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Many adolescents must overcome a broad range of barriers to access health information and care and are consequently reluctant to pursue assistance for their health concerns. In this review, we examine from whom and how adolescents seek help (for example, by consulting with friends and family members and by searching for health information using online platforms) and how adolescents treat symptoms without consulting with a clinician by engaging in self-medication. Next, we suggest ways to help adolescents receive accurate health information and access to healthcare through school-based health education programs and health centers. We also discuss how to improve the experience of care for adolescents by collaboratively engaging young patients with their physicians and caregivers using shared decision-making. Finally, we propose developing and posting accurate and engaging multilingual materials on popular online platforms to improve adolescent access to accurate health information and knowledge of how to engage with the healthcare system. Conclusion: The purpose of this review is to examine how adolescents seek, and propose ways to help adolescents access, health information and care despite the many barriers they face. What is Known: • Adolescents encounter a broad range of barriers to access health information and care and turn to family members and friends, and search online, for health information. In addition, adolescents benefit from school-based health education programs and health centers that reduce barriers to healthcare access. What is New: • Adolescents engage in self-medication, including with cannabis use, to treat self-diagnosed illness or symptoms in a potentially harmful manner. • While many adolescents distrust health information shared on social media, recent evidence suggests adolescents are receptive to, and will change some beliefs, in response to health information posted on social media platforms. [ABSTRACT FROM AUTHOR]

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CyberRwanda is a digital health intervention designed to increase knowledge of family planning and reproductive health (FP/RH) and access to youth-friendly services in Rwanda. Sixty schools in eight districts were randomized 1:1:1 to one of two CyberRwanda implementation models—self-service (tablet-only) or facilitated (tablet, activity booklet, peer facilitators)—or to control. Students aged 12–19 years were randomly selected to participate. Baseline and 12-month midline surveys assessed intermediate (secondary) outcomes of FP/RH and HIV knowledge, attitudes/beliefs, self-efficacy, and behavior. Prevalence differences (PDs) were estimated using generalized linear mixed models. There were 5,767 midline participants (51% female, mean/median age: 16 years, 29.9% sexually active). Those in CyberRwanda schools had higher knowledge of emergency contraception (57.3% vs. 47.5%, PD: 0.09, 95% confidence interval [CI]: 0.05–0.13); greater confidence in providing consent (73.3% vs. 68.1%, PD: 0.05, 95% CI: 0.01–0.08), negotiating partner's contraceptive use (88.3% vs. 85.0%, PD: 0.03, 95% CI: 0.01–0.06), and accessing/using contraceptive services (95.6% vs. 91.8%, PD: 0.03, 95% CI: 0.02–0.05); and more favorable views on FP/RH services (54.5% vs. 48.5%, PD: 0.06, 95% CI: 0.02–0.11) and condoms (76.9% vs. 71.3%, PD: 0.06, 95% CI: 0.03–0.08) compared to control. No significant differences in HIV/fertility knowledge, confidence in accessing HIV testing, or condom use were observed. CyberRwanda increased FP/RH knowledge, supportive attitudes/beliefs, self-efficacy, and behavior at 12 months. The 24-month endline analysis will reveal whether CyberRwanda's benefits on intermediate outcomes result in changes to the primary outcomes, including contraception use and childbearing. [ABSTRACT FROM AUTHOR]

Abstract Background This study explored the factors associated with the utilization of Youth-Friendly Sexual Reproductive Health (YFSRH) services among school-going Nigerian adolescents. Methods This cross-sectional study employed a mixed method involving school-going students attending five public secondary schools in Kogi State, Nigeria. Descriptive statistics were used to determine the patterns of utilisation of YFSRH services, whereas inferential statistics were performed to determine factors associated with utilization of YFSRH services. Qualitative data were analysed by thematic analyses of records using an inductive analysis. Results One in two secondary school-going students had used the YFSRH services. Most of the participants had poor awareness of YFSRH services and limited access to YFSRH services. While gender positively predicted the utilisation of YFSRH services among secondary school-going students (aOR = 5.7; 95% CI: 2.4–8.95, p = 0.001), we found that age (aOR = 0.94; 95% CI: 0.67–0.99, p =

Introduction: Adolescent mental health challenges have been identified as a public health concern globally, especially in low- and middle-income countries (LMICs), due to the scarcity of services, where help-seeking is often hampered by social stigma. A strategy to increase the availability of services is to implement, brief, stigma-free, and scalable interventions. The Shamiri Intervention (the Kiswahili word for “thrive”) is an example of a 4-week, group-based intervention which is implemented via 1-hour sessions within high school settings.

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.

COVID-19 threatens hard-won gains in sexual and reproductive health (SRH) through compromising the ability of services to meet needs. Youth are particularly threatened due to existing barriers to their access to services. CHIEDZA is a community-based integrated SRH intervention for youth being trialled in Zimbabwe. CHIEDZA closed in March 2020, in response to national lockdown, and reopened in May 2020, categorised as an essential service. We aimed to understand the impact of CHIEDZA's closure and its reopening, with adaptations to reduce COVID-19 transmission, on provider and youth experiences. Qualitative methods included interviews with service providers (n = 22) and youth (n = 26), and observations of CHIEDZA sites (n = 10) and intervention team meetings (n = 7). Analysis was iterative and inductive. The sudden closure of CHIEDZA impeded youth access to SRH services. The reopening of CHIEDZA was welcomed, but the necessary adaptations impacted the intervention and engagement with it. Adaptations restricted time with healthcare providers, heightening the tension between numbers of youths accessing the service and quality of service provision. The removal of social activities, which had particularly appealed to young men, impacted youth engagement and access to services, particularly for males. This paper demonstrates how a community-based youth-centred SRH intervention has been affected by and adapted to COVID-19. We demonstrate how critical ongoing service provision is, but how adaptations negatively impact service provision and youth engagement. The impact of adaptations additionally emphasises how time with non-judgemental providers, social activities, and integrated services are core components of youth-friendly services, not added extras. [ABSTRACT FROM AUTHOR]

Objectives: Significant variation in cultural and socio-economic factors across different countries means that modification of existing guidelines for youth-friendly health services are needed. Furthermore, including the views and perspectives of young people in developing health services add significant value. The aim of this study was to develop a national guideline for youth-friendly health services using the Delphi method.Methods: We invited young people with chronic conditions, managers of paediatric, psychiatric and relevant adult departments and health care professionals with experience and interest in adolescent medicine to participate. The initial list of elements was constructed based on international guidelines and systematic reviews. The study consisted of three electronic questionnaire rounds assessing relevance, importance and whether the elements were essential/very important, respectively. We used 70% agreement as cut-off.Results: More than 70% of participants agreed that only one element was essential: 'Young people should be actively involved in decisions about their treatment and encouraged and supported to ask questions about their illness and treatment'. Additionally, 18 elements reached more than 70% agreement, when the 'essential' was combined with the 'very important' category. We grouped these 19 elements into five themes: 1) staff competences and workflow, 2) developmentally appropriate communication, 3) focus on youth life, including mental health 4) youth participation and shared decisions, and 5) autonomy and transitional care.Conclusion: This guideline for a youth-friendly health care system may serve as inspiration for concrete changes, both locally and internationally, as it was developed together by young people, staff, and management. [ABSTRACT FROM AUTHOR]

Many adolescents must overcome a broad range of barriers to access health information and care and are consequently reluctant to pursue assistance for their health concerns. In this review, we examine from whom and how adolescents seek help (for example, by consulting with friends and family members and by searching for health information using online platforms) and how adolescents treat symptoms without consulting with a clinician by engaging in self-medication. Next, we suggest ways to help adolescents receive accurate health information and access to healthcare through school-based health education programs and health centers. We also discuss how to improve the experience of care for adolescents by collaboratively engaging young patients with their physicians and caregivers using shared decision-making. Finally, we propose developing and posting accurate and engaging multilingual materials on popular online platforms to improve adolescent access to accurate health information and knowledge of how to engage with the healthcare system., Conclusion: The purpose of this review is to examine how adolescents seek, and propose ways to help adolescents access, health information and care despite the many barriers they face., What Is Known: • Adolescents encounter a broad range of barriers to access health information and care and turn to family members and friends, and search online, for health information. In addition, adolescents benefit from school-based health education programs and health centers that reduce barriers to healthcare access., What Is New: • Adolescents engage in self-medication, including with cannabis use, to treat self-diagnosed illness or symptoms in a potentially harmful manner. • While many adolescents distrust health information shared on social media, recent evidence suggests adolescents are receptive to, and will change some beliefs, in response to health information posted on social media platforms., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

COVID-19 threatens hard-won gains in sexual and reproductive health (SRH) through compromising the ability of services to meet needs. Youth are particularly threatened due to existing barriers to their access to services. CHIEDZA is a community-based integrated SRH intervention for youth being trialled in Zimbabwe. CHIEDZA closed in March 2020, in response to national lockdown, and reopened in May 2020, categorised as an essential service. We aimed to understand the impact of CHIEDZA’s closure and its reopening, with adaptations to reduce COVID-19 transmission, on provider and youth experiences. Qualitative methods included interviews with service providers (n = 22) and youth (n = 26), and observations of CHIEDZA sites (n = 10) and intervention team meetings (n = 7). Analysis was iterative and inductive. The sudden closure of CHIEDZA impeded youth access to SRH services. The reopening of CHIEDZA was welcomed, but the necessary adaptations impacted the intervention and engagement with it. Adaptations restricted time with healthcare providers, heightening the tension between numbers of youths accessing the service and quality of service provision. The removal of social activities, which had particularly appealed to young men, impacted youth engagement and access to services, particularly for males. This paper demonstrates how a community-based youth-centred SRH intervention has been affected by and adapted to COVID-19. We demonstrate how critical ongoing service provision is, but how adaptations negatively impact service provision and youth engagement. The impact of adaptations additionally emphasises how time with non-judgemental providers, social activities, and integrated services are core components of youth-friendly services, not added extras.

Plain Language Summary Making sexual and reproductive (SRH) services easier for youth to access, organizing service delivery in a way that meets youth’s needs, and supporting health care professionals to interact with youth in a friendly manner can make SRH services more youth-friendly. If SRH services are more youth-friendly, more youth may use them. In Jordan, steps have been taken to make SRH services more youth-friendly, but youth still do not believe that providers are supportive of their needs. This study aims to measure physician’s, nurse’s, and midwives’ attitudes towards youth-friendly SRH services in Jordan. We also look at whether certain individual characteristics, such as age, type of service provider, etc. are related to provider attitudes We used a scale that tested in Jordan to measure provider attitudes. The scale focuses on three domains: (1) Attitudes towards SRH information and services offered to youth, (2) Norms and personal beliefs, and (3) Attitudes towards the policy and clinical environment. Possible scores range between 1 and 4, with higher scores reflecting more youth-friendly attitudes. Our sample includes 510 health care providers from four regions in Jordan. We used descriptive statistics and regression analysis to conduct our analysis. Our results show that physicians had more supportive attitudes than nurses or midwives on Subscales 1 and 3. Providers who reported having been trained in SRH issues in the past had higher scores on Subscale 3. No individual characteristics were related to Subscale 2. We find that in Jordan, provider attitudes may reflect deeply rooted cultural norms.

Objectives: LevelMind@JC youth mental wellness hubs have been launched as a novel early intervention initiative to mitigate the inevitable youth mental health problems in Hong Kong in 2019. The present study investigated the perceptions and experiences of these hubs amonst three key stakeholders, namely hub youths, hub carers of youths and hub staff. Method: An online survey assessing the perceptions and experiences of hubs on 6 major domains (e.g., youth‐friendly and nonstigmatizing characteristics) was administered to three stakeholders in December 2020. Seventy‐one hub youths (12–35 years old), 18 hub carers (30–64 years old) and 25 hub staff (24–59 years old) completed the survey. Results: On a 5‐point Likert scale with higher ratings representing better outcomes, all three stakeholders reported above‐average ratings on their overall satisfaction of hub experiences (hub youths: mean = 4.4, SD = 0.6; hub carers: mean = 4, SD = 0.8; hub staff: mean = 3.8, SD = 0.6). In addition, hub youths and hub carers reported above‐average ratings on youth‐friendly and nonstigmatizing characteristics regarding hubs (mean >=4.2). Conclusions: The present findings suggest that the key stakeholders are generally satisfied with and show support to the youth‐friendly, empowering and nonstigmatizing LevelMind @JC hubs. These findings along with the suggestions for hub improvement made by the stakeholders highlight the importance of taking cultural values into consideration whilst planning for mental services. More importantly, clinical implications are also highlighted which give insight for the development and implementation of a scalable, effective, and replicable early community intervention for psychiatric practise pertaining to youth mental health. [ABSTRACT FROM AUTHOR]

Background: In most developing countries, meeting young people’s sexual and reproductive health (SRH) needs remains a problem. Despite policy initiatives and strategic measures aimed at increasing youth utilization of sexual and reproductive health services in Ethiopia, its utilization remains very low. Therefore, this study aimed to assess Ethiopia’s youth-friendly sexual and reproductive health services’ utilisation and determinants. Methods: Scopus, Medline, Google Scholar, and CINAHL databases were searched for articles published until March 2021. The pooled prevalence and effect size of youth-friendly sexual and reproductive health service use and associated factors were estimated using a weighted DerSimonian-laird random effect model. The I2 statistics were used to determine the degree of heterogeneity. The funnel plot and Egger's regression test were used to examine publication bias. Subgroup analyses were performed to reduce underlying heterogeneity. Results: One thousand one hundred and ninety-one articles were generated from various databases, and a final 26 articles were included in the review, including 16246 participants. Ethiopia’s pooled prevalence of youth-friendly sexual and reproductive health service utilization was 42.73 % (95% CI: 35.38–50.09). The findings of this study showed that grade level 11–12, grade level 9–10, close to home sexual and reproductive health services, male sex, and discussion of sexual and reproductive health service with family, friends, and groups, ever experience sexual activity were associated with utilization of youth-friendly sexual and reproductive health services. Maternal educational status secondary school and above, age 15–19 years, age 20–24 years, having ever experienced reproductive problems, living with a partner, living alone, knowing about sexual and reproductive health, having a convenient working hour for youth-friendly service, and participation in a school clubs were also associated with the utilization of youth-friendly sexual and reproductive health services. Conclusion: We found several determinant factors for adolescent and youth utilization of sexual and reproductive health services. The review highlights the importance of improving service usage through youth education and promotion and the scaling up and institutionalizing of youth-friendly services through extensive capacity building.

INTRODUCTION: Youth health outcomes are poor in New Zealand and have a life-long impact on individuals, wha-nau (family) and society. Little is known about how young people view their experiences of general practice care despite it being the most common place to access health care. AIM: This study sought to explore young peoples' experiences of care in a selected, youth-friendly general practice. METHODS: In-depth individual interviews with six young people. RESULTS: Four themes were identified from young peoples' narratives in relation to their experiences of general practice care: going to the doctor is not easy for a young person; the attributes of staff make all the difference; specific youth-friendly consultation practices help young people; and a youth-friendly physical environment can help young people access services and feel safe. DISCUSSION: Even though the study general practice had explicitly instituted youth-friendly initiatives, including offering no-charge consultations and specialist staffmembers, young people still described considerable barriers to attendance. Many barriers are practice-based and could bemodified by staff training, provision of further youth care staff roles and consideration of environmental changes. Other barriers such as waiving prescription costs need government funding. [ABSTRACT FROM AUTHOR]

Background: Youth-friendly sexual and reproductive health (SRH) services are thought to make such services for adolescents more accessible and acceptable; however, provider attitudes may still present an important barrier. Improving youth SRH service utilization has been recognized as a national priority in Jordan; however, existing services remain underutilized. Previous studies found that youth perceive SRH services to be inadequate and that providers are not supportive of their needs. The purpose of this study is measure provider attitudes towards youth-friendly SRH services and explore their variation according to individual characteristics among health care professionals in Jordan. Methods: We measured provider attitudes towards youth-friendly SRH services using a scale that was developed and validated in Jordan. The scale consists of three subscales: (1) Attitudes towards SRH information and services offered to youth, (2) Norms and personal beliefs, and (3) Attitudes towards the policy and clinical environment. Possible scores range between 1 and 4, with higher scores reflecting more youth-friendly attitudes. Physicians, midwives and nurses working at either primary health centers, comprehensive care centers, or women's and children's health centers where services to adolescents are or should be offered were recruited from four governorates in Jordan using a two-stage, cluster sampling scheme. Differences in attitudes were assessed using simple and multivariable linear regression analysis. Results: The sample consisted of 510 providers from four governorates in Jordan. The mean provider score on the full scale was 2.7, with a range of 2.0 to 3.8. On Subscales 1 and 2, physicians exhibited significantly more youth-friendly attitudes than nurses by scoring 0.17 points higher than nurses on Subscale 1 (95% CI: 0.02–0.32; p < 0.05) in adjusted analyses. Providers who had been previously trained in SRH issues scored 0.10 points higher (95% CI: 0.00—0.20; p < 0.05) than those who had not on Subscale 3. No differences were found according to provider characteristics on Subscale 2. Providers exhibited the lowest scores related to items referencing youth sexual behavior. Conclusions: Provider attitudes towards youth-friendly SRH service delivery highlight context-specific, cultural concerns. The limited variation in attitudes related to norms and personal beliefs may be a reflection that such beliefs are deeply held across Jordanian society. Last, as past training on SRH was significantly associated with higher scores, our results suggest opportunity for intervention to improve providers' confidence and knowledge. Plain Language Summary: Making sexual and reproductive (SRH) services easier for youth to access, organizing service delivery in a way that meets youth's needs, and supporting health care professionals to interact with youth in a friendly manner can make SRH services more youth-friendly. If SRH services are more youth-friendly, more youth may use them. In Jordan, steps have been taken to make SRH services more youth-friendly, but youth still do not believe that providers are supportive of their needs. This study aims to measure physician's, nurse's, and midwives' attitudes towards youth-friendly SRH services in Jordan. We also look at whether certain individual characteristics, such as age, type of service provider, etc. are related to provider attitudes We used a scale that tested in Jordan to measure provider attitudes. The scale focuses on three domains: (1) Attitudes towards SRH information and services offered to youth, (2) Norms and personal beliefs, and (3) Attitudes towards the policy and clinical environment. Possible scores range between 1 and 4, with higher scores reflecting more youth-friendly attitudes. Our sample includes 510 health care providers from four regions in Jordan. We used descriptive statistics and regression analysis to conduct our analysis. Our results show that physicians had more supportive attitudes than nurses or midwives on Subscales 1 and 3. Providers who reported having been trained in SRH issues in the past had higher scores on Subscale 3. No individual characteristics were related to Subscale 2. We find that in Jordan, provider attitudes may reflect deeply rooted cultural norms. [ABSTRACT FROM AUTHOR]

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.

Abstract Background Adolescents in South Africa remain vulnerable to HIV. Therefore, it is crucial to provide accessible adolescent-friendly HIV prevention interventions that are sensitive to their needs. This study aimed to investigate the perceptions of HIV counsellors and other youth-serving professionals about the barriers to providing adolescent youth-friendly sexual and reproductive health services to adolescents in Soweto, South Africa. The study also explored how sexual and reproductive health services in South Africa could be improved to become more accessible to adolescents. Methods The research team conducted two focus group discussions with HIV counsellors, and 19 semi-structured interviews with youth-serving professionals from organisations working with adolescents. Audio-recorded data were transcribed verbatim and analysed using thematic analysis. Results The results of the study reveal that counsellors were expected to give adolescents HIV counselling and testing (HCT) but felt restricted by what they perceived as inflexible standard operating procedures. Counsellors reported inadequate training to address adolescent psychosocial issues during HCT. Healthcare provider attitudes were perceived as a barrier to adolescents using sexual and reproductive health services. Participants strongly recommended augmenting adolescent sexual and reproductive health services to include counsellors and adolescents in developing age- and context-specific HIV prevention services for adolescents. Conclusion Continuous upskilling of HIV counsellors is a critical step in providing adolescent-friendly services. Input from all relevant stakeholders, including counsellors and adolescents, is essential in designing adolescent-friendly services.

The health needs of adolescents and young adults (AYAs) have been neglected in tuberculosis (TB) care, control, and research. AYAs, who are distinct from younger children and older adults, undergo dynamic physical, psychological, emotional, cognitive, and social development. Five domains of adolescent well-being are crucial to a successful transition between childhood and adulthood: (1) Good health; (2) connectedness and contribution to society; (3) safety and a supportive environment; (4) learning, competence, education, skills, and employability; and (5) agency and resilience. This review summarizes the evidence of the impact of TB disease and treatment on these five domains of AYA well-being.

Meaning of place is usually approached as slow social cognitive construction. However, grounded on the theory of affordances, it may also stem from direct perception-action processes, which enable the formation of immediate perceived functional, social or symbolic meaning of place (Raymond et al., 2017b). In the present study, affordances of places, which are perceived by a specific perceiver in a specific place, were mapped using a web-map survey. Each place offers opportunities for interaction, behavior, use, feeling or meaning, which is directly perceived and actualized there. This paper aims at identifying the degree of youth-friendliness of urban neighborhoods using the hypothetical intertwined model of independent mobility and actualized affordances (Kyttä, 2004) combined with place use and meaning (Broberg et al., 2013a). SoftGISchildren methodology (Broberg et al., 2013a) was adopted to carry out a cross-sectional research, involving 145 sixth to ninth graders of the Great Lisbon area. SoftGIS integrates Public Participation Geographic Information Systems (PPGIS), enabling collection and place mapping of daily subjective environmental experiences in the physical environment, consequently allowing for individuals to be actively engaged in public processes of participation (Brown and Kyttä, 2014). A place based web survey called “Ideal City: a game of graphic imagination” was adopted. Participants were asked to map their home place, select and mark social, functional, leisure and emotional place transactions, and report actual and ideal mobility to these places. Findings on mobility showed that shorter distances to meaningful affordances of places promote active and independent travel; ideally, youths would like to be more frequently active and more frequently autonomous. As for meaningful places, a total of 1632 affordances were localized, with a higher number on social category. Neighborhood area (500 m around home place) was assessed as youth-friendly, where active and independent travel occurred more frequently, and social affordances were the most expressive type. Relational and affectional experience in the neighborhood places was meaningful for youth. Municipalities should consider these features when planning, designing and managing residential areas aiming for the well-being and health of young citizens; and include youths as specialists of space (spatialists) in planning participatory processes (PPGIS).

Meaning of place is usually approached as slow social cognitive construction. However, grounded on the theory of affordances, it may also stem from direct perception-action processes, which enable the formation of immediate perceived functional, social or symbolic meaning of place (Raymond et al., 2017b). In the present study, affordances of places, which are perceived by a specific perceiver in a specific place, were mapped using a web-map survey. Each place offers opportunities for interaction, behavior, use, feeling or meaning, which is directly perceived and actualized there. This paper aims at identifying the degree of youth-friendliness of urban neighborhoods using the hypothetical intertwined model of independent mobility and actualized affordances (Kyttä, 2004) combined with place use and meaning (Broberg et al., 2013a). SoftGISchildren methodology (Broberg et al., 2013a) was adopted to carry out a cross-sectional research, involving 145 sixth to ninth graders of the Great Lisbon area. SoftGIS integrates Public Participation Geographic Information Systems (PPGIS), enabling collection and place mapping of daily subjective environmental experiences in the physical environment, consequently allowing for individuals to be actively engaged in public processes of participation (Brown and Kyttä, 2014). A place based web survey called "Ideal City: a game of graphic imagination" was adopted. Participants were asked to map their home place, select and mark social, functional, leisure and emotional place transactions, and report actual and ideal mobility to these places. Findings on mobility showed that shorter distances to meaningful affordances of places promote active and independent travel; ideally, youths would like to be more frequently active and more frequently autonomous. As for meaningful places, a total of 1632 affordances were localized, with a higher number on social category. Neighborhood area (500 m around home place) was assessed as youth-friendly, where active and independent travel occurred more frequently, and social affordances were the most expressive type. Relational and affectional experience in the neighborhood places was meaningful for youth. Municipalities should consider these features when planning, designing and managing residential areas aiming for the well-being and health of young citizens; and include youths as specialists of space (spatialists) in planning participatory processes (PPGIS). [ABSTRACT FROM AUTHOR]

Background: This study explored the factors associated with the utilization of Youth-Friendly Sexual Reproductive Health (YFSRH) services among school-going Nigerian adolescents., Methods: This cross-sectional study employed a mixed method involving school-going students attending five public secondary schools in Kogi State, Nigeria. Descriptive statistics were used to determine the patterns of utilisation of YFSRH services, whereas inferential statistics were performed to determine factors associated with utilization of YFSRH services. Qualitative data were analysed by thematic analyses of records using an inductive analysis., Results: One in two secondary school-going students had used the YFSRH services. Most of the participants had poor awareness of YFSRH services and limited access to YFSRH services. While gender positively predicted the utilisation of YFSRH services among secondary school-going students (aOR = 5.7; 95% CI: 2.4-8.95, p = 0.001), we found that age (aOR = 0.94; 95% CI: 0.67-0.99, p = < 0.001), and religious beliefs (aOR = 0.84; 95% CI: 0.77-0.93, p = 0.001) showed a negative relationship with the utilization of YFSRH services., Conclusions: Our findings highlight the influence of gender, age, and religion on utilizing YFSRH services. This study recommends the inclusion of sexuality education into secondary school-going student's curricula, in order to create awareness about the benefit of utilization of sexual and reproductive health services, and this is to encourage young people to utilize the YFSRH services., (© 2023. The Author(s).)

Purpose To describe adolescents as a vulnerable population with unique healthcare needs, especially in relation to their sexual risk-taking behaviors; and to explicate the necessity of nurse practitioners (NPs) advocating for youth-friendly services and policies to meet adolescents' sexual and reproductive healthcare needs. Data sources CINAHL, Medline, PsychInfo, and PsychArticle databases were searched to identify theoretical and empirical literature regarding adolescence, vulnerability, sexual health outcomes, barriers to accessing reproductive health services, what it means to be youth friendly, and health advocacy to meet the health needs of adolescents. Conclusions Adolescents' health needs may not be fully met in traditional healthcare settings. Lack of access to youth-friendly sexual and reproductive health services increases adolescents' risks for poor health outcomes including sexually transmitted disease and unplanned pregnancy. Clinic, state, and national policies can create barriers for adolescents in obtaining sexual health services. Implications for practice NPs are philosophically and educationally prepared to be leaders in improving adolescent health outcomes. NPs can directly provide youth-friendly care as well as advocate for youth-friendly practices within their health system. In addition, NPs are well positioned to be leaders in advocating for state and national policies that improve adolescents' access to appropriate sexual and reproductive health care. [ABSTRACT FROM AUTHOR]

Background: Youth-friendly sexual and reproductive health (YFSRH) services for young people have high priority in many countries. Yet, little is known about the actual cost of delivering YFSRH services. This article analyses costs of a fully scaled up national youth clinic network (YCN) in Estonia. It reports; 1) total budget of the YCN during the period 2002 - 2012, and 2) annual clinic level costs of three youth clinics (YCs) in 2012. Methods: The retrospective cost analysis is based on financial and medical records of Estonian Health Insurance Fund (EHIF), Estonian Sexual Health Association (ESHA), National Institute for Health Development and the YCs. The programme level costs are analysed per year, financing source and a portion spent on coordination in 2002 - 2012. Costs of three YCs are analysed per clinic, expense category, patient and healthcare service in 2012. Results: The total budget of the YCN was € 8.38 million and it served 304,000 young patients in 2002 - 2012. 95% of the total budget was financed by the EHIF. 3.6% was spent on coordination. The YCs in Tallinn, Tartu and Ida-Virumaa had annual budgets of € 247,000, € 267,000 and € 42,000 respectively. In 2012 the three YCs provided YFSRH services to 19,700 patients, excluding sexuality education lessons and internet counselling. The YFSRH services cost € 543,000. Consequently, the average cost per patient was € 27.76. The largest expense categories were personnel salaries 35% and medical supplies 33%. Cost of the YFSRH services were; STI consultation € 54.80, SRH counselling € 13.13, contraception consultation € 9.32, internet counselling € 8.21 and sexuality education lesson € 1.52. Conclusions: The Estonian YCN is a positive example for other countries considering or already implementing similar programmes. The cost analyses highlighted the following: Sustainable funding is particularly important, without it the YFSRH services would not have been scaled up and sustained on the national level in Estonia. Investment in professional coordination of the YFSRH services is recommended, and it does not necessarily have to be expensive. Only 3.6% of the total budget of YCN was used for ESHA coordination, which is a small portion especially when taking into account ESHA’s substantial contributions to development, training, quality improvements and representation of the YCN. [ABSTRACT FROM AUTHOR]

Background A growing number of middle-income countries are scaling up youth-friendly sexual and reproductive health pilot projects to national level programmes. Yet, there are few case studies on successful national level scale-up of such programmes. Estonia is an excellent example of scale-up of a small grassroots adolescent sexual and reproductive health initiative to a national programme, which most likely contributed to improved adolescent sexual and reproductive health outcomes. This study; 1) documents the scale-up process of the Estonian youth clinic network 1991-2013, and 2) analyses factors that contributed to the successful scale-up. This research provides policy makers and programme managers with new insights to success factors of the scale-up, that can be used to support planning, implementation and scale-up of adolescent sexual and reproductive health programmes in other countries. Methods Information on the scale-up process and success factors were collected by conducting a literature review and interviewing key stakeholders. The findings were analysed using the WHO-ExpandNet framework, which provides a step-by-step process approach for design, implementation and assessment of the results of scaling-up health innovations. Results The scale-up was divided into two main phases: 1) planning the scale-up strategy 1991-1995 and 2) managing the scaling-up 1996-2013. The planning phase analysed innovation, user organizations (youth clinics), environment and resource team (a national NGO and international assistance). The managing phase examines strategic choices, advocacy, organization, resource mobilization, monitoring and evaluation, strategic planning and management of the scale-up. Conclusions The main factors that contributed to the successful scale-up in Estonia were: 1) favourable social and political climate, 2) clear demonstrated need for the adolescent services, 3) a national professional organization that advocated, coordinated and represented the youth clinics, 4) enthusiasm and dedication of personnel, 5) acceptance by user organizations and 6) sustainable funding through the national health insurance system. Finally, the measurement and recognition of the remarkable improvement of adolescent SRH outcomes in Estonia would not have been possible without development of good reporting and monitoring systems, and many studies and international publications. [ABSTRACT FROM AUTHOR]

Background: Youth-friendly sexual and reproductive health services (YFHS) have high priority in many countries. Yet, little is known about the cost and cost-effectiveness of good quality YFHS in resource limited settings. This paper analyses retrospectively costs and potential cost-effectiveness of four well performing youth-friendly health centres (YFHC) in Moldova. This study assesses: (1) what were the costs of YFHSs at centre level, (2) how much would scaling-up to a national good quality YFHS programme cost, and (3) was the programme potentially cost-effective? Methods: Four well performing YFHCs were selected for the study. YFHS costs were analysed per centre, funding source, service and person reached. The costing results were extrapolated to estimate cost of a good quality national YFHS programme in Moldova. A threshold analysis was carried out to estimate the required impact level for the YFHSs to break-even (become cost saving). Results: Average annual cost of a well performing YFHC was USD 26,000 in 2011. 58% was financed by the National Health Insurance Company and the rest by external donors (42%). Personnel salaries were the largest expense category (47%). The annual implementation costs of a good quality YFHSs in all 38 YFHCs of Moldova were estimated to be USD 1.0 million. The results of the threshold analysis indicate that the annual break-even impact points in a YFHC for: 1) STI services would be >364 averted STIs, 2) early pregnancy and contraceptive services >178 averted unwanted pregnancies, and 3) HIV services only >0.65 averted new HIV infections. Conclusions: The costing results highlight the following: 1) significant additional resources would be required for implementation of a good quality national YFHS programme, 2) the four well performing YFHCs rely heavily on external funding (42%), 3) which raises questions about financial sustainability of the programme. At the same time results of the threshold analysis are encouraging. The result suggest that, together the three SRH components (STI, early pregnancy and contraception, and HIV) are potentially cost saving. High cost savings resulting from averted lifetime treatment cost of HIV infected persons are likely to off-set the costs of STIs and unwanted pregnancies. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To review the literature on young people's perspectives on health care with a view to defining domains and indicators of youth-friendly care. Methods: Three bibliographic databases were searched to identify studies that purportedly measured young people's perspectives on health care. Each study was assessed to identify the constructs, domains, and indicators of adolescent-friendly health care. Results: Twenty-two studies were identified: 15 used quantitative methods, six used qualitative methods and one used mixed methodology. Eight domains stood out as central to young people's positive experience of care. These were: accessibility of health care; staff attitude; communication; medical competency; guideline-driven care; age appropriate environments; youth involvement in health care; and health outcomes. Staff attitudes, which included notions of respect and friendliness, appeared universally applicable, whereas other domains, such as an appropriate environment including cleanliness, were more specific to particular contexts. Conclusion: These eight domains provide a practical framework for assessing how well services are engaging young people. Measures of youth-friendly health care should address universally applicable indicators of youth-friendly care and may benefit from additional questions that are specific to the local health setting. [Copyright &y& Elsevier]

Aim. To examine how satisfied young people with depression are with the quality of care they receive from clinicians of a primary care service for young people with mental health problems. Background. There is a high prevalence of youth depression, but few studies have been undertaken to examine whether young people are satisfied with the care they receive in primary care youth mental health services. Design. Qualitative interpretative phenomenological analysis. Method. Individual, semi-structured, in-depth, audio-recorded interviews were carried out between March and September 2009. A purposive sample of 26 young people with depression, average age 18 years, were recruited through clinicians of a primary care service for young people with mental health problems, in Melbourne. Results. Three overlapping themes highlight youth participants' satisfaction with care: First, clinicians being youth-friendly, highlights how, overall, clinicians are perceived as approachable and supportive, understanding and non-judgemental. Second, clinicians adopting a broad-based style of care illustrates that their use primarily of psychosocial therapies, and the judicious use of antidepressant medication, is received favourably by youth. Third, care facilitating recovery highlights that clinicians' youth-friendly and broad-based approach enables a therapeutic dialogue to be established with the young people, contributing to recovery from depression; recovery, in turn, enhances satisfaction with clinicians. Conclusion. Youth-friendliness is an important expectation of mental health nurses and other clinicians within the youth service. This engagement style provides a useful framework for clinicians to adopt a broad-based approach to care. Ultimately, care should facilitate recovery from depression, and this strengthens satisfaction with mental health nurses and other clinicians. Relevance to clinical practice. The findings make an important contribution to knowledge and research in mental health nursing. In particular, youth-friendliness is an important prerequisite for continuing engagement with services, and a broad-based approach to care should be adopted. [ABSTRACT FROM AUTHOR]

Background: Meeting the medical and sexual health care needs of young people is crucial for sustainable development. In Uganda, youth are faced with a number of challenges related to accessing medical care and sexual health counselling services. This study sought to investigate the barriers faced by Ugandan university students in seeking medical care and sexual health counselling. Methods: This study is part of a cross-sectional survey conducted in 2005 among 980 students at Mbarara University of Science and Technology. Data was collected by means of a self-administered 11-page questionnaire. The barriers encountered by respondents in seeking medical care and sexual health counselling were classified into three categories reflecting the acceptability, accessibility, or availability of services. Results: Two out of five students reported unmet medical care needs, and one out of five reported unmet sexual health counselling needs. Acceptability of services was the main barrier faced by students for seeking medical care (70.4%) as well as for student in need of sexual health counselling (72.2%), regardless of age, gender, self-rated health, and rural/peri-urban or urban residence status. However, barriers differed within the various strata. There was a significant difference (p-value 0.01) in barriers faced by students originally from rural versus peri-urban/urban areas in seeking medical care (acceptability: 64.8%/74.5%, accessibility: 22.0% /12.6%, availability 13.2%/12.9%, respectively). Students who reported poor self-rated health encountered barriers in seeking both medical care and sexual health counselling that were significantly different from their other counterparts (p-value 0.001 and 0.007 respectively). Conclusions: Barriers faced by students in seeking medical and sexual health care should be reduced by interventions aimed at boosting confidence in health care services, encouraging young people to seek early treatment, and increasing awareness of where they can turn for services. The availability of medical services should be increased and waiting times and cost reduced for vulnerable groups. [ABSTRACT FROM AUTHOR]

Summary: Ambulatory pediatric and family medicine takes care of adolescent patients, most of whom regularly consult a physician. Consultations with young people involve issues specifically related to their age. Regarding health care systems and physicians, adolescents’ expectations vary from those of adults, not so much in terms of the issues discussed but in terms of the priorities that they give to them. Confidential interviews are not always proposed but are highly appreciated, as are certain personal qualities on the part of the caregivers such as honesty, respect, and friendliness. Finally, easy access to care together with the continuity of care are essential. Prevention of risk behaviors by screening and health education is clearly insufficient. This issue could be approached during the consultation through a psychosocial history. This is a good opportunity to discuss sensitive issues that adolescents seldom bring up themselves. More systematic prevention would probably decrease youth morbidity and mortality, which are both closely related to risk behaviors. To meet these expectations and special health care needs, the World Health Organization has developed the concept of youth-friendly health services. This concept can be applied in both a specialized adolescence center and a pediatric or family practice. Youth-friendly services are still rarely evaluated but seem to bring a clear benefit in terms of patient satisfaction and access to care. [Copyright &y& Elsevier]

The health needs of adolescents and young adults (AYAs) have been neglected in tuberculosis (TB) care, control, and research. AYAs, who are distinct from younger children and older adults, undergo dynamic physical, psychological, emotional, cognitive, and social development. Five domains of adolescent well-being are crucial to a successful transition between childhood and adulthood: (1) Good health; (2) connectedness and contribution to society; (3) safety and a supportive environment; (4) learning, competence, education, skills, and employability; and (5) agency and resilience. This review summarizes the evidence of the impact of TB disease and treatment on these five domains of AYA well-being. [ABSTRACT FROM AUTHOR]

Abstract Background Meeting the medical and sexual health care needs of young people is crucial for sustainable development. In Uganda, youth are faced with a number of challenges related to accessing medical care and sexual health counselling services. This study sought to investigate the barriers faced by Ugandan university students in seeking medical care and sexual health counselling. Methods This study is part of a cross-sectional survey conducted in 2005 among 980 students at Mbarara University of Science and Technology. Data was collected by means of a self-administered 11-page questionnaire. The barriers encountered by respondents in seeking medical care and sexual health counselling were classified into three categories reflecting the acceptability, accessibility, or availability of services. Results Two out of five students reported unmet medical care needs, and one out of five reported unmet sexual health counselling needs. Acceptability of services was the main barrier faced by students for seeking medical care (70.4%) as well as for student in need of sexual health counselling (72.2%), regardless of age, gender, self-rated health, and rural/peri-urban or urban residence status. However, barriers differed within the various strata. There was a significant difference (p-value 0.01) in barriers faced by students originally from rural versus peri-urban/urban areas in seeking medical care (acceptability: 64.8%/74.5%, accessibility: 22.0% /12.6%, availability 13.2%/12.9%, respectively). Students who reported poor self-rated health encountered barriers in seeking both medical care and sexual health counselling that were significantly different from their other counterparts (p-value 0.001 and 0.007 respectively). Conclusions Barriers faced by students in seeking medical and sexual health care should be reduced by interventions aimed at boosting confidence in health care services, encouraging young people to seek early treatment, and increasing awareness of where they can turn for services. The availability of medical services should be increased and waiting times and cost reduced for vulnerable groups.

Background: In most developing countries, meeting young people's sexual and reproductive health (SRH) needs remains a problem. Despite policy initiatives and strategic measures aimed at increasing youth utilization of sexual and reproductive health services in Ethiopia, its utilization remains very low. Therefore, this study aimed to assess Ethiopia's youth-friendly sexual and reproductive health services' utilisation and determinants., Methods: Scopus, Medline, Google Scholar, and CINAHL databases were searched for articles published until March 2021. The pooled prevalence and effect size of youth-friendly sexual and reproductive health service use and associated factors were estimated using a weighted DerSimonian-laird random effect model. The I 2 statistics were used to determine the degree of heterogeneity. The funnel plot and Egger's regression test were used to examine publication bias. Subgroup analyses were performed to reduce underlying heterogeneity., Results: One thousand one hundred and ninety-one articles were generated from various databases, and a final 26 articles were included in the review, including 16246 participants. Ethiopia's pooled prevalence of youth-friendly sexual and reproductive health service utilization was 42.73 % (95% CI: 35.38-50.09). The findings of this study showed that grade level 11-12, grade level 9-10, close to home sexual and reproductive health services, male sex, and discussion of sexual and reproductive health service with family, friends, and groups, ever experience sexual activity were associated with utilization of youth-friendly sexual and reproductive health services. Maternal educational status secondary school and above, age 15-19 years, age 20-24 years, having ever experienced reproductive problems, living with a partner, living alone, knowing about sexual and reproductive health, having a convenient working hour for youth-friendly service, and participation in a school clubs were also associated with the utilization of youth-friendly sexual and reproductive health services., Conclusion: We found several determinant factors for adolescent and youth utilization of sexual and reproductive health services. The review highlights the importance of improving service usage through youth education and promotion and the scaling up and institutionalizing of youth-friendly services through extensive capacity building., Competing Interests: The authors declare no conflict of interest., (© 2021 The Authors.)

Objectives: Significant variation in cultural and socio-economic factors across different countries means that modification of existing guidelines for youth-friendly health services are needed. Furthermore, including the views and perspectives of young people in developing health services add significant value. The aim of this study was to develop a national guideline for youth-friendly health services using the Delphi method., Methods: We invited young people with chronic conditions, managers of paediatric, psychiatric and relevant adult departments and health care professionals with experience and interest in adolescent medicine to participate. The initial list of elements was constructed based on international guidelines and systematic reviews. The study consisted of three electronic questionnaire rounds assessing relevance, importance and whether the elements were essential/very important, respectively. We used 70% agreement as cut-off., Results: More than 70% of participants agreed that only one element was essential: 'Young people should be actively involved in decisions about their treatment and encouraged and supported to ask questions about their illness and treatment'. Additionally, 18 elements reached more than 70% agreement, when the 'essential' was combined with the 'very important' category. We grouped these 19 elements into five themes: 1) staff competences and workflow, 2) developmentally appropriate communication, 3) focus on youth life, including mental health 4) youth participation and shared decisions, and 5) autonomy and transitional care., Conclusion: This guideline for a youth-friendly health care system may serve as inspiration for concrete changes, both locally and internationally, as it was developed together by young people, staff, and management., (© 2020 Walter de Gruyter GmbH, Berlin/Boston.)

Objective: To evaluate the effects of implementing the Adolescent Champion model, a novel quality improvement program targeted at helping primary care sites become more adolescent-centered.Study Design: Nine primary care sites from pediatrics, family medicine, and medicine-pediatrics implemented the Adolescent Champion model. Each site identified a multidisciplinary champion team to undergo training on adolescent-centered care, deliver prepackaged trainings to other staff and providers, make youth-friendly site changes, implement a standardized flow to confidentially screen for risky behaviors, and complete a quality improvement project regarding confidentiality practices. Adolescent patients, staff, and providers were surveyed at baseline, year-end, and 1-year follow-up to assess changes.Results: Adolescent patients' experiences with both their provider and the site overall significantly improved (P values from <.0001 to .004, N = 474 baseline, 386 year-end). Staff perceived an improvement in clinic practices relating to adolescents and in their ability to make institutional and personal change (P < .0001, N = 121 baseline, 109 year-end). The majority of changes were sustained 1-year postintervention. Frequently noted site improvements included: (1) initiating a method to gather feedback from adolescent patients; (2) adding trainings on confidentiality, cultural humility, and using a nonjudgmental approach; (3) updating immunizations at every visit; and (4) training providers in long acting reversible contraception via implant training.Conclusions: Implementing the Adolescent Champion model successfully helped primary care sites become more adolescent-centered. Further studies are needed to evaluate the effects of this model on patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Adolescents in South Africa remain vulnerable to HIV. Therefore, it is crucial to provide accessible adolescent-friendly HIV prevention interventions that are sensitive to their needs. This study aimed to investigate the perceptions of HIV counsellors and other youth-serving professionals about the barriers to providing adolescent youth-friendly sexual and reproductive health services to adolescents in Soweto, South Africa. The study also explored how sexual and reproductive health services in South Africa could be improved to become more accessible to adolescents., Methods: The research team conducted two focus group discussions with HIV counsellors, and 19 semi-structured interviews with youth-serving professionals from organisations working with adolescents. Audio-recorded data were transcribed verbatim and analysed using thematic analysis., Results: The results of the study reveal that counsellors were expected to give adolescents HIV counselling and testing (HCT) but felt restricted by what they perceived as inflexible standard operating procedures. Counsellors reported inadequate training to address adolescent psychosocial issues during HCT. Healthcare provider attitudes were perceived as a barrier to adolescents using sexual and reproductive health services. Participants strongly recommended augmenting adolescent sexual and reproductive health services to include counsellors and adolescents in developing age- and context-specific HIV prevention services for adolescents., Conclusion: Continuous upskilling of HIV counsellors is a critical step in providing adolescent-friendly services. Input from all relevant stakeholders, including counsellors and adolescents, is essential in designing adolescent-friendly services.