departement of Social sciences and humanities, cultural heritage, Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | - Daniela Luzi
- Departement of Social sciences and humanities, cultural heritage, Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | - Barbara Corso
- Departement of Biomedical sciences, Neuroscience Institute, National Research Council, Padova, Italy
| | - Nadia Minicuci
- Departement of Biomedical sciences, Neuroscience Institute, National Research Council, Padova, Italy
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10
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Michaud PA, Vervoort JPM, Visser A, Baltag V, Reijneveld SA, Kocken PL, Jansen D. Organization and activities of school health services among EU countries. Eur J Public Health 2021; 31:502-508. [PMID: 33582798 DOI: 10.1093/eurpub/ckaa200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND School health services (SHS) can be defined as health services provided to enrol pupils by health professionals and/or allied professions. The aim of this study was to explore the current state of the governance, organization and workforce of SHS and their provision of preventive activities in European countries. METHODS Observational study. Data were collected as part of the Horizon 2020-funded project 'Models of Child Health Appraised'. Only 1 expert from each of the 30 included European countries answered a closed-items questionnaire during the years 2017 and 2018. RESULTS All countries (except Spain and the Czech Republic, which do not have formal SHS) provided school-based individual screening and health-enhancing measures. The majority performed height, weight, vision and hearing checks; some integrated other assessments of limited evidence-based effectiveness. Most countries also delivered health education and promotion activities in areas, such as sexual health, substance use and healthy nutrition. Almost all countries seemed to suffer from a shortage of school health professionals; moreover, many of these professionals had no specific training in the area of school health and prevention. CONCLUSIONS Many EU countries need better administrative and legal support. They should promote evidence-based screening procedures and should hire and train more school health professionals. Overall, they need to adapt to the evolving health priorities of pupils, adopt a more holistic paradigm and extend their activities beyond traditional screening or vaccination procedures.
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Affiliation(s)
| | - Johanna P M Vervoort
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annemieke Visser
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Valentina Baltag
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organisation, Geneva, Switzerland
| | - Sijmen A Reijneveld
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,TNO Child Health, Leiden, The Netherlands
| | - Paul L Kocken
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Danielle Jansen
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Sociology and Interuniversity for Social Science Theory and Methodology (ICS), University of Groningen, Groningen, The Netherlands
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Lazzerini M, Armocida B, Valente EP, Berdzuli N. Antenatal screening practices in the WHO European Region: a mixed methods study. J Glob Health 2021; 10:020416. [PMID: 33312500 PMCID: PMC7719277 DOI: 10.7189/jogh.10.020416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Literature suggests an increasing trend towards more screening tests, while awareness of potential harms of screenings has been reported to be sub-optimal. This paper aimed to characterize ANC screening practices within the 53 countries of the WHO Europe Region and compare these to evidenced-based recommendations from WHO and from other key reference sources. Methods From January 2019 to July 2019 we conducted a survey among key informants (KIs) in the 53 countries of the WHO European Region and a systematic review of literature. KIs were invited to answer an online structured questionnaire, available both in English and Russian. Published and unpublished guidelines, policies or cross-sectional studies on ANC screening practices were searched for in four electronic databases (MEDLINE, Global Health Library, Web of Science, Google) and also sent by KIs. Data obtained from both methods were analysed and triangulated by two independent authors. Results Overall 42 countries participated in the survey. Among these, 36 (86%) reported national guidelines on ANC screening, but only 26 (61.9%) reported up-to-date and comprehensive guidelines. All countries reported supplemental use other guidelines, with 19 (45.2%) using more than three. When looking at current evidence-based recommendations, only one (ultrasound before 24 weeks) was reported to be implemented in all countries. Overall, 35 (83.3%) countries reported using at least five not-recommended ANC screening practices, with 21 (50%) implementing ≥10 not-recommended ANC screening practices. The systematic review resulted in 11871 records, with 111 (90 guidelines, 4 policies, 17 cross-sectional studies) matching inclusion criteria. Findings from the systematic review were largely consistent with those of the online survey: among the most comprehensive national guidelines identified, only six (24%) had a concordance ≥75% with the reference recommendations, independently from their publication date, while the few existing cross-sectional studies highlighted large heterogeneity in the implementation of ANC practices among countries. Conclusions Guidance on and implementation of evidenced-based recommendations on ANC screening is suboptimal in the WHO European Region. It is necessary to increase the availability of evidence-based high-quality national guidelines and their concrete use in routine practice.
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Affiliation(s)
- Marzia Lazzerini
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Benedetta Armocida
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Nino Berdzuli
- Division of Noncommunicable Diseases and Promoting Health through the Life-course, WHO Regional Office for Europe, UN City, Copenhagen, Denmark
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12
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Luzi D, Rocco I, Tamburis O, Corso B, Minicuci N, Pecoraro F. Variability in the assessment of children's primary healthcare in 30 European countries. Int J Qual Health Care 2021; 33:6101213. [PMID: 33449077 PMCID: PMC7869189 DOI: 10.1093/intqhc/mzab007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 12/12/2020] [Accepted: 01/13/2021] [Indexed: 12/17/2022] Open
Abstract
Background The high variability in the types and number of measures adopted to evaluate childcare across European countries makes it necessary to investigate country practices to identify trends in setting national priorities in the assessment of child well-being. Objective This paper intends to investigate country practices under the lens of variability to explore possible trends in setting national priority in the evaluation of childcare. In particular, it analyses variability considering to what extent this depends on the tendency of adopting a broad vision (i.e. selecting measures for a larger variety of aspects) or whether this is influenced by the choice of adopting an in-depth approach (i.e. using more measures to analyse a specific aspect) Methods An ad hoc questionnaire was administered to a national expert in each country and yielded 352 measures. To analyse variability, the breadth in the number of aspects considered was explored using a convergence index, while the depth in the distribution of measures in each aspect was investigated by computing a coefficient of variation. Countries were grouped by adopting a hierarchical clustering approach. Results There is a high variability across countries in the selection of measures that cover different aspects of childcare. Preferences in the distribution of measures are significant even at the domain level and in countries that use a limited number of measures and become more evident at the category and sub-category levels. The statistical analysis clusters countries in four main groups and two outliers. The in-depth distribution of measures focused on a specific aspect shows a homogeneous pattern, with the identification of two main groups of countries. Conclusions A limited set of measures are shared across countries hampering a robust comparison of paediatric models. The selection of measures shows that the evaluation is closely related to national priorities as resulting from the number and types of measures adopted. Moreover, a range of a reasonable number of measures can be hypothesized to address the quality of childcare under a multi-dimensional perspective.
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Affiliation(s)
- daniela Luzi
- National Research Council, Institute for Research on Population and Social Policies, via Palestro, 32, Rome, Lazio 00185, Italy
| | - Ilaria Rocco
- National Research Council, Neuroscience Institute, Via Giustiniani 2, Padua, Veneto 35128, Italy
| | - Oscar Tamburis
- National Research Council, Institute for Research on Population and Social Policies, via Palestro, 32, Rome, Lazio 00185, Italy
| | - Barbara Corso
- National Research Council, Neuroscience Institute, Via Giustiniani 2, Padua, Veneto 35128, Italy
| | - Nadia Minicuci
- National Research Council, Neuroscience Institute, Via Giustiniani 2, Padua, Veneto 35128, Italy
| | - Fabrizio Pecoraro
- Address reprint requests to: Fabrizio Pecoraro, National Research Council, Institute for Research on Population and Social Policies, via Palestro, 32, Rome, Lazio 00185, Italy. Tel: +39-06492724278; Fax: 39-06-4938-3724; E-mail:
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13
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Hoey H, Pettoello-Mantovani M, Vural M. Diversity of child health care in Europe. Arch Dis Child 2021; 106:732-733. [PMID: 32788200 PMCID: PMC8311076 DOI: 10.1136/archdischild-2020-319584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/08/2020] [Accepted: 07/15/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Hilary Hoey
- Paediatrics, Trinity College Dublin, Dublin 2, Ireland
- European Paediatric Association-Union of National European Paediatric Societies and Associations (EPA-UNEPSA), Berlin, Germany
| | - Massimo Pettoello-Mantovani
- European Paediatric Association-Union of National European Paediatric Societies and Associations (EPA-UNEPSA), Berlin, Germany
- Paediatrics, Ospedale Casa Sollievo della Sofferenza, University of Foggia, San Giovanni Rotondo, Italy
| | - Mehmet Vural
- European Paediatric Association-Union of National European Paediatric Societies and Associations (EPA-UNEPSA), Berlin, Germany
- Paediatrics, Istanbul University-Cerrahpasa, Istanbul, Turkey
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14
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Waller D, Brooks F, Perry L, Kang M, Steinbeck K. Australian federal, state and territory policy on the health and wellbeing of young people: A scoping review. Health Policy 2021; 125:1065-1076. [PMID: 34144850 DOI: 10.1016/j.healthpol.2021.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The health and wellbeing of young people are critical for the future of society but the extent to which they are addressed by overarching Australian Federal, State and Territory health policy is difficult to determine. Analysing high-level youth health policy will help establish how Australian governments are articulating and prioritising issues and may guide local and international health agendas. METHODS This scoping review aimed to determine the extent, range and nature of Australian high-level government policy focused on the general health and wellbeing of the general population of young people. Policies published by Australian Federal, State, or Territory government departments between 2008 and 2019 were thematically analysed employing Braun and Clark's six-step recursive framework. FINDINGS Twelve policy documents met inclusion criteria. Three meta-themes emerged, comprising policy development, youth health challenges, and policy goals. Policy goals fell into three ubiquitous and overarching categories focused on supporting public health, promoting equity, and improving the health system for young people. CONCLUSIONS A number of youth-specific health policies have been developed by Australian governments in recent years. Whilst goals and strategies are clearly articulated, more can be done to ensure a youth voice in policy development. The policy goals of supporting public health, promoting equity and improving the health system deserve consideration from other countries developing youth health policies.
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Affiliation(s)
- Daniel Waller
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo New South Wales 2007, Australia.
| | - Fiona Brooks
- Office of the Deputy Vice-Chancellor (Research), University of Technology Sydney, Ultimo New South Wales 2007, Australia.
| | - Lin Perry
- South Eastern Sydney Local Health District, Prince of Wales Hospital, Randwick, NSW 2031; School of Nursing, Faculty of Health, University of Technology Sydney, Ultimo New South Wales 2007, Australia.
| | - Melissa Kang
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo New South Wales 2007, Australia.
| | - Katharine Steinbeck
- Faculty of Medicine and Health, Discipline of Child and Adolescent Medicine, University of Sydney, Camperdown New South Wales 2006, Australia; The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead New South Wales Australia 2145.
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15
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Supporting every school to become a foundation for healthy lives. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:295-303. [PMID: 33485407 DOI: 10.1016/s2352-4642(20)30316-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 09/11/2020] [Accepted: 09/21/2020] [Indexed: 11/24/2022]
Abstract
As a setting where children and adolescents live and learn, linked to the family and embedded within the wider community, schools have an important influence on every student's health. Many health interventions have used schools as a platform, often for standalone programmatic initiatives to reduce health risks, and sometimes for more comprehensive approaches, but the interventions, uptake, and sustainability are generally disappointing. Evidence shows that, to improve health and to reduce inequality, all students must attend school from a young age and for as long as possible, and their educational success therein must be maximised. Thus, beyond educational benefits, schools are also important for health. Coherence between each school's policies, structures and systems, human resources, and practices is required to advance both academic and health outcomes. Beyond simply implementing ready-made programmes into schools, health professionals can position themselves as catalysts for structural change as they have many opportunities to advocate for, and participate in, the intersectoral implementation of reforms and innovations in school systems to promote the health of all students.
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Lo Moro G, Soneson E, Jones PB, Galante J. Establishing a Theory-Based Multi-Level Approach for Primary Prevention of Mental Disorders in Young People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9445. [PMID: 33339317 PMCID: PMC7766147 DOI: 10.3390/ijerph17249445] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/06/2020] [Accepted: 12/12/2020] [Indexed: 12/14/2022]
Abstract
The increasing prevalence of mental health disorders and psychosocial distress among young people exceeds the capacity of mental health services. Social and systemic factors determine mental health as much as individual factors. To determine how best to address multi-level risk factors, we must first understand the distribution of risk. Previously, we have used psychometric methods applied to two epidemiologically-principled samples of people aged 14-24 to establish a robust, latent common mental distress (CMD) factor of depression and anxiety normally distributed across the population. This was linearly associated with suicidal thoughts and non-suicidal self-harm such that effective interventions to reduce CMD across the whole population could have a greater total benefit than those that focus on the minority with the most severe scores. In a randomised trial of mindfulness interventions in university students (the Mindful Student Study), we demonstrated a population-shift effect whereby the intervention group appeared resilient to a universal stressor. Given these findings, and in light of the COVID-19 pandemic, we argue that population-based interventions to reduce CMD are urgently required. To target all types of mental health determinants, these interventions must be multi-level. Careful design and evaluation, interdisciplinary work, and extensive local stakeholder involvement are crucial for these interventions to be effective.
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Affiliation(s)
- Giuseppina Lo Moro
- Department of Public Health Sciences, University of Turin, 10126 Torino, Italy;
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK;
| | - Emma Soneson
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK;
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK;
- National Institute for Health Research Applied Research Collaboration East of England, Cambridge CB2 8AH, UK
| | - Julieta Galante
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK;
- National Institute for Health Research Applied Research Collaboration East of England, Cambridge CB2 8AH, UK
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17
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Michaud PA, Visser A, Vervoort JPM, Kocken P, Reijneveld SA, Jansen DEMC. Availability and accessibility of primary mental health services for adolescents: an overview of national recommendations and services in EU. Eur J Public Health 2020; 30:1127-1133. [PMID: 32820338 DOI: 10.1093/eurpub/ckaa102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mental health problems in adolescence can profoundly jeopardize adolescent current and future health and functioning. We aimed to describe existing recommendations and services regarding the delivery of primary mental health care for adolescents in 31 European countries. METHODS Data on the availability and accessibility of primary mental health services were collected, as part of the Horizon 2020-funded project Models of Child Health Appraised. One expert from each country answered a closed items questionnaire during years 2017-18. RESULTS All 31 participating countries had some policy or recommendations regarding the availability and accessibility of primary mental health services for adolescents, but their focus and implementation varied largely between and within countries. Only half of the participating countries had recommendations on screening adolescents for mental health issues and burdens. Merely a quarter of the countries had ambulatory facilities targeting specifically adolescents throughout the whole country. Just over half had some kind of suicide prevention programs. Same-day access to primary care in case of -health emergencies was possible in 21 countries, but often not throughout the whole country. Nineteen countries had strategies securing accessible mental health care for vulnerable adolescents. CONCLUSIONS Overall, around half of European countries had strategies securing access to various primary mental health care for adolescents. They frequently did not guarantee care over the whole country and often tackled a limited number of situations. EU countries should widen the range of policies and recommendations governing the delivery of mental health care to adolescents and monitor their implementation.
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Affiliation(s)
| | - Annemieke Visser
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Paul Kocken
- Department of Child Health, TNO Leiden, The Netherlands.,Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Erasmus School of Social and Behavioural Sciences, Rotterdam, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Child Health, TNO Leiden, The Netherlands
| | - Danielle E M C Jansen
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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18
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Luo X, Zheng R, Jin X, Sun Y, Chen L, Peng J, Huang X, Tian X, Mei L. Barriers to Adolescent Health Care in Maternal and Children's Healthcare Hospitals: Based on a National Survey in China. J Adolesc Health 2020; 67:S32-S37. [PMID: 33246531 DOI: 10.1016/j.jadohealth.2020.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 05/31/2020] [Accepted: 07/12/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Adolescence is a critical period for physical and psychological development; therefore, health interventions at this phase may be especially beneficial. In this study, we aim to describe the distribution of the adolescent health care system in China and to compare the perceived barriers of running an adolescent clinic (AC) proposed by hospitals with corresponding government entities. METHODS A nationwide online survey was launched by the National Health Commission of China in December 2015, among 116 Maternal and Children's Healthcare (MCH) hospitals located across 24 randomized selected provinces. The online survey included management questionnaires filled out by health administrators from local health commissions and service questionnaires filled out by adolescent care providers from MCH hospitals. RESULTS Among the surveyed provinces, only 7% have special funding for adolescent health care, 13% have a supporting policy, 8% have guidelines/service standards, and 16% provide adolescent health care based in MCH hospitals. Among the 116 MCH hospitals investigated, 31 (27%) had a functioning AC and 15 (13%) used to have an AC. Compared with the MCH hospitals that never have an AC, those that previously had an AC were more likely to perceive demand as a barrier (odds ratio = 8.02; p value < .05) but less likely to perceive guidelines/service standards as a problem (odds ratio = .09; p value < .01). The perceptions of health administrators and adolescent health care providers differed markedly on demand and profits: both were ranked highly by supply side (health providers) but ranked low by the health administrators. CONCLUSIONS This national survey, for the first time, presents a whole picture of adolescent health care in MCH hospital settings in China. Among the surveyed MCH hospitals, major areas of discordance between administrators and health care providers were barriers in demand and profits, which health administrators tend to overlook. A number of strategic priorities are proposed to best guide the development of the adolescent health care system in China, including improved linkage between health and education and community systems, comprehensive approaches move beyond sexual and reproductive education, as well as the workforce development and capacity-building.
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Affiliation(s)
- Xiaomin Luo
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ruimin Zheng
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Xi Jin
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ying Sun
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Li Chen
- Department of Medicine, Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Jiong Peng
- United Nations Population Fund - China, Beijing, China
| | - Xiaona Huang
- United Nations Children's Fund - China, Beijing, China
| | - Xiaobo Tian
- United Nations Children's Fund - China, Beijing, China
| | - Lili Mei
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
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Michaud PA, Visser A, Vervoort J, Kocken P, Reijneveld S, Blair M, Alexander D, Rigby M, Weber M, Jansen D. Do European Union countries adequately address the healthcare needs of adolescents in the area of sexual reproductive health and rights? Arch Dis Child 2020; 105:40-46. [PMID: 31270093 PMCID: PMC6951236 DOI: 10.1136/archdischild-2019-317073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/16/2019] [Accepted: 06/18/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND OBJECTIVES Adolescent sexual and reproductive health and rights (SRHR) are of particular relevance given their potential short-term or long-term health consequences. This study evaluates recommendations and policies regarding access to care in this area in 31 European countries (European Union (EU) plus Iceland, Norway and Switzerland). METHODS As part of the EU funded Models of Child Health Appraised project, data were gathered using a 43-item questionnaire sent to experts responsible for collecting information in each country. RESULTS Ten countries have not developed any formal policy or recommendation that guarantee the respect of confidentiality and the possibility of consulting a physician without parents knowing. Nearly half of the countries do not have centres specialised in adolescent healthcare, tackling comprehensive health issues or focusing specifically on SRH. Access to emergency contraception and information regarding pregnancy, including testing, is easy in most countries. However, oral contraception is delivered free of charge in only 10 countries. Twenty-three countries do not meet current standards in terms of providing policy-based pregnancy care, and only 13 have set up special programmes for pregnant adolescents. In only seven countries can adolescents definitely have their pregnancy terminated without their parents knowing (and in another seven countries in selected situations). CONCLUSION The provision and availability of adolescent-friendly SRHR care are far from optimal in around half of the surveyed countries. These results call for the review and implementation of policies, specialised healthcare centres and training initiatives for primary care providers.
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Affiliation(s)
| | - Annemieke Visser
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johanna Vervoort
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul Kocken
- Department Public Health and Primary Care, TNO, Department Child Health, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Mitch Blair
- Paediatrics, Imperial College London, Harrow, UK
| | | | | | - Martin Weber
- WHO Regional Office for Europe, WHO, Copenhagen, Denmark
| | - Danielle Jansen
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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An exploratory survey on the state of training in adolescent medicine and health in 36 European countries. Eur J Pediatr 2019; 178:1559-1565. [PMID: 31463767 PMCID: PMC6733827 DOI: 10.1007/s00431-019-03445-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/18/2019] [Accepted: 08/06/2019] [Indexed: 11/11/2022]
Abstract
The development of adolescent health and medicine as a medical discipline lags behind in Europe compared with other regions of the world. This study aims to evaluate the structure and content of adolescent medicine and health training curricula for medical students, paediatricians, and other primary care physicians in the European region. A questionnaire survey was sent by e-mail to experts in the field from 36 European countries, addressing the content of adolescent health issues. Data was obtained from all 36 countries. At the undergraduate level, seven countries reported some mandatory stand-alone teaching (sessions dealing specifically with adolescents), while seven countries reported optional stand-alone teaching. In only 7 out of 36 countries were issues critical to adolescents covered as stand-alone sessions. At the postgraduate level, 15 countries delivered stand-alone mandatory training sessions to primary, secondary, or tertiary care paediatricians, covering most of the five critical areas listed in the questionnaire. In another 13 countries, such sessions were not mandatory and were inexistent in eight of them. The coverage among school physicians was similar but was much lower among general practitioners.Conclusion: Paediatric associations and academic institutions should advocate for a better coverage of adolescent health and medicine in the training curricula of health care providers. What is known: • In most European countries, adolescent medicine is still poorly represented as a discipline. • Experts have recently published recommendations regarding what form the structure and content of a training curriculum in this field should take. What is new: • This paper gives information on the extent and content of training in adolescent medicine and health as currently offered within under- and postgraduate European training curricula, in terms of stand-alone mandatory (versus optional) sessions. • In many European countries, both medical students and residents are poorly exposed to the basic knowledge and skills pertaining to adolescent health care.
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