Adolescent Friendly Health Services Research Articles

162. How Adolescent-Friendly Are Rural Health Services?

The development of positive health practices during adolescence prepares adolescents to enter adulthood as healthy adults. However, adolescents living in rural, frontier areas may face substantial barriers to accessing quality preventative health services that are developmentally appropriate. Recent recommendations by the Institutes of Medicine suggest adolescent friendly health services are accessible, acceptable, appropriate, equitable, and effective. In addition, evidence-based practice recommendations, including Bright Futures, provide specific guidance for risk evaluation and health promotion topics during adolescent well child exams.

Integrating adolescent-friendly health services into the public health system: an experience from rural India.

Although India's health policy is directed toward improving adolescent reproductive health, adolescent-friendly health services are scarce. The intervention for "integrating adolescent-friendly health services into the public health system" is an effort to improve the health status of adolescents in rural areas of the Varanasi (Arajiline) and Bangalore (Hosakote) districts in India. The purpose of this article is to describe the features of the intervention and investigate the impact on improving awareness and utilization of services by adolescent as well as quality of ARSH services in the intervention districts. Data from project monitoring, community survey (737 adolescents), exit interviews (120 adolescents), assessment of adolescent sexual and reproductive health clinics (n = 4), and health service statistics were used. Descriptive analyses and paired t-tests were used to compare the two intervention districts. Overall, the percentage of adolescents who were aware of the services being offered at a health-care facility was higher in Hosakote (range: 56.2% to 74.7%) as compared to Arajiline (range: 67.3% to 96.9); 23.3% and 42.6% of adolescents in Arajiline and Hosakote typically sought multiple services at any one visit. A large percentage of clients (Arajiline: 81.7%; Hosakote: 95.0%) were satisfied with the services they received from the facility. The relative change in uptake of services from the first quarter (January to March 2009) to the last quarter (October to December 2010) was significantly higher in Arajiline (7.93, P = 0.020) than in Hosakote (0.78, P = 0.007). The intervention had positive results for the public health system and the services are being scaled up to different blocks of the districts, under a public-private partnership.

Resource needs for adolescent friendly health services: estimates for 74 low- and middle-income countries.

BackgroundIn order to achieve Millennium Development Goals 4, 5 and 6, it is essential to address adolescents’ health.ObjectiveTo estimate the additional resources required to scale up adolescent friendly health service interventions with the objective to reduce mortality and morbidity among individuals aged 10 to 19 years in 74 low- and middle- income countries.MethodsA costing model was developed to estimate the financial resources needed to scale-up delivery of a set of interventions including contraception, maternity care, management of sexually transmitted infections, HIV testing and counseling, safe abortion services, HIV harm reduction, HIV care and treatment and care of injuries due to intimate partner physical and sexual violence. Financial costs were estimated for each intervention, country and year using a bottom-up ingredients approach, defining costs at different levels of delivery (i.e., community, health centre, and hospital level). Programme activity costs to improve quality of care were also estimated, including activities undertaken at national-, district- and facility level in order to improve adolescents’ use of health services (i.e., to render health services adolescent friendly).ResultsCosts of achieving universal coverage are estimated at an additional US$ 15.41 billion for the period 2011–2015, increasing from US$ 1.86 billion in 2011 to US$ 4,31 billion in 2015. This corresponds to approximately US$ 1.02 per adolescent in 2011, increasing to 4.70 in 2015. On average, for all 74 countries, an annual additional expenditure per capita ranging from of US$ 0.38 in 2011 to US$ 0.82 in 2015, would be required to support the scale-up of key adolescent friendly health services.ConclusionThe estimated costs show a substantial investment gap and are indicative of the additional investments required to scale up health service delivery to adolescents towards universal coverage by 2015.

Health workers' attitudes toward sexual and reproductive health services for unmarried adolescents in Ethiopia.

BackgroundAdolescents in developing countries face a range of sexual and reproductive health problems. Lack of health care service for reproductive health or difficulty in accessing them are among them. In this study we aimed to examine health care workers' attitudes toward sexual and reproductive health services to unmarried adolescents in Ethiopia.MethodsWe conducted a descriptive cross-sectional survey among 423 health care service providers working in eastern Ethiopia in 2010. A pre-tested structured questionnaire was used to collect data. Descriptive statistics, chi-square tests and logistic regression were performed to drive proportions and associations.ResultsThe majority of health workers had positive attitudes. However, nearly one third (30%) of health care workers had negative attitudes toward providing RH services to unmarried adolescents. Close to half (46.5%) of the respondents had unfavorable responses toward providing family planning to unmarried adolescents. About 13% of health workers agreed to setting up penal rules and regulations against adolescents that practice pre-marital sexual intercourse. The multivariate analysis indicated that being married (OR 2.15; 95% CI 1.44 - 3.06), lower education level (OR 1.45; 95% CI 1.04 - 1.99), being a health extension worker (OR 2.49; 95% CI 1.43 - 4.35), lack of training on reproductive health services (OR 5.27; 95% CI 1.51 - 5.89) to be significantly associated with negative attitudes toward provision of sexual and reproductive services to adolescents.ConclusionsThe majority of the health workers had generally positive attitudes toward sexual and reproductive health to adolescents. However, a minority has displayed negatives attitudes. Such negative attitudes will be barriers to service utilization by adolescents and hampers the efforts to reduce sexually transmitted infections and unwanted pregnancies among unmarried adolescents. We therefore call for a targeted effort toward alleviating negative attitudes toward adolescent-friendly reproductive health service and re-enforcing the positive ones.

Mechanisms for achieving adolescent-friendly services in Ecuador: a realist evaluation approach

Background: Despite evidence showing that adolescent-friendly health services (AFSs) increase young people's access to these services, health systems across the world are failing to integrate this approach. In Latin America, policies aimed at strengthening AFS abound. However, such services are offered only in a limited number of sites, and providers’ attitudes and respect for confidentiality have not been addressed to a sufficient extent.Methods: The aim of this study was to explore the mechanisms that triggered the transformation of an ‘ordinary’ health care facility into an AFS in Ecuador. For this purpose, a realist evaluation approach was used in order to analyse three well-functioning AFSs. Information was gathered at the national level and from each of the settings including: (i) statistical information and unpublished reports; (ii) in-depth interviews and focus group discussions with policy makers, health care providers, users and adolescents participating in youth organisations and (iii) observations at the health care facilities. Thematic analysis was carried out, driven by the realist evaluation approach, namely exploring the connections between mechanisms, contexts and outcomes.Results: The results highlighted that the development of the AFSs was mediated by four mechanisms: grounded self-confidence in trying new things, legitimacy, a transformative process and an integral approach to adolescents. Along this process, contextual factors at the national and institutional levels were further explored.Conclusion: The Ministry of Health of Ecuador, based on the New Guidelines for Comprehensive Care of Adolescent Health, has started the scaling up of AFSs. Our research points towards the need to recognise and incorporate these mechanisms as part of the implementation strategy from the very beginning of the process. Although contextually limited to Ecuador, many mechanisms and good practices in these AFS may be relevant to the Latin American setting and elsewhere.

Factors associated with adolescents’ perspectives on health needs and preference for health information sources in Taiwan

ObjectiveTo identify health needs, preferred sources of health information and associated factors in Taiwanese adolescents.DesignCross-sectional questionnaire-based survey conducted in Taiwanese adolescents aged 12–18 years in 2010.Outcome measuresAdolescents were queried about...

Awareness and Utilization of Emergency Contraceptives among Female Undergraduate Students of University of Benin, Benin City, Nigeria

Any woman of reproductive age may need Emergency Contraception (EC) at some point to avoid an unintended pregnancy. The aim of this study is to determine the awareness and utilization of EC among female undergraduate students of the University of Benin, Benin City, Nigeria. A descriptive cross-sectional study was carried out among 450 randomly selected full time female undergraduate students. The tool for data collection was a semi-structured self administered questionnaire. The mean age of the respondents was 22.2 ± 2.9 years with majority (88.0%) of them being single. Majority 276 (61.3%) of the respondents were sexually active out of which 213 (77.2%) had engaged in unprotected sexual intercourse and 110 (39.9%) had had an unintended pregnancy. Three hundred and seventy one (82.4%) respondents were aware of EC and their main source of information about EC was from friends (27.4%). Only 122 (32.9%) respondents had correct knowledge of EC while 45 (12.1%) had used it. Various incorrect methods/forms of EC were used by respondents to protect against unwanted pregnancy. Although, the awareness of EC among female undergraduates was high, correct knowledge and utilization by the students was low. There is therefore an urgent need to educate adolescents and young people in the university about EC especially in the area of correct methods available for them. The establishment of Reproductive Health Clubs and Adolescentfriendly health services where students can seek health information especially in reproductive health should be encouraged in the university.

187 The Conditions of Adolescent Patients at a Danish Tertiary University Hospital

Aims: We aimed to explore conditions of adolescent inpatients viewed by the staff. Methods: Questionnaire survey among the staff at Copenhagen University Hospital Rigshospitalet from five paediatric (n=36) and 13 adult (n=64) in-patient wards. Results: Confidentiality and consent: Only 1/3 of the participants estimated that their colleagues were fully familiar with the rules on confidentiality and consent for adolescents < 18 years. Staff skills: 28% knew of professionals with special skills in the care of adolescent patients. However, there was no structured education or evaluation. Only a small minority knew any written guidelines for the care of adolescent patients. Involvement of adolescents: 70% found it important to involve young patients when deciding whether admission should take place at the paediatric or adult ward. However, this was the case in only a minority of cases. At the paediatric departments, 1/4 of the staff felt that the patients were involved too little in treatment decisions. Environment: Dayrooms dedicated for adolescents were present in two of the paediatric and none of the adult wards, and only 1/3 of staff found that the general facilities met the need of adolescents. There were activities dedicated for adolescents at two paediatric and one adult department. Conclusions: Although international guidelines for adolescent friendly health services exist, there was no structured staff education or clear written guidelines. Involvement of adolescent patients regarding treatment decisions could be improved especially at the paediatric departments. Adolescent-specific activities and environment were sparse especially at the adult wards.

Adolescent‐friendly health services: What have children's hospitals got to do with it?

Journal of Paediatrics and Child HealthVolume 46, Issue 5 p. 214-216 Adolescent-friendly health services: What have children's hospitals got to do with it? Susan M Sawyer, Corresponding Author Susan M Sawyer Centre for Adolescent Health, Royal Children's Hospital, Department of Paediatrics, The University of Melbourne, Murdoch Childrens Research Institute, Melbourne, Victoria,Professor SM Sawyer, Centre for Adolescent Health, 2 Gatehouse Street, Parkville, Vic. 3052, Australia. Fax: 03 93456502; email: [email protected]Search for more papers by this authorJenny Proimos, Jenny Proimos Centre for Adolescent Health, Royal Children's Hospital, Department of Paediatrics, The University of Melbourne,Search for more papers by this authorSusan J Towns, Susan J Towns Department of Adolescent Medicine, The Children's Hospital at Westmead, and Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, AustraliaSearch for more papers by this author Susan M Sawyer, Corresponding Author Susan M Sawyer Centre for Adolescent Health, Royal Children's Hospital, Department of Paediatrics, The University of Melbourne, Murdoch Childrens Research Institute, Melbourne, Victoria,Professor SM Sawyer, Centre for Adolescent Health, 2 Gatehouse Street, Parkville, Vic. 3052, Australia. Fax: 03 93456502; email: [email protected]Search for more papers by this authorJenny Proimos, Jenny Proimos Centre for Adolescent Health, Royal Children's Hospital, Department of Paediatrics, The University of Melbourne,Search for more papers by this authorSusan J Towns, Susan J Towns Department of Adolescent Medicine, The Children's Hospital at Westmead, and Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, AustraliaSearch for more papers by this author First published: 18 May 2010 https://doi.org/10.1111/j.1440-1754.2010.01729.xCitations: 19Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume46, Issue5May 2010Pages 214-216 RelatedInformation

Nutritional Status, Dietary Intake, and Relevant Knowledge of Adolescent Girls in Rural Bangladesh

This study estimated the levels and differentials in nutritional status and dietary intake and relevant knowledge of adolescent girls in rural Bangladesh using data from the Baseline Survey 2004 of the National Nutrition Programme. A stratified two-stage random cluster-sampling was used for selecting 4,993 unmarried adolescent girls aged 13-18 years in 708 rural clusters. Female interviewers visited girls at home to record their education, occupation, dietary knowledge, seven-day food-frequency, intake of iron and folic acid, morbidity, weight, and height. They inquired mothers about age of their daughters and possessions of durable assets to divide households into asset quintiles. Results revealed that 26% of the girls were thin, with body mass index (BMI)-for-age <15th percentile), 0.3% obese (BMI-for-age >95th percentile), and 32% stunted (height-for-age < or = 2SD). Risks of being thin and stunted were higher if girls had general morbidity in the last fortnight and foul-smelling vaginal discharge than their peers. Consumptions of non-staple good-quality food items in the last week were less frequent and correlated well positively with the household asset quintile. Girls of the highest asset quintile ate fish/meat 2.1 (55%) days more and egg/milk two (91%) days more than the girls in the lowest asset quintile. The overall dietary knowledge was low. More than half could not name the main food sources of energy and protein, and 36% were not aware of the importance of taking extra nutrients during adolescence for growth spurt. The use of iron supplement was 21% in nutrition-intervention areas compared to 8% in non-intervention areas. Factors associated with the increased use of iron supplements were related to awareness of the girls about extra nutrients and their access to mass media and education. Community-based adolescent-friendly health and nutrition education and services and economic development may improve the overall health and nutritional knowledge and status of adolescents.

Trainings in health sector: Need for a paradigm shift

Trainings in health sector: Need for a paradigm shift

Adolescent friendly health services in India: A need of the hour

Adolescents account for almost one third of India's population. They are prone to suffer from reproductive and sexual health, nutritional, mental and behavioral problems. Health services which cater exclusively to the needs of adolescents are scanty and concentrated in urban areas. Adolescent Friendly Health Services (AFHS) which provide a broad range of preventive, promotive and curative services under one roof can help to ensure improved availability, accessibility and utilization of health services. AFHS is being initiated by governmental, private and non-governmental organizations. Lessons to improve the quality of AFHS could be further learnt from evaluation of pilot projects and success stories of similar initiatives in other countries.

Elizabeth Mapella: prioritising adolescent health in Tanzania

In Tanzania as in many sub-Saharan African countries the evolution of the HIV/AIDS epidemic has brought into stark relief the need for policies to protect the health of adolescents a group frequently lost to health services. But for Elizabeth Mapella who since 1998 has been working to improve the countrys adolescent and reproductive health services through her work in the ministry of health the problems afflicting this age-group have long been a cause for concern: "I want to know why young people are suffering and what to do to make a difference. And that curiosity is also part of what makes me continue to work in this area." Becoming a doctor was the realisation of an ambition Mapella had held since a hospital visit when she was 14 years old. "When I was young I had an attack of malaria and I was taken by my parents for treatment in a nearby centre. I was so impressed by the clinician who attended me and from then on my ambition was to be a doctor" she explains. Although adolescent healthwas not regarded as a specialist area when she was doing her clinical training through her obstetric training and modules on child health she began to realise that there was a real need for services that adolescents felt comfortable using: "In that age bracket I started to see how severe the problem is--especially when they are pregnant" Mapella says. (excerpt)

Acceptability as a key determinant of client satisfaction: lessons from an evaluation of adolescent friendly health services in Mongolia

Purpose The primary focus of this study is to investigate which characteristics of health service quality are most likely to determine client satisfaction with health services among adolescents in Mongolia. Methods Data were gathered from 1301 male and female clients. Exit interviews were used to measure client satisfaction; 82 clinics were visited. All clients between the ages of 10 and 19 years were asked to participate in the client exit interview; those who agreed to participate completed the questionnaire. Bivariate and multivariate analyses were conducted to determine significant associations between service satisfaction and the independent variables. All variables showing a significant bivariate association with service satisfaction ( p ≤ .05) were retained for logistic regression analyses. Results The strongest determinant to client satisfaction related to acceptability: adequate facility physical environment, receiving adequate information about the facility, and if the facility was private (i.e., other people didn’t know the services the client received). Additionally, clients who said they received some interruptions, either by other health workers or clients, were significantly less likely to be satisfied with the services. Conclusions This study demonstrates the importance of understanding and measuring different aspects of health service quality in defining client satisfaction. Although both accessibility and acceptability of services have been shown to be important in other studies, characteristics relating to acceptability emerged as critical in determining client satisfaction among adolescents in Mongolia. Efforts to improve health service delivery to adolescents need to understand and address the “adolescent friendly” characteristics that are most salient, and least fulfilled, in each particular context.

Health Sector Reform and Sexual and Reproductive Health Services in Mongolia

Abstract Since its transition to democracy, Mongolia has undergone a series of reforms, both at national level and in the health sector. This paper examines the pace and scope of these reforms, the ways in which they have impacted on sexual and reproductive health services and their implications for the health workforce. Formerly pro-natalist, Mongolia has made significant advances in contraceptive use, women's education and reductions in maternal mortality. However, rising adolescent pregnancy and sexually transmitted infections, and persisting high levels of abortion, remain challenges. The implementation of the National Reproductive Health Programme has targeted skills development, outreach and the provision of resources. Innovative adolescent-friendly health services have engaged urban youth, and the development of family group practices has created incentives to provide primary medical care for marginalised communities, including sexual and reproductive health services. The Health Sector Strategic Masterplan offers a platform for coordinated development in health, but is threatened by a lack of consensus in both government and donor communities, competing health priorities and the politicisation of emerging debates on fertility and abortion. With previous gains in sexual and reproductive health vulnerable to political change, these tensions risk the exacerbation of existing disparities and the development by default of a two-tiered health care system.

The Perception of South African Adolescents Regarding Primary Health Care Services

Most of the South African public health facilities fail to provide adolescent-friendly health services. A quantitative, descriptive research study was conducted at Stinkwater, a rural area in Hammanskraal, South Africa. The objective of the study was to describe the adolescent's preferences regarding primary health care services. A survey was conducted among 119 adolescents. It was found that adolescents wished to be involved in the planning of the activities of the adolescent health service, and that friendliness and respect for adolescents were seen as desirable characteristics of an adolescent-friendly health care service. Adolescents preferred services to be available throughout the week and to be located at the school, youth center, community center, hospital, or clinic. Health education was indicated as a priority and the health care team should include different members of a multidisciplinary team. Adolescents preferred that their health services be separated from adult services and that a male nurse be employed in the adolescent service in order to create a less feminine image. It was also recommended that all adolescents be educated about the types of services available. Understanding health care service preferences of adolescents is needed in order to deliver optimal health care to this group.

Disease and health seeking patterns among adolescents in Uganda.

Adolescents in Uganda have a heavy burden of disease mainly from STD's, HIV and effects of unwanted pregnancy. Currently there are initiatives to address this problem. This paper presents results of a project which piloted a package of adolescent health services with the aim of identifying the best approach for providing quality, accessible, and affordable adolescent friendly services. The main objective of the study was to evaluate the impact of adolescent-friendly health services piloted in the Jinja district Uganda. The specific objectives were to assess adolescents' knowledge, attitudes, and practices related to access and utilization of adolescent friendly services; to assess the perceptions and skills of health workers; and to identify options for scaling up services and sustainability of such services. A KAP (Knowledge, Attitude and Practice) study was conducted among adolescents and service providers at eight health units. Four of the health units had implemented a package of adolescent friendly services, while four other health units had not implemented the package, but were comparable in terms of level of service delivery, catchment size and population characteristics. A structured questionnaire and in-depth interviews were used to collect data. A total of 128 adolescents and 42 health workers were interviewed, and focus group discussions were used to collect data. More adolescents utilized routine services at four pilot health units as follows: antenatal care (72.8% vs. 53.7%, p = 0.000), maternity care (70.6% vs. 53.1%, p = 0.005), family planning (69.4% vs. 21.1%, p = 0.000), management of STD's (65.5% vs. 31.9%, p = 0.000) and access to laboratory services (49.8% vs. 4.4%, p = 0.000). Adolescents at pilot sites were more knowledgeable on adolescent health problems (74.8% vs. 48.9%, p = 0.000), factors predisposing adolescents to health problems (73.4% vs. 52.5%, p = 0.003), family planning methods (84.5% vs. 68.7%, p = 0.000), HIV as a problem to adolescents (84.5% vs. 68.7%, p = 0.011), and STD's as a problem to adolescents (76.3 vs. 50.2%, p = 0.004). One of the main constraints to the pilot project was an erratic supply of contraceptives and STD drugs mainly from inadequacies in the national health system. Implementation of adolescent friendly services improved access and use of services among adolescents; this lead to reduced morbidity from STD's, HIV, and unwanted pregnancies. In order to reach more adolescents, services have to be scaled to lower health units up to the community level. Training of health workers, ensuring a constant supply of contraceptives, STD drugs, and availing voluntary HIV testing and counseling services are key program issues to consider.

Sex, Studies or Strife? What to Integrate in Adolescent Health Services

If health services for adolescents are to be successfully integrated into the existing health care system, they will need to reach out to meet the needs that adolescents themselves perceive as salient. This paper describes a study aiming to elicit the needs of adolescents in higher secondary schools in Goa, India, in 1999–2000. The objective was to generate information which could guide the development of adolescent-friendly health services by integrating the health needs identified by adolescents themselves. The study began with free-listing, followed by focus group discussions and in-depth interviews to elicit areas of concern. Then, a survey of 811 students with a self-report questionnaire was carried out. The findings demonstrate that there is clearly an unmet need for information about sexual and reproductive health, but also a large, unmet need for psychosocial support for health issues ranging from violence in schools to poor relationships with parents, stress-related health complaints and educational difficulties, which are often perceived by adolescents to be of primary importance. Integrating these issues into programmes is likely to be an essential element in developing health services and programmes which can reach out to the majority of adolescents in school settings in India.

Monitoring and evaluation of loveLife's AIDS prevention and advocacy activities in South Africa, 1999–2001

loveLife is the largest effort ever launched in South Africa to change adolescent sexual behaviour with the aim of reducing the rate of HIV infection among 15–20 year olds by 50%, reducing other STIs, and reducing the incidence of teenage pregnancy. loveLife combines high-powered media awareness and education, development of adolescent-friendly reproductive health services, and outreach and support programmes. The 5-year research and evaluation plan includes a multi-year comprehensive observational study, tracking change in a range of behavioural indicators and in sexual health outcomes. In its first 2 years, loveLife reached more than 4 million youth. Sixty-two percent of youth and 59% of their parents/guardians recognize the brand, while the vast majority of parents (97%) and youth (89%) exposed to loveLife, identified loveLife as being positive. Challenges in the next years are the continued roll out of the programme, and the development of institutional support and behaviour change.

Youth and the National Children's Agenda

Youth and the National Children's Agenda