Health Clinics & Hangouts

In most countries, health services are provided to the general population – including adolescents – by hospitals and clinics run by the government, NGOs and individuals and organizations in the private sector.

A range of real and perceived barriers hinders the use of health services by adolescents. These include items which are external to the health services – legal frameworks governing health actions, out-of-pocket costs, and cultural and community attitudes – and the developmental context of adolescence which includes an increasing desire for privacy and confidentiality, with embarrassment, shame, and a fear of being judged. In addition, adolescents are less experienced users of health care, with the consequence that time is required to engage them in consultations, especially around sensitive issues. Inexperience also results in a majority of adolescents not appreciating that certain health risks, such as substance use, bullying, or overweight, can be raised with health professionals.

To respond to this, in many countries, NGOs are involved in providing health services that are intended to specifically respond to the needs of adolescents, and to be “friendly” to them. To be considered adolescent friendly, health services should have the following characteristics.

  • Equitable: All adolescents, not just certain groups, are able to obtain the health services they need.
  • Accessible: Adolescents are able to obtain the services that are provided.
  • Acceptable: Health services are provided in ways that meet the expectations of adolescent clients.
  • Appropriate: Adolescents have access to the health services they adolescents need.
  • Effective: The right health services are provided in the right way and make a positive contribution to the health of adolescents.

What adolescents view as responsive or youth friendly health care is similar across countries of all income levels.

  • Health-care services depend on adolescent help-seeking.
  • School-based promotion of services, mass media campaigns, and social media all have potential roles to reduce developmental barriers to accessing health care by promotion of health literacy and help- seeking.

Adolescent values

  • Patient-centered care with an emphasis on respect,
  • Coordination of care,
  • Appropriate provision of information,
  • High-quality communication,
  • Involvement in decisions about care, and
  • The ability of health care providers to listen to their needs.

Adolescent Clinic “Rules of Engagement”

  • Invest time – staff should be friendly, uphold strict confidentiality, be patient, make eye-contact, and most importantly be non-judgmental.
  • Staff continuity is important, especially with respect to counselling
  • Adolescent-friendly areas within the clinic: a space to relax, listen to music, have access to computers, and desks to do homework while waiting.
  • DON’T want to share the space with adults/younger children
  • Adolescent clubs/groups can be helpful
  • Adherence always challenging – ongoing reminding – calls before and after, WhatsApp groups, retention officers visit homes if needed
  • Ongoing encouragement is needed – introducing milestone certificates can help.
  • Clinic specific interventions:
    • Music for pelvic exams
    • Models/pictures for explanations
    • Try and schedule clinics to fit in with their lives – after school/late clinics & Saturdays

The most effective strategies to remove barriers to health care for adolescents is to use a combination of high-quality health care provider training, adolescent-friendly facility improvements, and broad information dissemination via the community, schools, and mass media to drive demand.

Read this editorial for a take on what fast food outlets and adolescent healthcare services do (or should!) have in common.

Community based platforms

Community-based platforms: where young people can meet regularly with peers and mentors should be accessible, private, and safe

Case Study:

In South Africa the use of mobile units with teen truck attractions (as listed below) have been used as a method to meet and attend to adolescent health needs in places where adolescents already congregate (hangout). Other health service interventions and attractions, appropriate for adolescents in places where they hang out, could include:

  • Social media – the use of social media to provide interactive information
  • Point of care health screening
  • Health education – breaking cultural barriers
  • Health education – quizzes with prizes
  • “Sexy” condoms (colourful, friendly packaging)
  • Loud music
  • Convenient times (12h00 – 18h00) and accessible spaces.
  • Convenient places
  • Friendly, non-judgmental, accessible

BY YOLISWA NTSEPE (MA, PhD)
ADOLESCENT PROGRAMMES MANAGER

UPDATED NOV 22, 2023

TABLE OF CONTENTS:

  1. why adolescents?
  2. where do adults fit in?
  3. research methods and designs
  4. ethical concerns with adolescents
  5. protocol development
  6. adolescent friendly site assessment
  7. adolescent peer supporters
  8. implementation frameworks
  9. standard operating procedures
  10. data collection
  11. dissemination

REFERENCES & ADDITIONAL RESOURCES:

WHO 2009 Quality Assessment Guidebook: A guide to assessing health services for adolescent clients.

Pike C, Celum C, Bekker L-G. Adolescent healthcare: I’m Lovin’ it. S Afr J HIV Med. 2020;21(1), a1147. https://doi.org/10.4102/sajhivmed.v21i1.1147