The contribution of interagency collaboration to the promotion of young people's sexual health

This paper employs a case study approach in order to examinethe contribution of interagency working to the delivery of educationand services in the difficult field of young people's sexualhealth. It reports on a collaborative UK initiative involvingteachers, community health practitioners, health promotion staff,and youth and community workers. The provision included school-basedsex education, drop-in advice and information facilities, ‘detached’street work, and a young person's clinic. A qualitative studywas completed involving detailed interviews with 25 staff fromthe different agencies involved. The findings suggest that interagencycollaboration can enhance the work of each organization, andcan achieve a comprehensive response to young people's sexualhealth needs by making positive use of the distinctive roles,skills, knowledge and approaches of the different agencies.The potential that such a collaboration will have a significantimpact on young people's sexual health is discussed.     

The experience of young people with contraceptive consultations and health care workers

In the United Kingdom, services for contraceptive consultation and family planning were first opened in the 1960s. Early and relevant information to adolescents is of importance. The aim of this paper was to examine young people's attitudes towards and experiences of consultations with health care providers about contraception, taking account of the context of their contraceptive use. Young people aged 16-21 years were recruited to the study from health services (young people's contraceptive and sexual health clinics and a termination of pregnancy clinic), secondary schools and community projects (a youth club, a young mothers' support group, a community education project and a young women offenders unit). As part of the needs' assessment, in-depth interviews and focus groups were conducted. Thirty-two young male and females were interviewed. Knowledge about contraception, sexually transmitted infections and the risk of pregnancy was often high. Many respondents noted that in a five to ten minute consultation there was not the time to discuss personal factors that may affect contraceptive decision making and effective use of methods. Many described a feeling of being rushed through the service and did not feel they had the opportunity to ask questions. What young people said they wanted from consultations with health care workers and their experiences of the consultation process often conflicted. They wanted the time and opportunity to discuss their options. Often the young men, who were accessing services, described how initially they had gone in to collect condoms, but once they knew the clinic and staff would consider making an appointment. It is concluded that young people want to be given choices and information regarding contraception that fit their lifestyles. Improving the structures of contraceptive and sexual health services for young people will help to remove some of the barriers that prevent some young people from accessing them. However, it is just as important that barriers in the service delivery are tackled to ensure young people receive effective contraceptive advice.     

Promising outreach practices: enrolling low-income children in health insurance programs in California

Strategies used by outreach workers to successfully enroll underserved and uninsured California children into low cost health insurance programs such as MediCal and Healthy Families are examined. Outreach workers are particularly effective in enrolling and retaining hard to reach populations, especially immigrant families, in health programs. Skilled in grassroots communications and members of the communities they serve, outreach workers are key to building viral community support. Effective outreach depends on the selection of outreach workers with appropriate personal characteristics and then training them in a number of core competencies. This article analyzes the main avenues used by outreach workers within the First Things First demonstration project: person-to-person contact, utilization of existing of institutions, and public communication strategies. Structural and systemic barriers remain to enrolling children in public health insurance programs that exceed the scope of outreach workers. Thus, effective outreach programs should address both structural issues and staff selection and training.     

Access to primary health care for Australian adolescents: How congruent are the perspectives of health service providers and young people,and does it matter?

OBJECTIVE: To explore the extent of congruence between the views of service providers and young people (on adolescents' health concerns, barriers to accessing health services and ideal service model) in order to improve and increase the appropriateness, quality and usage of primary health care services. METHODS: A qualitative data collection technique was used. During 2001/02, focus groups were conducted in urban and rural locations with adolescents (in and out of mainstream education), general practitioners, community health staff and youth health workers. RESULTS: Service providers and young people identified a similar range of health concerns for young people, with young people adding additional issues of great importance to them that service providers felt were not in their 'domain of treatment'. There was reasonable congruence in regard to 'ideal service model' with some differences relating to methods of information delivery. However, for 'barriers to accessing services' there were major discrepancies. CONCLUSIONS: While there is some common understanding between young people and service providers on certain aspects of health services, there are clearly areas where perceptions differ. This discrepancy matters because it may adversely affect the quality of provider-adolescent interaction and the willingness of adolescents to access services. IMPLICATIONS: To deliver optimal health services to young people, the differences in understanding regarding services need to be addressed. Strategies could include promotion to, and encouragement of, young people to seek help, continuing professional education of providers and changes in remuneration policies.     

An innovative method to involve community health workers as partners in evaluation research

Objectives. We developed a process through which community outreach workers, whose role is not typically that of a trained researcher, could actively participate in collection of qualitative evaluation data.Methods. Outreach workers for a community-based intervention project received training in qualitative research methodology and certification in research ethics. They used a Voice over Internet Protocol phone-in system to provide narrative reports about challenges faced by women they encountered in their outreach activities as well as their own experiences as outreach workers.Results. Qualitative data contributed by outreach workers provided insights not otherwise available to the evaluation team, including details about the complex lives of underserved women at risk for poor pregnancy outcomes and the challenges and rewards of the outreach worker role.Conclusions. Lay health workers can be a valuable asset as part of a research team. Training in research ethics and methods can be tailored to their educational level and preferences, and their insights provide important information and perspectives that may not be accessible via other data collection methods. Challenges encountered in the dual roles of researcher and lay health worker can be addressed in training.Lay health workers are an increasingly important component of many community-based public health intervention efforts. Systematic literature reviews summarize evidence for the effectiveness of lay health workers in improving health access and outcomes with respect to a wide variety of health concerns, including childhood immunization, breastfeeding, infant and child mortality, and pulmonary tuberculosis.^1,2Community outreach workers are lay health workers who typically have close ties to the communities they serve and establish trusting relationships with clients and study participants. These qualities not only account for outreach workers’ effectiveness in connecting with hard-to-reach populations but also make them valuable partners in program evaluation because of the depth of their knowledge and insights into community members’ complex lives, including impediments to and facilitators of healthy living and full access to care and services.³ However, there are few examples in the literature of the community and client-focused knowledge held by outreach workers being systematically documented and integrated into research or program evaluations. We describe how one program used Internet-based technology and qualitative methods to enhance the participation of community outreach workers as community-based researchers in the evaluation of a public health intervention.     

年轻女性务工人员生殖健康状况分析

目的:了解工厂里年轻女性(流动人口)生殖健康的现况及影响因素,为年轻女性的生殖健康保健提供参考依据。方法:采用社会学领域的定性研究方法,对工厂里年轻女性进行了个人深入访谈;对工厂管理者、卫生服务提供者及决策者进行了关键人物访谈。结果:年轻女工普遍缺乏避孕知识、性保健知识;未婚先孕、人工流产是主要的健康问题;到私立医院就诊,就诊费用高、时间紧、生殖健康知识缺乏是影响生殖健康服务利用的主要因素。结论:年轻女性务工人员是生殖健康保健的弱势人群,政府和企业应将生殖保健政策更倾向于女性务工人员,开展行之有效的措施及健康宣传,以提高生殖健康服务的利用。     

Minding the gap: health and social care provider perceptions of parental communication and Black-Canadian youths’ sexual health

Abstract

Health and social care providers’ perceptions of Black-Canadian parent-youth sexual health communication has important implications for addressing knowledge gaps in the provision of services to young people and their parents. Providers’ perceptions are crucial as they often act as advisers in tailoring programmes or services to the perceived needs of parents and youth. To understand these perceptions, 17 semi-structured in-depth interviews were conducted with providers who worked with African, Caribbean or Black (ACB) parents and youth in Toronto, Ontario, Canada. Critical Race Theory was used to help guide the interpretation of findings. The findings revealed providers believed that many parents were unlikely to explicitly discuss sexual health or HIV prevention with young people. Additionally, providers perceived that the content of and approach to parent-youth sexual health communication differed between African and Caribbean clients. Moreover, providers believed that both parents’ and young people’s sex and gender impacted the quality, content and style of sexual health communication and had important implications for programme development. Overall, findings suggest a need for understanding the development of providers’ perceptions of this communication, ways to address these perceptions and further parent-provider collaboration to promote Black youths’ sexual health.     

Positive approaches to education for sexual health with examples from Asia and Africa.

Some approaches to health education are presented based on experiences in Asia and Africa. Consideration in project design should be given to methodology, location, timing, and target group. There is no one correct approach. Qualitative evaluations are possible. Outreach to a larger population such as the out-of-school unemployed is an important goal, as well as directing Family Life Education (FLE) to the primary school level, when children are still in school. Sexual health is defined as state of physical and psychological well being including sexuality. FLE is a culturally sensitive approach to sexual health education. The avoidance of sexual terms promotes acceptance in countries such as Sri Lanka. The problem of sexuality and adolescence and the current protracted period is that adults view this period as an inconvenience rather than an inevitability. The needs of youth need to be recognized in spite of the resistance some cultures may feel about sex education encouraging promiscuity. The example is given of the government of Mali, which in conjunction with the International Planned Parenthood Federation, trained 150 workers to mobilize youth and introduce them to FLE. The prerequisite is mental preparation of the adult population through training programs. An example of an effective method of role play presentation by youth of major youth issues was used in creating a positive feeling for youth among World Health Assembly delegates, who are Ministers of Health and Senior Government Health Officials. The Youth Counseling Services and Family Education Project in Ethiopia is described. It was a youth-designed and youth-implemented project which took into consideration working hours, staff attitude, and hospitality toward youths. Other methods described are: 1) drama, 2) songs, 3) role play, 4) literature, 5) videos and film shows, 6) radio, and 7) telephone. Integration of FLE can be positive when it is combined with youth centers, income-generation projects, and nongovernmental organizations. Examples are given for type of project.     

Involving service users in sexual health service development

OBJECTIVES: The study objectives were to document users' experience of family planning and genitourinary medicine clinics and young people's services working within the time constraints of rapid service development and maximising the utility of this data for service improvement. METHODS: A total of 93 users of family planning and genitourinary medicine services participated in one of 13 facilitated discussion groups. Some 61% of the sample were women, 64% were aged over 25 years and 47% were Black Caribbean or Black African. The clinic journey was drawn on a wall covered with paper and participants added their comments during the discussion. RESULTS: Users had similar concerns across the three service types. Users perceived some receptionists and clinicians as un-friendly and judgmental and described others providing a quality service often under difficult conditions. Reception was insufficiently confidential, waiting environments uncomfortable, waiting times long and more information was needed throughout service use. CONCLUSIONS: Those elements of sexual health services known to be a source of dissatisfaction among young people may also be a problem for older service users and are experienced across different types of sexual health service. This preliminary study demonstrates the feasibility and acceptability of focus group evaluations of sexual health services. This approach generates qualitative data from relatively large numbers of users within a time-scale consistent with service development.     

"I'd never share a needle" -- [but I often have unsafe sex]: considering the paradox of young people's sex and drugs talk

This paper presents an analysis of the self-reported sexual and drug injecting behavior of 178 young people and the qualitative accounts of injecting drug use and sexual behavior of a smaller group of 30 who are interviewed as part of the larger sample. The research was conducted in the Australian state of Victoria and Queensland through 89 youth specific health and housing services. Results revealed that young people's stories of the culture and practices surrounding injecting drug use were encouraging with regards to the attention given to notions of responsibility and care for others, and a coherent discourse of belief in safe injecting practice was also evident. A notion of the 'druggie' or responsible drug user was contrasted to a 'junkie' or irresponsible user, within the culture of drug use described. Conversely, reported sexual behaviors revealed neither consistent discourses about safe sex, nor an unambiguously expressed personal commitment to safe sex.     

Adolescent health in the Caribbean: a regional portrait

OBJECTIVES: This study assessed youth health in the Caribbean Community and Common Market countries and describes the prevalence of health-related factors. METHODS: We used a self-administered classroom questionnaire; questions addressed general health, health care, nutrition, sexual history, drug use, mental health, violence, family characteristics, and relationships with others. RESULTS: Most youths reported good health; however, 1 in 10 reported a limiting disability or significant health problems. Violence was a pervasive concern. Of those who reported history of sexual intercourse, many reported that their first intercourse was forced, and nearly half reported that they were aged 10 years or younger when they first had intercourse. CONCLUSIONS: Although most young people are healthy, problems indicate the importance of monitoring trends and designing effective youth health programs.     

Public and private collaboration in establishing a young person's sexual health clinic in a commercial setting

OBJECTIVE: To define the key factors and constraints in public-private sector collaboration in establishing and delivering a young person's sexual health clinic within an existing commercial establishment. CONSULTATION, PLANNING AND IMPLEMENTATION PHASES: Consultations were held between the Health Promotion Department, family planning and commercial outlets, resulting in the establishment of the UK's first sexual health service within commercial premises. Once the clinic had been operational for 6 months, a single researcher carried out semi-structured interviews with 13 staff representing all levels within the partner organisations. POST-IMPLEMENTATION INTERVIEWS: There was agreement by all interviewees on the objectives of the clinic. The problems encountered during the establishment of the service were with the legislation pertaining to pharmacies and the adverse press coverage of a minority public view of the provision of sexual health services to young people. No respondent identified conflict between the aims of the clinic and the strategic objectives of their organisation. RECOMMENDATIONS: Common aims are imperative for successful interagency working. Wider initial consultations may have helped to identify potential problems and confirm common aims at an earlier stage of the development of the project. The involvement of senior management may also have improved the smooth running of the project.     

Evaluating a streamlined clinical tool and educational outreach intervention for health care workers in Malawi: the PALM PLUS case study

BACKGROUND: Nearly 3 million people in resource-poor countries receive antiretrovirals for the treatment of HIV/AIDS, yet millions more require treatment. Key barriers to treatment scale up are shortages of trained health care workers, and challenges integrating HIV/AIDS care with primary care. THE RESEARCH: PALM PLUS (Practical Approach to Lung Health and HIV/AIDS in Malawi) is an intervention designed to simplify and integrate existing Malawian national guidelines into a single, simple, user-friendly guideline for mid-level health care workers. Training utilizes a peer-to-peer educational outreach approach. Research is being undertaken to evaluate this intervention to generate evidence that will guide future decision-making for consideration of roll out in Malawi. The research consists of a cluster randomized trial in 30 public health centres in Zomba District that measures the effect of the intervention on staff satisfaction and retention, quality of patient care, and costs through quantitative, qualitative and health economics methods. RESULTS AND OUTCOMES: In the first phase of qualitative inquiry respondents from intervention sites demonstrated in-depth knowledge of PALM PLUS compared to those from control sites. Participants in intervention sites felt that the PALM PLUS tool empowered them to provide better health services to patients. Interim staff retention data shows that there were, on average, 3 to 4 staff departing from the control and intervention sites per month. Additional qualitative, quantitative and economic analyses are planned. THE PARTNERSHIP: Dignitas International and the Knowledge Translation Unit at the University of Cape Town Lung Institute have led the adaptation and development of the PALM PLUS intervention, using experience gained through the implementation of the South African precursor, PALSA PLUS. The Malawian partners, REACH Trust and the Research Unit at the Ministry of Health, have led the qualitative and economic evaluations. Dignitas and Ministry of Health have facilitated interaction with implementers and policy-makers. CHALLENGES AND SUCCESSES: This initiative is an example of South-South knowledge translation between South Africa and Malawi, mediated by a Canadian academic-NGO hybrid. Our success in developing and rolling out PALM PLUS in Malawi suggests that it is possible to adapt and implement this intervention for use in other resource-limited settings.     

Avoiding shame: young LGBT people, homophobia and self-destructive behaviours

This paper reports on findings from qualitative research conducted in the UK that sought to explore the connections between sexual identities and self-destructive behaviours in young people. International evidence demonstrates that there are elevated rates of suicide and alcohol abuse amongst lesbian, gay, bisexual and transgender (LGBT) youth. Rarely included in this body of research are investigations into young LGBT people's views and experiences of self-destructive behaviours. Data from interviews and focus groups with young LGBT participants suggest a strong link between homophobia and self-destructive behaviours. Utilising a discourse analytic approach, we argue that homophobia works to punish at a deep individual level and requires young LGBT people to manage being positioned, because of their sexual desire or gendered ways of being, as abnormal, dirty and disgusting. At the centre of the complex and multiple ways in which young LGBT people negotiate homophobia are 'modalities of shame-avoidance' such as: the routinization and minimizing of homophobia; maintaining individual 'adult' responsibility; and constructing 'proud' identities. The paper argues that these strategies of shame-avoidance suggest young LGBT people manage homophobia individually, without expectation of support and, as such, may make them vulnerable to self-destructive behaviours.     

The role of cannabis in supporting young people's cigarette smoking: a qualitative exploration

This paper reports findings from a qualitative study which explores the role of cannabis in young people's lives during their early teenage years. In particular, it focuses on the relationship between cannabis and tobacco-related beliefs and behaviour. Fifty-nine young people of both sexes, aged 13-15, from different socioeconomic backgrounds, and with a wide range of cigarette and cannabis use experience, took part in the study. All were recruited from youth club settings and most were interviewed in self-selected friendship pairs. The paper argues that, while many young people appear to hold predominantly negative views about cigarettes, particularly in relation to their potential to foster dependence, cannabis is often viewed as relatively benign. In spite of these beliefs, for some 'cannabis-oriented' young people, their cannabis use appears to support and reinforce their smoking habit. The paper concludes that a coordinated approach to the planning and delivery of services which addresses young people's health risk behaviours is required. Smoking cessation and drugs education practitioners need to break with tradition, and find ways of working more closely together.     

Young people and sexual agency in rural Uganda

This paper offers an analysis of young people's sexual agency in rural Uganda. Drawing on definitions of agency from within the international development literature, it focuses on: decision-making processes leading to young people's involvement in relationships; actions undertaken to maintain 'secret' relationships in contexts where young people's sexual agency is generally prohibited; transactional and gendered negotiations between young people involved within a relationship; and a range of outcomes arising from young people's sexual activity. An understanding of the dynamics and temporal nature of young people's sexual agency, and the consequences that follow from it, challenges the widely held view that young people do not know what they are doing in relation to their sexual health. This should enable practitioners to identify avenues for developing HIV prevention and sexual health programmes that are more fully based in, and driven by, the realities of young people's sexual lives.     

Vulnerability and sexual and reproductive health among Zambian secondary school students

The present study aimed to explore secondary school students' needs in relation to sexual and reproductive health in order to inform efforts to improve the quality of health services available to young people. The study involved data collection from 716 11–22‐year‐old students in four secondary schools in an urban area in Zambia. Students completed a questionnaire and were invited to write down any inquiries they had regarding sexuality and reproduction. Findings revealed that boys and girls lack adequate information about human reproduction and STIs, including HIV. To avoid misconceptions and myths, they also need clear information on contraceptives and masturbation. Responses indicate that young people would welcome guidance and support related to contraception, pregnancy, abortion and STIs/HIV, but also on love and relationships. Culture, religion and gender are important factors influencing sexuality and sexual abuse. These issues need to be taken into consideration when developing youth‐friendly programmes for young people.     

Sexually transmitted infection (STI) testing among young oil and gas workers: the need for innovative, place-based approaches to STI control

BACKGROUND: Northeastern British Columbia is undergoing rapid in-migration of young, primarily male workers in response to the "boom" in the oil/gas industries. Accompanying the boom is a rise in Chlamydia rates among youth, which exceed the provincial average by 22%. STI testing reduces the disease burden, contributing to STI prevention. OBJECTIVES: 1) To document youths' perceptions regarding the socio-cultural and structural forces that affect young oil/gas workers' access to STI testing; 2) to gather service providers' perspectives on sexual health service delivery for workers; and 3) to develop recommendations to improve the accessibility of STI testing. METHODS: We conducted ethnographic fieldwork (8 weeks) in a remote oil/gas community, including in-depth interviews with 25 young people (ages 15-25) and 14 health and social service providers. RESULTS: Participants identified limited opportunities to access testing, geographic isolation, and 'rigger' culture as three key categories inhibiting STI testing among oil/gas Workers. DISCUSSION: These results suggest the need for place-based approaches to STI control. Innovative outreach strategies are suggested to address oil/gas workers' needs, including a locally tailored STI awareness campaign, condom distribution, expanded clinic hours, and onsite STI testing.     

The national health demonstration projects

The White Paper Towards a Healthier Scotland pledged 15 million Pounds to support four national health demonstration projects to lead the way in achieving sustained improvement in child health, young people's sexual health, coronary heart disease and cancer. The Starting Well project aims to demonstrate that child health in Glasgow can be improved by a programme of activities which both supports families and provides them with access to enhanced community-based resources. The Healthy Respect project aims to help young people in Lothian develop a positive attitude to their own sexuality and that of others, and a healthy respect for their partners, in order to reduce unplanned teenage pregnancies and sexually transmitted infections. The Have a Heart Paisley project is targeting coronary heart disease among the population of Scotland's largest town. The Cancer Challenge project is piloting a screening programme in the North East of Scotland for the detection of colorectal cancer. Though each project has specific objectives, appropriate to its own topic, all share underlying principles. The projects will act as test beds for action and a learning resource for the rest of Scotland.     

Young people's contraception and sexual health: report of a local needs assessment in Staveley,North Derbyshire

This project assessed the contraception and sexual health needs of people aged under 25 years in the small town of Staveley, UK, and sought to determine how the community family planning service could best meet these needs. One hundred and seventeen young people and 17 local professionals took part. The preferred ideal was found to be a holistic youth service based in an accessible, non-clinic setting. Clinic-based services should be more user-friendly, and various ways to achieve this were suggested. Both clients and professionals need greater awareness of all local services.