Assessing youth-friendly sexual and reproductive health services: a systematic review

Abstract

BackgroundOver 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.MethodsWe 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.ResultsOur 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.ConclusionsThis 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.

Understanding practitioner perspectives of youth healthcare using thematic and lexical analyses

“…[13][14][15][16] A systematic review suggested youth access to sexual and reproductive health services is hindered by service accessibility; privacy and confidentiality; and staff characteristics and competencies. 17 Another concluded that youth engagement with health systems is influenced by "the ability to recognize and understand health issues; service knowledge and attitudes toward help-seeking; structural barriers; professionals' knowledge, skills, attitudes; service environments and structures; ability to navigate the health system; youth participation; and technology opportunities". 18 Additionally, many social determinants of youth health lie beyond the remit of most social services.…”

Adaptation and validation of a self‐report measure of youth‐friendly primary healthcare services

“…Adapted and validated versions of the YFHS‐WHO+ questionnaire can be used to identify and standardize indicators of effectiveness of YFHS across contexts (Mazur et al. ). Such indicators can optimize the effectiveness of global health policy on youth health care whilst guiding efficient resource allocation.…”

“…Wider use could expand the dimensions of the YFHS-WHO+ questionnaire and address the need for the use of a single instrument across contexts to allow for comparison of findings (Mazur et al 2018). Adapted and validated versions of the YFHS-WHO+ questionnaire can be used to identify and standardize indicators of effectiveness of YFHS across contexts (Mazur et al 2018). Such indicators can optimize the effectiveness of global health policy on youth health care whilst guiding efficient resource allocation.…”

“…Many YFHS have emerged worldwide and the effectiveness of such youth‐friendly initiatives have been assessed with a variety of instruments of which only some have been validated (Mazur et al. ; Tylee et al. ).…”

“…Youth-friendly health services (YFHS) are tailored according to the demands of the youth (WHO 2002) and should be accessible, acceptable and appropriate to the youth, improve the health of young people and be equitably provided (WHO 2012). Many YFHS have emerged worldwide and the effectiveness of such youth-friendly initiatives have been assessed with a variety of instruments of which only some have been validated (Mazur et al 2018;Tylee et al 2007). Few instruments have measured the perceptions of the youth with regard to youthfriendliness despite the growing concept of patient-centred care that recognizes the patient's own values and perceptions (Ambresin et al 2013).…”