Youth friendly communication in a transition clinic aimed at adolescents with chronic illness

Background Good communication skills are considered a cornerstone in a "youth friendly approach". However, research in the field as well as transition guidelines only sparsely explain what doctor-patient communication involves. Furthermore, only few guidelines exist regarding concrete communication skills for health professionals who want to apply a youth friendly communication approach to their practice. Objective To examine how health professionals trained in adolescent medicine practise a youth friendly approach when communicating with adolescents with chronic illness. Methods Data from 10 non-participation observations of transition consultations with adolescents with juvenile idiopathic arthritis (JIA) were analysed using a qualitative positioning analysis approach focusing on the health professionals' reflexive and interactive positionings as well as the décor of the consultation room. Results The health professionals in the transition clinic positioned the adolescent patients as independent interlocutors, children, and adolescents, and they positioned themselves as imperfect/untraditional, appreciative and non-judgmental. The positionings were based on a number of linguistic tools such as affirmation, recognition, examples, asking for the adolescents' own expert knowledge and the décor. The health professionals actively negotiated power. Conclusion Positionings and linguistic tools were inspired by youth friendly tools including the HEADS (Home Education/Eating Activities Drugs Sex/Safety/Self harm) interview, motivational interviewing, and an adolescent medicine practice. A central component was negotiating of power. Limitations of the study include a risk of too positive interpretations of data, i.e. because of the presence of the observer, who could have affected the health professionals' positionings.

A mobile school-based HCT service - is it youth friendly?

BACKGROUND

Despite an increase in HIV Counselling and Testing (HCT), few young people have been tested. It has been suggested that they do not test because formal health services (where HCT is provided) are often not youth friendly. The World Health Organisation describes a youth-friendly health service (YFHS) as one which is accessible, equitable, acceptable, appropriate, and effective. A mobile school-based model has been implemented by a non-governmental organisation in Cape Town in an attempt to make HCT more youth friendly and accessible to young people. The objective of this study was to explore whether this mobile school-based HCT service is youth friendly.

METHODS

The study was descriptive, using three qualitative data collection methods: observation of the HCT site at two secondary schools; interviews with six service providers; and direct observation of 21 HCT counselling sessions.

KEY RESULTS

The mobile school-based HCT service fulfilled some of the criteria for being a YFHS. The service was equitable in that all students, irrespective of race, gender, age, or socio-economic status, were free to use the service. It was accessible in terms of location and cost, but students were not well informed to make decisions about using the service. The service was acceptable in that confidentiality was guaranteed and the service providers were friendly and non-judgemental, but it was not considered acceptable in that there was limited privacy. The service was appropriate in that HCT is recommended as an intervention for decreasing the transmission of HIV, based on evidence and expert opinion; however, in this case, HCT was provided as a stand-alone service rather than part of a full package of services. Moreover, studies have suggested that young people want to know their HIV status. The service was ineffective in that it identified students who are HIV positive; however, these students were not assisted to access care.

CONCLUSION

Providing HCT in the school setting may make HCT more accessible for students, but it needs to be provided in an equitable, accessible, acceptable, and effective way.

'I wouldn't get that feedback from anywhere else': learning partnerships and the use of high school students as simulated patients to enhance medical students' communication skills

BACKGROUND

This article evaluates whether the use of high school students as simulated patients who provide formative feedback enhances the capacity of medical students in their fifth year of training to initiate screening conversations and communicate effectively with adolescents about sensitive health issues.

METHODS

Focus group interviews with medical students (n = 52) and school students aged 15-16 (n = 107) were conducted prior to and following involvement in Learning Partnerships workshops. Prior to workshops focus groups with school students asked about attitudes to help-seeking in relation to sensitive health issues, and following workshops asked whether the workshop had made a difference to their concerns. Prior to workshops focus groups with medical students asked about their needs in relation to initiating conversations with adolescents about sensitive health issues, and following workshops asked whether the workshop had made a difference to their concerns. Surveys were also completed by 164 medical students and 66 school students following the workshops. This survey featured 19 items asking participants to rank the usefulness of the workshops out of 10 (1 = not at all useful, 10 = extremely useful) across areas such as skills and understanding, value of learning activities and overall value of the workshop. SPSS software was used to obtain mean plus standard deviation scores for each item on the survey.

RESULTS

The Learning Partnerships workshops assisted medical students to improve their skills and confidence in communicating with adolescents about sensitive health issues such as mental health, sexual health and drug and alcohol use. They also assisted young people to perceive doctors as more likely potential sources for help.

CONCLUSIONS

These findings suggest that the innovative methods included in Learning Partnerships may assist in broader education programs training doctors to be more effective helping agents and aid the promotion of adolescent friendly health care. This research provides evidence that a new way of teaching may contribute to enhancing doctors' capacity and willingness to initiate screening conversations and enhance adolescents' preparedness to seek help. This has implications for educational design, content and communication style within adolescent health.

Evaluating youth-friendly health services: young people's perspectives from a simulated client study in urban South Africa

Background

Few youth-friendly health services worldwide have been scaled up or evaluated from young people’s perspectives. South Africa’s Youth Friendly Services (YFS) programme is one of the few to have been scaled up. This study investigated young people’s experiences of using sexual and reproductive health services at clinics providing the YFS programme, compared to those that did not, using the simulated client method.

Design

Fifteen primary healthcare clinics in Soweto were randomly sampled: seven provided the YFS programme. Simulated clients conducted 58 visits; young men requested information on condom reliability and young women on contraceptive methods. There were two outcome measures: a single measure of the overall clinic experience (clinic visit score) and whether or not simulated clients would recommend a clinic to their peers. The clinic visit score was based on variables relating to the simulated clients’ interactions with staff, details of their consultation, privacy, confidentiality, the healthcare workers’ characteristics, and the clinic environment. A larger score corresponds to a worse experience than a smaller one. Multilevel regression models and framework analysis were used to investigate young people’s experiences.

Results

Health facilities providing the YFS programme did not deliver a more positive experience to young people than those not providing the programme (mean difference in clinic visit score: −0.18, 95% CI: −0.95, 0.60, p=0.656). They were also no more likely to be recommended by simulated clients to their peers (odds ratio: 0.48, 95% CI: 0.11, 2.10, p=0.331). More positive experiences were characterised by young people as those where healthcare workers were friendly, respectful, knew how to talk to young people, and appeared to value them seeking health information. Less positive experiences were characterised by having to show soiled sanitary products to obtain contraceptives, healthcare workers expressing negative opinions about young people seeking information, lack of privacy, and inadequate information.

Conclusions

The provision and impact of the YFS programme are limited. Future research should explore implementation. Regular training and monitoring could enable healthcare workers to address young people’s needs.