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Young people's experiences with Health Services: Final Report
Abstract and Figures
This research was contracted by the Commissioner for Children and Young to better understand young people's perception of health services. The consultations with over 1,000 young people, has identified opportunities to strengthen the focus on young people in health policies and services.
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... Health services need to be prepared to evaluate, promote, consult and partner. What was not mentioned here, but has been reported elsewhere, 1,21,23 is that the local young people themselves need to be key to this process. A multifaceted, well resourced, innovative and contextualized service is required, staffed by individuals who themselves share many of these characteristics. ...
... Transport available 10 Safe environment 10 Child care available 10 Transport available 20 Low cost 1,20 Venue in a location which is easy to find and to get to 1,21,23 ...
... Transport available 10 Safe environment 10 Child care available 10 Transport available 20 Low cost 1,20 Venue in a location which is easy to find and to get to 1,21,23 ...
... Health services need to be prepared to evaluate, promote, consult and partner. What was not mentioned here, but has been reported elsewhere, 1,21,23 is that the local young people themselves need to be key to this process. A multifaceted, well resourced, innovative and contextualized service is required, staffed by individuals who themselves share many of these characteristics. ...
... Transport available 10 Safe environment 10 Child care available 10 Transport available 20 Low cost 1,20 Venue in a location which is easy to find and to get to 1,21,23 ...
... Transport available 10 Safe environment 10 Child care available 10 Transport available 20 Low cost 1,20 Venue in a location which is easy to find and to get to 1,21,23 ...
Background:
Young Aboriginal people are at an important stage in the development of their health and wellbeing. They experience significant morbidity and mortality, and their access to medical services may be limited by geographic remoteness and difficulty obtaining appropriate care. Aboriginal Community Controlled Health Services offer primary health care considered to be more accessible for Aboriginal people.
Objective:
This study is one component of research aiming to enhance access for young Aboriginal people in a remote area of Western Australia. It aims to add to our previous study focusing on perceptions of local young people, through exploring the understandings of health care staff regarding access for young Aboriginal people.
Methods:
This qualitative study involved semistructured individual and group interviews with 24 staff who work with young Aboriginal people at a remote Aboriginal Community Controlled Health Service. Transcripts were descriptively coded and thematically analyzed by the research team.
Results:
Staff identified a number of challenges in working with 16- to 25-year-old Aboriginal people, which revolved around the interface between the service, its staff and the young people. They also suggested strategies designed to engage these young people. The strategies included relationship-building, communication, trust and confidentiality with individuals; and targeted clinics, partnerships, health promotion, and an open door policy by clinics. The strategies used by staff were flexible and expansive in nature.
Conclusions:
Engagement can be enhanced by a health service willing to "go the extra mile," with a strategic, enveloping and innovative approach, resourcing and the right people with the right attitude.
... These findings are supported by a recently conducted population-based study in the Netherlands, which reported a higher level of stress significantly associated with healthcare avoidance [38]. The evidence suggests that healthcare access for youths who perceive the need for care is often complicated by a lack of knowledge and understanding about the process of seeking help, fears of stigmatization, a preference for self-reliance, concerns regarding confidentiality, and a lack of resources including money and the availability of professional help [63][64][65]. Other studies of healthcare avoidance, access, and utilization during COVID-19 have found similar conclusions. ...
Background:
Access to healthcare for young people is essential to ensure they can build a foundation for a healthy life. However, during the COVID-19 pandemic, many people avoided seeking healthcare, adversely affecting population health. We investigated the factors associated with the avoidance of healthcare for Australian young people when they reported that they needed healthcare. We were able to compare healthcare avoidance during the COVID-19 pandemic with healthcare avoidance prior to COVID-19.
Methods:
We used two recent data collection waves from the Longitudinal Study of Australian Children (LSAC)-Wave 9C1 during the COVID-19 pandemic in 2020, and Wave 8 data which were collected in 2018. The primary outcome of this study revealed the avoidance of healthcare among those who perceived the need for care. Bivariate analyses and multiple logistic regression models were employed to identify the factors associated with the avoidance of healthcare during the COVID-19 and pre-COVID-19 periods.
Results:
In the sample of 1110 young people, 39.6% avoided healthcare during the first year of the COVID-19 pandemic even though they perceived that they had a health problem that required healthcare. This healthcare avoidance was similar to the healthcare avoidance in the pre-COVID-19 pandemic period (41.4%). The factors most strongly associated with healthcare avoidance during the COVID-19 pandemic were female gender, an ongoing medical condition, and moderately high psychological distress. In comparison, prior to the pandemic, the factor associated with healthcare avoidance was only psychological distress. The most common reason for not seeking healthcare was thinking that the problem would spontaneously resolve itself (55.9% during COVID-19 vs. 35.7% pre-COVID-19 pandemic).
Conclusions:
A large proportion of youths avoided healthcare when they felt they needed to seek care, both during and before the COVID-19 pandemic.
... This study is reported according to the consolidated criteria for reporting qualitative research guidelines [32], and was conducted in conjunction with an independent social and market research agency, Market Solutions P/L (http:// www.marketsolutions.com.au/). The agency was selected to assist with the study given their strong track record in conducting social science research [33,34], and their familiarity with qualitative methodology and research, particularly amongst socioeconomically disadvantaged groups. The agency is accredited to the international ISO standard for market, social and opinion research (AS ISO 20252) and is a member of the Association of Market Research Organisations (AMSRO). ...
Background
Men of low socioeconomic position (SEP) are less likely than those of higher SEP to consume fruits and vegetables, and more likely to eat processed discretionary foods. Education level is a widely used marker of SEP. Few studies have explored determinants of socioeconomic inequalities in men’s eating behaviours. The present study aimed to explore intrapersonal, social and environmental factors potentially contributing to educational inequalities in men’s eating behaviour.
Methods
Thirty Australian men aged 18–60 years (15 each with tertiary or non-tertiary education) from two large metropolitan sites (Melbourne, Victoria; and Newcastle, New South Wales) participated in qualitative, semi-structured, one-on-one telephone interviews about their perceptions of influences on their and other men’s eating behaviours. The social ecological model informed interview question development, and data were examined using abductive thematic analysis.
Results
Themes equally salient across tertiary and non-tertiary educated groups included attitudes about masculinity; nutrition knowledge and awareness; ‘moralising’ consumption of certain foods; the influence of children on eating; availability of healthy foods; convenience; and the interplay between cost, convenience, taste and healthfulness when choosing foods. More prominent influences among tertiary educated men included using advanced cooking skills but having relatively infrequent involvement in other food-related tasks; the influence of partner/spouse support on eating; access to healthy food; and cost. More predominant influences among non-tertiary educated men included having fewer cooking skills but frequent involvement in food-related tasks; identifying that ‘no-one’ influenced their diet; having mobile worksites; and adhering to food budgets.
Conclusions
This study identified key similarities and differences in perceived influences on eating behaviours among men with lower and higher education levels. Further research is needed to determine the extent to which such influences explain socioeconomic variations in men’s dietary intakes, and to identify feasible strategies that might support healthy eating among men in different socioeconomic groups.
Electronic supplementary material
The online version of this article (10.1186/s12889-018-6162-6) contains supplementary material, which is available to authorized users.
... While the evidence is limited on how precisely to implement antidepressant discontinuation [34], unequivocally GPs have a strong role to play in the process as facilitators of safe discontinuation and managing discontinuation symptoms [35,36]. Given that GPs are one of the most frequently utilised health care providers amongst young people [20,37] and that the vast majority of young people are not in receipt of specialist mental health care, visits to their GP represents an important opportunity for intervention. Accordingly, GPs must be supported to continuously improve their patient care. ...
Background
Current clinical guidelines recommend non-pharmacological interventions as first-line treatments for young patients aged 16–24 years with a mental health condition (MHC). However, several studies have noted increasing trends in psychotropic prescribing for this age group, especially in antidepressant prescribing. In Australia, the vast majority of psychotropic medications prescribed to young people come from the general practice setting. To assess whether Australian General Practitioners (GPs) are prescribing in accordance with clinical guideline recommendations, this study examined trends in GP prescribing of psychotropic medications to young patients aged 16–24 years.
Methods
We performed a retrospective analysis of routine general practice data from 9112 patients aged 16–24 years with a MHC. Data were extracted from the Melbourne East Monash General Practice Database from 1/01/2009 to 31/12/2014. The main outcome measures included the number of consultations for patients with MHCs, psychotropic prescribing by GPs, and patient characteristics associated with the likelihood of being prescribed a psychotropic.
Results
In total, 9112 out of a total of 77,466 young patients were identified as having a MHC in this study, and 11,934 psychotropic prescriptions were provided to 3967 (43.5%) of them over the study period. Antidepressants accounted for 81.4% of total psychotropic prescriptions, followed by anxiolytics (9.6%) and antipsychotics (9.0%). The number of prescriptions issued to individuals with MHCs increased over time. Women and patients aged 21–24 years had higher incidence rates for prescription than men and those aged 16–17 (IRR: 1.15, 95% CI 1.08–1.22, IRR: 1.93, 95% CI 1.750–2.11).
Conclusions
Our findings demonstrate an increasing trend in GP prescribing of psychotropics to young people over the study period with higher levels of prescribing to women and those 21–24 years of age. Although GP prescribing corresponded with guideline recommendations on the whole, there were discrepancies between GP’s antidepressant prescribing and guideline recommendations, reasons for which were unclear. Research is needed to investigate GPs decision-making processes underlying their prescribing, to target interventions to improve existing data in GP records to improve management, and to identify areas of further training if needed to facilitate greater concordance between clinical practice and guideline recommendations.
Background
The rates of young people reporting psychological distress in Australia is increasing but service access by this group remains poor. Many young people are not seeking help for mental health concerns despite often being aware that they may need to. This issue is compounded by the complex nature of barriers that adolescents face when accessing and engaging with mental health services. This paper presents the integrated findings of a three phase mixed methods approach exploring the determinants of mental health service access and use by adolescents in Perth, Western Australia. This research sought to identify the barriers and facilitators experienced by adolescents during mental health help-seeking. This was done by highlighting and comparing the real-world experiences of adolescent mental health consumers at varying points of the help-seeking process with those of professionals providing mental health services.
Methods
The overarching study utilised a sequential mixed methods approach comprising of three phases. Each phase investigated its own discrete population: (Phase 1) mental health professionals and clinicians providing services to adolescents; (Phase 2) adolescents aged 14-18 years who intended to seek help for their mental health but had either not yet done so or had discontinued treatment, and; (Phase 3) adolescents aged 14-18 years who were currently using a mental health service or had previously used a mental health service in the past 24 months. Phases 1 and 3 used qualitative interviews, and phase 2 comprised an online survey. The findings of all three phases were then integrated. Equal weighting was given to the qualitative and quantitative results.
Results
Six main themes emerged from the integration of findings relating to the determinants for adolescent mental health service access and use: (1) Service entry criteria and intake processes; (2) Invalidating experiences; (3) Mental health system resourcing and service provision; (4) Service features (environment and location etc.); (5) Additional support, and; (6) Client-centred approach to care.
Conclusions
A strong consensus between sample groups on the determinants influencing adolescent mental health service access and use was evident in this study. The alignment of views emphasises the importance of the identified themes and highlights how gaps in mental health service provision are experienced by differing stakeholders. The identified themes provide practical areas of focus for future mental health reform.
Identify the perceived benefit of mental health service use for two adolescent populations: (i) those who had considered getting help from a mental health service but had not yet done so, and (ii) those who had previously contacted or accessed a mental health service but not continued with care. Cross-sectional online survey of adolescents aged 14–18 years currently residing in Perth, Western Australia. Those who had previously accessed a mental health service but not continued with care often had less favourable perceptions of service benefit. Participants in both populations considered that mental health service use was least likely to be beneficial for conduct-related behaviours. Participants in both population groups from single-carer households or identifying as LGBTIQ reported a higher perceived benefit of mental health services. Our study highlights potential gaps in adolescent knowledge regarding mental health help-seeking. Perceptions of service benefit were often no different or less favourable amongst those who had previously accessed a mental health service but not continued with care. The range of sociodemographic factors significantly associated with perceived benefit across both populations in the sample indicates subpopulations of young people may require extra support within the system.
The Policy ContextBuilding Knowledge of CollaborationA Model for Collaboration Across SectorsConclusion
References
Objectives: To highlight the scope and ramifications of racism on health and health care of Indigenous Australians, and suggest approaches for minimising racism's adverse health impacts. Methods: Literature review and conceptual frameworks based on the historical, structural and social determinants of health and health care were used to highlight the scope and ramifications of racism in relation to health, and to Indigenous health care access. Results: Racism has major adverse impacts on the health of Indigenous Australians, and significantly hinders their access to effective health care. Most of racism's negative effects on Indigenous health may be ameliorated through addressing structural determinants of health inequities, improving community awareness regarding racial prejudice, strengthening political will to address racism, improving cultural competence among health workers, and health service redesign to facilitate optimal access to Indigenous health care.
