Assessing the dimensionality of YFHS-Swe: a questionnaire to assess youth-friendliness in differentiated health services

Beyond supply and demand: a new ecological framework for understanding the access of young migrants to sexual and reproductive health services in Sweden

BACKGROUND

Although the sexual and reproductive health and rights (SRHR) of young people and migrants should be prioritised, young migrants' sexual and reproductive health (SRH) is rarely studied in Sweden.

OBJECTIVES

To explore young migrants' understanding and experiences of sexual rights and examine their perceptions and experiences in accessing SRH services.

METHODS

This is a mixed method study including a national survey that recruited 1773 newly arrived young migrants; a youth clinic survey that recruited 1089 youths after visiting youth clinics; and a qualitative study that included 13 interviews with newly arrived Arabic-speaking migrant men. The results are synthesised using a new ecological framework of access to understand the factors influencing young migrant access to health care based on the levels of the ecological model and the five steps of access: approachability, acceptability, adequacy, affordability, and quality.

RESULTS

Young migrants understood SRH as both 'essential' and 'a right.' Their sexual rights were less fulfiled compared to other young people in Sweden, particularly for men, non-binary, LGBTQ+, those born in South Asia, without a residence permit, and those of low economic conditions. SRH services were largely unapproachable as almost half of those who needed them did not utilise them. Services were generally acceptable due to the 'open environment,' however, some young migrants faced cultural insensitivity, fear of exposure, low parental support, and long waiting times. SRH services' quality was perceived as good, however, negative experiences were reported, particularly in the domains of respect, equity, privacy, non-prejudice, and consultation quality.

CONCLUSION

The access of young migrants to SRH services is facilitated by an 'open environment' and available and good quality services; however, they faced serious barriers such as limited access to information about the health system, comprehensive sexual education, lack of cultural sensitivity, and cultural racism.

Assessing care trajectories of adolescent females seeking early induced abortion in New South Wales: multistage, mixed-methods study protocol

INTRODUCTION

In Australia, New South Wales (NSW), abortion has recently been removed from the criminal code. Previous research from Australia and other high-income countries has focused on adult women's access to abortion services. This protocol describes a five-stage mixed-methods study to determine the care trajectories and experiences of adolescent females, aged 16-19 years, seeking an early induced abortion in NSW. The aims are to (1) explore the needs and perspectives of adolescent females seeking sexual and reproductive health services in NSW and (2) develop a framework for abortion service provision for adolescents in NSW.

METHODS AND ANALYSIS

This study comprises: (1) semistructured qualitative interviews with key informants, individuals with diverse, in-depth experience of providing and/or supporting abortion care in NSW; (2) a cross-sectional online survey of adolescent females residing in NSW; (3) case study interviews with adolescents females who have accessed an abortion service in NSW; (4) a co-design workshop with adolescents who took part in stage 3 to develop relevant knowledge and recommendations and (5) a knowledge dissemination forum with key stakeholders.

ETHICS AND DISSEMINATION

Ethics approval has been received from the University of Technology Sydney Human Research Ethics Committee for this study. Data collection commenced in March 2019 and will continue until the end of 2020. This study aims to develop a deep understanding of adolescent abortion care trajectories and experiences of abortion services in NSW. The study will deliver co-produced recommendations to improve adolescent access to abortion information and services.

The perception of youth health centres' friendliness: does it differ between immigrant and Swedish-Scandinavian youths?

BACKGROUND

Ensuring a good quality service and equal access according to need for all young people is a key objective of the Swedish health system. The aim of this study was to explore youths' perception of youth health centres' (YHCs') friendliness and to assess the differences in perception between immigrant and Swedish-Scandinavian youths.

METHODS

All YHCs in the four northern counties in Sweden were invited (22 centres), and 20 agreed to participate. Overall, 1089 youths aged 16-25 years answered the youth-friendly health services-Sweden questionnaire between September 2016 and February 2017. Thirteen sub-domains of friendliness were identified and their scores were calculated. Multilevel analysis was used to examine the differences in perception between immigrant and Swedish-Scandinavian youths.

RESULTS

Our sample consisted of 971 Swedish-Scandinavian youths (89.2%) and 118 immigrants (10.8%). Generally, both groups perceived the services to be very friendly. All 13 sub-domains were rated more than three in a four-point scale except for fear of exposure and parental support of psychosocial services. However, immigrant youths perceived YHCs less friendly than their counterparts, particularly regarding the domains of equity, respect, quality and parental support.

CONCLUSIONS

Our study suggests that even though youths perceived YHCs as highly friendly, there is a space for improvement regarding access to health care. Our findings highlight the importance of an open and culturally sensitive attitude of the staff and the need to engage parents and community as a key to improve immigrant youths' accessibility to health care.

Assessing the youth-friendliness of youth clinics in northern Sweden: a survey analyzing the perspective of the youth

Background

Sweden has nearly 300 youth clinics that have been offering services since the 1970s. However, no evaluation has been done to assess their youth-friendliness. This study aims to assess: i) to what extent youth clinics are perceived as youth-friendly by the young people using them; and ii) if the level of youth friendliness is equally perceived across different sociodemographic groups of users.

Methods

The four northernmost counties of Sweden were included in the study. Of the total identified 22 youth clinics, 20 participated by giving out questionnaires to the youth after their visits to the respective youth clinics. In total 1110 youth participated in the study and answered questions according to the World Health Organization’s criteria of accessibility, equity, respect, privacy and confidentiality, no judgement, and quality. Means and frequencies were calculated, and t-test and ANOVA were used to compare means by sociodemographic variables.

Results

Participants perceived the youth clinics as very youth friendly across the measured domains, with scores as high as 4.8 and 4.9 (of a maximum of 5). Youth clinics were perceived in a similar way regardless of gender, but other sociodemographic factors influenced some of the domains, especially ethnic background.

Conclusions

The perception of youth friendliness in youth clinics was very high. Nonetheless, younger users; users who did not categorize themselves as either heterosexual, homosexual, or bisexual; users with trans-experiences; and users with non-Swedish backgrounds gave youth clinics lower scores for certain domains.

Dimensionality and reliability of USM pre-clinical medical students' guidance and counselling needs questionnaire

OBJECTIVE

There is no standard mechanism for empathy guidance and counselling for medical students. This study aimed to determine the dimensionality and reliability of a questionnaire developed for establishing guidance and counselling for pre-clinical medical students at Universiti Sains Malaysia (USM).

METHODS

A cross-sectional study was conducted among undergraduate medical students of the School of Medical Sciences of USM. The proposed USM Medical Students' Guidance and Counselling Needs (USM-MSGCN) questionnaire is a self-administered instrument that consists of 68 initial items developed from the recommendation of medical students, counsellors, and lecturers in the medical education department. To determine the dimensionality (construct validity) and reliability of the questionnaire, exploratory factor analysis and Cronbach's alpha internal consistency reliability analysis were conducted.

RESULTS

A total of 208 students participated in the study. Factor analysis revealed that the items were not unidimensional; four potential constructs could be extracted from the questionnaire, namely, self-leadership (7 items), communication (5 items), learning (5 items), and psychological coping skills (3 items), with factor loading ranges of 0.56-0.82, 0.56-0.88, 0.65-0.84, and 0.79-0.80, respectively. These domains had the following internal consistency reliability (Cronbach's alpha): 0.89, 0.90, 0.87, and 0.87, respectively; the overall alpha value was 0.93.

CONCLUSION

Four factors, with 20 items in the USM-MSGCN questionnaire had good validity and reliability values when administered among the pre-clinical medical students.