Youth Friendly Research Articles

Policy Formulation Analysis of Youth Friendly City: Policy Studies of Ministry of Youth and Sports and the City Government of Bandung

The planning of Youth Friendly City policy by Indonesian Ministry of Youth and Sports is expected to strengthen youth development and empowerment in each region of Indonesia, through the assistance of the preparation of youth regulation, competition, and awards. The city of Bandung has become a pilot project for Youth Friendly City. This research is an action-research approach which based on Soft System Methodology (SSM) to analyze the formulation of Youth Decent Friendly policy at the Ministry of Youth and Sports and also the City Government of Bandung. The results of this study indicate that indicators of the development of Youth Friendly City as stated in Regulation No. 11 of the Ministry of Youth and Sports 2017, refers to 4 (four) clusters, namely: life, play, work/school, and health/welfare still require more action plans. The results from this study is expected to be a reference for all city/regional government in Indonesia, especially the Government of Bandung on the policy of Youth Friendly City.

Provider attitudes towards a brief behavioral intervention for sexual health in Moldova

BackgroundBrief behavioral interventions are seen as an efficient way to improve knowledge, change behavior, and reduce provider stigma regarding sexual health. When grounded in evidence-based behavioral change techniques and delivered using Brief Sexuality-related Communication (BSC) tools, brief behavioral interventions can address client-driven sexual health goals in a single session with their provider. Evidence for the efficacy of brief interventions for creating gains in sexual health comes largely from resource rich settings, and there is a lack of knowledge of how brief interventions can be implemented in the more resource constrained environments of low- and middle-income countries. As a first step in developing a brief intervention to address sexual health issues in Moldova, this paper reports on qualitative data collected from Moldovan providers to understand their attitudes, willingness and perceived barriers to the brief intervention and its implementation.MethodsThirty-nine in-depth interviews (IDI) were conducted between February and March 2020, with health providers recruited from three primary health care institutions, two Youth Friendly Health Centers and counselors from three NGOs who work with key populations in Moldova, including health centers selected from two cites - the capital city, Chisinau and from the Comrat Region. The IDI addressed four domains of provider attitudes: 1) attitudes towards the intervention; 2) willingness and motivation to implement the intervention; 3) logistics of providing the intervention and 4) ability to implement the intervention. A coding analysis approach was applied to all interview transcripts.ResultsProviders largely reported being willing to be trained in and implement the brief intervention. Willingness to implement the intervention stemmed from two perceptions: that it would improve the ability of providers to talk with their clients about sex, and that vulnerable groups would benefit from these conversations. However, while there were generally positive attitudes towards the intervention, providers consistently reported structural barriers to their perceived ability to implement the intervention.ConclusionsWhile providers reported high levels of initial acceptance of a brief behavioral intervention, care is needed to ensure that brief interventions, and the training of providers on brief interventions, incorporate cultural attitudes and norms around sex, particularly in highly patriarchal settings, and provide opportunities for providers to practice the intervention in ways that address their assumptions and implicit biases.

Utilization of Reproductive Health Services among Youths in Owerri, Southeastern Nigeria

Youths are faced with immense reproductive health problems and they have limited access to reproductive health services. This study was carried out to investigate the utilization of reproductive health services among youths in Owerri, Southeastern Nigeria. The study was a descriptive cross sectional study and the multistage sampling technique was adopted to select samples for the study. A well-structured questionnaire was used to interview the subjects and obtain data for the study which was uploaded into the SPSS version 21 software and the Chi-square was used to test for association at 5% level of significance. A total of 424 people were studied comprising of 276 (65.1%) males and 148 (34.9%) females. Results showed that only 106 (25%) showing good knowledge of reproductive health services while 318 (75%) showed poor knowledge. Among the 148 that have used reproductive services, 56.8% responded that they seek reproductive services in the home of a health worker, 29.1% seek reproductive health services through public health facilities such as health centers, clinic or NGO, and 14.2% obtain their reproductive health services through drug shops such as a pharmacy or chemist. SPSS analysis using the Chi-square showed that the male gender showed poorer knowledge of RHS than the female gender but gender was not found to be significant (p=0.098, χ2=1.993). Other significant socio-demographic factors include marital status (p=0.0001, χ2= 46.29), living pattern (p=0.005, χ2=6.93) and education (p=0.0001, χ2= 17.8). In conclusion, the study showed that the knowledge and the level of utilization RHS is still low among youths in the study area. It was recommended that stakeholders sensitize the public on the importance of youth reproductive health services and strengthen the idea of youth friendly reproductive health services. Keywords: Youth, Utilization, Knowledge, Reproductive Health Services, Youth Friendly Services.

The Effect of Peer Education on Decision-Making, Smoking-Promoting Factors, Self-Efficacy, Addiction, and Behavior Change in the Process of Quitting Smoking of Young People.

PurposeThe study aims to examine the effect of peer education on the decision to quit smoking, factors that encourage smoking, self-efficacy, addiction, and behavior change in students who apply to the Youth Friendly Center to quit smoking.Participants and MethodsThis research is a Randomized Controlled Trials study. The experimental group consisted of students who were enrolled in the peer education course (n=759). The control group has consisted of students (n=1095) who did not enroll in this course.ResultsParticipants in the experimental group to quit smoking, more than the control group (p>0,01). The addiction level of the participants in the experimental group, less than the participants in the control group (p>0,01). According to the scores of the participants in the control group of the participants in the experimental group, the factors that trigger smoking, and the benefit sub-dimension scores in the Decision Balance Scale were low. Loss sub-dimension scores, which show the losses from the harms of smoking, increased significantly in the Self-Efficacy Scale, Behavior Change Process Scale, and Decision Balance Scale (p>0,01).ConclusionPeer educators trained by the researcher and her team in the Youth Friendly Center Smoking Quit Program have an important effect in supporting/improving the cognitive and behavioral change processes of university students in smoking quit compared to those who do not receive an education. 94% success of the smoking quit program; Students’ voluntary application to receive professional support, students’ voluntary attendance of the treatment program for 6 months, strong communication and feedback, effective and functional professional counseling, and social support depend on strengthening the program with peer education. Especially with peer education, the development of leadership and role model characteristics made the smoking quit program preferred by students.

Barriers and opportunities to using health information in policy implementation: The case of adolescent and youth friendly health services in the Western Cape.

BackgroundThe production, use and exchange of health information is an essential part of the health services, as it is used to inform daily decision-making and to develop new policies, guidelines and programmes. However, there is little insight into how health care workers (HCWs) get access to and use health information when implementing new health programmes.AimThis study explored the multifaceted role of health information within policy implementation processes and aimed to understand the complexities experienced by HCWs who need to develop adolescent health profiles (AHPs), a criterion of implementing a larger Adolescent and Youth Friendly Services Programme (AYFSP).SettingThis case study was undertaken in Gugulethu, a peri-urban, low-income neighbourhood in Cape Town, South Africa.MethodsData were collected through ethnographic qualitative methods, including participant observation, interviews and workshops, and 15 participants were enrolled for this purpose.ResultsFindings showed that HCWs experienced different barriers when accessing information to develop the AHPs, including a lack of access to databases, a lack of support and inadequate guidelines. Nevertheless, HCWs were resourceful in using informal information and building strategic relationships to navigate and gain access to the necessary data to develop AHPs.ConclusionThis case study provided insights into the practical difficulties and innovative strategies which arise when HCWs attempt to access and use health information within a real-life health programme. Findings highlighted the need for more training, support and guidance for HCWs to improve the meaningful use of health information during policy implementation processes and to strengthen health services in South African primary care clinics.

A Study of Quality and Proficiency of the Service Providers in Delivering the Adolescent and Youth Friendly Services under the Rashtriya Kishor Swasthya Karyakram Programme in Madhya Pradesh

Despite existing frameworks for the improvement of adolescent reproductive health, there is a lack in provision of the Adolescent Friendly Health Services (AFHS). The primary objective of this study was to assess the quality and proficiency of service providers to deliver Adolescent Friendly Health Services (AFHS) in central India. Data was gathered by visiting 30 secondary and tertiary level health facilities to assess their infrastructure and preparedness for providing AFHS using a pre-designed questionnaire based on WHO guidelines for assessing quality. Descriptive analysis was done using SPSS v21 and Microsoft Excel. Quality of AFHS services was found to be poor in non- RKSK facilities. However the knowledge level, training status and counseling skills of the service provider was found to be highly substandard in both RKSK and Non-RKSK facilities. The RKSK program has not been properly implemented and has failed to make an impact where it was required.

The Utilization of Sexual and Reproductive Health Services among young people: A cross-sectional study in Greece

Purpose: To explore young people’s experiences of public or private services received for their sexual and reproductive healthcare. Materials and Methods: A cross-sectional study was carried out involving 358 students from vocational post-secondary education during the academic year 2018-2019, using a questionnaire based on the directions of the Youth Friendly Sexual and Reproductive Health Services (SRHS) proposed by the International Planned Parenthood Federation (IPPF). Results: Out of 358 students, only 35(9.78%) visited public health services, while 85 (23.74%) visited both public and private services.  Gynaecologists, in private sectors, were visited by 127 students of whom 34.6% and 33,1% were between the ages of 18-20 and 21-30 years, respectively.  111 students (31.01%) did not use any service. A slight difference between the staff friendliness and the services received between the public and private sectors was observed. Similarly, a marginal lead was apparent in the private sector with regards to availability of appointments, emergencies and privacy. In the public sector, fewer participants were informed of the abortion services available. Conclusions:  The satisfaction rate was quite high regarding healthcare consultation, in both sectors. However, counseling on contraceptive methods, information on the prevention of sexually transmitted infections, and other aspects of sexual and reproductive health were not satisfactorily covered. Finally, participants wished for more counseling and a greater focus on personal concerns.

Assessing the HIV Knowledge, Awareness, and Utilization of YFS among Undergraduates in Rivers State, Nigeria

Background: The establishment of a Youth Friendly Centre (YFC) is to ensure that the reproductive and sexual health needs of young people are adequately met. However, data have shown that a number of them are not even aware of such Centres in their vicinities or the services they offer, how much more utilize them. Therefore, this study aimed at assessing the level of HIV knowledge, awareness, and utilization of Youth Friendly Services (YFS) among undergraduates in Rivers State University, Rivers State, Nigeria.
 Methods: A total of 520 students were given structured self-administered questionnaire which had been validated and pretested. Four hundred and forty-six questionnaires were returned properly filled. Information regarding knowledge of Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS), awareness, and utilization of Youth Friendly Services were obtained from the students.
 Results: Two hundred and nineteen (49.1%) of the students indicated HIV had no cure, while 73(16.4%) reported that there was a cure and 154 (34.5%) specified they were uncertain. The female respondents had a better knowledge compared to their male counterparts. The respondents exhibited a high knowledge of HIV preventive measures with the majority 357 (80%) indicating that abstinence was the best means. All the students agreed that everyone was at risk of HIV if they engaged in risky behaviors. In spite of this good knowledge on HIV, only 112 (25.1%) of the students were aware of a YFCs on campus.
 Conclusion: The high knowledge level of HIV exhibited by the students did not translate to the awareness and utilization of the YFS. There is still so much to be done by health workers and the university committee if the students are to be encouraged to use the services offered at the Centre.

Multi-level Barriers for Utilization of Youth Friendly Reproductive Health Services (YFRHS) among Youths

The present study aims to examine the multi-level barriers to utilize by the youth-friendly reproductive health services (YFRHS) among the school-going youths of the Surkhet valley of Nepal. This study is based on the sequential explanatory research design under mixed-method research. The quantitative data were collected using the self- administered questionnaire from the 249 youths, aged between the 15-24 years, those selected by using random sampling. The qualitative data were collected using the Focus Group Discussions (FGDs) from the 12 participants who were selected purposively. The study confirmed that school-going youths do not have appropriate utilization of YFHS due to multi-layered barriers. However, the utilization of the service was higher among females, those the older age group, studying in the upper classes, the upper castes, and married youths. The key findings and themes are recognized as multi-layered barriers including personal-level, health system-level, community-level, and policy-level on the entire socio-ecological field. Among them, the existing health system is the foremost barrier. Multi-level interventions are, therefore, required to increase the YFRHS utilization and improve concerns for school-going-youths.

Implementation of Adolescent and Youth Friendly Health Services in a Rural Region of Tigray, Ethiopia

Abstract Background The Eastern Zone of the Tigray (Ethiopia) is inhabited by 900,000 people, 34% of whom are adolescents and young people between 10-24 years of age, who are easily influenced by the social and family context and are exposed to significant health risks associated with the earliness of their approach to sexual life. Nonetheless, even if a complete health service is available, the quality is often undermined by the lack of the so-called Youth-Friendly Corners (high confidentiality spaces reserved for young people), promoted internationally by WHO. The aim of the study is to evaluate the effectiveness of the program established in this zone by the Medical Collaboration Committee regarding the creation of friendly health services for adolescent and youth people (AYFHS), especially built for sex education, family planning, abortion, and sexual transmitted infection (STI) prevention. Methods The program “#Youths at the centre!” was implemented in 20 rural health centers in the North-East Tigray on April 2018. Data from these AYFHS were collected monthly in aggregated indicators, separated for gender and age class. Use of AYFHS during 2018 and 2019 was assessed using percentage and 95% confidence interval and the period of implementation of the project and centers' characteristics were analyzed to investigate differences in AYFHS utilization. Results A monthly mean of 6.04% (6.01% - 6.08%) of adolescents and young people utilized an AYHFS for any of its service; 0.03% accessed for counseling, diagnosis, and treatment of STI, 1.31% for family planning, 1.09% for delivery, and 0.05% for legal abortion. Lower level of utilization was observed in more remote health centers, despite a general increase across the study period. Conclusions This project shows the importance of providing friendly facilities dedicated to adolescents and youth in low-income countries, in order to increment the utilization of health services from this population, especially in rural contexts. Key messages In rural areas of Africa the risks associated with poor health information of young people and the earliness of the beginning of sexual life remain a Public Health problem. In low income countries the presence of high confidentially spaces for young people in the Health Services could increase their utilization, especially for sex education and family planning.

AN ASSESSMENT OF CHALLENGES INFLUENCING ACCESS TO COMPREHENSIVE HIV CARE AMONG ADOLESCENTS AND YOUTH AGED 15-24 YEARS AT NAKURU COUNTY REFERRAL HOSPITAL IN KENYA

Purpose: Adolescents and youth living with HIV/AIDs experience numerous challenges and support needs, some of which occur in school and affect their quality of life. Several reasons have been advanced to explain this trend includes; stigma, peer pressure and discrimination. However, little focus has been made on socio-cultural, socioeconomic and clinical challenges facing Adolescents and Youth Living with HIV/AIDS (AYLHIV). The objective of this study was to assess the challenges influencing access to comprehensive HIV care among adolescents and youth aged 15-24 years at Nakuru county referral hospital in Kenya.Methodology: Adopting social cognitive theory, a descriptive survey research design was used. Purposive and proportionate random sampling techniques were used to obtain a sample size of 47 AYLHIV. Questionnaires and focused group discussions were used to collect data from AYLHIV; while Interview schedules were to collect data from counsellors in November 2019. Data were analyzed by the use of descriptive statistics in January 2020.Findings: The study concludes that the main socio-cultural challenges faced by AYLWA at County Referral Hospitals are stigma and frequent change of caregivers resulting in poor adherence to ARV medications. Moreover, no major socio-economic challenges were affecting AYLWA at the health facilities. Further, the main clinical challenges facing AYLWA were poor adherence and low viral suppression.Unique Contribution to Theory, Practice and Policy: The study recommends the need to offer and strengthen psychosocial support to AYLWA to enable them to cope with their status and educate the caregivers on the importance of the AYLWA having a consistent caregiver for continuity. The hospital management should avail more trained adherence counsellors for this role. Moreover, the hospital management needs to strengthen the Youth Friendly HIV services to improve responsiveness to the youth needs. This will enhance peer support.

Association between HIV/AIDS Knowledge and Risk Behaviors among African American Undergraduate Students at a Historically Black University

Objective: This study aimed to assess the association between HIV/AIDS knowledge and risk behaviors relating to HIV infection among African American undergraduate students at a Historically Black University.
 Methods: A cross-sectional study method was used. A total of 400 participants were randomly selected from Jackson State University undergraduate students. This study utilized a self-administered questionnaire on HIV/AIDS knowledge and their risk behaviors.
 Results: Majority of the students (96.5%) had good knowledge about the disease, some respondents had some misconceptions about HIV infection. This study found no significant difference between male and female participants of this study on HIV/AIDS knowledge (χ2 = 3.05; P = 0.08). About 75.8% of respondents in this study have had at least one HIV risk behavior. HIV risk behaviors of these students were not varied by gender (χ2 = 2.76; P = 0.1). However, some students engaged in various HIV risk behaviors such as having unprotected sexual intercourse, multiple sexual partners, low and inconsistent condom use. There was an association between HIV/AIDS knowledge and risk behaviors relating to the disease (p= 0.03, Pearson’s χ2 = 5.237).
 Conclusions: Majority of the students demonstrated good knowledge of the disease and practiced at least one risk behavior predisposing them to HIV infection. There was an association between HIV/AIDS knowledge and risk behaviors relating to the disease infection. This study finding has shown that good knowledge about HIV/AIDS may not translate into positive behavior change. Hence, this study calls for sustained effective youth friendly programs geared toward addressing gaps in HIV/AIDS knowledge, misconceptions of the disease and eliminating various risk behaviors identified in this study.

Assessing Front Office StaffAwareness on Mental Health Resources at Youth Friendly Clinics in Los Angeles County.

Mental illness is a global health challenge and continues to rise among minors. Community clinics are well positioned to provide mental health services to young people. To assess community clinic front staff awareness of recent legislation mandating access by minors to mental health services and the actual services delivered by these clinics. We conducted a face-to-face survey with front office staff at community clinics in service planning areas (SPA) 6, 7, and 8 in Los Angeles County (LAC) to understand the staff awareness of the services provided to the minor by the clinic. These SPAs have been previously identified as serving a low socioeconomic population. Fisher's exact test and the chi-square test were conducted to understand the factors influencing the front desk personnel awareness. Data were collected from 17 clinics in SPA6, 15 clinics in SPA7, and 4 clinics in SPA8. All of the clinics provided Family-PACT insurance, resources for domestic abuse, intimate partner violence, mental health (such as anxiety and depression) and alcohol/drug abuse; however responding front desk staff in twenty-five out of 36 (69.4%) clinics was aware of the availability of Family-PACT insurance to minor patients; 21 (58.3%) was aware that the clinic provided resources for domestic abuse or intimate partner violence, and 20 (55.5%) was aware that the clinic offered resources for mental health (such as anxiety or depression) or alcohol/drug abuse to minor patients. In this pilot study, about half of the front desk staff at the surveyed clinics in LA County did not know that the clinic is fully authorized and equipped to provide mental health services to the minors (patients under 18years of age). These are missed opportunities. There is a need for better education of the front-desk personnel.

Clinical outcomes post transition to adult services in young adults with perinatally acquired HIV infection: mortality, retention in care and viral suppression.

Adolescence is the only age group globally where HIV-associated mortality is rising, with poorer outcomes at all stages of the care cascade compared with adults. We examined post transition outcomes for young adults living with perinatal HIV. Retrospective cohort analysis. A tertiary Youth Friendly Service London, UK. A total of 180 young adults living with perinatal HIV registered between 1 January 2006 and 31 December 2017 contributed 921 person-years of follow-up post transition to adult services. Youth Friendly Service with multidisciplinary care and walk-in access. Mortality, morbidity, retention in care, antiretroviral therapy (ART) uptake and HIV-viral load suppression. Crude incidence rates are reported per 1000 person-years. Of 180 youth registered, four (2.2%) died, 14 (7.8%) transferred care and four (2.2%) were lost to follow-up. For the 158 retained in care, the median age was 22.9 years [interquartile ranges (IQR) 20.3-25.4], 56% were female, 85% Black African, with a median length of follow-up in adult care of 5.5 years (IQR 2.9-7.3). 157 (99.4%) ever received an ART prescription, 127/157 (81%) with a latest HIV-viral load less than 200 copies RNA/ml, median CD4 cell count of 626 cells/μl (IQR 441-820). The all-cause mortality was 4.3/1000 person-years [95% confidence interval (CI) 1.2-11.1], 10 fold the aged-matched UK HIV-negative population [0.43/1000 person-years (95% CI 0.41-0.44)]. Post transition, 17/180 (9.4%) developed a new AIDS diagnosis; crude incidence rates 18.5/1000 person-years (95% CI 10.8-29.6). While this youth-friendly multidisciplinary service achieved high engagement and coverage of suppressive ART, mortality remains markedly increased compared with the general UK population.

223. “Make all Health Services Youth Friendly”: A Qualitative Study Exploring the Provision of Sexual and Reproductive Health Care for Young Women in Maluku, Indonesia

223. “Make all Health Services Youth Friendly”: A Qualitative Study Exploring the Provision of Sexual and Reproductive Health Care for Young Women in Maluku, Indonesia

Community youth teams facilitating participatory adolescent groups, youth leadership activities and livelihood promotion to improve school attendance, dietary diversity and mental health among adolescent girls in rural eastern India: protocol for a cluster-randomised controlled trial

BackgroundImproving the health and development of adolescents aged 10–19 years is a global health priority. One in five adolescents globally live in India. The Rashtriya Kishor Swasthya Karyakram (RKSK), India’s national adolescent health strategy, recommends supporting community-based peer educators to conduct group meetings with boys and girls. Groups aim to give adolescents a space to discuss the social and health issues affecting them and build their capacity to become active community members and leaders. There have been no evaluations of the community component of RKSK to date. In this protocol, we describe the evaluation of the Jharkhand Initiative for Adolescent Health (JIAH), a community intervention aligned with RKSK and designed to improve school attendance, dietary diversity and mental health among adolescent girls aged 10–19 years in rural Jharkhand, eastern India.MethodsThe JIAH intervention is delivered by a community youth team consisting of yuva saathis (friends of youth), youth leadership facilitators and livelihood promoters. Teams conduct (a) peer-led Participatory Learning and Action meetings with girls and boys, mobilising adolescents, parents, health workers, teachers and the wider community to make changes for adolescent health and development; (b) group-based youth leadership activities to build adolescents’ confidence and resilience; and (c) livelihood promotion with adolescents and their families to provide training and practical skills. We are evaluating the JIAH intervention through a parallel-group, two-arm, superiority, cluster-randomised controlled trial. The unit of randomisation is a geographic cluster of ~1000 people. A total of 38 clusters covering an estimated population of 40,676 have been randomised to control or intervention arms. Nineteen intervention clusters have adolescent groups, youth leadership activities and livelihood promotion. Nineteen control clusters receive livelihood promotion only. Study participants are adolescent girls aged 10–19 years, married or unmarried, in or out of school, living in the study area. Intervention activities are open to all adolescent boys and girls, regardless of their participation in surveys. We will collect data through baseline and endline surveys. Primary trial outcomes are school attendance, dietary diversity and internalising and externalising mental health problems. Secondary outcomes include access to school-related entitlements, emotional or physical violence, self-efficacy and resilience.Trial registrationISRCTN17206016. Registered on 27 June 2018.

Youth’s Perspectives on a Sustainable Model for the Provision of Youth Friendly Sexual and Reproductive Health Services in Kenya: A Quantitative Approach

Nearly half of the world’s population comprise youths. However, addressing their Sexual and Reproductive Health (SRH) remains a challenge. Globally countries are mandated to continually provide Youth Friendly Sexual and Reproductive Health services (YFSRHs) to the youth. The objective of this study was to assess and describe youth’s perspectives on a sustainable model for the provision of YFSRHs in Kenya. Data was collected among 400 youths aged 18 - 24 years in Embu and Kirinyaga counties, Kenya. A structured questionnaire was utilized as the data collection tool. Collected data was analyzed using SAS statistical software version 9.4. Statistical threshold of P ≤ 0.05 was used. Overall the mean age of the study participants was ±standard deviation (SD) 21.2 ± 1.86 years. Majority of the participants’ perspective on the health care system sustainability was that the waiting time at the facility should be less than an hour, accessible geographically (less than a kilometre), affordable (≤20 Ksh.), and convenient working hours (weekday and weekends ratio 1:1). Advocacy was on health care provider’s attributes of politeness, welcoming, confidential and non-judgmental. The most preferred locations for the youth friendly centres by the participants were community and school based locations. Similarly, parental and community support was reported to highly contribute to sustained utilization and provision of the YFSRHs (P < 0.001). Unlike popular belief, 99.8% did not see the need for recreational facilities at the youth centres to ensure sustainability of the model. To ensure a sustainable model for the provision of YFSRHs, there is need for a multi-sectoral and stakeholder involvement that is; youth, health care system structure, health care service providers, parents and community. Further research is needed on parents and health care service provider’s perspectives on how to sustain the provision of YFSRH services.

Quality assessment in primary health care: Adolescent and Youth Friendly Service, a Mozambican case study.

Introductiondespite the Mozambican Ministry of Health's efforts to deliver family planning to all girls of childbearing age, the adolescent pregnancy rate remains high. The Adolescent and Youth Friendly Service (AYFS), integrated into overall primary health care programs throughout the country, aims to reverse this situation. Our study objective was to assess this health care service's quality in its location in Marrere Health Centre, Nampula, northern Mozambique, using clients' perspective.Methodswe implemented a descriptive cross-sectional quantitative study sampling 124 individuals, who had recently accessed the AYFS at Marrere Health Centre. Data were collected through a questionnaire using a 5-point Likert scale in questions regarding satisfaction level (i.e. always, most times, sometimes, few times, never) and additional open answer questions to gain greater specific understanding.Resultsa total of 126 users of the AYFS were evaluated, all from the Emacua ethnic-linguistic group. 85 (67%) were adolescents (<19 years), 78.2% female. The mean age was 17.6 years. We found an average of 0.54 pregnancies per woman and 87 participants (69%) never had a pregnancy; of 39 (31%) who had been pregnant, 17 (44%) were able to report the date of the first prenatal visit, on average performed at week 16 (2nd trimester), though with 9 (53%) having performed it during the first trimester. Spontaneous and induced abortions were reported respectively in 4 and 34 cases, respectively, and none with adolescents. The “overall satisfaction” rate was more frequent in both groups, being answered by 93.8% of youth and adults (>= 19 years) and 72.0% of adolescents, a statistically significant difference between the two groups (p <0.05).Conclusionwhile most users are satisfied with the services there was, however, some sharp criticism. Health professionals' practice with the protocol varied, and there were significant deficiencies in information and communication with users. Open communication within families and information reinforcement about sexual and reproductive health and male participation in family planning were found to be in need of strengthening. Our recommendations include reinforcing health professional's training to protect adolescents and young people' sexual health, an important strategy in primary health care to achieve universal health coverage.

Family Management Practices and Positive Youth Development in Stepfamilies and Single‐Mother Families

ObjectiveTo determine how engagement in family management practices (i.e., parent–youth closeness, knowledge of youth's friends, shared family meals, and media monitoring) is associated with positive developmental outcomes for youth living in diverse family structures.BackgroundAs patterns of unmarried childbearing, cohabitation, divorce, and remarriage have changed in the United States, youth increasingly live in diverse family structures. Limited research, however, addresses positive youth development in these families. Specific family tasks and caregiver constellations in the home may mean that youth in different family structures benefit differently from family management practices.MethodUsing data from 9,131 households with a 12‐ to 17‐year‐old child in the 2011–2012 National Survey of Children's Health, structural equation modeling was used to test whether four family management practices were associated with two positive youth developmental outcomes (flourishing and extracurricular activity participation). Multigroup analyses tested for differences in the associations across family structures.ResultsFamily management practices were generally positively associated with positive youth development. The strength of associations between specific family management practices and positive youth developmental outcomes, however, varied across family structures, suggesting that practices may have differing effectiveness depending on family context.ConclusionUnderstanding mechanisms that promote positive youth developmental outcomes in diverse family structures and how mechanisms may function differently across family contexts can broaden the sophistication of family theories and interventions.

Assessment of Adolescent and Youth Friendly Health Services in Sri Lanka using WHO’s ‘4S’ Framework

Abstract Background The Adolescent and Youth Friendly Health Services (AYFHS) in Sri Lanka (SL) are provided via three service models, viz., hospital-based, field-based and centre-based. This study assessed the implementation status of AYFHS in SL. Methods A panel of experts conducted the review by adopting a participatory approach. Policies and supporting documents were collected from the relevant sectors of the Ministry of Health using electronic and manual search and by visiting institutions/resource persons. The strengths and weaknesses of the AYFHS were identified using the WHO’s ’4S’ Framework consisting strategic information (S1), supportive evidence-informed policies (S2), strengthening services for adolescents (S3) and strengthening collaboration with other sectors (S4). Results While recent development of guidelines, standards and protocols in line with WHO/UNAIDS ’Global Standards for Quality Health-care Services for Adolescents’ was the main strength on S1, gaps in timeliness, completeness and accuracy of the data; and the gaps in effective utilization of sub-national level data addressing area specific problems were the main weaknesses. On S2, SL has a strong, supportive policy environment to promote adolescent health. Lack of coherence in existing health related policies was the main gap. A comprehensive health care package was a strength on S3, while difficulty in reaching the vulnerable groups, curative service oriented service package and underutilization of the health services by adolescents were the weaknesses. On S4, lack of sustained political commitment identifying adolescent health as a priority development issue across multi-stakeholders and their silo mentality to maintain the accountability/ownership of cross-cutting programmatic activities were the weaknesses. Conclusions Despite numerous imposing challenges, with mainstreaming and constructive monitoring, the AYFHS in SL will remain as one of the best adolescent health programmes in the region. Key messages Assessment of Sri Lankan AYFHS according to the WHO’s ’4S’ Framework revealed multiple strengths such as updated guidelines, supportive policy environment and comprehensive care package. Despite numerous imposing challenges, with mainstreaming and constructive monitoring, the AYFHS in SL will remain as one of the best adolescent health programmes in the region.