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Goicolea I, Richter Sundberg L, Wiklund M, Gotfredsen A, Christianson M. Widening the scope of mental health with a 'youth centred' approach: a qualitative study involving health care professionals in Sweden's youth clinics. Int J Qual Stud Health Well-being 2024; 19:2348879. [PMID: 38700475 PMCID: PMC11073406 DOI: 10.1080/17482631.2024.2348879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/25/2024] [Indexed: 05/05/2024] Open
Abstract
PURPOSE The aim of this study was to explore how health care providers at youth clinics (YCs) in Sweden engage with, focus on, and navigate across the mental health youth space, while upholding the core bedrock principle of "youth-centeredness". METHODS Qualitative interviews were conducted with 21 health care professionals working in three YCs located in three different regions of Sweden. Data were analysed using reflexive thematic analysis informed by the work of Braun and Clarke. RESULTS The three themes were: 1) "youth mission-at the core of the YCs" work and challenged by a stronger involvement in mental ill health'; 2) "YCs" unique and complementary role in the youth mental health system: a holistic perspective, team work, and a focus on normalization', and 3) "Caught between a rock and a hard place: to treat at a care level that is not optimal for the young users" needs or to refer within an unreliable system'. CONCLUSION This study reflects the individuality and key features of YCs, their widening roles within the mental health sphere, and the challenges faced in maintaining and expanding the characteristic "youth-centred" approach while expanding their work with mental health.
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Affiliation(s)
- Isabel Goicolea
- Department of Epidemiology and Global Health, Umeå International School of Public Health, Umeå University, Umeå, Sweden
| | | | - Maria Wiklund
- Department of Community medicine and rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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Durán-Martín E, Sanz-Barbero B, Muñoz-Haba A, March S, Vives-Cases C. "Thanks to my activists Friends": a qualitative study of perspectives of young adults and professionals on the factors related to seeking support among victims of sexual violence in Spain. Arch Public Health 2024; 82:93. [PMID: 38907306 PMCID: PMC11191312 DOI: 10.1186/s13690-024-01319-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: 03/04/2024] [Accepted: 06/09/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Sexual violence (SV) is a public health problem with high prevalence among the young population. The use of formal resources for SV care (e.g. institutional services) is low in this age group. This study applies a framework of health assets to identify the factors that positively influence the search for support for SV among young people, the functions of that support and the level of proximity as articulated by both young people and professionals. METHODS A qualitative study was conducted through 38 semi-structured interviews with young people and professionals from SV resource centers and/or care services for the young population in Spain. A thematic theoretical analysis was conducted, embedded in inductive insights emerging from the data, following a particular adaptation of the constant comparative method, under the grounded theory approach. This analysis was carried out by coding the interview transcripts with the support of Atlas.ti. RESULTS Young women identified assets, categorized as feminist, that they believe they are essential in the search for formal support services for SV. However, unlike young men, they considered the police and judicial system to be barriers and not assets. There were also differences between the young people and professionals in identifying assets. Young people also considered their partner and traditional media as health assets, in contrast to professionals who did not identify these as such valuable resources in the help-seeking process. Informal assets, such as family, friends and the internet are considered close resources. In contrast, specialized care services for gender-based violence/SV and the judicial and police systems were perceived as more distant resources among the young interviewees. CONCLUSIONS This study shows similarities and discrepancies among young women and men and SV response professionals in identifying assets for seeking SV support among youth. The study shows an inverse relationship between perceptions of proximity and the level of formality of the asset. This study also contributes to map the relationships and information exchanges between assets. It is advisable to inform professionals about the assets that professionals do not acknowledge, and about actions that allow young people to access formal resources.
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Affiliation(s)
- Eva Durán-Martín
- International Doctoral School of the Universidad Nacional de Educación a Distancia and Instituto Mixto de la Escuela Nacional de Salud (UNED- IMIENS), Madrid, 28015, Spain.
| | - Belén Sanz-Barbero
- National School of Public Health, Instituto de Salud Carlos III, Madrid, 28029, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
| | | | | | - Carmen Vives-Cases
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Department of Community Nursing, Preventive Medicine and Public Health an History of Science, Universidad de Alicante (UA), Alicante, 03690, Spain
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Wittevrongel E, Kessels R, Everaert G, Vrijens M, Danckaerts M, van Winkel R. A user perspective on youth mental health services: Increasing help-seeking behaviour requires addressing service preferences and attitudinal barriers. Early Interv Psychiatry 2024. [PMID: 38853403 DOI: 10.1111/eip.13584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/22/2024] [Accepted: 05/28/2024] [Indexed: 06/11/2024]
Abstract
AIM Although the incidence of mental health problems is highest in young people, the majority do not seek help. Reducing the discrepancy between need for care and access to services requires an understanding of the user perspective, which is largely lacking. This study aimed to examine preferences for mental health service attributes and their relative importance among young people, as well as the potential impact on actual help-seeking intentions. METHODS Youth aged 16-24 years (N = 258) participated in a discrete choice experiment. In addition to choosing which service would suit their needs most out of two service options in nine choice sets, participants were asked whether they would consult the chosen service in the case of mental health problems. Demographic information was also collected, as well as their current mental health status, experience with and perceived barriers to care. Panel mixed logit models were estimated. RESULTS Young people's preferences were mostly driven by the attribute 'format', with a preference for individual rather than group therapy. Other attributes, in order of importance, were 'wait times' (short), 'cost' (low), 'healthcare professionals' expertise' (particular experience with working with youth aged 12 to 25 years), and 'location' (house in a city). However, a majority of young people would not consult the service they had indicated, mainly due to attitudinal barriers such as wanting to deal with problems on their own (self-reliance). CONCLUSIONS Addressing psychological barriers to access care should be a priority in mental health policies. Furthermore, entry point services, in particular, should be able to provide the option of individual treatment.
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Affiliation(s)
- Eline Wittevrongel
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Centre for Clinical Psychiatry, Leuven, Belgium
- KU Leuven, University Psychiatric Centre (UPC), Leuven, Belgium
| | - Roselinde Kessels
- Department of Data Analytics and Digitalization, Maastricht University, Maastricht, The Netherlands
- Department of Economics, University of Antwerp, Antwerp, Belgium
| | - Geert Everaert
- Neuro-Psychiatric Clinic Saint Joseph V.Z.W, Pittem, Belgium
| | - May Vrijens
- Asster Psychiatric Hospital, Sint-Truiden, Belgium
| | - Marina Danckaerts
- KU Leuven, University Psychiatric Centre (UPC), Leuven, Belgium
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Centre for Developmental Psychiatry, Leuven, Belgium
| | - Ruud van Winkel
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Centre for Clinical Psychiatry, Leuven, Belgium
- KU Leuven, University Psychiatric Centre (UPC), Leuven, Belgium
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Chipako I, Singhal S, Hollingsworth B. Impact of sexual and reproductive health interventions among young people in sub-Saharan Africa: a scoping review. Front Glob Womens Health 2024; 5:1344135. [PMID: 38699461 PMCID: PMC11063325 DOI: 10.3389/fgwh.2024.1344135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/29/2024] [Indexed: 05/05/2024] Open
Abstract
Objectives The aim of this scoping review was to identify and provide an overview of the impact of sexual and reproductive health (SRH) interventions on reproductive health outcomes among young people in sub-Saharan Africa. Methods Searches were carried out in five data bases. The databases were searched using variations and combinations of the following keywords: contraception, family planning, birth control, young people and adolescents. The Cochrane risk-of-bias 2 and Risk of Bias in Non-Randomized Studies-of-Interventions tools were used to assess risk of bias for articles included. Results Community-based programs, mHealth, SRH education, counselling, community health workers, youth friendly health services, economic support and mass media interventions generally had a positive effect on childbirth spacing, modern contraceptive knowledge, modern contraceptive use/uptake, adolescent sexual abstinence, pregnancy and myths and misperceptions about modern contraception. Conclusion Sexual and reproductive health interventions have a positive impact on sexual and reproductive health outcomes. With the increasing popularity of mHealth coupled with the effectiveness of youth friendly health services, future youth SRH interventions could integrate both strategies to improve SRH services access and utilization.
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Affiliation(s)
- Isaac Chipako
- Health Economics and Policy Department, Division of Health Research Graduate College, Lancaster University, Lancaster, United Kingdom
| | - Saurabh Singhal
- Economics Department, Lancaster University, Lancaster, United Kingdom
| | - Bruce Hollingsworth
- Health Economics and Policy Department, Division of Health Research Graduate College, Lancaster University, Lancaster, United Kingdom
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Brunet Johansson A, Hurtig AK, Nkulu Kalengayi FK. Sexual and Reproductive Health and Rights for Young Migrants in Sweden: An Ideal-Type Analysis Exploring Regional Variations of Accessible Documents. Int J Public Health 2024; 69:1606568. [PMID: 38698911 PMCID: PMC11063276 DOI: 10.3389/ijph.2024.1606568] [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: 08/31/2023] [Accepted: 04/08/2024] [Indexed: 05/05/2024] Open
Abstract
Objectives: This study aims to map sexual and reproductive health and rights (SRHR) policies, strategies, and interventions targeting young migrants and describe the patterns of organisation, resources, and services across Sweden's 21 regions. Methods: We conducted a document analysis of accessible online documents on SRHR policies, strategies, and interventions targeting young migrants in Sweden's 21 regions. We used ideal-type analysis of the documents to create a typology, which formed the basis of a ratings system illustrating variations in organisation, resources, and services across regions. Results: Findings suggest that efforts aimed at addressing young migrants' SRHR are fragmented and unequal across regions. While SRHR policies and strategies are commonplace, they routinely lack specificity. Available resources vary depending on region and resource type. Additionally, information and interventions, although common, do not consistently meet the specific needs of migrant youths. Conclusion: This study suggests that fragmented efforts are fuelling geographic inequalities in fulfilling SRHR among young migrants. There is an urgent need to improve national coordination and collaboration between national and local actors in SRHR efforts targeting young migrants to ensure equity.
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Affiliation(s)
- Albert Brunet Johansson
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
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Otero-García L, Durán-Martín E, Castellanos-Torres E, Sanz-Barbero B, Vives-Cases C. Accessibility of intimate partner violence-related services for young women in Spain. Qualitative study on professionals' perspectives. PLoS One 2024; 19:e0297886. [PMID: 38573923 PMCID: PMC10994297 DOI: 10.1371/journal.pone.0297886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/03/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION Intimate partner violence (IPV) is common among young people, but the use of IPV resources among young adult women and teenagers is limited. This study aims to analyze professionals' perceptions about the main barriers and facilitators encountered by young women (16-29 years old) exposed to intimate partner violence (IPV) when accessing formal services in Spain. METHODS Qualitative study based on 17 in depth interviews carried out in 2019 with professionals who manage resources for IPV care in Madrid (Spain) from different sectors (social services, health care, security forces, women or youth issues offices, associations). A qualitative content analysis was conducted. RESULTS The professionals interviewed perceive the following barriers: 1) Time it takes for young women to recognize IPV because the social construction of sexual-affective relationships is permeated by gender inequality; 2) The process of leaving a situation of abuse; 3) Barriers inherent to IPV services. The key aspects to improve access to these resources are related to care services, professional practice, and the young women themselves. CONCLUSIONS There are both psychosocial barriers, derived from the process of leaving a situation of violence, as well as structural barriers for young women to access and properly use the recognized services specifically aimed at them or comprehensive IPV care. Services need to be tailored to the needs of young women so they can be truly effective in order to escape IPV.
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Affiliation(s)
- Laura Otero-García
- Nursing Department, Faculty of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Eva Durán-Martín
- International Doctoral School of the Universidad Nacional de Educación a Distancia and the Joint Research Institute of the Nacional School of Health (UNED- IMIENS), Madrid, Spain
| | - Esther Castellanos-Torres
- Public Health Research Group, Department of Community Nursing, Preventive Medicine and Public Health an History of Science, University of Alicante, Alicante, Spain
- Department of Social Sciences, University Carlos III, Madrid, Spain
| | - Belén Sanz-Barbero
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Carmen Vives-Cases
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Public Health Research Group, Department of Community Nursing, Preventive Medicine and Public Health an History of Science, University of Alicante, Alicante, Spain
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Pettersson J, Baroudi M. Exploring barriers and strategies for improving sexual and reproductive health access for young men in Sweden: Insights from healthcare providers in youth clinics. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 39:100942. [PMID: 38091863 DOI: 10.1016/j.srhc.2023.100942] [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: 04/26/2023] [Revised: 10/19/2023] [Accepted: 12/05/2023] [Indexed: 03/16/2024]
Abstract
METHODS Youth clinics in Sweden are not reaching young men to the same extent as young women. We conducted a qualitative study to explore healthcare providers' (HCPs) perspectives on the barriers to young men's access to sexual and reproductive health (SRH) services and how youth clinics can better accommodate the needs of young men. We used thematic analysis to analyze eight interviews with nine HCPs (three men and six women). RESULTS We developed three themes: 1) It's about the youth clinics and those working in them-the clinics suffered from low organizational support, which affected their ability to accommodate young men's needs and were perceived as "girls' clinics". Midwifery, which is the main profession of HCPs working with SRH in the clinics, was perceived as a women's profession for women's SRH; 2) It's not all about the youth clinics-young men were perceived as lacking essential knowledge about SRH and gender norms were preventing young men from visiting youth clinics; 3) Organizational strategies for improving access-the participants discussed strategies to attract young men, including separate reception for young men, hiring more male staff, having higher age limits for young men, and digital solutions to address privacy concerns. CONCLUSION There is a need for societal efforts to increase young men's knowledge about SRH and improve their access to SRH services. Several strategies can be adapted by youth clinics to attract more young men but there is need for further research to design and evaluate such interventions.
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Affiliation(s)
| | - Mazen Baroudi
- Department of Epidemiology and Global Health, Umeå University, Sweden.
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Bahl D, Bassi S, Maity H, Krishnan S, Dringus S, Mason-Jones A, Malik A, Arora M. Compliance of Adolescent Friendly Health Clinics with National and International Standards: Quantitative findings from the i-Saathiya study. BMJ Open 2024; 14:e078749. [PMID: 38355176 PMCID: PMC10868312 DOI: 10.1136/bmjopen-2023-078749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/28/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE Indian adolescents experience several health challenges requiring acceptable, equitable, appropriate and effective healthcare services. Our objective was to assess the compliance of Adolescent Friendly Health Clinics (AFHCs) in two of India's largest states, using both national benchmarks (under Rashtriya Kishor Swasthya Karyakram-RKSK) and global standards (by WHO). DESIGN Cross-sectional study comprising structured observations and interactions (November 2021 to June 2022). SETTING Fourteen AFHCs across all levels of health system were included from two districts of Maharashtra (n=8) and Madhya Pradesh (n=6). These AFHCs were observed using checklist, and few items of checklist were verified by interactions with AFHC's health workers (medical officers/auxillary nurse midwives/counsellors) handlings adolescents. The developed checklist included 57 items based on adapted global standards and 25 items using national benchmarks. RESULT High compliance of AFHCs with RKSK's benchmarks was attributed to various items including the accessibility through local transport (n=14, 100%), clean surroundings (n=11, 78.5%), presence of signage (n=10, 71.4%), convenient operating days and time (n=11, 78.5%), and secure storage of records (n=13, 92.9%). Concurrently, items that showed low compliance encompassed, the availability of Information, Education and communication (IEC) resources, which were deficient in 57.1% of AFHCs (n=8). Similarly, designated areas for clinical services (n=10, 71.4%) and commodity disbursement (n=9, 64.3%) lacked in more than half of the recruited AFHCs. Additionally, lack of guidelines for referrals (n=13, 92.9%), as well as standard operating procedures to ensure equity, non-judgemental attitude, competence, confidentiality and referral as per WHO standards. CONCLUSION Evidence spotlights the strengths and gaps in AFHCs, aligning with, government's priorities on adolescent health. Addressing the identified gaps is crucial to creating healthcare facilities that are adolescent-friendly, easily accessible and effectively navigate adolescent health challenges. This concerted effort would contribute to their development and transformation, playing a pivotal role in India's progress.
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Affiliation(s)
- Deepika Bahl
- Health Promotion Division, Public Health Foundation of India, New Delhi, Delhi, India
| | - Shalini Bassi
- Health Promotion Division, Public Health Foundation of India, New Delhi, Delhi, India
| | - Heeya Maity
- Health Promotion Division, Public Health Foundation of India, New Delhi, Delhi, India
| | - Supriya Krishnan
- Health Promotion Division, Public Health Foundation of India, New Delhi, Delhi, India
| | | | | | - Anku Malik
- Health Promotion Division, Public Health Foundation of India, New Delhi, Delhi, India
| | - Monika Arora
- Health Promotion Division, Public Health Foundation of India, New Delhi, Delhi, India
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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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Wittevrongel E, van Winkel R, Jackers M, Colman L, Versyck M, Camp E, Everaert G, Vrijens M, Baeyens D, Danckaerts M. How to make mental health services more youth-friendly? A Delphi study involving young adults, parents and professionals. Health Expect 2023; 26:2532-2548. [PMID: 37608557 PMCID: PMC10632649 DOI: 10.1111/hex.13832] [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: 03/29/2023] [Revised: 07/15/2023] [Accepted: 07/20/2023] [Indexed: 08/24/2023] Open
Abstract
INTRODUCTION Although youth-friendly service characteristics have been previously identified, consensus among a representative group of stakeholders about which of these characteristics are truly relevant to the youth-friendliness of services is currently lacking. In our study, young adults, parents and professionals were consulted on this topic to reveal existing (dis)agreement. In addition, (dis)agreement on feasibility for implementation in clinical practice was also assessed. METHODS A mixed-method Delphi approach was used with three online questionnaire rounds and a physical meeting. Young adults (18-26 years) and parents were part of a public panel and professionals were allocated to the professional panel. In the rounds, participants were asked to rate the importance and feasibility of each item. Subsequently, the percentage agreement (% of participants giving a score of 7 or above on a 9-point Likert scale) within and across panels was calculated. Consensus was assumed to have been reached when at least 70% agreement was achieved. A thematic analysis of the qualitative data, obtained in the rounds and the physical meeting, was performed to identify overarching themes and characteristics of relevance to the youth-friendliness of services. RESULTS For 65% of the items included in the Delphi questionnaire, consensus on importance was reached within both panels. Participants showed more insecurity about the feasibility of these items, however. Our thematic analysis revealed reasons for disagreement between and within the panels. CONCLUSIONS Our study revealed substantial between- and within-panel agreement on youth-friendly service characteristics. We recommend that the items for which consensus was reached should be used as a checklist in terms of youth mental health service development, design and delivery. The characteristics for which there was disagreement between and within the panels should inspire an ongoing trialogue between young adults, parents and professionals both on the individual level and the service level. PATIENT OR PUBLIC CONTRIBUTION In this study, (parents of) young adults with lived experience were included as experts, including one of the coauthors. This coauthor contributed to the manuscript by having a final say about the included quotes.
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Affiliation(s)
- Eline Wittevrongel
- Department of Neurosciences, Research Group Psychiatry, Center for Clinical PsychiatryKU LeuvenLeuvenBelgium
- University Psychiatric Center (UPC) KU LeuvenLeuvenBelgium
| | - Ruud van Winkel
- Department of Neurosciences, Research Group Psychiatry, Center for Clinical PsychiatryKU LeuvenLeuvenBelgium
- University Psychiatric Center (UPC) KU LeuvenLeuvenBelgium
| | - Maarten Jackers
- Department of Neurosciences, Research Group Psychiatry, Center for Clinical PsychiatryKU LeuvenLeuvenBelgium
| | | | - Melina Versyck
- Faculty of MedicineKU LeuvenLeuvenBelgium
- mArquee Multiversum Psychiatric HospitalAntwerpenBelgium
| | - Eline Camp
- Faculty of MedicineKU LeuvenLeuvenBelgium
| | - Geert Everaert
- Neuro‐Psychiatric Clinic Saint Joseph V.Z.W.PittemBelgium
| | - May Vrijens
- Asster Psychiatric HospitalSint‐TruidenBelgium
| | - Dieter Baeyens
- Faculty of Psychology and Educational Sciences, Parenting and Special EducationKU LeuvenLeuvenBelgium
| | - Marina Danckaerts
- University Psychiatric Center (UPC) KU LeuvenLeuvenBelgium
- Department of Neurosciences, Research Group Psychiatry, Center for Developmental PsychiatryKU LeuvenLeuvenBelgium
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Musanje K, Camlin CS, Kamya MR, Vanderplasschen W, Louise Sinclair D, Getahun M, Kirabo H, Nangendo J, Kiweewa J, White RG, Kasujja R. Culturally adapting a mindfulness and acceptance-based intervention to support the mental health of adolescents on antiretroviral therapy in Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001605. [PMID: 36963093 PMCID: PMC10021405 DOI: 10.1371/journal.pgph.0001605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/24/2023] [Indexed: 03/09/2023]
Abstract
The dual burden of living with HIV and negotiating life stage changes has been identified as a contributing factor to lapsed adherence among adolescents with HIV in sub-Saharan Africa. While psychosocial support can promote medication adherence, most interventions in use with adolescents were originally developed for the general population creating a gap in appropriate support. Life-stage-appropriate, evidence-based psychosocial support interventions have been used with young people in high-income contexts, prompting interest in their use in low-income contexts. However, many interventions are less effective when implemented outside of their original settings, hence the need for modifications before implementation. We aimed to culturally adapt an evidence-based psychosocial support intervention designed to improve the mental health of young people for use among adolescents with HIV in a sub-Saharan African context and to explore the acceptability of the adapted intervention among adolescents. We engaged thirty stakeholders (n = 30) in Kampala, Uganda including psychologists, psychiatrists, social workers, HIV counselors, religious leaders and adolescent peers from December 2021 to April 2022 to modify an evidence-based intervention for adolescents. Key adaptations included simplifying the language, adding local practices, integrating locally relevant slang and stories into therapy, introducing racially-congruent visuals and cards representing emotions, and adjusting therapy materials for use in resource-constrained settings. We then tested the acceptability of the intervention in a small sample of service users using a qualitative approach. We recruited nine adolescents with HIV from a participating clinic in Kampala, delivered six 90-minute sessions of the adapted intervention across three weeks and conducted in-depth interviews to assess the acceptability of the intervention. We used thematic analysis to analyze the qualitative data. The adapted intervention was perceived as acceptable among adolescents with HIV, with many stating that it helped them overcome fears, increased their self-acceptance, and gave them the confidence to make careful health-enhancing decisions.
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Affiliation(s)
- Khamisi Musanje
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
- Department of Educational, Social and Organizational Psychology, Makerere University, Kampala, Uganda
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Moses R. Kamya
- Department of Medicine, Makerere University, Kampala, Uganda
| | | | | | - Monica Getahun
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Hope Kirabo
- Department of Mental Health and Community Psychology, Makerere University, Kampala, Uganda
| | - Joan Nangendo
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
| | - John Kiweewa
- Fairfield University, Fairfield, Connecticut, United States of America
| | - Ross G. White
- School of Psychology, Queens University, Belfast, Northern Ireland, United Kingdom
| | - Rosco Kasujja
- Department of Mental Health and Community Psychology, Makerere University, Kampala, Uganda
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12
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Forcadell-Díez L, Benlliure JB, Martínez C, Pérez G. An in-depth analysis of the sexuality needs of Barcelona's youth: a holistic view using mixed method. Sex Reprod Health Matters 2022; 30:2135728. [PMID: 36399103 PMCID: PMC9678000 DOI: 10.1080/26410397.2022.2135728] [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] [Indexed: 11/19/2022] Open
Abstract
A positive experience of sexuality during youth is key to good sexual health later in life. Addressing young people's sexual health needs and sexual and reproductive rights is thus essential. This study aimed to identify unmet sexual health needs among youth in the city of Barcelona (Spain) through mixed methods research. We analysed the narratives of young people (n = 50) aged 14-24 years with different genders, origins, sexualities and socioeconomic backgrounds, collected from January to April 2019. A descriptive statistical analysis was also conducted on the records of visits to sexual health services and reasons for consultation. We found that 21% (n = 32,161) of young people aged 14-24 years had used sexual healthcare services in Barcelona between 2015 and 2017, while the reasons for consultation differed across sex, gender and socioeconomic background. Young people declared that they needed more information to enjoy their sexuality, to know where to go in case of an unexpected situation and to learn how to combat gender-based violence. They stated that the sexuality education they had received was sparse and focused on risks. We found that formal sex education is scarce, with informal sex education thus acquiring a major role. Current services can be improved by expanding coverage, training professionals and reducing acceptability and accessibility barriers. Sexism is ubiquitous in young people's sexual, dating and personal relationships. We recommend planning sexual health care services and formal sexual education, in which a strong gender strategy is embedded, as part of the same strategy.
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Affiliation(s)
- Lluís Forcadell-Díez
- Predoctoral Researcher, Agència de Salut Pública de Barcelona, Barcelona, Spain
- PhD Candidate, Universitat Pompeu Fabra, Barcelona, Spain
| | - Jordi Baroja Benlliure
- Director, Centre Jove d’Atenció a les Sexualitats, Barcelona, Spain
- Associate Professor of Sexual Health, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Cristina Martínez
- Director, Programa d'Atenció a la Salut Sexual i Reproductiva, Institut Català de la Salut, Barcelona, Spain
- Associate Professor of Nursing, Universitat de Barcelona, Barcelona, Spain
| | - Gloria Pérez
- Responsible for Sexual and Reproductive Health Information Systems, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Associate Professor of Medicine and Public Health, Universitat Pompeu Fabra, Barcelona, Spain
- Researcher, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
- Researcher, CIBER de Epidemiología y Salud Pública, Madrid, Spain
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Garrett SM, Rose SB, McKinlay EM. Young people talk about primary care and telehealth: A survey of 15- to 25-year olds in the Wellington region of New Zealand. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6345-e6355. [PMID: 36263614 PMCID: PMC10092684 DOI: 10.1111/hsc.14076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/02/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
Young people are known to face challenges when accessing healthcare and generally have low rates of health service utilisation. Use of telehealth might be one way to improve access, but evidence is needed from young people as to how acceptable it is. This online survey of 15- to 25-year olds in the greater Wellington region of New Zealand sought young people's views on telehealth (phone and videocalls) as a means of accessing primary care. The survey included both forced-choice questions and free-text options. We report here on the free-text data from open-ended questions that were qualitatively analysed using template analysis. A total of 346 participants took part between August 6 and September 21, 2021, of whom 60% were female, 12% Māori (indigenous) ethnicity, and 38% had used telehealth methods of consulting previously. Analysis was undertaken of the free-text comments that were provided by 132 participants (38%). Although those contributing comments described both benefits and drawbacks to using telehealth, more drawbacks were cited, with specific examples given to illustrate a range of concerns and potential limitations of telehealth including privacy, communication difficulties and compromised quality of care. Participants thought telehealth could be used successfully in specific situations, for example by people concerned about leaving the house due to anxiety, illness or being immunocompromised and for simple consultations or when the person knows exactly what they need. Respondents expressed a strong desire to be offered the choice between in-person and telehealth consultations. Providing young people with a choice of consultation mode together with clear information about all aspects of a telehealth consultation is important if clinicians want young people to engage with this method of primary care service delivery.
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Affiliation(s)
- Susan M. Garrett
- Department of Primary Health Care and General PracticeUniversity of OtagoWellingtonNew Zealand
| | - Sally B. Rose
- Department of Primary Health Care and General PracticeUniversity of OtagoWellingtonNew Zealand
| | - Eileen M. McKinlay
- Department of Primary Health Care and General PracticeUniversity of OtagoWellingtonNew Zealand
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Bassey AE, James EN, Miteu GD. Are youth-friendly reproductive health services accessible for young people with disabilities during the COVID-19 pandemic in Nigeria? Ann Med Surg (Lond) 2022; 84:104856. [PMID: 36373067 PMCID: PMC9637286 DOI: 10.1016/j.amsu.2022.104856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/22/2022] [Accepted: 10/30/2022] [Indexed: 11/08/2022] Open
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Petersson C, Swahnberg K, Peterson U, Oscarsson M. Teenagers' and young adults' sexual behaviour and its associations with exposure to violence, among visitors at a Youth Centre in Sweden. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 34:100781. [PMID: 36156382 DOI: 10.1016/j.srhc.2022.100781] [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: 02/28/2022] [Revised: 07/26/2022] [Accepted: 09/09/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aimed to investigate differences between teenagers and young adults in sexual behaviours and exposure to emotional, physical and/or sexual violence, and the associations between sexual behaviours and exposure to violence, among youths who visit a Youth Centre in Sweden. METHODS A cross-sectional web survey was used among sexually experienced teenagers, aged 15-19, and young adults 20-24 years, wherein a total of 452 participated. Descriptive and bivariate analyses were used in the study. RESULTS A majority had unprotected sex during the last year, namely 55.4 % of teenagers and 58.3 % of young adults. A higher proportion of teenagers reported having early sex debut, before 15 years age, compared with young adults (p = .003). A higher proportion of young adults reported having experienced a sexually transmitted infection (p = <.001). Nearly half of the teenagers (44.9 %) and the young adults (44.6 %) stated having been exposed to emotional, physical and/or sexual violence during their lifetime. Associations were found between all types of exposure to violence and having unprotected sex, using alcohol or drugs together with sex, and having had three or more different sex partners during last year. CONCLUSIONS Regardless of age, there was a high proportion of youths, visiting a Youth Centre, having unprotected sex and who experienced exposure to violence. As these experiences may negatively affect youths' future sexual and reproductive health, healthcare professionals should identify youths in need or with early-in-life needs.
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Affiliation(s)
- Carina Petersson
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
| | - Katarina Swahnberg
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
| | - Ulla Peterson
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
| | - Marie Oscarsson
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
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16
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Goicolea I, Wiklund M, Linander I, Sundberg LR. Protecting, managing and bending boundaries: a biomedicalization perspective on Swedish youth clinics’ responses to mental (ill) health. BMC Health Serv Res 2022; 22:863. [PMID: 35791015 PMCID: PMC9254401 DOI: 10.1186/s12913-022-08259-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Sweden has provided around 300 youth clinics (YCs) to address the health needs of young people since the 1970s. During the last few years, and as part of an effort to strengthen mental healthcare for young people, YCs’ role in the provision of mental healthcare has been widely debated. With such debates as background, the aim of this study is to analyse Swedish YCs’ responses to the mental (ill) healthcare needs of young people, from the perspective of national level stakeholders. Methods We used thematic analysis of interviews with eight national level stakeholders in the field of youth mental health in Sweden. Building upon the concept of biomedicalization we examined the discourses on mental (ill) health, healthcare and youth that such responses reproduce. Results YCs engage in the three simultaneous, but at times contradictory, responses of protecting, managing and bending boundaries. Remaining true to their mission as a health-promotion service compels them to protect their boundaries and limit the type of mental health issues they address. However, the perceived malfunctioning of specialized services has led them to bend these boundaries to allow in more young people with severe mental health problems. Caught between protecting and bending boundaries, the response of managing boundaries to decide who should be allowed in and who should be sent elsewhere has emerged as a middle-way response. However, it is not free from conflicts. Conclusion Building upon the concept of biomedicalization, this study poses two questions. The first relates to whether it is possible to support young people and their health without reinforcing discourses that represent young people as collectively at risk, and if so how this can be done. The second relates to the provision of mental healthcare for young people, and the need to identify conditions for integrating diagnosis and treatment within YCs, without hindering their holistic and youth-centred approach.
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Thomson A, Christensen E, Wiklund M, Christianson M. A safe place - Adolescents' and young adults' perceptions of youth clinics in northern Sweden. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 33:100752. [PMID: 35803180 DOI: 10.1016/j.srhc.2022.100752] [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: 11/30/2021] [Revised: 05/19/2022] [Accepted: 06/27/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND/OBJECTIVE Adolescents and young adults are a diverse group with varied health needs. In Sweden, youth clinics are critical for improving their sexual, reproductive, mental, and general health. The aim of this qualitative study was to gain a deeper understanding of key conditions needed for youth friendliness, and to better understand youth-friendly health services from the perspective of adolescents and young adults in northern Sweden. METHODS Information was collected through focus group discussions and interviews with 23 adolescents and young adults (aged 16 to 25) at youth clinics in each of the four northernmost regions of Sweden. Interviews were analysed inductively using Braun and Clarke's thematic analysis. RESULTS Three themes and six sub-themes emerged. A safe, empowering and holistic space, outlines how youth-friendly physical spaces and staff contributed to a sense of safety in contrast to other healthcare facilities. The theme Youth clinics are accessible - but reaching out is challenging, refers to low thresholds for visiting youth clinics and perceived barriers to access. The third theme "You feel a bit vulnerable" - the importance of privacy, highlights privacy dimensions and young people's vulnerability when their privacy is compromised. CONCLUSION Adolescents and young adults perceived youth clinics as being youth-friendly. Key conditions for youth friendliness were safety, respect, a holistic and empowering approach, accessibility, and privacy. Youth-friendly opening hours and outreach to specifically target groups with access barriers are needed. Young people should be involved in the development of equitable youth-friendly health services.
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Affiliation(s)
- Anna Thomson
- Department of Nursing, Umeå University, Umeå, Sweden
| | | | - Maria Wiklund
- Unit of Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden; Sweden Arctic Research Centre (Arcum), Umeå University, Umeå, Sweden
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Tirado V, Engberg S, Holmblad IS, Strömdahl S, Ekström AM, Hurtig AK. "One-time interventions, it doesn't lead to much" - healthcare provider views to improving sexual and reproductive health services for young migrants in Sweden. BMC Health Serv Res 2022; 22:668. [PMID: 35585585 PMCID: PMC9115984 DOI: 10.1186/s12913-022-07945-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 04/11/2022] [Indexed: 11/14/2022] Open
Abstract
Background Sexual and reproductive health and rights (SRHR) is an important aspect for young people. In Sweden, young migrants often encounter barriers to accessing and using sexual and reproductive health (SRH) services, despite that these services are free of charge for young people (ages 15–25). Healthcare providers’ views and best practices are of great importance for improving the utilisation of existing SRH services, particularly for young people. This study aims to understand healthcare providers’ experiences and perspectives on barriers to SRHR among young migrants and their suggestions for strategies to improve the provision of SRH services to this group. Methods Midwives, counsellors and nurses with at least five years of professional experience within SRHR were reached through a purposeful sample at primary care clinics, specialised clinics and youth-friendly clinics, which provide SRH services to migrant youths in Stockholm. Twelve interviews were conducted from May 2018 to February 2020. Qualitative content analysis was performed. Results The analysis identified one theme: Improving the fragmentation in the SRH services, and four sub-themes: 1. Being unaware of SRHR; 2. Creating trust and responsive interactions; 3. Communicating in the same language; and 4. Collaborating to build bridges. The barriers included distrust in the healthcare system, socio-cultural norms surrounding SRHR, incomplete translations, and a need for long-lasting collaboration with SRH services and other range of services for migrants. The strategies for improvement as suggested by participants included involving existing cultural groups and organisations to enable trust, consistent and dependable interpreters, a streamline of SRH services with other healthcare staff and health facilities, and collaborations with homes designated for young migrants and language schools for a direct linkage to service providers. Conclusions Findings indicate that there are fragmentations in SRH services, and these include lack of knowledge about SRHR among migrant youth, language and communication barriers, and a lack of structure needed to build dependable services that go beyond one-time interventions. While initiatives and strategies from healthcare providers for improvement of SRH services exist, the implementation of some strategies may also require involving the regional and national decision-makers and multi-stakeholders like communities, civil society and young migrants themselves.
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Affiliation(s)
- Veronika Tirado
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Siri Engberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Susanne Strömdahl
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Sciences, Infectious Medicine, Uppsala University, Uppsala, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Venhälsan, Södersjukhuset, Stockholm, Sweden
| | - Anna Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Weaver E, Freeman N, Mack S, Titmuss A, Dowler J, Corpus S, Hyatt T, Ellis E, Sanderson C, Connors C, Moore E, Silver B, Azzopardi P, Maple-Brown L, Kirkham R. "I Don't Really Know What Diabetes Is": A Qualitative Study Exploring the Experiences of Aboriginal and Torres Strait Islander Young People Aged 10 to 25 Years Living With Type 2 Diabetes in Northern and Central Australia. Can J Diabetes 2022; 46:S1499-2671(22)00095-8. [PMID: 35963668 DOI: 10.1016/j.jcjd.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/14/2022] [Accepted: 04/26/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our aim in this study was to gain an understanding of the experiences of Aboriginal and Torres Strait Islander young people aged 10 to 25 years with type 2 diabetes (T2D) living in Northern and Central Australia. METHODS In this qualitative study we explored participants' experiences of T2D using a social constructionist epistemology and a phenomenologic methodology. Twenty-seven young people participated in semistructured in-depth interviews from 4 primary health-care sites. RESULTS Three major constructs emerged. Young people experienced a normalisation-shame paradox in response to their diagnosis (partly related to that "everyone has diabetes," as well as the fear that friends "might judge [me]"), had suboptimal levels of understanding of T2D ("I don't really know what diabetes is. I just need somebody to explain to me a bit more") and experienced multiple barriers inhibiting their T2D management. These included complex lives ("I have a rheumatic heart disease […] then they told me that I have diabetes…I have two things") and the availability of support ("[I] talk to my mum…I talk to my aunty too…I don't talk to anyone else"). Successful management requires support from health professionals and family and includes strengthening social networks and educational opportunities. CONCLUSIONS Our findings reinforce the need for alternative support systems tailored to the specific needs of young Aboriginal and Torres Strait Islander people with T2D. Enhanced models of care must be codesigned with young people and their communities and include a focus on shifting norms and expectations about youth T2D to reduce diabetes stigma and broaden social support and consider the delivery of health information in youth-friendly environments.
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Affiliation(s)
- Emma Weaver
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
| | - Natasha Freeman
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Shiree Mack
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Angela Titmuss
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; Department of Paediatrics, Division of Women, Children and Youth, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - James Dowler
- Department of Paediatrics, Alice Springs Hospital, Northern Territory, Australia
| | - Sumaria Corpus
- Danila Dilba Health Services, Darwin, Northern Territory, Australia; Endocrine Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Teresa Hyatt
- Population and Primary Health Care, Top End Health Service, Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Elna Ellis
- Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Cheryl Sanderson
- Danila Dilba Health Services, Darwin, Northern Territory, Australia; Aboriginal Medical Service Alliance Northern Territory, Alice Springs, Northern Territory, Australia
| | - Christine Connors
- Population and Primary Health Care, Top End Health Service, Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Elizabeth Moore
- Aboriginal Medical Service Alliance Northern Territory, Alice Springs, Northern Territory, Australia
| | - Bronwyn Silver
- Central Australian Aboriginal Congress, Alice Springs, Northern Territory, Australia
| | - Peter Azzopardi
- Burnet Institute, Melbourne, Victoria, Australia; Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; Endocrine Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Renae Kirkham
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Zheng W. Cluster Analysis Algorithm in the Analysis of College Students' Mental Health Education. Appl Bionics Biomech 2022; 2022:6394707. [PMID: 35480710 PMCID: PMC9038429 DOI: 10.1155/2022/6394707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/28/2022] [Indexed: 12/02/2022] Open
Abstract
With the rapid development of curricula, a large number of studies are emerging to assist in the development of curricula. But in an information society, in the face of rapid learning and increased life expectancy, students face the pressure not to forget; the mental health status as a result of our curricula is closely related to our learning. The research and application of the integration algorithm plays an important role in the analysis of the mental health education system. The purpose of this work is to study the application analysis algorithm in the students' context. This work applies the integration analysis algorithm to students' mental health analysis and identifies students' mental health problems using the integration analysis algorithm so that students are well informed and guided. Based on the system engineering method, using the data mining clustering method, a detailed analysis and research on the mental health of college students is done. In this work, a method of student behavior analysis and statistical tools are used to collect mental health data to find common features of different groups of students, in order to better visualize and investigate the mental health of these students on a scientific basis. The results of this study are as follows: a general analysis algorithm application on the analysis of students' mental health education system allows for an effective understanding of scientific data. FCM and FCM algorithms based on the density of information entropy characteristics were used to investigate the effect of mental health factors on the results of the study and the practicality of the algorithm used, which provided an effective method for the prevention of student mental problems. Assisting the school in formulating corresponding new methods of early prevention and intervention of college students' psychological disorders will create a good and healthy atmosphere for college students' study and life. The research results provide a reliable basis for managing and cultivating students.
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Affiliation(s)
- Wanting Zheng
- School of Clinical Medical Technology, Sichuan Vocational College of Health and Rehabilitation, Zigong, 643000 Sichuan, China
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21
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Durán-Martín E, Vives-Cases C, Otero-García L, Castellanos-Torres E, Sanz-Barbero B. Do we have friendly services to meet the needs of young women exposed to intimate partner violence in the Madrid region? Health Expect 2022; 25:1058-1068. [PMID: 35199409 PMCID: PMC9122426 DOI: 10.1111/hex.13453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/18/2022] [Accepted: 02/07/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Women experiencing intimate partner violence (IPV) do not tend to go very frequently to formal support services. The objective of this study is to identify barriers related to the accessibility, acceptability, equity, appropriateness and effectiveness of IPV services from the perspective of the professionals working in the IPV public services. Methods A qualitative study was carried out in the Madrid region based on 13 semi‐structured interviews of young women who had survived IPV as well as 17 interviews with professionals. A thematic content analysis was performed, guided by the dimensions proposed by the World Health Organization (WHO) for friendly services for young people. Results From the perspective of the young women and professionals, barriers were identified for all the dimensions of the WHO's friendly services for young people: accessibility: lack of information and support from the social setting, scarce dissemination of the services, economic cost, non‐adapted schedules, inadequate locations or lack of services in settings close to young people; acceptability: lack of protocols to guarantee confidentiality, lack of speed in the provision of services or their referral, unwelcoming environments or unsympathetic professional malpractice; equity: discriminatory professional attitudes towards groups with different social status and lack of protocols to ensure the care of these groups; appropriateness: unmet needs and lack of multidisciplinary teams; and effectiveness: shortage of time, resources, competent professionals, protocols and coordination. Conclusions Strategies are needed to make the necessary changes to promote friendly services for the care of young people exposed to IPV. Additionally, it must be emphasized that resources are needed to raise awareness and disseminate IPV services, as well as to train professionals in this area. Patient or Public Contribution This paper is based on professionals' perspectives of public IPV‐related services of different areas such as Psychology, Social Work, Nursing, Psychiatry, Social Education and young women exposed to IPV. They either work in the public administration at the local, regional or state level or in NGOs in Spain.
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Affiliation(s)
- Eva Durán-Martín
- International Doctoral School, Universidad Nacional de Estudios a Distancia (UNED), Madrid, Spain
| | - Carmen Vives-Cases
- Department of Community Nursing, Preventive Medicine and Public Health and the History of Science, Universitat d' Alacant, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Laura Otero-García
- Department of Nursing, Universdad Autónoma de Madrid, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Belen Sanz-Barbero
- Department of Epidemiology and Biostatistics, Institute of Health Carlos III, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Richter Sundberg L, Christianson M, Wiklund M, Hurtig AK, Goicolea I. How can we strengthen mental health services in Swedish youth clinics? A health policy and systems study protocol. BMJ Open 2021; 11:e048922. [PMID: 34686550 PMCID: PMC8543652 DOI: 10.1136/bmjopen-2021-048922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Strengthening first-line mental healthcare services for youth remains a priority for the Swedish government. The government is currently investigating how different sectors involved can be strengthened, but evidence is scarce. Youth clinics play a key role in these discussions, being one of the most trusted services for youth. However, analysis of organisational functions and coordination with other services is important to strengthen youth clinics' role in first-line mental healthcare. This study investigates these challenges and aims to analyse the integration of mental healthcare within youth clinics to identify strategies to strengthen first-line mental healthcare for youth in Sweden. METHODS AND ANALYSIS This study adopts a health policy and systems approach. In the first phase, a formative realist evaluation is conducted to ascertain what works in terms of integrating mental healthcare services within youth clinics, for what type of youth subpopulations and under what circumstances. National-level stakeholders will be interviewed to elicit the programme theory that explains how the intervention is supposed to work. The programme theory will then be tested in three-five cases. The cases will be comprised of youth clinics and their stakeholders. Quantitative and qualitative information will be gathered, including via visual methodologies and questionnaires. The second phase includes a concept mapping study, engaging stakeholders and young people to build consensus on strategies to strengthen the integration of mental healthcare into youth clinics. ETHICS AND DISSEMINATION The Swedish Ethical Review Authority has approved the study (2019-02910 and 2020-04720). The results will be published in open-access peer-reviewed journals and presented at scientific conferences.
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Affiliation(s)
| | | | - Maria Wiklund
- Department of Community Medicine and Rehabilitation, unit of Physiotherapy, Umeå University, Umeå, Sweden
| | - Anna-Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Isabel Goicolea
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Unis B, Nilsson J, Bjuresäter K. Sexual Health Promotion among Swedish Adolescents - Professionals' Experiences. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2021; 33:410-425. [PMID: 38595740 PMCID: PMC10903572 DOI: 10.1080/19317611.2021.1921893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 04/10/2021] [Accepted: 04/20/2021] [Indexed: 04/11/2024]
Abstract
In this grounded theory study the aim was to explore professionals' experiences of promotion of adolescents' sexual health, and views on inter-professional collaboration in relation to this subject. Data collection was by five focus group interviews and two pair interviews with professionals working with sexual health promotion in health care and schools. The results showed that professionals were reaching out to young people through competence and trusting relationships along with working on a broader front. In conclusion, professionals need to be knowledgeable about the world of young people, accessible and able to offer adequate support, and improve their inter-professional collaborations.
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Affiliation(s)
- Brian Unis
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Jan Nilsson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Kaisa Bjuresäter
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden
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Changes in sexual behavior among high-school students over a 40-year period. Sci Rep 2021; 11:13963. [PMID: 34234211 PMCID: PMC8263598 DOI: 10.1038/s41598-021-93410-6] [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] [Received: 03/25/2021] [Accepted: 06/23/2021] [Indexed: 12/18/2022] Open
Abstract
The aim of this study was to investigate sexual behavior, contraceptive use, risk factors as well as sources of sex information among first-year high-school students in Sweden. Secondly, to assess differences between genders and study programs as well as changes over a 40-year period. A repeated cross-sectional survey was conducted in two cities. A questionnaire comprising 77 items was used. The study population consisted of 415 students (63.4% females). The median age of sexual intercourse was 15 years. In total, 37% had had sexual intercourse, compared to 56.3% in 2009 and 45% in 1999 (p < 0.001), and the proportion of students who had their first sexual intercourse was not influenced by gender. More students in vocational programs (46.3%), compared to theoretical (33.3%), had experience of at least one sexual intercourse (p = 0.019). The same extend of contraception use at first and latest intercourse was reported, compared to previous studies. Forty-nine percent were mostly informed about sex from the internet, while in previous years, magazines, family and youth clinics were the main information sources. Comparing over time, students were in general less sexually experienced and less engaged in non-penetrative sex and physical intimacy. These findings call for a new approach, when designing sex and relationship education and health-care counseling in adolescents.
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Garney W, Wilson K, Ajayi KV, Panjwani S, Love SM, Flores S, Garcia K, Esquivel C. Social-Ecological Barriers to Access to Healthcare for Adolescents: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4138. [PMID: 33919813 PMCID: PMC8070789 DOI: 10.3390/ijerph18084138] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 11/17/2022]
Abstract
Access to healthcare for adolescents is often overlooked in the United States due to federal and state-sponsored insurance programs such as Medicaid and the Children's Health Insurance Program. While these types of programs provide some relief, the issue of healthcare access goes beyond insurance coverage and includes an array of ecological factors that hinder youths from receiving services. The purpose of this scoping review was to identify social-ecological barriers to adolescents' healthcare access and utilization in the United States. We followed the PRISMA and scoping review methodological framework to conduct a comprehensive literature search in eight electronic databases for peer-reviewed articles published between 2010 and 2020. An inductive content analysis was performed to thematize the categories identified in the data extraction based on the Social-Ecological Model (SEM). Fifty studies were identified. Barriers across the five SEM levels emerged as primary themes within the literature, including intrapersonal-limited knowledge of and poor previous experiences with healthcare services, interpersonal-cultural and linguistic barriers, organizational-structural barriers in healthcare systems, community-social stigma, and policy-inadequate insurance coverage. Healthcare access for adolescents is a systems-level problem requiring a multifaceted approach that considers complex and adaptive behaviors.
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Affiliation(s)
- Whitney Garney
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (K.W.); (K.V.A.); (S.P.); (S.M.L.); (S.F.); (K.G.); (C.E.)
- Laboratory for Community Health Evaluation and Systems Science (CHESS), Texas A&M University, College Station, TX 77843, USA
| | - Kelly Wilson
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (K.W.); (K.V.A.); (S.P.); (S.M.L.); (S.F.); (K.G.); (C.E.)
| | - Kobi V. Ajayi
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (K.W.); (K.V.A.); (S.P.); (S.M.L.); (S.F.); (K.G.); (C.E.)
- Laboratory for Community Health Evaluation and Systems Science (CHESS), Texas A&M University, College Station, TX 77843, USA
- Education, Direction, Empowerment, & Nurturing (EDEN) Foundation, Abuja 900211, Nigeria
| | - Sonya Panjwani
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (K.W.); (K.V.A.); (S.P.); (S.M.L.); (S.F.); (K.G.); (C.E.)
- Laboratory for Community Health Evaluation and Systems Science (CHESS), Texas A&M University, College Station, TX 77843, USA
| | - Skylar M. Love
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (K.W.); (K.V.A.); (S.P.); (S.M.L.); (S.F.); (K.G.); (C.E.)
- Laboratory for Community Health Evaluation and Systems Science (CHESS), Texas A&M University, College Station, TX 77843, USA
| | - Sara Flores
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (K.W.); (K.V.A.); (S.P.); (S.M.L.); (S.F.); (K.G.); (C.E.)
- Laboratory for Community Health Evaluation and Systems Science (CHESS), Texas A&M University, College Station, TX 77843, USA
| | - Kristen Garcia
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (K.W.); (K.V.A.); (S.P.); (S.M.L.); (S.F.); (K.G.); (C.E.)
- Laboratory for Community Health Evaluation and Systems Science (CHESS), Texas A&M University, College Station, TX 77843, USA
| | - Christi Esquivel
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (K.W.); (K.V.A.); (S.P.); (S.M.L.); (S.F.); (K.G.); (C.E.)
- Laboratory for Community Health Evaluation and Systems Science (CHESS), Texas A&M University, College Station, TX 77843, USA
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Folayan MO, Sam-Agudu NA, Adeniyi A, Oziegbe E, Chukwumah NM, Mapayi B. A proposed one-stop-shop approach for the delivery of integrated oral, mental, sexual and reproductive healthcare to adolescents in Nigeria. Pan Afr Med J 2020; 37:172. [PMID: 33447327 PMCID: PMC7778170 DOI: 10.11604/pamj.2020.37.172.22824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/24/2020] [Indexed: 11/25/2022] Open
Abstract
The interconnectedness of oral, mental, sexual, and reproductive health (OMSRH) in adolescents prompts exploration of novel approaches to facilitate comprehensive access of this population to the relevant health services. This paper proposes an integrated one-stop-shop approach to increasing adolescents' access to OMSRH care by leveraging on dental clinics as a template for integration, using a non-stigmatized platform to deliver stigmatized healthcare. Novel healthcare delivery models are needed to enhance adolescents' access to the comprehensive prevention and treatment services that they critically need. Effective, integrated health care for this population is lacking, especially across various health areas. This is a proposal for leveraging dental clinics for integrated OMSRH care, using facility-based services, to adolescents. Emphasis will be placed on reducing stigma as a barrier to service accessibility, acceptability, equitability and appropriateness. Empirical studies will be required to test the feasibility, validity and effectiveness of this proposed model.
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Affiliation(s)
| | - Nadia Adjoa Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria.,Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Abiola Adeniyi
- Faculty of Dentistry, Lagos State University College of Medicine, Lagos, Nigeria
| | - Elizabeth Oziegbe
- Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Nneka Maureen Chukwumah
- Department of Preventive Dentistry, College of Medical Sciences, University of Benin, Benin City, Edo, Nigeria
| | - Boladale Mapayi
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
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Barriers to utilization of adolescent friendly health services in primary healthcare facilities in Armenia: a qualitative study. Int J Public Health 2020; 65:1247-1255. [PMID: 33067702 DOI: 10.1007/s00038-020-01499-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES The study aimed to explore potential challenges that hamper utilization of adolescent friendly health services (AFHS) in primary healthcare (PHC) facilities in Armenia. METHODS A qualitative study using in-depth interviews and focus group discussions was conducted with experts in adolescent health, PHC providers and facility managers from public PHC facilities and adolescents from the two largest cities in Armenia. We also collected data through observations in PHC facilities. We utilized a directed content analysis approach for data analysis. RESULTS The study identified various factors negatively influencing utilization of AFHS in Armenia. These factors included adolescents' poor health literacy and awareness of health services, lack of PHPs' professional competencies, and breaches of confidentiality. Several facility-level barriers such as lack of privacy, inconvenient operating hours and long waiting times also contributed to insufficient service utilization by adolescents. CONCLUSIONS The study findings shed light on different perspectives related to various challenges adolescents faced in PHC facilities in Armenia. Targeted interventions needed to improve adolescents' health literacy, to enhance the PHPs' competencies and to create a friendly and welcoming environment in PHC facilities.
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Jonsson F, Goicolea I, Christianson M, Carson DB, Wiklund M. Landscapes of care and despair for rural youth - a qualitative study in the northern Swedish 'periphery'. Int J Equity Health 2020; 19:171. [PMID: 33008434 PMCID: PMC7531094 DOI: 10.1186/s12939-020-01288-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/23/2020] [Indexed: 11/11/2022] Open
Abstract
Background This study emerges as a response to the lack of youth perspectives when it comes to discussions about access to and experiences of health and social services in rural areas. It subsequently contributes to the literature by positioning young people at the centre of this debate, and by taking a more holistic approach to the topic than is typically the case. Specifically, based on the idea that a good life in proper health for young people may be contingent on notions of care that are bounded up in multi-layered social and spatial environments, the aim of this study was to explore what characterises ‘landscapes of care’ for rural youth. Methods In this qualitative study, the participants included young people and professionals residing in five diverse areas across the northern Swedish ‘peripheral’ inland. Individual interviews (16 in total) and focus group discussions (26 in total) were conducted with 63 youth aged 14–27 years and with 44 professionals operating across sectors such as health centres, school health, integration units, youth clinics and youth clubs. Following an emergent design and using thematic analysis, we developed one main theme, ‘landscapes of care and despair’, comprising the two themes: ‘(dis)connectedness’ and ‘extended support or troubling gaps’. Results The findings illustrate how various health-promoting and potentially harmful aspects acting at structural, organisational and interpersonal levels contributed to dynamic landscapes characterised simultaneously by care and despair. In particular, our study shows how rural youths’ feelings of belongingness to people and places coupled with opportunities to participate in society and access practical and emotional support appear to facilitate their care within rural settings. However, although the results indicate that some in the diverse group of rural youth were cared for and about, a negative picture was painted in parallel. These aspects of despair included youths’ senses of exclusion and marginalisation, degrading attitudes towards them and their problems, as well as recurrent gaps in the provision and practices of care. Conclusions To gain a more comprehensive understanding about the health of rural youth, this study highlights the benefits investigating ‘care-ful’ and ‘uncaring’ aspects bounded up in dynamic and multi-layered landscapes.
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Affiliation(s)
- Frida Jonsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden. .,Arctic Research Centre (Arcum), Umeå University, Umeå, Sweden.
| | - Isabel Goicolea
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | - Dean B Carson
- Arctic Research Centre (Arcum), Umeå University, Umeå, Sweden.,School of Business and Law, CQUniversity, Rockhampton, Australia
| | - Maria Wiklund
- Arctic Research Centre (Arcum), Umeå University, Umeå, Sweden.,Department of Community Medicine and Rehabilitation, Unit of Physiotherapy, Umeå University, Umeå, Sweden
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Baroudi M, San Sebastian M, Hurtig AK, Goicolea I. The perception of youth health centres' friendliness: does it differ between immigrant and Swedish-Scandinavian youths? Eur J Public Health 2020; 30:780-785. [PMID: 32417877 PMCID: PMC7445032 DOI: 10.1093/eurpub/ckaa077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Mazen Baroudi
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | - Anna-Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Isabel Goicolea
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Assessing the youth-friendliness of youth clinics in northern Sweden: a survey analyzing the perspective of the youth. BMC Health Serv Res 2020; 20:346. [PMID: 32326967 PMCID: PMC7178958 DOI: 10.1186/s12913-020-05188-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/05/2020] [Indexed: 11/13/2022] Open
Abstract
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.
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Awang H, Ab Rahman A, Sukeri S, Hashim N, Nik Abdul Rashid NR. Making Health Services Adolescent-Friendly in Northeastern Peninsular Malaysia: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041341. [PMID: 32093018 PMCID: PMC7068545 DOI: 10.3390/ijerph17041341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/14/2020] [Accepted: 02/15/2020] [Indexed: 06/10/2023]
Abstract
A mixed-methods study was conducted in a Malaysian state beginning with a cross-sectional quantitative study to determine the relationship between clinic characteristics and clinic score of adolescent-friendliness. Subsequently, perceptions of healthcare providers on the facilitating factors for the provision of adolescent-friendly health services were explored qualitatively to support the quantitative findings. Availability of trained healthcare providers, adequate privacy, dedicated adolescent health services team, and adolescent health promotional activities were the clinic characteristics that significantly (p < 0.05) related with clinics' scores of adolescent-friendliness. The facilitating factors required for adolescent-friendly health services were (1) healthcare providers' commitment and prioritization towards adolescent-friendly health services; (2) organizational supports; (3) appropriate clinic settings; and (4) external supports for adolescent health promotional activities. The qualitative findings reaffirmed those of the quantitative study on the significant clinic characteristics required for adolescent-friendly health services. This study provides valuable insight for the Ministry of Health to elicit the required facilitating factors to further improve the quality of adolescent health services in Malaysia.
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Affiliation(s)
- Hafizuddin Awang
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (H.A.); (A.A.R.)
| | - Azriani Ab Rahman
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (H.A.); (A.A.R.)
| | - Surianti Sukeri
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (H.A.); (A.A.R.)
| | - Noran Hashim
- Maternal and Child Health Unit, Kelantan State Health Department, Kota Bharu 15590, Kelantan, Malaysia;
| | - Nik Rubiah Nik Abdul Rashid
- Adolescent Health Sector, Family Health Development Division, Ministry of Health, Parcel E, Federal Government Administration Centre, Putrajaya 62590, Malaysia;
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Awang H, Ab Rahman A, Sukeri S, Hashim N, Nik Abdul Rashid NR. Adolescent-friendly health services in primary healthcare facilities in Malaysia and its correlation with adolescent satisfaction level. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2019. [DOI: 10.1080/02673843.2019.1685556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Hafizuddin Awang
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia , Kubang Kerian, Malaysia
| | - Azriani Ab Rahman
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia , Kubang Kerian, Malaysia
| | - Surianti Sukeri
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia , Kubang Kerian, Malaysia
| | - Noran Hashim
- Maternal and Child Health Unit , Kelantan State Health Department, Kota Bharu, Kelantan, Malaysia
| | - Nik Rubiah Nik Abdul Rashid
- Adolescent Health Sector, Family Health Development Division, Ministry of Health, Parcel E, Federal Government Administration Centre , Putrajaya, Malaysia
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Chirewa B, Wakhisi A. Emergency hormonal contraceptive service provision via community pharmacies in the UK: a systematic review of pharmacists' and young women's views, perspectives and experiences. Perspect Public Health 2019; 140:108-116. [PMID: 31402746 DOI: 10.1177/1757913919867356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Unintended pregnancy among young people remains a major public health problem in the UK, despite recent evidence suggesting that the number of teenage pregnancies in England is falling. Community pharmacies have the potential to reduce health inequalities among young women through improved and appropriate access to sexual health services. This study seeks to examine the views, perceptions and experiences of young women and community pharmacists concerning emergency hormonal contraceptive (EHC) provision from community pharmacies in the UK. METHODS Six electronic databases were searched for articles published in English between 2000 and 2017. Titles and abstracts were screened by two researchers according to the inclusion criteria. RESULTS A total of eight papers reporting studies carried out within the UK were included. Five key themes were identified from the perspectives of young women: convenience and ease of access, embarrassment and non-judgemental services, free services, confidentiality and pharmacist being helpful. Six key themes were identified from the perspectives of the pharmacists: concerns about supply of EHC, improved access, no need for appointment, confidentiality, free EHC and training. CONCLUSIONS The review suggests that services should be designed based on the views, perceptions and experiences of the service users and providers in order to reduce inequities to access of EHC. Pharmacists who provide EHC should continuously upgrade their knowledge base through training if the sexual health needs of the young women who access pharmacies are to be adequately met.
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Affiliation(s)
- B Chirewa
- Faculty of Health and Social Care, University of Chester, Riverside Building, Castle Drive, Chester CH1 1SL, UK
| | - A Wakhisi
- London Borough of Havering, Romford, UK
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Muchabaiwa L, Mbonigaba J. Impact of the adolescent and youth sexual and reproductive health strategy on service utilisation and health outcomes in Zimbabwe. PLoS One 2019; 14:e0218588. [PMID: 31237891 PMCID: PMC6592535 DOI: 10.1371/journal.pone.0218588] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 06/06/2019] [Indexed: 11/18/2022] Open
Abstract
Poor reproductive health among youth and adolescents threatens their future health and economic wellbeing in Zimbabwe amidst a high HIV/AIDS prevalence. This study evaluates the impact of a multi-pronged adolescent sexual and reproductive health (ASRH) strategy implemented by government of Zimbabwe between 2010 and 2015 to improve ASRH in terms of the uptake of condoms and HIV testing as well as outcomes in terms of sexually transmitted infection (STI) prevalence and HIV prevalence. We combine the difference in difference and propensity score matching methods to analyse repeated Zimbabwe demographic health survey cross-sectional datasets. Young people aged 15–19 years at baseline in 2010, who were exposed for the entire five-year strategy are designated as the treatment group and young adults aged 25–29 at baseline as the control. We find that the ASRH strategy increased HIV testing amongst youth by 36.6 percent, whilst treatment of STIs also increased by 30.4 percent. We also find that the HIV prevalence trajectory was reduced by 0.7 percent. We do not find evidence of impact on condom use and STI prevalence. The findings also suggest that although HIV testing increased for all socio-economic groups that were investigated, the effect was not the same. Lastly, we do not find evidence supporting that more resources translate to better ASRH outcomes. We recommend designing future ASRH strategies in a way that differentiates service delivery for youths in HIV hotspots, rural areas and out of school. We also recommend improving the strategy’s coordination and monitoring, as well as aligning and enforcing government policies that promote sexual and reproductive health rights.
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Affiliation(s)
- Lazarus Muchabaiwa
- Economics Department, School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
- Economics Department, Bindura University of Science Education, Bindura, Zimbabwe
- * E-mail:
| | - Josue Mbonigaba
- Economics Department, School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
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Nkosi B, Seeley J, Ngwenya N, Mchunu SL, Gumede D, Ferguson J, Doyle AM. Exploring adolescents and young people's candidacy for utilising health services in a rural district, South Africa. BMC Health Serv Res 2019; 19:195. [PMID: 30922372 PMCID: PMC6438017 DOI: 10.1186/s12913-019-3960-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We use the 'candidacy framework' to describe adolescents' and young people's (AYP) experiences of health services in a rural KwaZulu-Natal district, South Africa. METHODS A qualitative approach was used including group discussions, in-depth and key informant interviews with a purposive sample of AYP (n = 70), community leaders (n = 15), school health teams (n = 10), and health service providers (n = 6). RESULTS Findings indicate tacit understanding among AYP that they are candidates for general health services. However, HIV stigma, apprehensions and misconceptions about sexual and reproductive health, and socio-cultural views which disapprove of AYP pre-marital sex undermine their candidacy for sexual and reproductive services. CONCLUSION Consideration and understanding of the vulnerabilities and reasons AYP exclude themselves will inform interventions to address their health needs. AYP's participation in the design of health services will increase their acceptability and encourage uptake of services.
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Affiliation(s)
- Busisiwe Nkosi
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, 3rd Floor, K-RITH Tower Building, 719 Umbilo Road, Congella, Durban, KwaZulu-Natal 4001 South Africa
| | - Janet Seeley
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, 3rd Floor, K-RITH Tower Building, 719 Umbilo Road, Congella, Durban, KwaZulu-Natal 4001 South Africa
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Nothando Ngwenya
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, 3rd Floor, K-RITH Tower Building, 719 Umbilo Road, Congella, Durban, KwaZulu-Natal 4001 South Africa
| | - S. Lerato Mchunu
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, 3rd Floor, K-RITH Tower Building, 719 Umbilo Road, Congella, Durban, KwaZulu-Natal 4001 South Africa
| | - Dumile Gumede
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, 3rd Floor, K-RITH Tower Building, 719 Umbilo Road, Congella, Durban, KwaZulu-Natal 4001 South Africa
| | - Jane Ferguson
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, 3rd Floor, K-RITH Tower Building, 719 Umbilo Road, Congella, Durban, KwaZulu-Natal 4001 South Africa
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Aoife M. Doyle
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Michaud PA, Weber MW, Namazova-Baranova L, Ambresin AE. Improving the quality of care delivered to adolescents in Europe: a time to invest. Arch Dis Child 2019; 104:214-216. [PMID: 29599165 DOI: 10.1136/archdischild-2017-314429] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 03/07/2018] [Accepted: 03/10/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Pierre-André Michaud
- Adolescent Medicine and Health, Lausanne University Hospital, Lausanne, Switzerland
| | - Martin W Weber
- Child and Adolescent Health, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Leyla Namazova-Baranova
- Department of Pediatrics, Scientific Centre of Children's Health, Russian State Medical University, Moscow, Russia
| | - Anne-Emmanuelle Ambresin
- Interdisciplinary Division for Adolescent Health, Lausanne University Hospital, Lausanne, Switzerland
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Hultstrand Ahlin C, Carson D, Goicolea I. "There is no reward penny for going out and picking up youths": issues in the design of accessible youth healthcare services in rural northern Sweden. BMC Res Notes 2019; 12:74. [PMID: 30717774 PMCID: PMC6360772 DOI: 10.1186/s13104-019-4108-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/31/2019] [Indexed: 11/10/2022] Open
Abstract
Objective There is a continuing challenge to ensure equitable access to youth healthcare services in small rural communities. Sweden’s ‘youth clinic’ system is an attempt to provide comprehensive youth health services from a single centre, but many small rural communities have not adopted the youth clinic model. This study uses one case study to examine what the issues might be in establishing a youth clinic in a small rural community. The objective of this paper is to examine the issues around youth healthcare access in one municipality without a youth clinic, and to explore whether and how a youth clinic model might contribute to access in this municipality. Results Three categories emerged from the analysis; (i) rural closeness; both good and bad, (ii) youth are not in the centre of the healthcare organization, and (iii) adapting youth clinics to a rural setting. While limited to one case example, the study provides valuable insights into youth health service planning in particular types of rural communities. This paper identified structural barriers to developing youth-specific services, and some alternative approaches that might be more suitable to smaller communities. Electronic supplementary material The online version of this article (10.1186/s13104-019-4108-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Dean Carson
- Northern Institute, Charles Darwin University, Casuarina, NT, 0909, Australia
| | - Isabel Goicolea
- Unit of Epidemiology and Global Health, Department of Clinical Medicine and Public Health, Umeå University, 901 87, Umeå, Sweden
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Lee YP, Ngaiman NKB, Poon LY, Abdul Jalil HB, Yap MH, Abdin E, Subramaniam M, Lee H, Verma SK. Evaluating Singapore's CHAT Assessment Service by the World Mental Health Organisation (WHO) "Youth-Friendly" Health Services Framework. Front Psychiatry 2019; 10:422. [PMID: 31281269 PMCID: PMC6595047 DOI: 10.3389/fpsyt.2019.00422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/28/2019] [Indexed: 11/13/2022] Open
Abstract
Young people experience high rates of mental health issues. However, many do not seek professional help. In order to encourage help-seeking behavior among young people, it is important to ensure that services are youth-friendly. This study aims to evaluate the Community Health Assessment Team (CHAT)'s mental health assessment service model using the World Health Organization (WHO) youth-friendly health service framework of accessibility, acceptability, and appropriateness (AAA), and to ascertain the extent to which the CHAT service model is youth-friendly. Three hundred young people aged 16-30 years, who had gone through CHAT mental health assessments, completed a 27-item questionnaire. Majority rated the items in the questionnaire favorably. Our results suggest that majority of the young people who accessed CHAT mental health assessment service found it to be youth-friendly.
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Affiliation(s)
- Yi Ping Lee
- Early Psychosis Intervention Programme (EPIP), Institute of Mental Health, Singapore, Singapore
| | | | - Lye Yin Poon
- Institute of Mental Health, Singapore, Singapore
| | | | - Ming Hui Yap
- Early Psychosis Intervention Programme (EPIP), Institute of Mental Health, Singapore, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Helen Lee
- Early Psychosis Intervention Programme (EPIP), Institute of Mental Health, Singapore, Singapore
| | - Swapna K Verma
- Early Psychosis Intervention Programme (EPIP), Institute of Mental Health, Singapore, Singapore
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Goicolea I, Hultstrand Ahlin C, Waenerlund AK, Marchal B, Christianson M, Wiklund M, Hurtig AK, San Sebastian M. Accessibility and factors associated with utilization of mental health services in youth health centers. A qualitative comparative analysis in northern Sweden. Int J Ment Health Syst 2018; 12:69. [PMID: 30459827 PMCID: PMC6234690 DOI: 10.1186/s13033-018-0249-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 11/09/2018] [Indexed: 11/10/2022] Open
Abstract
Background Youth-friendly health care services can facilitate young people's access to health care services and promote their health, including their mental health. In Sweden, a network of youth health centers exist since the 1970s, incorporated within the public health system. Even if such centers take a holistic approach to youth health, the focus has been in sexual and reproductive health care, and the extent of integrating mental health care services is less developed though it varies notably between different centers. This study aims to analyse the various conditions that are sufficient and/or necessary to make Swedish youth health centers accessible for mental and psychosocial health. Methods Multiple case study design, using qualitative comparative analysis to assess the various conditions that makes a youth health center accessible for mental and psychosocial issues and mental health. The cases included 18 youth health centers (from a total of 22) in the four northern counties of Sweden. Results In order to enhance accessibility for mental health services, youth health centers need to be trusted by young people. Trust was necessary but not sufficient, meaning that it had to be combined with other conditions: either having a team with a variety of professions represented in the youth health center, or being a youth health center that is both easy to contact and well-staffed with mental health professionals. Conclusions Differentiated, first-line services for youth can play an important role in promoting youth mental health if certain conditions are fulfilled. Trust is necessary, but has to be combined with either multidisciplinary teams, or expertise on mental health and easy accessibility.
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Affiliation(s)
- Isabel Goicolea
- 1Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Anna-Karin Waenerlund
- 1Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Bruno Marchal
- 3Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Maria Wiklund
- 4Unit of Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Anna-Karin Hurtig
- 1Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Miguel San Sebastian
- 1Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Baroudi M, Waenerlund AK, San Sebastian M, Goicolea I. Assessing the dimensionality of YFHS-Swe: a questionnaire to assess youth-friendliness in differentiated health services. Glob Health Action 2018; 10:1380399. [PMID: 29043946 PMCID: PMC5678427 DOI: 10.1080/16549716.2017.1380399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The aim of this study was to assess the dimensionality of YFHS-Swe and identify possible unique factors in the evaluation of youth-friendliness. YFHS-Swe was answered by 1110 youths aged 16 to 25 years visiting youth clinics in Northern Sweden. Thirteen factors were identified by exploratory factor analysis and except for one factor they all proved to fit well and have good reliability when assessed by the confirmatory factor analysis. The YFHS-Swe proved to be credible and suitable for assessing youth-friendliness of differentiated health services in Sweden. With cultural and linguistic adaptations, it can be used in similar settings internationally.
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Affiliation(s)
- Mazen Baroudi
- a Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Anna-Karin Waenerlund
- a Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Miguel San Sebastian
- a Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Isabel Goicolea
- a Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
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Wagenius CM, San Sebastián M, Gustafsson PE, Goicolea I. Access for all? Assessing vertical and horizontal inequities in healthcare utilization among young people in northern Sweden. Scand J Public Health 2018; 47:1-8. [PMID: 29779450 DOI: 10.1177/1403494818774965] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies in Sweden have detected socioeconomic inequities in access to healthcare services. However, there is limited information regarding access in younger populations. The aim of this study was to explore vertical and horizontal inequities in access to healthcare services in young adults in the north of Sweden. METHODS The study used data from the Health on Equal Terms survey (age group 16-24 years, n = 2726) for the health and healthcare variables and from national registers for the sociodemographic characteristics. Self-rated healthcare utilization was measured as visits to general practitioners, youth clinics and nurses. Crude and multivariable binomial regression analysis, stratified by sex, was used to assess vertical equity, adjusting for sociodemographic characteristics, and horizontal equity, adjusting for need variables. RESULTS Vertical inequity was detected for all three healthcare services (youth clinics, general practitioners and nurses), with variations for men and women. Horizontal inequities were also found for both men and women in relation to all three healthcare services. CONCLUSIONS These findings suggest that both vertical and horizontal inequities in access exist for young people in northern Sweden and that the associations between sociodemographic characteristics and healthcare utilization are complex and need further investigation.
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Affiliation(s)
- Cecilia M Wagenius
- 1 Norrbotten County Council, Public Health Centre, Sweden.,2 Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Miguel San Sebastián
- 2 Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Per E Gustafsson
- 2 Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Isabel Goicolea
- 2 Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden
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Mazur A, Brindis CD, Decker MJ. Assessing youth-friendly sexual and reproductive health services: a systematic review. BMC Health Serv Res 2018; 18:216. [PMID: 29587727 PMCID: PMC5870922 DOI: 10.1186/s12913-018-2982-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 03/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the last quarter century, there has been an emergence of evidence-based research directed toward the development, implementation, and assessment of youth-friendly health services (YFHS) to improve the delivery of sexual and reproductive health services for young people. Despite these research efforts, evidence supporting the effectiveness of YFHS is limited, which may be attributed to a lack of consensus on how to define and measure youth-friendliness to track progress and evaluate outcomes. The purpose of this systematic review is to assess how youth-friendly sexual and reproductive health services are measured worldwide. METHODS We conducted a systematic review of studies measuring youth-friendly sexual and reproductive health services at health facilities published between January 2000 and June 2015 using PubMed, Web of Science, and POPLINE databases. Additional studies were identified by reviewing references of selected articles. Studies were screened to identify measurements and indicators that have been used to measure YFHS. RESULTS Our review identified 20 studies from an initial search of more than 11,000 records, including six from high-income countries and 14 from low-and middle-income countries. The review identified 115 indicators used for measuring youth-friendly sexual and reproductive health services. Our review found a lack of consistency in the tools and indicators used to measure YFHS. The three most frequently assessed domains were accessibility, staff characteristics and competency, and confidentiality and privacy. The majority of the indicators were not specific to young people's needs and often reflected basic standards of care. CONCLUSIONS This review shows the need for standardization and prioritization of indicators for the evaluation of YFHS. The results can be used to identify a core set of indicators that can be incorporated into a framework for assessing youth-friendly sexual and reproductive health services. There is a need to further distinguish between those variables that may have greatest impact on the use of services by young people, such as respect and privacy, those that impact the quality of services offered, and those that have limited relevance. Conducting more rigorous studies using a refined set of indicators is critical to measure and compare the impact and effectiveness of YFHS efforts.
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Affiliation(s)
- Amanda Mazur
- Philip R. Lee Institute for Health Policy Studies and Bixby Center for Global Reproductive Health, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94143-0936 USA
| | - Claire D. Brindis
- Philip R. Lee Institute for Health Policy Studies and Bixby Center for Global Reproductive Health, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94143-0936 USA
- Adolescent and Young Adult Health National Resource Center, University of California, San Francisco, 3333 California Street, Suite 245, San Francisco, CA 94143-0503 USA
| | - Martha J. Decker
- Philip R. Lee Institute for Health Policy Studies and Bixby Center for Global Reproductive Health, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94143-0936 USA
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Ogu R, Maduka O, Alamina F, Adebiyi O, Agala V, Eke G, Porbeni I, Offor N, Abam C, Nte A, Okonofua F. Mainstreaming youth-friendly health services into existing primary health care facilities: experiences from South-South Nigeria. Int J Adolesc Med Health 2018; 32:ijamh-2017-0151. [PMID: 29369812 DOI: 10.1515/ijamh-2017-0151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 11/26/2017] [Indexed: 11/15/2022]
Abstract
Background Youth friendly services, an evidence based approach to overcome the barriers experienced by youths in accessing care, is poorly implemented. The Medical Women's Association of Nigeria (MWAN) Rivers State chapter, was supported by Ford Foundation to mainstream youth-friendly health services (YFHS) into existing primary health care facilities in two hard-to-reach communities. This paper presents the interventions, findings, challenges and recommendations. Methods This study project was implemented in stages: design, baseline survey, interventions and evaluation, between 2014 and 2016. Interventions included facility modifications, health worker capacity building, school and community outreaches, peer group activities, and interpersonal communication. Pre-and-post-intervention surveys were carried out among in- and out-of-school youths to determine the effects of the interventions. Results The most commonly stated barriers to uptake of youth friendly health services included: unavailability of services (154; 33.1%), unavailability of health care workers (167; 38.9%), unaffordability of services (108; 45.8%) and difficulty in communicating with health workers (85; 36.0%). Post-intervention, utilization improved across all services while the perception of barriers to utilization of services reduced (p < 0.05). The interventions implemented increased the odds of youths utilizing YFHS 1.81 times (95% CI = 1.39-2.37). Conclusion Facility modifications, capacity building of health workers, school and community outreaches, peer group activities, and interpersonal communication improved utilization across all services while the perception of barriers to utilization of services reduced. Implementation of YFHS is impacted by external factors often beyond the control of project implementers. Innovative solutions outside of routine health care delivery systems are critical for success. Further evaluation to explore the effect of these interventions is needed. Strengthening of health systems remains a vital strategy for scale-up of YFHS.
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Affiliation(s)
- Rosemary Ogu
- Medical Women's Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria.,Department of Obstetrics and Gynaecology, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
| | - Omosivie Maduka
- Medical Women's Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria.,Department of Preventive and Social Medicine, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
| | - Folusho Alamina
- Medical Women's Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria.,Department of Community Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Obelebra Adebiyi
- Medical Women's Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria.,Department of Medical and Dental Services, Rivers State Hospitals Management Board, Port Harcourt, Nigeria
| | - Vetty Agala
- Medical Women's Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria.,Free Medical Care Programme, Rivers State Ministry of Health, Port Harcourt, Nigeria
| | - Gracia Eke
- Medical Women's Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria.,Department of Paediatrics, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
| | - Ibimonye Porbeni
- Medical Women's Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria
| | - Nnesochi Offor
- Medical Women's Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria.,Free Medical Care Programme, Rivers State Ministry of Health, Port Harcourt, Nigeria
| | - Claribel Abam
- Medical Women's Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria.,Office of the Executive Secretary, Rivers State Primary Health Care Management Board, Port Harcourt, Nigeria
| | - Alice Nte
- Medical Women's Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria.,Department of Paediatrics, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
| | - Friday Okonofua
- Department of Youth Sexuality, Reproductive Health and Rights, Ford Foundation Office of West Africa, Lagos, Nigeria
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Goicolea I, Carson D, San Sebastian M, Christianson M, Wiklund M, Hurtig AK. Health care access for rural youth on equal terms? A mixed methods study protocol in northern Sweden. Int J Equity Health 2018; 17:6. [PMID: 29325552 PMCID: PMC5765630 DOI: 10.1186/s12939-018-0718-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/04/2018] [Indexed: 12/02/2022] Open
Abstract
Background The purpose of this paper is to propose a protocol for researching the impact of rural youth health service strategies on health care access. There has been no published comprehensive assessment of the effectiveness of youth health strategies in rural areas, and there is no clearly articulated model of how such assessments might be conducted. The protocol described here aims to gather information to; i) Assess rural youth access to health care according to their needs, ii) Identify and understand the strategies developed in rural areas to promote youth access to health care, and iii) Propose actions for further improvement. The protocol is described with particular reference to research being undertaken in the four northernmost counties of Sweden, which contain a widely dispersed and diverse youth population. Methods The protocol proposes qualitative and quantitative methodologies sequentially in four phases. First, to map youth access to health care according to their health care needs, including assessing horizontal equity (equal use of health care for equivalent health needs,) and vertical equity (people with greater health needs should receive more health care than those with lesser needs). Second, a multiple case study design investigates strategies developed across the region (youth clinics, internet applications, public health programs) to improve youth access to health care. Third, qualitative comparative analysis of the 24 rural municipalities in the region identifies the best combination of conditions leading to high youth access to health care. Fourth, a concept mapping study involving rural stakeholders, care providers and youth provides recommended actions to improve rural youth access to health care. Discussion The implementation of this research protocol will contribute to 1) generating knowledge that could contribute to strengthening rural youth access to health care, as well as to 2) advancing the application of mixed methods to explore access to health care.
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Affiliation(s)
- Isabel Goicolea
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - Dean Carson
- Demography and Growth Planning, Northern Institute, Charles Darwin University, Darwin, Australia.,Centre for Rural Medicine, Storuman, Sweden.,Arctic Centre at Umeå University, Umeå, Sweden
| | - Miguel San Sebastian
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Maria Wiklund
- Unit of Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Anna-Karin Hurtig
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Brownlie EB, Chaim G, Heffernan O, Herzog T, Henderson J. Youth Services System Review: Moving From Knowledge Gathering to Implementation Through Collaboration, Youth Engagement, and Exploring Local Community Needs. ACTA ACUST UNITED AC 2017. [DOI: 10.7870/cjcmh-2017-018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article describes a two-phase, multi-sectoral project aimed at enhancing youth services addressing substance use in Ontario. In the information gathering phase, a youth-focused website and survey, focus groups, and interviews were used to elicit perspectives from multiple stakeholders. In the implementation phase, capacity-building and consultations on transition-aged youth needs were conducted to inform youth transition-readiness checklists. We discuss the importance of engaging youth as collaborators as well as respondents and the processes used to tailor findings to local contexts for implementation.
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Affiliation(s)
- E. B. Brownlie
- Centre for Addiction and Mental Health and University of Toronto
| | - Gloria Chaim
- Centre for Addiction and Mental Health and University of Toronto
| | | | | | - Joanna Henderson
- Centre for Addiction and Mental Health and University of Toronto
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Adams R, Van Der Heever MM, Damons A. Perceptions of clients on awareness and the geographical location of a South African university sexual health clinic. Afr J Prim Health Care Fam Med 2017; 9:e1-e9. [PMID: 29041801 PMCID: PMC5645577 DOI: 10.4102/phcfm.v9i1.1350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 06/14/2017] [Accepted: 06/28/2017] [Indexed: 11/24/2022] Open
Abstract
Background The Campus Health Service at Stellenbosch University has a sub-division, a sexual health clinic, which provides sexual health services. The clients of the sexual health clinic consist of staff members and students. Aim This article reports on the perceptions of clients that relate to awareness and the geographical location of the clinic. Setting The Campus Health Service at Stellenbosch University’s main campus. Method A descriptive qualitative approach was applied utilising in-depth interviews. A sample of n = 15 was drawn through purposive sampling and data saturation was achieved with the sample. Results The following themes emerged from the data: location of the clinic, awareness of sexual health services and marketing and advertising. Conclusion The findings of the study revealed that accessibility of the clinic is influenced by the geographical location of the clinic and that marketing and awareness of services require attention.
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Malm D, Bishop L, Gustafsson P, Waenerlund AK, Goicolea I. Validation of a questionnaire to measure youth-friendliness of Swedish youth clinics. Scand J Public Health 2017; 45:366-372. [PMID: 28385109 DOI: 10.1177/1403494817699479] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM This study presents the validation process of a tool to assess the youth-friendliness of Swedish youth clinics, based on the Youth-Friendly Health Services - World Health Organization Plus (YFHS-WHO+) questionnaire but adapted to the specific context of differentiated services catering only for young people in this country. METHODS The validation process followed five steps: (1) translation, (2) revision by professionals, (3) pretests with young people, (4) back-translation and discussion with the developers of the original YFHS-WHO+ questionnaire and (5) internal consistency and test-retest reliability testing. RESULTS The final Swedish version, titled Youth-Friendly Health Services-Sweden (YFHS-Swe), differs from the original in terms of adjustments in language and in changes to make it better correspond to the reality of the Swedish youth clinics, while maintaining the meaning and intention of the original questionnaire. The YFHS-Swe questionnaire generated reproducible responses (test-retest coefficient of 0.79 for the total score) and can be considered a measure of a cohesive construct (Cronbach alpha of 0.95 for the total score). CONCLUSIONS The study suggests that the YFHS-Swe questionnaire is a reliable instrument that can be an asset for youth clinics to evaluate their work and make regional and national comparisons between clinics. The YFHS-Swe could also serve as a basis for validating instruments to assess youth-friendliness of differentiated services for young people in other countries.
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Affiliation(s)
- Desire Malm
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Linn Bishop
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Per Gustafsson
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Anna-Karin Waenerlund
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Isabel Goicolea
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden
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