ArticleLiterature Review

How Marginalized Young People Access, Engage With, and Navigate Health-Care Systems in the Digital Age: Systematic Review

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Abstract

Purpose: This systematic review examines how marginalized young people access and engage with health services and navigate health-care systems in high-income countries. Methods: Medline, CINAHL, PsychInfo, The University of Sydney Library database, and Google Scholar were searched to identify qualitative and quantitative original research, published from 2006 to 2017, that focused on selected definitions of marginalized young people (12 to 24 years), their parents/carers, and/or health professionals working with these populations. A thematic synthesis was undertaken identifying themes across and between groups on barriers and/or facilitators to access, engagement, and/or navigation of health-care systems. Results: Of 1,796 articles identified, 68 studies in the final selection focused on marginalized young people who were homeless (n = 20), living in rural areas (n = 14), of refugee background (n = 11), gender and/or sexuality diverse (n = 11), indigenous (n = 4), low income (n = 4), young offenders (n = 2), or living with a disability (n = 2). Studies were from the United States, Australia, Canada, United Kingdom, New Zealand, and Portugal, including 44 qualitative, 16 quantitative, and 8 mixed-method study types. Sample sizes ranged from 3 to 1,388. Eight themes were identified relating to 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. Conclusions: Marginalized young people experience barriers in addition to those common to all young people. Future studies should consider the role of technology in access, engagement, and health system navigation, and the impact of intersectionality between marginalized groups.

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... For people living in regional areas, physical barriers to accessing healthcare, including transport needs, costs and limited service availability, have been well documented [4,8,36]. Similarly, we found these issues relating to the physical inability to reach a service were barriers to access in both urban and regional areas. ...
... That's not so the case for spinal clinic, the referrals for spinal tend to be a little bit more successful in getting from metro to Bendigo." ID17, Regional, EP, M, [30][31][32][33][34][35][36] "… making things a little bit more kind of user-friendly so the patients can actually access what they want. I think that's sort of part of the benefit to the NDIS is having a bit more of that decision-making, like empowering the patient, but if the system is too complicated for them to be able to navigate, then it just puts that same barrier backup that the NDIS is trying to address." ...
... So it is a challenge for sure." ID12, Statewide, PT, F, [30][31][32][33][34][35][36] "… that's a real key, that if clients were provided with the emotional support and the psychological support right from the word go, and that ability for them to be able to accept their injury, and work with the allied health professionals, then they would have much more positive outcomes…I think the key things are the people that have had traumatic events need to be provided with services to deal with their psychological and emotional health, which isn't being done effectively at the moment. Their care services need to be improved in this area." ...
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Barriers to accessing healthcare exist following serious injury. These issues are not well understood and may have dire consequences for healthcare utilisation and patients’ long-term recovery. The aim of this qualitative study was to explore factors perceived by allied health professionals to affect access to healthcare beyond hospital discharge for people with serious injuries in urban and regional Victoria, Australia. Twenty-five semi-structured interviews were conducted with community-based allied health professionals involved in post-discharge care for people following serious injury across different urban and regional areas. Interview transcripts were analysed using thematic analysis. Many allied health professionals perceived that complex funding systems and health services restrict access in both urban and regional areas. Limited availability of necessary health professionals was consistently reported, which particularly restricted access to mental healthcare. Access to healthcare was also felt to be hindered by a reliance on others for transportation, costs, emotional stress and often lengthy time of travel. Across urban and regional areas, a number of factors limit access to healthcare. Better understanding of health service delivery models and areas for change, including the use of technology and telehealth, may improve equitable access to healthcare.
... Barriers to healthcare for young people in Australia and internationally are well known, with confidentiality concerns consistently cited as the most important. [1][2][3] Technology has the potential to improve access to healthcare; for example, through enhancing access to information about health and health services as well as young people's ability to communicate with services. 3 However, relatively few studies have examined its role in these activities. ...
... [1][2][3] Technology has the potential to improve access to healthcare; for example, through enhancing access to information about health and health services as well as young people's ability to communicate with services. 3 However, relatively few studies have examined its role in these activities. 4 To achieve equitable health outcomes across populations, including those who are marginalised, access must also be equitable. ...
... 5 Marginalised young people experience access barriers common to all young people, such as lack of suitable services, cost and lack of health literacy. 3 However, these are exacerbated for certain marginalised young people. For example, structural barriers have been highlighted for homeless young people 6 and confidentiality concerns have been identified as a significant concern by rural young people. ...
Article
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Objective: To quantify barriers to healthcare for young people (12-24 years) and identify socio-demographic correlates and predictors. Methods: This cross-sectional survey targeted young people living in New South Wales, Australia, with oversampling of marginalised groups. Principles Component Analysis (PCA) identified clusters of barriers. Ordinal regression identified predictors of each barrier cluster. Results: A total of 1,416 young people completed surveys. Participants with chronic conditions and increasing psychological distress reported a greater number of barriers. Of 11 potential barriers to visiting a health service, cost was most common (45.8%). The PCA identified three clusters: structural barriers (61.3%), attitudinal barriers (44.1%) and barriers relating to emerging autonomy (33.8%). Conclusions: Barriers to healthcare reported by young people are multi-dimensional and have changed over time. Structural barriers, especially cost, are the most prominent among young people. Approaches to overcome structural barriers need to be addressed to better support marginalised young people's healthcare access. Implications for public health: Understanding predictors of different barrier types can inform more targeted approaches to improving access. Equitable access to healthcare is a priority for early diagnosis and treatment in young people, especially reducing out of pocket costs.
... In a therapeutic relationship, the development of trust requires a therapist who can communicate compassion, nonjudgmental acceptance, and empathic understanding (Robards et al., 2018;Stafford & Draucker, 2020;Teyber & McClure, 2011). Nonjudgmental acceptance refers to providers who can both feel connected to clients and endorse their autonomy simultaneously (Berlin, 2005;Manuel et al., 2018;Munson et al., 2015). ...
... The research on youth relationships with case workers, social workers, foster parents and clinicians indicates that marginalized youth appreciate efforts by helping professionals to forge genuine relationships in spite of the bureaucratic requirements of the role (Munford & Sanders, 2015b;Sapiro & Ward, 2019). Marginalized youth appreciate providers who understand, respect, and welcome their unique ethnic and cultural heritage (Munford & Sanders, 2015a) and their sexual/gender identity without judgment or discrimination (Robards et al., 2018). Other factors that promote engagement include a client-centered focus on the goals of the young person (Klodnick et al., 2020;Ungar & Ikeda, 2017), an avoidance of stigmatizing language (Klodnick et al., 2020;Munson et al., 2016), and a preference for shared decision-making whenever possible (Skehan & Davis, 2017). ...
... The findings reinforce the existing knowledge base on engagement in mental health services. Echoing the findings of Anderson et al. (2017) and Robards et al. (2018), these participants expressed concerns about the confidentiality of the working relationship, as well as concerns about how they would be treated by service providers. Findings show that older youth and young adults value confidentiality, and at the same time are acutely aware of the limits to confidentiality in helping relationships. ...
Article
Marginalized youth are at elevated risk for mental health difficulties, yet they encounter numerous barriers to engagement with mental health services. Past negative experiences with family, social workers, and systems of care contribute to distrust of service providers and ambivalence about engaging in trusting relationships with adults. This longitudinal qualitative study explored how marginalized youth living with mental health conditions make decisions about trust in their relationships with helping professionals. Semi-structured, open-ended in-depth interviews were conducted with 13 young women living with a mood or anxiety disorder, exploring trust, mutuality, and disconnection in relationships between marginalized youth and helping professionals. Eleven of the participants also participated in a second interview, 3 months later, that explored participants’ relationships with friends and family. Transcripts were analyzed using thematic analysis and interpreted through the lens of relational-cultural theory. Results indicated that the majority of interview participants described feeling unseen, judged, or invalidated in their relationships with family members. Four themes emerged as factors in the assessment of the trustworthiness of service providers: genuine caring; understanding; non-judgmental acceptance; and adult respect for youth agency. Concerns about confidentiality and mandated reporting informed participants’ decisions about disclosure in these relationships. Analysis of findings reveals evidence of the central relational paradox in these descriptions of helping relationships, reflecting the simultaneous appeal and peril of vulnerability in relationships, especially relationships characterized by power differentials. Findings suggest that practitioners working with marginalized youth can expect both openness and guardedness in the treatment relationship.
... We use the collective word 'Indigenous' to describe people who originate from a particular region, however, acknowledge the rich diversity and knowledge represented by this term. Despite the need, Indigenous youth worldwide are less likely to access mental health treatment than non-marginalised young people (5,6). Barriers to accessing mental health treatment include stigma, fear, shame, intergenerational trauma, distrust of services and being unable to identify signs and symptoms of illness (5,6). ...
... Despite the need, Indigenous youth worldwide are less likely to access mental health treatment than non-marginalised young people (5,6). Barriers to accessing mental health treatment include stigma, fear, shame, intergenerational trauma, distrust of services and being unable to identify signs and symptoms of illness (5,6). Furthermore, the location of populations in need are often decentralised, meaning long distances, increased costs and challenges in the delivery of services (5,7). ...
... Despite the need for culturally safe, effective, early intervention treatments, there remains relatively few approaches which are evidence based (10). Recent increased availability of technology and connectivity has been identi ed as an opportunity to increase access to health services within underserved communities and marginalised youth populations (6). ...
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Background: Indigenous youth worldwide are at greater risk of developing mental health concerns due to ongoing inequity and disadvantage. Digital mental health solutions are identified as a potential approach to improving access to mental health treatment for Indigenous youth, with evidence of acceptability and effectiveness beginning to emerge. Although collaborative design, development and evaluation is widely recognised as necessary to improving the acceptability of these tools, there is limited evidence to guide engagement of Indigenous youth in these processes. The objective of this scoping review is to map evidence regarding the collaborative involvement of Indigenous youth in the design and/or evaluation of digital mental health interventions. Methods: Scoping review methodology includes six stages, 1) identifying research question; 2) identifying relevant studies; 3) developing a study selection and data extraction method; 4) charting the data; 5) collating, summarising and reporting results. Additionally, Step 6) consultation, engages a male and female Indigenous health researcher in reviewing protocols, analysis and findings, enhancing credibility and ensuring findings are informed by Indigenous worldviews. Searches for relevant literature are undertaken in the following databases: EBSCOhost databases (Academic Search Premiere, Computer and Applied Science complete, CINAHL Plus with Full text, MEDLINE with full text, APA PsychArticles, Psychology and Behavioural Sciences collection, APA PsychInfo), PubMed, and Scopus. In addition, Infomit and Google (limited to the first 200 results) are searched for grey literature. All primary studies and grey literature in English that meet eligibility criteria are included. Data, including; study methods, methodologies, digital mental health program details, participant information and engagement and reporting processes are extracted and included for analysis. Data extraction variables are guided by the Consolidated Criteria for Strengthening Reporting of Health Research (CONSIDER statement). This statement provides a best practice checklist for reporting research involving Indigenous peoples. This scoping review protocol has been registered with Open Science Framework (available via osf.io/2nkc6). Discussion: To date, there are no reviews which critically analyse engagement of Indigenous youth in the development and evaluation of youth-specific digital mental health interventions. This review will aim to fill that gap and appraise alignment of current practice with best practice guidelines to inform future research. It will highlight appropriate strategies for the engagement of youth in collaborative processes, providing guidance for health practitioners, policy makers, and researchers working in the field of Indigenous youth and digital mental health.
... Online patient records provide access to electronic health records [12], albeit through various platforms with little or no data transfer between services, and with varying degrees of access depending on where you live [7]. As for young, marginalized persons ICT has been found to have an impact on how they access, engage and navigate healthcare systems, as well as being a positive addition to face-to-face contact [13]. Research has also shown that having a disability can lead to difficulties using ICT and digital exclusion [10,14]. ...
... At the age of eighteen, young persons' requiring ongoing support form health-and social services are transferred from children's services to adult services. Where the paediatric services provide continuity, regularity and familiar faces [22], adult health services are known to be fragmented, harder to access and challenging to navigate [13,23,24]. Many adolescents with disability or chronic conditions are in continual contact with health-and social services and educational services [25]. ...
... The potential ICT carried with it in relation to making engagement easier, such as providing easier ways for booking appointments and allowing for direct communication, increased engagement. This is in line with previous studies, showing that ICT could enhance access to services and provide alternative ways to initiate contact with services [13]. As stated by Way and Redden [18], use of ICT could increase engagement. ...
Article
Purpose The use of Information and communications technologies (ICT) in the public sector is widespread and on the increase. There is a need to develop knowledge regarding the end users experiences of using ICT to engage with services. This study aims to provide knowledge regarding young persons with disabilities or chronic disease experience using ICT to engage with health- and social care services. Materials and methods Nine young persons between 16 and 25, living with chronic disease or physical disability, participated in this study. The data was collected using semi-structured interviews. The interviews were recorded, transcribed verbatim and analysed using Constructivist Grounded Theory. Results Three categories were identified that reflected the young persons’ experiences with using ICT to engage with health and social care services. (1) Navigating in an information overflow, (2) Experiencing disparate dialogues, (3) Utilising the potential of ICT. The young persons experienced that ICT used for engaging with health and social care services did not necessarily fit their need, yet, they saw how ICT had potential to increase engagement with services, especially with an increased focus on dialogue. The findings can be subsumed by the core category Inaccessible Possibilities, illustrating both the potentials and the challenges ICT presented. Conclusion The study shows that although young persons are perceived as digitally native, they experienced challenges using ICT to engage with health- and social services. The poor fit of ICT combined with navigation- and accessibility issues, hinder engagement. However, ICT inhabit a potential to increase engagement, especially communication. • IMPLICATIONS FOR REHABILITATION • Young persons’ experiences show that ICT can be useful for enhancing engagement with health and social care services • ICT provided by health and social services does not necessarily meet young persons need for dialogue • An increased focus on accessibility and design is necessary to ensure people with disabilities access to ICT used by health- and social care services
... (14,31,32,35,44,45) Care organised around the person CMOC 4 ( g 6)shows that in a context of where care is organised around the person, the mechanism of exibility and personalisation is triggered, allowing patients to feel that their particular needs are understood and met. (21,29,33,44,(46)(47)(48)(49) Health system navigability is enhanced through having coordinated and co-located care, (7,29,33,34,47,(50)(51)(52) through having clear and intuitive patient pathways managed by staff and providers who bring patients along to the next step, (14,33,47,53,54) and through accompanying patients either by link workers or peer advocates. (21,33,(54)(55)(56)(57)(58) Having this kind of support helps patients by providing extra motivation and con dence in seeking health services when needed and navigating institutional locations such as hospitals and clinics, and negotiating patient pathways which may be complex. ...
... (14,31,32,35,44,45) Care organised around the person CMOC 4 ( g 6)shows that in a context of where care is organised around the person, the mechanism of exibility and personalisation is triggered, allowing patients to feel that their particular needs are understood and met. (21,29,33,44,(46)(47)(48)(49) Health system navigability is enhanced through having coordinated and co-located care, (7,29,33,34,47,(50)(51)(52) through having clear and intuitive patient pathways managed by staff and providers who bring patients along to the next step, (14,33,47,53,54) and through accompanying patients either by link workers or peer advocates. (21,33,(54)(55)(56)(57)(58) Having this kind of support helps patients by providing extra motivation and con dence in seeking health services when needed and navigating institutional locations such as hospitals and clinics, and negotiating patient pathways which may be complex. ...
... (14,31,32,35,44,45) Care organised around the person CMOC 4 ( g 6)shows that in a context of where care is organised around the person, the mechanism of exibility and personalisation is triggered, allowing patients to feel that their particular needs are understood and met. (21,29,33,44,(46)(47)(48)(49) Health system navigability is enhanced through having coordinated and co-located care, (7,29,33,34,47,(50)(51)(52) through having clear and intuitive patient pathways managed by staff and providers who bring patients along to the next step, (14,33,47,53,54) and through accompanying patients either by link workers or peer advocates. (21,33,(54)(55)(56)(57)(58) Having this kind of support helps patients by providing extra motivation and con dence in seeking health services when needed and navigating institutional locations such as hospitals and clinics, and negotiating patient pathways which may be complex. ...
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Objective: The objective of this study was to identify and understand the health system contexts and mechanisms that allow for homeless populations to access appropriate healthcare when needed. Design: A realist review. Data sources: Ovid MEDLINE, embase.com, CINAHL, ASSIA and grey literature until April 2019. Eligibility criteria for selecting studies: The purpose of the review was to identify health system patterns which enable access to healthcare for people who experience homelessness. Peer reviewed articles were first identified through a systematic search, grey literature searching, citation tracking and expert recommendations. Studies meeting the inclusion criteria were assessed for rigour and relevance and coded to identify data relating to contexts, mechanisms and/or outcomes. Analysis: Inductive coding was used to generate Context-Mechanism-Outcome configurations which were refined and then used to build several iterations of the overarching programme theory. Results: Searching identified 330 review articles, of which 24 were included. Additional searching of grey literature yielded 50 records of which 12 were included. An additional 11 grey literature and primary sources were identified through citation tracking and expert recommendation for a total of 47 included sources. The analysis found that healthcare access for populations experiencing homelessness is improved when services are coordinated and delivered in a way that is organised around the person with a high degree of flexibility and a culture that rejects stigma generating trusting relationships between patients and staff/providers. Health systems should provide long-term, dependable funding for services to ensure sustainability and staff retention. Conclusions: With homelessness on the rise internationally, this study will inform health systems policy-making and implementation. It contributes to our understanding how healthcare systems can be more accessible for populations experiencing homelessness by providing long-term stable funding, promoting inclusive cultures and limiting stigma. Health systems should be flexible, timely and connected.
... Instead, we emphasise the importance of enabling environments and services that can provide access to resources that allow young migrants to build on their resilience 12 Recent literature reviews have focused on the use of SRH services among migrant and/or refugee populations. 3,10,[13][14][15] These reviews focus on 'health service utilisation of young migrants' 15 , 'SRH use in overall migrant populations' 10,13,14,16,17 and SRH service use by culturally and linguistically diverse (CALD) young people in the context of a specific country, namely Australia. 3 The review that focuses on SRH service use among CALD young people in Australia found, for example, that many CALD young people remain hidden to and underserved by SRH services. ...
... Instead, we emphasise the importance of enabling environments and services that can provide access to resources that allow young migrants to build on their resilience 12 Recent literature reviews have focused on the use of SRH services among migrant and/or refugee populations. 3,10,[13][14][15] These reviews focus on 'health service utilisation of young migrants' 15 , 'SRH use in overall migrant populations' 10,13,14,16,17 and SRH service use by culturally and linguistically diverse (CALD) young people in the context of a specific country, namely Australia. 3 The review that focuses on SRH service use among CALD young people in Australia found, for example, that many CALD young people remain hidden to and underserved by SRH services. ...
... 16 Some of the structural barriers to SRH care (clinical hours, waiting time, confidentiality) identified in this review can be addressed using online sexual health consultation or telehealth; both have shown to address access barriers of SRH service use in young people. 15,37 Studies showed that online consultation for Chlamydia followed by home-based testing kits increased the screening rates of Chlamydia in marginalised youth 38 or those who lived in a remote location with limited sexual health services available to them. 39,40 Online testing can be offered to young migrants who do not wish to attend sexual health clinics for confidentiality concerns; however, considerable caution should be exercised while posting the testing kits as many young migrants live with their parents. ...
Article
Young people with migrant or refugee backgrounds from low- and middle-income countries settle in high-income countries and tend to underutilise sexual and reproductive health (SRH) services. This review aimed to explore perceptions and experiences of SRH services and the factors that shape their use among migrant youth. It focuses on qualitative studies that examine SRH service use among young migrants living in high-income countries. Seven peer-review databases and web-based grey literature were searched using pre-determined search criteria. The review includes 16 articles that met the inclusion criteria. The qualitative evidence synthesis (QES) method was used to synthesise findings. Thematic analysis resulted in five main themes and 11 sub-themes. Findings suggest that despite diversity of countries of origin and host countries, there were considerable similarities in their perceptions of and experiences with SRH services. Some young migrants reported experiences of discrimination by service providers. Cost of care was a deterrent to SRH service use in countries without universal healthcare coverage. Lack of information about SRH services, concerns about confidentiality, community stigma around sexually transmitted infections and premarital sex were key barriers to SRH service use. Health systems should integrate flexible service delivery options to address access barriers of SRH service use in young migrants. Engagement with parents and communities can help to destigmatise sexual health problems, including STIs. Host countries need to equip young migrants with the knowledge required to make informed SRH decisions and access relevant SRH services and resources.
... We use the collective term 'Indigenous' to describe people who originate from a particular region but acknowledge the rich diversity of cultures and knowledge represented by this term. Despite the need, Indigenous young people worldwide are less likely to access mental health treatment than nonmarginalised young people [5,6]. Barriers to accessing mental health treatment include stigma, fear, shame, intergenerational trauma, distrust of services and being unable to identify signs and symptoms of illness [5,6]. ...
... Despite the need, Indigenous young people worldwide are less likely to access mental health treatment than nonmarginalised young people [5,6]. Barriers to accessing mental health treatment include stigma, fear, shame, intergenerational trauma, distrust of services and being unable to identify signs and symptoms of illness [5,6]. Furthermore, the location of populations in need are often decentralised, meaning long distances and increased costs and challenges in the delivery of services [5,7]. ...
... Despite the need for culturally safe, effective and early intervention treatments, there remain relatively few approaches which are evidencebased. Recent increased availability of technology and connectivity has been identified as an opportunity to increase access to health services within underserved communities and marginalised youth populations [6]. ...
Article
Full-text available
Background Indigenous young people worldwide are at greater risk of developing mental health concerns due to ongoing inequity and disadvantage. Digital mental health (dMH) interventions are identified as a potential approach to improving access to mental health treatment for Indigenous youth. Although involvement in the development and evaluation of dMH resources is widely recommended, there is limited evidence to guide engagement of Indigenous young people in these processes. This scoping review aims to examine the methods used to involve Indigenous young people in the development or evaluation of dMH interventions. Methods Articles published in English, involving Indigenous young people (aged 10–24 years) in the development or evaluation of dMH interventions, originating from Australia, New Zealand, Canada and the USA will be eligible for inclusion. PubMed, Scopus and EBSCOhost databases (Academic Search Premiere, Computer and Applied Science complete, CINAHL, MEDLINE, APA PsychArticles, Psychology and Behavioural Sciences collection, APA PsychInfo) will be searched to identify eligible articles (from January 1990 onwards). Infomit and Google Scholar (limited to 200 results) will be searched for grey literature. Two reviewers will independently screen citations, abstracts and full-text articles. Study methods, methodologies, dMH intervention details, participant information and engagement, and dissemination methods will be extracted, analysed (utilising content analysis), and qualitatively assessed for alignment with best practice ethical guidelines for undertaking Indigenous health research. A narrative summary of findings will be presented. Reporting will follow the Consolidated Criteria for Strengthening Reporting of Health Research involving Indigenous peoples (CONSIDER) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. Discussion To date, there are no reviews which analyse engagement of Indigenous young people in the development and evaluation of dMH interventions. This review will appraise alignment of current practice with best practice guidelines to inform future research. It will highlight appropriate methods for the engagement of young people in study processes, providing guidance for health practitioners, policy makers, and researchers working in the field of Indigenous youth and dMH. Systematic review registration Open Science Framework (osf.io/2nkc6).
... On the other hand, the level of education and socioeconomic status play an important role in the adoption of digital services and use of the internet, even among young people who are labeled as technologically more savvy than older generations [7,55]. According to Robards et al [55], marginalized young people particularly need assistance and guidance to use digitalized health care services. ...
... On the other hand, the level of education and socioeconomic status play an important role in the adoption of digital services and use of the internet, even among young people who are labeled as technologically more savvy than older generations [7,55]. According to Robards et al [55], marginalized young people particularly need assistance and guidance to use digitalized health care services. ...
Article
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Background The significance of web-based health and social care services has been highlighted in recent years. There is a risk that the digitalization of public services will reinforce the digital and social exclusion of vulnerable groups, such as individuals with mental health problems. Objective This study aims to examine the associations between mental health problems and attitudes toward web-based health and social care services in the general population. The attitudes measured include lack of interest, perceived need for face-to-face encounters, and concern for safety. The study also evaluates whether sociodemographic characteristics (age, gender, education level, and poverty) modify these associations. Methods Cross-sectional population-based data were collected from 4495 Finnish adults in 2017. Linear regression was used to examine the main effects and interactions of poor mental health and sociodemographic characteristics on attitudes toward web-based health and social care services. Results The results show that mental health was associated with attitudes toward web-based health and social care services. Individuals with mental health problems were especially concerned about the safety of web-based services. Poor mental health was independently associated with negative attitudes toward web-based services over the effects of sociodemographic factors. Some of the associations between poor mental health and negative attitudes toward web-based services were stronger among older people and men. With regard to sociodemographic characteristics, particularly higher age, low education, and poverty were associated with negative attitudes toward web-based health and social care services. Conclusions Poor mental health is associated with negative attitudes toward web-based health and social care services and thus indirectly with exclusion. It seems that being older and being male both reinforce the link between poor mental health and exclusion. In supporting the digital inclusion of people with mental health problems, attention should be paid to guidance and counseling, reliability, and the user-friendliness of web-based services as well as to the prevention of poverty. In addition, it is essential to see web-based services as complementary to, and not a substitute for, face-to-face services.
... The stigma associated with sexual health also undoubtedly heightens privacy concerns held by users of internet-based testing [23]. The concerns over privacy and anonymity identified in this review simultaneously highlight the potential of digital interventions to overcome stigma as a barrier to accessing health care-in the context of both sexual health and other conditions-and the underresearched phenomenon of the role that stigma plays when using internet-based interventions [23,45,51,52]. Our finding that many people are concerned about aspects of the internet-based testing process that could allow others to know they had used sexual health services emphasizes the role providers have in mitigating that risk and suggests a need for further exploration of the role that stigma plays when individuals access, or consider accessing, internet-based health care. ...
... The concern identified that internet-based testing may deprive users of important aspects of face-to-face testing is significant, particularly as internet-based testing is one of the few health interventions that allows users to have no direct contact with clinical staff. Although it did not appear to deter the majority of participants from the prospect of using internet-based testing, it aligns with evidence from other contexts that digital health care is seen as supplementary and that service users are willing to use it provided it does not replace face-to-face care [51]. This may also be the case for the delivery of test results remotely, a topic on which limited evidence exists and to which this review therefore makes a notable contribution [56]. ...
Article
Background: Internet-based testing for sexually transmitted infections (STIs) allows asymptomatic individuals to order a self-sampling kit online and receive their results electronically, reducing the need to attend a clinic unless for treatment. This approach has become increasingly common, however there is evidence that barriers exist to accessing it, particularly among some high-risk populations. We review the qualitative evidence on this topic, as qualitative research is well-placed to identify the complex influences which relate to accessing testing. Objective: To explore perceptions and experiences of internet-based testing for STIs among users and potential users. Methods: Searches were run through five electronic databases (CINAHL, EMBASE, MEDLINE, PsychINFO and Web of Science) to identify peer-reviewed studies published between 2005 and 2018. Search terms were drawn from four categories: STIs; testing or screening; digital health; and qualitative methods. Included studies were conducted in high-income countries and explored patient perceptions or experiences of internet-based testing, and data underwent thematic synthesis. Results: A total of 11 studies were included in the review, from 1735 identified in the initial search. The synthesis identified that internet-based testing is viewed widely as being acceptable, and is preferred over clinic testing by many individuals due to perceived convenience and anonymity. However, a number of studies identified concerns relating to test accuracy and lack of communication with practitioners, particularly when receiving results. There was a lack of consensus on preferred media for results delivery, although convenience and confidentiality were again strong influencing factors. The majority of included studies were limited by the fact that they researched hypothetical services. Conclusions: Internet-based testing providers may benefit from emphasising its comparative convenience and privacy compared to face-to-face testing in order to improve uptake, as well as alleviating concerns about the self-sampling process. There is a clear need for further research exploring in-depth the perceptions and experiences of people who have accessed internet-based testing, and for research on internet-based testing explicitly gathering the views of populations which are at high-risk of STIs. Clinicaltrial:
... Barriers to helpseeking among young people include concerns about confidentiality, lack of awareness of services available, stigma, poor accessibility, perceived attitudes of health care workers, cost and inadequately trained health care providers [12]. A recent systematic review of research among marginalised young people found barriers existed across all groups but were more prominent for some [13]. Among homeless young people, cost barriers were more pronounced, while fear of discrimination appeared more salient for sexuality and gender diverse young people. ...
... For rural young people, confidentiality concerns, transport and availability of services featured more strongly. Among refugee youth, language barriers and difficulty understanding health systems presented more commonly as barriers and among Indigenous young people, culturally sensitive services were cited as particularly important [13]. ...
Article
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Background Young people (12–24 years) visit general practice but may not have a ‘regular’ general practitioner (GP). Whether continuity of GP care influences experiences with, and barriers to, health care among young people is unknown. This paper explores the association between having a regular GP and experience of healthcare barriers and attitudes to health system navigation among young people in New South Wales (NSW), Australia. Methods This study was a cross-sectional survey administered either online or face-to-face in community settings. Young people living in NSW were recruited, with oversampling of those from five socio-culturally marginalised groups (those who were Aboriginal and Torres Strait Islander, homeless, of refugee background, in rural or remote locations, sexuality and/or gender diverse). In this analysis of a larger dataset, we examined associations between having a regular GP, demographic and health status variables, barriers to health care and attitudes to health system navigation, using chi-square tests and odds ratios. Content and thematic analyses were applied to free-text responses to explore young people’s views about having a regular GP. Results One thousand four hundred and sixteen young people completed the survey between 2016 and 2017. Of these, 81.1% had seen a GP in the previous 6 months and 57.8% had a regular GP. Cost was the most frequently cited barrier (45.8%) to accessing health care generally. Those with a regular GP were less likely to cite cost and other structural barriers, feeling judged, and not knowing which service to go to. Having a regular GP was associated with having more positive attitudes to health system navigation. Free-text responses provided qualitative insights, including the importance of building a relationship with one GP. Conclusions General practice is the appropriate setting for preventive health care and care coordination. Having a regular GP is associated with fewer barriers and more positive attitudes to health system navigation and may provide better engagement with and coordination of care. Strategies are needed to increase the proportion of young people who have a regular GP.
... Whether clinicians can provide effective and reliable treatment, perform assessments [26,27], identify ailments and symptoms [28], manage suicidal behaviors [26,28,29], and provide personable, compassionate services [26,30,31] remains uncertain. Furthermore, digital delivery of services may be complicated by the symptomatology of some mental health conditions [26,29], concurrent medical conditions [29], and socioeconomic factors [31][32][33][34][35][36][37][38][39][40][41][42]. A lack of information, resources, and understanding of complex patient-related factors could negatively affect care delivery and overall patient health. ...
... Existing research on digital interventions rarely covers comorbid conditions, emergency situations, or complex socioeconomic factors. For example, research on people experiencing homelessness is limited to commentaries and policy recommendations based on available research in the general population [32][33][34][35][36][37][38][39][40][41][42]. This is of particular concern when considering that those of lower socioeconomic status or with complex life circumstances show reduced benefits from digital health interventions [148,165,407]. ...
Article
Full-text available
Background: The COVID-19 pandemic has shifted mental health care delivery to digital platforms, videoconferencing, and other mobile communications. However, existing reviews of digital health interventions are narrow in scope and focus on a limited number of mental health conditions. Objective: To address this gap, we conducted a comprehensive systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions. Methods: We searched MEDLINE for secondary literature published between 2010 and 2021 on the use, efficacy, and appropriateness of digital health interventions for the delivery of mental health care. Results: Of the 3022 records identified, 466 proceeded to full-text review and 304 met the criteria for inclusion in this study. A majority (52%) of research involved the treatment of substance use disorders, 29% focused on mood, anxiety, and traumatic stress disorders, and >5% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence. Conclusions: Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions.
... Future research should consider designing interventions to be delivered via platforms that SGMY are most likely to find acceptable and easily accessible. For example, as a way to increase access to mental healthcare, interventions could provide SGMY with the ability to participate in treatment remotely (Robards, Kang, Usherwood, & Sanci, 2018). ...
... Results of the study are being used to further inform the ongoing development of the intervention. Of note, all of the ongoing research is choosing to focus on integrating technology for intervention delivery, which may be particularly appealing for SGMY (Robards et al., 2018). Intervention delivery modalities that enable SGMY to control the extent to which they disclose their sexual and gender identity status, and the ways in which they engage with mental health services, can provide an affirming environment for psychotherapeutic progress. ...
Article
Full-text available
Sexual and gender minority youth (SGMY) are disproportionately affected by mental health problems, including depression and suicidality. Recently, there has been increased interest in developing and adapting evidence-based treatments for depressive symptoms tailored to address the unique issues facing SGMY. This is the first systematic review of interventions targeting depressive symptoms that have been adapted for SGMY populations. Findings from these studies provide evidence in support of the feasibility, acceptability, and preliminary efficacy for SGM-informed interventions for the treatment of depressive symptoms. Fully powered randomized controlled trials are needed to determine the efficacy of these adapted treatments prior to dissemination.
... Here, younger migrants reported worse treatment experience in our sample from 7 EU countries. A recent systematic literature review by Robards and colleagues [32] found that for marginalized young people, the decision to access health services is affected by previous bad experiences during which they felt treated differently and with disrespect by healthcare professionals. In the same article, the study population highlighted different actions to be considered in the delivery of healthcare for migrant young groups such as culturally appropriate services, cultural sensitivity of staff, and the use of interpreters. ...
Article
Full-text available
Background: Discrimination based on ethnicity and the lack of translation services in healthcare have been identified as main barriers to healthcare access. However, the actual experiences of migrant patients in Europe are rarely present in the literature. Objectives: The aim of this study was to assess healthcare discrimination as perceived by migrants themselves and the availability of translation services in the healthcare systems of Europe. Methods: A total of 1407 migrants in 10 European Union countries (consortium members of the Mig-HealthCare project) were surveyed concerning healthcare discrimination, access to healthcare services, and need of translation services using an interviewer-administered questionnaire. Migrants in three countries were excluded from the analysis, due to small sample size, and the new sample consisted of N = 1294 migrants. Descriptive statistics and multivariable regression analyses were conducted to investigate the risk factors on perceived healthcare discrimination for migrants and refugees in the EU. Results: Mean age was 32 (±11) years and 816 (63.26%) participants were males. The majority came from Syria, Afghanistan, Iraq, Nigeria, and Iran. Older migrants reported better treatment experience. Migrants in Italy (0.191; 95% CI [0.029, 0.352]) and Austria (0.167; 95% CI [0.012, 0.323]) scored higher in the Discrimination Scale to Medical Settings (DMS) compared with Spain. Additionally, migrants with better mental health scored lower in the DMS scale (0.994; 95% CI [0.993, 0.996]), while those with no legal permission in Greece tended to perceive more healthcare discrimination compared with migrants with some kind of permission (1.384; 95% CI [1.189, 1.611]), as opposed to Austria (0.763; 95% CI [0.632, 0.922]). Female migrants had higher odds of needing healthcare assistance but not being able to access them compared with males (1.613; 95% CI [1.183, 2.199]). Finally, migrants with chronic problems had the highest odds of needing and not having access to healthcare services compared with migrants who had other health problems (3.292; 95% CI [1.585, 6.837]). Conclusions: Development of culturally sensitive and linguistically diverse healthcare services should be one of the main aims of relevant health policies and strategies at the European level in order to respond to the unmet needs of the migrant population.
... In addition, while novelty and variety can drive engagement for users in general [47,97,119], these can be especially important for young people [93,101]. In part, this may reflect that young adults who have not connected to formal services have limited exposure to psychological concepts and strategies [110], and might benefit from experimenting with an array of content until they find what works for them. In addition, personalization and tailoring are endorsed by users of all ages [69], but may have particular appeal for young adults [64,101]. ...
Conference Paper
Young adults have high rates of mental health conditions, but most do not want or cannot access formal treatment. We therefore recruited young adults with depression or anxiety symptoms to co-design a digital tool for self-managing their mental health concerns. Through study activities-consisting of an online discussion group and a series of design workshops-participants highlighted the importance of easy-to-use digital tools that allow them to exercise independence in their self-management. They described ways that an automated messaging tool might benefit them by: facilitating experimentation with diverse concepts and experiences; allowing variable depth of engagement based on preferences, availability, and mood; and collecting feedback to personalize the tool. While participants wanted to feel supported by an automated tool, they cautioned against incorporating an overtly human-like motivational tone. We discuss ways to apply these findings to improve the design and dissemination of digital mental health tools for young adults.
... Lack of care was evident in the case of one participant who experienced significant withdrawal effects from following her GP's medical advice to abruptly cease her prescribed medication. Such examples strengthen the call for healthcare professionals to actively participate in optimising opportunities for medication information provision [50], and to seriously consider the specific needs and particular concerns of this population [51]. ...
Article
Full-text available
Background: Young people face significant challenges when managing a mental illness, such as acquiring treatment autonomy, being inexperienced users of the healthcare system and associated peer-related stigma. While medication use can be challenging in its own right, there is comparatively little information about the associated experiences and needs of young people with mental illness, particularly in the Australian context. This exploratory study will provide valuable insight into how this group is currently supported in relation to medication use. Methods: Young people (aged 14-25 years) who had used a prescription medication for any mental illness for a minimum of 2 months were eligible to participate in this qualitative exploratory study. Semi-structured interviews were conducted between October 2017-September 2018 in consultation rooms at two youth-focused mental health support organisations in Brisbane, Queensland. Interview questions explored how participants managed their medication and related experiences. Interviews were transcribed verbatim and descriptively analysed using thematic analysis. Results: Eighteen young people discussed their lived experience during interviews averaging 50 min in duration. Finding the right medication that reduced symptom severity with minimal side-effects was identified as a complex experience for many, particularly when there was a lack of information, support or reduced financial capacity. Young people described a range of strategies to manage medication side-effects, changes and to support routine medication use. Conclusions: Young people persevered with taking medication to manage a mental illness within a healthcare system that does not adequately support this vulnerable population. There remains a clear directive for healthcare professionals to provide credible information that proactively engages young people as healthcare participants, and for policy makers to consider financial burden for this population with limited financial capacity.
... At the general level, this came across through descriptions of omniscient and hardy professionals that transcended barriers while extending their support beyond the roles and responsibilities of their profession to care for and about youth. More specifically, it comprised portrayals of practical assistances such as personalising and tailoring care according to need while "fixing appointments for them" (Elin, social councillor, S3) to help youth navigate within 'complex, fragmented bureaucratic health systems' ( [42] p. 377). The work of pioneering professionals also involved accounts of empathy and compassion, with them stretching emotionally outside what might be expected in their profession. ...
Article
Full-text available
Background: This study emerges as a response to the lack of youth perspectives when it comes to discussions about access to and experiences of health and social services in rural areas. It subsequently contributes to the literature by positioning young people at the centre of this debate, and by taking a more holistic approach to the topic than is typically the case. Specifically, based on the idea that a good life in proper health for young people may be contingent on notions of care that are bounded up in multi-layered social and spatial environments, the aim of this study was to explore what characterises 'landscapes of care' for rural youth. Methods: In this qualitative study, the participants included young people and professionals residing in five diverse areas across the northern Swedish 'peripheral' inland. Individual interviews (16 in total) and focus group discussions (26 in total) were conducted with 63 youth aged 14-27 years and with 44 professionals operating across sectors such as health centres, school health, integration units, youth clinics and youth clubs. Following an emergent design and using thematic analysis, we developed one main theme, 'landscapes of care and despair', comprising the two themes: '(dis)connectedness' and 'extended support or troubling gaps'. Results: The findings illustrate how various health-promoting and potentially harmful aspects acting at structural, organisational and interpersonal levels contributed to dynamic landscapes characterised simultaneously by care and despair. In particular, our study shows how rural youths' feelings of belongingness to people and places coupled with opportunities to participate in society and access practical and emotional support appear to facilitate their care within rural settings. However, although the results indicate that some in the diverse group of rural youth were cared for and about, a negative picture was painted in parallel. These aspects of despair included youths' senses of exclusion and marginalisation, degrading attitudes towards them and their problems, as well as recurrent gaps in the provision and practices of care. Conclusions: To gain a more comprehensive understanding about the health of rural youth, this study highlights the benefits investigating 'care-ful' and 'uncaring' aspects bounded up in dynamic and multi-layered landscapes.
... 834). Studies affirm positive influences for sexual and gender minorities finding online spaces to express themselves (Alexander & Losh, 2010) and to find a sense of self (Robards, Kang, Usherwood, & Sanci, 2018). However, we noted that discrimination and marginalization follow transgender people online, through a re-imposition of offline sociostructural oppression. ...
Article
Full-text available
Fluid performances of gender online by gender-diverse individuals facing discrimination and fetishization raises questions about whether these acts are a source of empowerment or reinforce prevailing prejudice. We combine virtual ethnography and interviews with transwomen sex workers in Singapore (n=14) to explore the dynamic between sociostructural oppression and agentic resistance. First, heterosexual power relations manifest online via digital practices of access, surveillance, and intervention to discriminate against and objectify respondents’ identities and bodies. Second, the online response can be categorized into specific digital practices of avoidance involving privacy and anonymity, accommodation via subtle practices of submission, and collaboration via community mobilization. Finally, gender performativity on sites for sex solicitation manifests in the presentation of both essentialist (submissive femininity) and provocative (hyper-sexual) embodiments, defying simplistic characterization into the structure-agency dynamic. We discuss the co-constructive nature of socially situated gender performances and the potential for challenging normative regimes of gender.
... Studies have documented the benefits of tailored content which is flexible to users' needs within guided e-interventions (Fleischmann et al., 2018;Palacios et al., 2018). The need for autonomy may be particularly marked among students, given the developmental tasks of young adults (i.e. the attainment of autonomy and independence) (Robards et al., 2018;Wilson et al., 2011). ...
Article
Internet-based treatments for depression have the potential to promote the mental health of university students. Yet, little is known about students' experiences of Internet-based mental health interventions (also known as e-interventions) and the acceptability of this mode of treatment in low-resource settings. Our aims were to investigate South African university students' experiences of using a brief semi-guided Internet-based cognitive behavioural therapy (iCBT) for depression and document the acceptability of this mode of psychotherapy. Data were collected via in-depth semi-structured interviews with students (n = 9) who had moderate to moderately severe symptoms of depression (as assessed by the PHQ-9) and had used a 7 session guided skills-based iCBT intervention. Data were analysed inductively using thematic analysis, with the aid of Atlas-ti software. Participants found the anonymity, privacy and accessibility of iCBT appealing, believing this facilitated use of the intervention and overcame stigma associated with accessing traditional campus counselling services. The intervention was helpful and facilitated self-disclosure, emotional expression, self-awareness and skill acquisition. However, students also reported disappointment with the lack of human contact and immediate responsiveness, articulating an expectation that the e-intervention would mimic face-to-face psychotherapy. Moves to incorporate iCBT into student counselling should take account of and manage students' expectations about the ability of e-interventions to mimic traditional therapy and/or incorporate more opportunities for human interaction.
... Social media can provide connection to others with shared experiences of discrimination as well as the ability to access vital information that may not be accessible outside of online spears due to societal heteronormativity, homophobia and transphobia ( Schmitz et al., 2020;Yeshua-Katz, 2019 ). Connection to online communities has been found to increase resilience in gender and sexual minority youth (McInroy, 2019), aid in identity formation (Lucero, 2017), connect youth to supportive peers and adults (Byron et al., 2019;Hanckel & Morris, 2014;Robards et al., 2018), support the development of sexuality and gender identity, and help guide the process of coming out (Pullen & Cooper, 2010). ...
Article
Full-text available
In March 2020, with the global number of COVID-19 cases on the rise, many people were advised to stay at home and leave only for necessities. Across the globe, people were on lockdown. Very little is known about how this period of quarantine due to the pandemic has impacted the lives of gender and sexual minority youth. Between February and June of 2020, TikTok—a short- video sharing platform—was the most downloaded social media app. The purpose of this study was to use a digital ethnographic approach on TikTok to explore the experiences of gender and sexual minority youth during COVID-19. Thematic analysis of the data collected resulted in an overarching theme of TikTok as a supportive community. Additionally, four sub themes were examined including support with family relationships, identity formation, community and belonging and sharing knowledge and information. This study demonstrates the need for further research into gender and sexual minority youth social media cultures and highlights the resilience and resourcefulness of gender and sexual minority youth when faced with unprecedented circumstances.
... Structural interventions that directly or indirectly reduce STI risk support biomedical prevention by either facilitating access to prevention or reducing the need for it by mitigating the circumstances that produce risk. 106 In New York City, an evaluation of an effort to provide affordable housing to youth emerging from foster care showed that youth who were in the housing program (with health access support) had under one-third the rate of STI diagnosis than youth not in the program. 107 In India, ongoing interventions on social determinants of health are aimed at reducing HIV risk through supporting girls in low castes entering and staying in secondary education: the mediating factor is delaying the age of marriage and reducing the proportion entering into sex work. ...
Article
In the past two decades, major advances in biomedical intervention approaches to prevent HIV and many sexually transmissible infections (STIs) have shown great promise. However, challenges to prevention remain in the area of achieving population-level impact for biomedical prevention approaches. In this paper we address what social and behavioural research approaches can contribute beyond well-known behaviour change and counselling interventions. We organise work into five areas. Adherence and disinhibition research is primarily into individual-level constructs pertaining to maximising intervention effectiveness. Coverage research represents a population-level construct germane to maximising efficient prioritisation for prevention. Research covering social determinants, a second population-level construct, contributes to both prioritisation and effectiveness. Finally, disparities and social inequities need to be incorporated into prevention, given the pervasive and persistent disparities found in rates of HIV and STIs and in their antecedents.
... As health systems recognise and respond to the specific needs of young people, it is important to ensure equity of access for all groups. In our systematic review [37] we found that studies into access and health system navigation for marginalised young people almost always focused on only one group, yet it is likely that multiple marginalisation is not an uncommon experience for young people. ...
Article
Full-text available
Background: The aim of this study was to measure young people's health status and explore associations between health status and belonging to one or more socio-culturally marginalised group. Methods: part of the Access 3 project, this cross-sectional survey of young people aged 12-24 years living in New South Wales, Australia, oversampled young people from one or more of the following groups: Aboriginal and or Torres Strait Islander; living in rural and remote areas; homeless; refugee; and/or, sexuality and/or gender diverse. This paper reports on findings pertaining to health status, presence of chronic health conditions, psychological distress, and wellbeing measures. Results: 1416 participants completed the survey; 897 (63.3%) belonged to at least one marginalised group; 574 (40.5%) to one, 281 (19.8%) to two and 42 (3.0%) to three or four groups. Belonging to more marginalised groups was significantly associated with having more chronic health conditions (p = 0.001), a greater likelihood of high psychological distress (p = 0.001) and of illness or injury related absence from school or work (p < 0.05). Conclusions: increasing marginalisation is associated with decreasing health status. Using an intersectional lens can to be a useful way to understand disadvantage for young people belonging to multiple marginalised groups.
... É necessário considerar o papel das tecnologias em saúde no acesso, engajamento e seu impacto nas oficinas educativas com adolescentes. 20,21 Percebe-se que a utilização das tecnologias em saúde nas oficinas educativas pode contribuir favoravelmente para o êxito das ações, especialmente quando direcionadas aos adolescentes. Os aspectos aqui evidenciados possibilitam construir uma nova prática em saúde e sugerem a replicação do estudo em outros cenários. ...
Article
Full-text available
INTRODUCTION: adolescence is a phase of life characterized by situations of vulnerability that predispose adolescents to risky situations. Technological innovations can promote the health of adolescents through educational workshops to empower them about caring for their health. OBJECTIVE: to know the facilitators' perception of health technologies used in educational workshops with adolescents. METHOD: qualitative study carried out with 14 facilitators of the extension project Adolescer com Saúde (Adolescent with Health). Data were collected through semi-structured interviews, submitted to content analysis in thematic modality. RESULTS: three thematic categories emerged. Facilitators perceive educational workshops as appropriate health technologies that enhance health promotion. It was apprehended that the use of educational workshops can contribute to the success of actions, especially when directed at adolescents. CONCLUSION: the facilitators realize that educational workshops, as health technologies, are important. The recurrent use of soft technologies was evidenced and represents a resource that strengthens health education actions.
... LGBTQI) and a lack of choice and agency around treatment options (Brown, 2016;De Haan et al., 2012;Robards, Kang, Usherwood & Sanci, 2018). ...
Conference Paper
This thesis explores the role of interactions between people and horses in Equine-Assisted Therapy and Learning interventions (EAT/L) for disadvantaged young people (YP). Part one is a conceptual review of the theories, methods, and techniques currently used in EAT/L research and practice for disadvantaged YP. Part two is an empirical research paper that explores the role of interactions between people and horses in interventions at a charity offering EAT/L for disadvantaged YP. It aimed to develop a theory of the role of horse-human interactions in EAT/L from the views and experiences of people facilitating and participating in it. It is a qualitative study using semi-structured interviews with 13 young people and 6 staff, and observations of EAT/L sessions that they participated in. Part three is a critical appraisal of the research process. It focuses on the ways in which the researcher’s worldview, experiences, preconceptions and intentions influenced the research process, and how the process of the research influenced the researcher’s personal development and clinical and research practice.
... La deuxième question de recherche a abouti à des constats similaires des autres études menées sur le sujet, à savoir, des difficultés d'accès aux services psychosociaux, à de l'information et à des suivis en regard de la médication ou du diagnostic. Or, les études menées sur les perceptions des jeunes en situation d'itinérance sur les difficultés d'accès aux soins et services en santé mentale (Duford, 2014;Darbyshire, Muir-Cochrane et Fereday, 2006), à l'instar des revues systématiques (Brown et collab., 2016;Robards et collab., 2018), ne se sont pas penchées sur les liens entre leurs expériences de soins et services et leur rapport à la médication ou au diagnostic en santé mentale. ...
Article
Full-text available
Cet article présente les résultats d’une recherche exploratoire menée auprès de jeunes fréquentant des Auberges du cœur, lesquelles hébergent des jeunes en difficulté et en situation d’itinérance à Drummondville et à Montréal. Nous nous sommes intéressés aux rapports qu’entretiennent ces jeunes avec leurs diagnostics et la médication en santé mentale ainsi qu’à la manière dont elles ou ils sont suivis par les professionnelles ou professionnels de la santé. Nous revenons sur trois éléments clefs de notre étude : 1. l’existence de longs processus d’ajustement solitaire vis-à-vis de la médication pouvant aboutir à un abandon ou un refus de la prescription; 2. les difficultés d’accessibilité à certains services, notamment d’aide psychologique; 3. le développement d’un rapport ambigu, à la fois « expert » et « critique » sur les usages de la médication, conduisant à une prise de distance vis-à-vis de certaines institutions, médicales ou liées aux services sociaux. Mots-clés : Jeunes, Santé mentale, Diagnostics, Médication, Jeunes en difficulté, Jeunes en situation d’itinérance, Auberges du cœur, Québec
... [8][9][10] Such barriers include knowledge gaps concerning available services, competing needs to secure food and shelter, and the unavailability (eg, timing, location) of services necessary to meet their needs. [11][12][13][14] People considered hard-to-reach or hidden also regularly experience discriminatory interactions within healthcare encounters that result in unmet health needs and future reluctance to engage with these services. 9 11 15 16 Consequently, hardto-reach and hidden populations are chronically underserved in current health services, thereby contributing to the urgent need to redress health inequities among such groups. ...
Article
Full-text available
Introduction Outreach is regularly identified as an effective strategy to engage underserved, hard-to-reach and hidden populations with essential life-sustaining health services. Despite the increasing expansion of outreach programmes, particularly in HIV prevention and health promotion with youth, sex workers, people living with mental health and substance use challenges, and those affected by homelessness, there has been limited synthesis of the evidence concerning the core components of outreach programming or indicators of its successful implementation. Without this understanding, current outreach programmes may be limited in achieving the desired aims. The aim of this scoping review is to explore how outreach has been operationalised and implemented in various community settings with people underserved in current healthcare contexts. Understanding the state of knowledge pertaining to outreach as programming and as practice involving the engagement of people considered hard-to-reach will enable the identification of promising trends and limitations in the field. Methods and analysis This scoping review follows the Arksey and O’Malley’s framework. CINAHL, MEDLINE, PsycINFO and PubMed databases will be searched for peer-reviewed references focused on outreach with hard-to-reach and hidden groups from 1 January 2008 to 30 April 2020. Guided by explicit inclusion and exclusion criteria, three reviewers will independently assess references in two successive stages. Titles and abstracts will be reviewed followed by full-text assessment of papers meeting the review criteria. A descriptive overview, tabular and/or graphical summaries and a thematic analysis will be carried out on extracted data. Ethics and dissemination Ethics approval was not required as the only data source was peer-reviewed documents. Outreach knowledge users who are members of the project team will participate in all aspects of study design, implementation and result dissemination strategies.
... Given the rapid expansion in utilization of telehealth during the pandemic and the positive experiences of many providers, patients, and families, it may be tempting to think of telehealth as a panacea for the myriad barriers to health care access. However, research indicates that many families do not have the access to technology to allow for consistent use of telehealth, and that this is especially true for underserved and marginalized populations (Liburd et al., 2020;Robards et al., 2018). In fact, the same populations disproportionately impacted by COVID-19 may have the most difficulty accessing telemedicine (Lame et al., 2020), suggesting that telehealth may inadvertently exacerbate existing inequalities, rather than moving toward equity in access to care. ...
Article
The COVID-19 pandemic has wrought widespread devastation upon children and families across the United States, widening existing health disparities and inequities that disproportionately affect communities of color. In health care settings specifically, social work is the key workforce tasked with responding to patient and family psychosocial needs, both of which have increased substantially since the emergence of COVID-19. There is a need to understand ways in which hospital social workers’ roles, responsibilities, and integration within interprofessional teams have evolved in response to these challenges. In this qualitative study, focus groups were conducted with 55 social workers employed across multiple settings in a large, urban, pediatric hospital in Spring 2020. Thematic analyses revealed salient superordinate themes related to the pandemic’s impact on social work practice and social workers themselves, institutional facilitators and impediments to effective social work and interprofessional practice, and social work perspectives on future pandemic recovery efforts. Within each theme, a number of interrelated subthemes emerged elucidating nuances of telehealth adoption in the context of remote work, the salience of social determinants of health, and the critical role of social work in social justice oriented pandemic preparedness and response efforts. Implications for interprofessional practice and the profession at large are discussed.
... Page 27 Recent trends in adolescent health, wellbeing, education and safety Migrant and refugee adolescents may also face additional difficulties in accessing mental health services and navigating the healthcare system in general. These difficulties can relate to cultural stigma, language barriers and lack of system knowledge (Robards, Kang, Usherwood, & Sanci, 2018;Valibhoy, Szwarc, & Kaplan, 2017), as well as the complex immigration policy environment in which eligibility to access Medicare is determined by visa categories (Taylor & Haintz, 2018). ...
Book
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The 2018 State of Victoria's Children Report provides an overview of how adolescent Victorians are faring, in terms of educational outcomes, health and wellbeing, safety and home life. The report finds that most adolescent Victorians are in good physical and mental health, have positive peer and family relationships, and live in safe community environments. Rates of smoking, drinking and illicit drug use have declined to record lows. NAPLAN performance and Year 12 attainment rates are improving, setting up this generation for success in life. The report also highlights several generational challenges. Many adolescents are overweight and most do not meet guidelines for diet, exercise or screen time. Increasing numbers are reporting mental health problems and many do not find mental health services to be accessible. Self-harm presentations to emergency departments are higher than in the past, and there are increasing rates of children in contact with child protection. The report highlights the government policies and programs in place to address these challenges. The 2018 report also showcases the artistic talents of Victoria's students, with artwork from the Victorian Top Art finalists on display throughout the report.
... 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. These challenges collectively suggest many young people are likely to experience health issues that have the features of a wicked problem. ...
Article
Full-text available
Background: Youth health issues represent a "wicked problem" - they are complex and multifaceted. Furthermore, they are likely to require novel approaches to understand their complexity and develop novel solutions. Objective: Given the importance of youth healthcare, and the need for novel approaches, the aim of this article was to demonstrate the innovative use of two research methods - thematic and lexical analyses - to better understand practitioner perspectives of youth healthcare. It clarifies the factors that shape practitioner ability to support young people and opportunities to improve practice. Design and setting: Focus groups and interviews were conducted with 37 youth health practitioners. They represented government and non-government services; hospital and community services; and metropolitan and regional services. Results: Thematic analysis highlighted the complexity of participants' work and the judgements made as they negotiated relationships with young people and ancillary services. Lexical analysis revealed two hitherto neglected dimensions of the complexity of youth healthcare - uncertainty and corporeality. Discussion: In addition to affirming the complexities of youth healthcare, this study revealed how practitioners (can) negotiate these complexities. These findings were only possible because of the innovative use of the two research methods. Conclusions: This study has important theoretical, methodological and practical implications. Theoretically, it is the first to view the complexities of youth healthcare through the wicked problem lens. Methodologically, it highlights the complementary value of thematic and lexical analyses. Practically, it reinforces the importance of policy support and professional development to enable practitioners to grasp the complexities of their work.
... We systematically searched for full-length empirical studies published between 2004 and 2019 in scholarly peer-reviewed journals in English, focusing on Indigenous contexts using the search terms listed in Table 1. This timeframe was considered sufficient to obtain up-to-date evidence of the use of more current digital technology in Indigenous communities, which has increased in recent years due to the availability of technology and connectivity (Rice et al., 2016;Robards, Kang, Usherwood, & Sanci, 2018). All articles were further screened using the following inclusion criteria (see Table 2). ...
Article
Mental health issues in Indigenous communities have been increasingly documented by media, research, and government reports. High rates of suicide, depression, and substance abuse are prevalent among Indigenous people, especially youth. Research has reported that many Indigenous communities have adopted and are keen to adopt digital technologies, which have shown potential to provide e-mental health (eMH) resources for Indigenous people. By conducting a systematic literature review, this article examines the impact of Indigenous people's interactions with digital media on their mental health and wellbeing. The twenty-seven empirical studies included in this review were conducted with Indigenous participants primarily across four countries. We analyzed the studies' research objectives and respective instruments to measure the impact of an array of digital technologies adopted by Indigenous people for their mental health needs or used in Indigenous-specific eMH programs. This paper reports on themes found in the peer-reviewed literature, including Indigenous people and other stakeholders’ perspectives on eMH and the viability of its implementation. The findings suggest that digital technologies can be effective in aiding the provision and improvement of Indigenous mental health services, particularly when applying decolonizing, culturally appropriate approaches. This review provides insights for researchers, health professionals, and educators to develop and implement innovative eMH resources for Indigenous communities.
... However, some studies did note the underrepresentation of ethnic minority groups [53, 54] and children and young people with severe or complex needs [45,53,54]. Wider literature on healthcare access and transition note the additional barriers faced by children and young people from ethnic minority groups [71][72][73] and with chronic conditions [74,75], suggesting PPIE is currently falling short of the ambition of involving all children and young people in research to "improve health and wellbeing for themselves, their families and their communities" [1,2]. ...
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Background There has been an increasing interest in how children and young people can be involved in patient and public involvement and engagement (PPIE) in health research. However, relatively little robust evidence exists about which children and young people are reported as being involved or excluded from PPIE; the methods reported as being used to involve them in PPIE; and the reasons presented for their involvement in PPIE and what happens as a result. We performed a scoping review to identify, synthesise and present what is known from the literature about patient and public involvement and engagement activities with children and young people in health related research. Methods Relevant studies were identified by searches in Scopus, Medline, CINAHL, Cochrane and PsychInfo databases, and hand checking of reference lists and grey literature. An adapted version of the Guidance for Reporting Involvement of Patients and the Public (GRIPP2) was used as a framework to collate the data. Two reviewers independently screened articles and decisions were consensually made. Main findings A total of 9805 references were identified (after duplicates were removed) through the literature search, of which 233 full-text articles were assessed for eligibility. Forty studies published between 2000 and 2019 were included in the review. The review reveals ambiguities in the quality of reporting of PPIE with children with clear reporting on demographics and health conditions. The review found that children and young people were commonly involved in multiple stages of research but there was also significant variation in the level at which children and young people were involved in PPIE. Evaluation of the impact of children and young people’s involvement in PPIE was limited. Conclusions Consultation, engagement and participation can all offer children and young people worthwhile ways of contributing to research with the level, purpose and impact of involvement determined by the children and young people themselves. However, careful decisions need to be made to ensure that it is suited to the context, setting and focus so that the desired PPIE impacts are achieved. Improvements should be made to the evaluation and reporting of PPIE in research. This will help researchers and funders to better understand the benefits, challenges and impact of PPIE with children and young people on health research.
... These studies, focusing on increasing child participation in health care, have shown that digital tools providing support for communication and participation have a positive outcome on the children's involvement and engagement in their own care (IM Carlsson et al, unpublished data, 2019;I Larsson et al, unpublished data, 2019) [30][31][32][33]. However, despite widespread optimism about the potential of such digital tools, research reveals that disparities remain in relation to health and well-being among those who are in vulnerable positions such as children with disabilities [34], and the evidence base for informing policy and practice in relation to this is insufficient [35,36].This study is part of an overall research project with the aim of strengthening children's participation in pediatric rehabilitation services by developing, validating, and evaluating an electronic health intervention that is based on a digital decision support tool for children with disabilities. The overall research project involves children with disabilities, their parents, young people with disabilities, and professionals in a user-centered design process, striving to mediate the children's voices and introducing a child-centered way of working in pediatric rehabilitation services. ...
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Background: Building a health care system in accordance with the rule of law requires child-centered care, where children and young people, regardless of ability, are allowed to participate in visits with their health care professionals. As part of an overall project focusing on developing and implementing a digital decision support tool to increase the participation of children with disabilities in pediatric rehabilitation, this study brings new knowledge as to how this specific patient group views participation. Objective: The aim of this formative study was to explore the experiences of children and young people with disabilities concerning increasing their participation in the pediatric rehabilitation services. Methods: The formative study had an explorative design, based on a latent qualitative content analysis with an inductive approach. Interviews were conducted with 20 children (6-17 years) and 8 young people (19-30 years) with disabilities about their experiences of participation in pediatric rehabilitation services. Results: A total of 3 categories emerged reflecting the participants' possibilities of participation in the pediatric rehabilitation services: to feel involved, to feel independent, and to work in partnership. To feel involved meant being listened to and being connected, to feel independent meant being admitted and being enabled, and to work in partnership meant being supported and being able to entrust others with the decision making. With the overall theme moving toward empowerment of children in pediatric rehabilitation, a true feeling of participation can be experienced. Conclusions: The views of children and young people with disabilities are that children should be given the prerequisites for empowerment by being allowed to feel involved and independent as well as to work in partnership to experience true participation in the pediatric rehabilitation services. This finding is essential in the design of a digital decision support tool based on the children's needs and perspectives.
... Bisexual+ youth on the asexual + spectrum also experienced less visibility and more dismissal of their identity than other bisexual+ young people (McInroy et al., 2020;Van Houdenhove et al., 2015). Young people living in regional and outer metropolitan areas were less likely to have access to supportive environments and were more likely to experience overt discrimination and threats to safety relating to their sexuality or gender than those in metropolitan areas (Robards et al., 2018;. CALD young people also faced additional challenges around communicating their identity with family, sensitive cultural and religious attitudes toward sexuality, and experiences of racism (Fattoracci et al., 2021;Henningham, 2021;Souleymanov et al., 2020). ...
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Multi-gender attracted (bisexual+) youth experience a high risk for suicide and mental health problems, but little is known about their protective factors. This study explored the challenges and supporting factors for wellbeing in a sample of diverse bisexual+ young people through semi-structured qualitative interviews. Participants (n = 15) were aged 17–25 years and were multi-gender attracted. The sample included young people who were transgender and gender diverse (TGD), culturally and linguistically diverse (CALD), Aboriginal, living in regional areas, and on the asexual spectrum. This research demonstrated unique challenges and protective factors for bisexual+ wellbeing compared to other sexual minority youth. In particular, the findings highlight the exclusion and stigmatization that many bisexual+ young people face, including from within the LGBTQIA+ community. These experiences were more pronounced for some bisexual+ youth, including TGD or CALD young people. Consequently, bisexual+ youth often had limited social support and a sense of belonging, which can buffer against the impact of marginalization among lesbian and gay youth. Despite these challenges, young people were resilient, empathetic and tolerant of others. Those who had access to supportive environments, visibility, and information on their diversity found these healing. Wellbeing in bisexual+ youth was impacted by a myriad of intersecting aspects of identity and experience, highlighting the importance of intersectional approaches in understanding minority experiences. The findings underscore the need for targeted and intersectional services for sexually diverse youth to address the wellbeing needs of this diverse group.
Article
Background: With the growing prevalence of mental illness in young people, healthcare professionals require an understanding of the social and psychological implications of medication use in this population. Aim: To characterize the qualitative literature regarding the perceptions and experiences of young people taking medication for mental illness. Methods: A narrative review of qualitative studies involving young people (13–24 years) taking any medication as treatment for a mental illness. The Medication Experience Model guided analysis of quotes related to medication use. Results: Of the 27 included studies, the majority involved participants with depression and utilized interviews. Young people reported a wide range of mental health medication experiences, both negative and positive, which could influence medication acceptance. Lack of autonomy and the influence of family members were challenges faced by this population. Conclusions: Young people reported that medications had affected them in various ways across multiple dimensions. Lack of involvement in decision-making and a loss of autonomy were of particular relevance to young people, issues which should also be of interest to healthcare professionals.
Article
Objective. Young adults aged 18-24 years often delay or avoid seeking help for their mental health concerns. E-mental health - the use of the internet to deliver mental health information, services and care - offers a low cost, easy-access option. However the factors which influence online help-seeking among this cohort remain unclear. Methods. Andersen’s healthcare utilisation model was adapted to examine correlates of e-mental health use among Australian youth. One hundred and sixty one young adults completed an online survey comprising of sociodemographic questions, online feature preferences, the Actual and General Help-seeking Questionnaires, Berkman-Syme Social Network Index, General Self-Efficacy Scale, Service Obstacles Scale and Depression, Anxiety and Stress Scales. Results. Almost 70% of young people reported having previously accessed some form of online support for their personal or emotional problems. This included informal information via social media but also formalised counselling services. Notably, perception of service satisfaction was low. Hierarchical logistical regression identified two significant predisposing factors to subsequent online help seeking: prior face-to-face service use and living or cohabitating with others. Conclusions. E-mental health is accessed by young people in Australia, yet more needs to be done to better integrate this service model into the healthcare system. This includes training and education for consumers and professionals about existing, effective programs.
Article
This qualitative descriptive study explored what young people who are transitionally housed need to promote occupational participation. Nine young people and four staff members from a transitional living facility participated in interviews and focus groups. Results suggested that the young people need opportunities to practice independent living skills, develop routines to support employment, housing, and education, and receive more individualized support from service providers. Findings also reveal that service providers experience a range of barriers to meeting young people's needs. This study underscores the importance of occupational therapy practitioners being informed of national and regional policies as well as emerging evidence of innovative approaches with populations, communities, and individuals so as to ultimately develop novel, collaborative, occupation-based programs to help young people set goals and transition out of homelessness.
Article
Purpose of review: Schools are increasingly at the forefront of mental healthcare for young people internationally. This review aims to describe recent developments in school-based mental health activities to respond to mental health needs in adolescents, with a focus on empirical studies aimed at preventing, ameliorating or treating mental disorders. Recent findings: The field is characterized by substantial heterogeneity in program design and research methods. Evidence for effectiveness of single-faceted school-based mental health programs is equivocal. Recent systematic reviews and meta-analyses have reported mixed findings across a variety of single-faceted universal and targeted programs at post-intervention, short-term and long-term follow-up. The largest and most recent review and network meta-analyses conclude there is limited evidence in support of these forms of school-based anxiety and depression prevention programs. Feasibility studies, which include consideration of appropriate service providers, suggest a need to consider schools as complex systems when designing interventions. Recent models adopting whole-school approaches appear feasible, effective and potentially sustainable with modest levels of resourcing. Summary: Greater evidence is needed regarding long-term impact and sustainability of interventions. Recent trials of multifaceted and multilevel interventions show particular promise. Future research should further explore strategies embedded within school systems and processes.
Article
Gender diverse young people face well-documented physical, mental and sexual health disparities compared to the general population. Differential access to healthcare is a key driver of these inequities and literature highlights high unmet healthcare need among members of this group. Healthcare access has been described through a model that defines five dimensions of health services: approachability; acceptability; availability and accommodation; affordability; and appropriateness; and five abilities of health service consumers that interact with these dimensions: the abilities to perceive, seek, reach, pay and engage. This comprehensive literature review examined barriers to and facilitators of healthcare access among gender diverse young people using the lens provided by this model as it relates to dimensions of access at the health service level and/or the abilities of health service users. We advocate expansion of this model to incorporate demand- and supply-side barriers and facilitators of access, and important structural factors including the gender binary health system framework, intersectionality and stigma. Findings highlight the need for improvements to healthcare provider education and the participatory redesign of health services with a focus on intersectionality, individually-tailored service provision and healthcare that is responsive to the unique needs of gender diverse young people.
Article
People in prison represent a high‐risk population for HCV infection control. With the advent of new direct antiviral agents (DAAs) HCV micro‐elimination in prison setting became a feasible strategy. We assessed the impact of an intervention for HCV testing and treatment in 2017 and 2018 in a jail (San Vittore,SV) and a prison for sentenced individuals (Opera,OP). A dedicated protocol was applied and implemented over the two years. We collected data on demographics, HCV testing and treatment on all inmates present on October 31st 2017 and 2018. In the two facilities there were 2,366 and 2,369 inmates in 2017 and 2018 respectively; the majority were men (95.6%; 96.4%) and Italians (57.0%; 61.9%) with a median age of 41 years. Prevalence of lifetime reported drug use remained high (46.5%; 44.2%). HCV screening coverage was 89% in both years, while HCV‐RNA test coverage increased (90.6%; 99.0%). HCV sero‐prevalence remained stable (10.1%; 9.2%). In 2017 among inmates with HCV chronic infection 90 (42.4%) individuals had started DAAs treatment and 106 (54.6%) in 2018; of whom 38 (17.9%) and 74 (38.1%) achieved the SVR. The viremic pool decreased significantly over time (SV,24.4%; 15.4%;OP, 16.1%;<1%). Among inmates with HCV‐positive serology in 2018, 121 (81.0%) were never linked to care before incarceration. Our study showed how a targeted and well‐implemented HCV test‐and‐treat intervention in prison was feasible and effective in achieving micro‐elimination. Viral hepatitis elimination agenda may help drawing interest onto this neglected population and bringing prison health higher up in the global public health agenda.
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.
Conference Paper
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To define a Strategy for the German automotive industry to face the actual and future challenges, it is important to know the relevant markets and thus the customers of today and tomorrow. The following questions, among others, are central to this. What is the position of the various markets regarding electromobility and how has demand for German cars developed? Are certain markets already saturated and do new ones need to be developed? Are there markets in which the German automotive industry has not performed so well in the past, but is now gaining momentum? To answer these questions, a market analysis is carried out.
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Adolescents who are pregnant are a vulnerable population at risk for poor health literacy. Health literacy is an important determinant of health, and poor health literacy among adolescents is correlated with high-risk health behaviors and adverse health outcomes into adulthood. A review of the literature showed a significant gap in research related to health literacy in pregnant adolescents. The limited findings indicate the need for additional research attention on health literacy in pregnant adolescents and upstream approaches to improve adolescent health literacy, such as incorporating health literacy education into secondary schools. To strengthen approaches that build health literacy capacity, it is imperative that future research focuses on pregnant adolescents’ health literacy related to health behaviors, health outcomes, measurement instruments, health literacy frameworks, and targeted interventions.
Article
Background: Patient navigation is a complex intervention that has garnered substantial interest and investment across Canada. We conducted an environmental scan to understand the landscape of patient navigation programs within the health care system in Alberta, Canada. Methods: We included patient navigation programs within Alberta Health Services (AHS) and Alberta's Primary Care Networks (PCNs). Key informants were asked in October 2016 to identify existing programs and their corresponding program contacts. These program contacts were invited to complete a telephone-based survey from October 2016 to July 2017, to provide program descriptions and eligibility criteria, and to identify gaps in navigation. Programs were included if they engaged patients on an individual basis, and either facilitated continuity of care or promoted patient and family empowerment. We tabulated results and calculated summary statistics for program characteristics. Results: Ninety-five potentially eligible programs were identified by key informants. The response rate to the study survey was 73% (n = 69). After excluding programs not meeting inclusion criteria, we included a total of 58 programs in the study: 43 AHS programs and 15 PCN programs. Nearly all programs (93%, n = 54) delivered navigation via an individual acting as a navigator. A minority of programs also included nonnavigator components, such as Web-based resources (7%, n = 4) and process or structural changes to facilitate navigation (22%, n = 13). Certain patient subgroups were particularly well-served by patient navigation; these included patients with cancer, substance use disorders or mental health concerns, and pediatric patients. Gaps identified in navigation fell under 4 domains: awareness, resources, geographic distribution and integration. Interpretation: Patient navigation programs are common and have extended beyond cancer care, from which the construct originated; however, gaps include a lack of awareness and inequitable access to the programs. These findings will be of interest to those developing and implementing patient navigation interventions in Alberta and other jurisdictions.
Article
Objective Developing effective interventions to promote successful transition to adulthood for adolescents and young adults (AYA) with spina bifida (SB) requires input from SB community stakeholders, particularly AYA themselves. The goal of this study was to identify and prioritize facilitators and barriers of successful transition to a healthy adult life for AYA with SB. Methods We utilized concept mapping, a community-engaged research methodology. We recruited a purposeful sample of SB community stakeholders: AYA with SB, parents/caregivers, pediatric and adult healthcare providers, and community organizations. Participants generated ideas to open-ended prompts. A subset of participants sorted responses into groups of similar ideas. Multidimensional scaling and hierarchical cluster analysis were applied to generate cluster maps. The concept map was determined by identifying the optimal cluster number that qualitatively represented meaningful and distinct concepts. Concepts were rated by participants for importance and feasibility. Results Participants generated 90 unique ideas that were then sorted. The research team chose a 10-cluster concept map: coordinated and comprehensive medical care, health and wellness, self-management, self-advocacy, skills to maximize independence, inclusivity and relationship supports, physical accessibility of the environment, employment, finances, and community- and school-based resources. Self-management, self-advocacy, and inclusivity and relationship supports were rated as both highly feasible and important. Conclusions By using concept mapping to engage diverse stakeholders, including people with intellectual, development, and physical disabilities, this study prioritized less traditional areas like inclusivity and relationship supports to focus improvement efforts relevant to AYA with SB becoming healthy adults.
Article
Objective: Lesbian, gay, and bisexual (LGB) individuals are at higher risk of poor mental health, and have more unmet mental health needs, compared to their heterosexual counterparts. Few studies have examined predictors of mental health service use amongst LGB Australians, and barriers to accessing these services Method: Participants were 592 LGB individuals (Mage = 29.39, SD = 10.83) living in urban (n= 411) and non-urban (n = 181) areas of Australia. Participants were recruited using social media advertising and completed an online questionnaire measuring mental health service use, psychological distress, and barriers to accessing services. Results: Most participants (66.6%) had accessed mental health services in the past, or had not accessed such services but reported it would have been useful (18.9%). The majority (66%) were currently experiencing psychological distress; of this group, only 18.2% had accessed services in the past one month. Barriers to accessing services included financial constraints, time limitations, and minority stress-related barriers. There was no difference between urban and non-urban respondents in their prior service use, though living in non-urban areas of Australia was associated with more barriers. Conclusions: This research highlights significant unmet mental health needs, and important barriers to accessing services, among LGB Australians Key Points What is already known about this topic: • Lesbian, gay, and bisexual (LGB) people experience poorer mental health, largely due to the stigma associated with being a sexual minority in society • LGB individuals have more unmet mental health needs compared to their heterosexual counterparts • Those in non-urban areas of Australia have less service use and more barriers to accessing services than those in urban areas What this topic adds: • Participants reported a range of barriers to accessing psychological services, including general barriers, such as service costs and distance to services, as well as minority stress-related barriers, including fears of discrimination, and a perceived lack of practitioners trained to work with LGB people • Those in rural areas reported more barriers to accessing services, though there were no differences in service use between urban and non-urban participants. Women reported more service use and more barriers compared to men • Barriers to accessing services were negatively associated with mental health service use, suggesting that barriers to accessing services in LGB Australians may inhibit service use
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Objective The objective of this study was to identify and understand the health system contexts and mechanisms that allow for homeless populations to access appropriate healthcare when needed. Design A realist review. Data sources Ovid MEDLINE, embase.com, CINAHL, ASSIA and grey literature until April 2019. Eligibility criteria for selecting studies The purpose of the review was to identify health system patterns which enable access to healthcare for people who experience homelessness. Peer-reviewed articles were identified through a systematic search, grey literature search, citation tracking and expert recommendations. Studies meeting the inclusion criteria were assessed for rigour and relevance and coded to identify data relating to contexts, mechanisms and/or outcomes. Analysis Inductive and deductive coding was used to generate context–mechanism–outcome configurations, which were refined and then used to build several iterations of the overarching programme theory. Results Systematic searching identified 330 review articles, of which 24 were included. An additional 11 grey literature and primary sources were identified through citation tracking and expert recommendation. Additional purposive searching of grey literature yielded 50 records, of which 12 were included, for a total of 47 included sources. The analysis found that healthcare access for populations experiencing homelessness is improved when services are coordinated and delivered in a way that is organised around the person with a high degree of flexibility and a culture that rejects stigma, generating trusting relationships between patients and staff/practitioners. Health systems should provide long-term, dependable funding for services to ensure sustainability and staff retention. Conclusions With homelessness on the rise internationally, healthcare systems should focus on high-level factors such as funding stability, building inclusive cultures and setting goals which encourage and support staff to provide flexible, timely and connected services to improve access.
Article
This study is the first trans-inclusive exploration of the relation between running away from home, health, and access to healthcare and supportive figures as a function of gender among adolescents. Secondary data analysis of the 2013 BC Adolescent Health Survey found that trans adolescents were 4.25 times as likely as males, and 3.0 times as likely as females, to have run away. Logistic regressions indicated that runaway adolescents of all genders had greater odds of reporting poor or fair overall health (OR: 2.9) and mental health (OR: 4.5), and of foregoing needed physical (OR: 4.8) and mental health care (OR: 4.5) compared to adolescents who had not run away. The relation between running away and health was exacerbated among trans adolescents. Trans and female youth were also less likely than males to report receiving helpful support. Findings highlight the importance of offering trans-affirming services and care to mitigate harms associated with running away from home.
Article
Objective Cardiovascular disease (CVD) and its risk factors disproportionately affect people returning from incarceration. These individuals face multiple barriers to obtaining care, which can impact CVD and risk factor management and may be mitigated through use of a smartphone application (app). Therefore, we explored the CVD-related needs of people released from incarceration and which app features would support these needs. Materials and Methods In 2019, we collected qualitative data through 7 focus groups with 76 returning citizens and 19 key informants through interviews and small group discussions in Baltimore, Maryland. Verbal data were audio-recorded, transcribed, and analyzed using inductive thematic coding with N-Vivo qualitative software. Results Returning citizens face multiple barriers when trying to engage in care and services related to cardiovascular health, including around medications and health insurance. Some major challenges were identifying trusted social services and making cardiovascular health a priority. Findings suggested that CVD risk factors could be more effectively addressed in combination with attending to other pressing needs related to employment, housing, behavioral health, and building trust. Participants suggested that a smartphone app would be most useful if it broadly addressed these issues by linking returning citizens to social services, including recommendations from peers, and facilitating access to healthcare. Discussion Returning citizens need broad support for societal reintegration. Addressing social issues would allow them to focus on cardiovascular health. Conclusion Given the challenges experienced after release from incarceration, an app focused on social and health-access issues may help returning citizens meet their CVD needs.
Technical Report
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Transitions between health care systems are difficult to navigate when patients with mental health conditions leave an integrated system. The authors synthesize evidence from studies of interventions that facilitate transitions between mental health care systems, such as the transition from the Military Health System to the Veterans Health Administration.
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Homeless and runaway youth are at disproportionate risk for adverse health outcomes. Many barriers to accessing healthcare have been documented; however, the relative impact of discrete barriers on homeless youth healthcare utilization behavior is not firmly established. We administered a survey examining reported barriers and healthcare utilization among adolescents and young adults accessing services at three community centers for homeless and runaway youth. Of 180 respondents, 57 % were male, 80 % non-White, and 21 % identified as a sexual minority. Stepwise logistic regression models, controlling for age and study site, explored associations between barriers and 3 healthcare utilization outcomes (doctor visit in past 12 months; regular care provider; frequent emergency department (ED) visits). The most commonly reported barriers were "don't have a ride" (27.2 %), "no insurance" (23.3 %), and "costs too much" (22.8 %). All fear-based barriers (e.g., "I don't trust the doctors") were reported by <5 % of surveyed youth. Significant predictors of having seen a doctor in the past 12 months included sexual minority status (OR 2.8, p = 0.04) and possession of health insurance (OR 4.9, p < 0.001). Female sex (OR 5.2, p < 0.001) and reported external barriers other than health insurance (OR 0.2, p < 0.001) were associated with having a regular care provider. Fear-based concerns were associated (OR 3.8, p = 0.02) with frequent ED visits, as was being insured (OR 2.2, p = 0.03). These results underscore the need to clearly define healthcare outcomes when investigating barriers to care among homeless and runaway youth as the impact of discrete barriers varies depending on outcome of focus.
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The imbalance between need and available resources with respect to youth mental ill-health has encouraged a growing body of literature around technology to support existing face-to-face services. However, this literature has not adequately investigated the perspective of youth as consumers and no data exists on the views of rural youth. In response to this gap, in-depth qualitative study investigated the perspectives of rural youth who were currently seeking help at a mental health service. Semi-structured interviews were carried out with a clinical sample of 10 young people (5 female), aged 16–22 years. Participants were recruited from two different mental health services located in two rural South Australian regions. Data were analysed via inductive thematic analysis. Results highlighted a young person’s desire for self-determination around their health and help-seeking within a service current environment that systematically subverts it. Overall, participants had long and complex histories of help-seeking associated with a history of isolation, disadvantage and trauma. A strong need for personal connection in the context of help-seeking was evident. Preferences for, and actual use of, the internet for mental healthcare existed on a continuum from no current (or future desire) to use technologies through to active interest in, and current use of, technologies as an adjunct to face-to-face care. Limited financial and infrastructural resourcing made it more difficult to access help online. Understanding and actively seeking out these views in design and implementation of technologies is in line with the current shift toward more consumer-focused and inclusive service design and delivery.
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Access to needed mental health services can be particularly difficult for newly arrived refugee and asylum-seeking adolescents, although many attend school. This study examined young refugees' impressions and experience of mental health services integrated within the school system. Semi-structured interviews were conducted with 40 adolescent refugees discharged by three school-based mental health services across the United Kingdom. Two-thirds preferred to be seen at school. Rumination and worry about insecurity in the asylum process had a negative impact particularly on the adolescents' social functioning and ability to focus at school. The important role played by teachers in supporting and mediating contact with mental health services was valued by those interviewed. The study confirms that schools offer an important location for mental health services for adolescent refugees and provide an important portal for integration of services.
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Street-involved (SI) youth comprise a substantial component of the urban homeless population. Despite being significant users of hospital emergency department (ED) services for acute and ongoing health needs, little is known about their experiences of ED care and the factors affecting their ED use. This study used a grounded theory and community-based approach to examine these issues. Focus groups and individual interviews were facilitated with 48 SI youth between ages 15 and 26 years, recruited in hospital or through community agencies serving SI youth in a major Western Canadian city. Results demonstrate that SI youth often perceived suboptimal care and experienced long waiting periods that led to many avoiding or prematurely exiting the ED. Service gaps appeared to have a negative bearing on their care and health outcomes. Findings invite a critical review of ED care processes, structures, and staff interactions in the aim of enhancing ED services to SI youth. © The Author(s) 2015.
Article
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Refugee young people have been identified as a group with high risk for mental health problems, due to their experience of trauma, forced migration, and stressors associated with settlement. A high prevalence of mental health problems is reported in this group, however some research suggests refugee young people have low rates of mental health service access. There is little information available on barriers and facilitators to mental service delivery for this group. Using data from 15 focus groups and five key informant interviews with a total of 115 service providers from 12 agencies in Melbourne, Australia, this paper explores barriers and facilitators to engaging young people from refugee backgrounds with mental health services. Eight key themes emerged: cultural concepts of mental health, illness, and treatment; service accessibility; trust; working with interpreters; engaging family and community; the style and approach of mental health providers; advocacy; and continuity of care. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
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Background Homeless young adults are a vulnerable population with great healthcare needs. Under the Affordable Care Act, homeless young adults are eligible for Medicaid, in some states, including California. This study assesses homeless young adults' health insurance coverage and healthcare utilization prior to Medicaid expansion. Methods All homeless young adults accessing services at a drop-in center in Venice, CA, were invited to complete a self-administered questionnaire; 70% of eligible clients participated (n = 125). Results Within this majority White, heterosexual, male sample, 70% of homeless young adults did not have health insurance in the prior year, and 39% reported their last healthcare visit was at an emergency room. Past year unmet healthcare needs were reported by 31%, and financial cost was the main reported barrier to receiving care. Multivariable logistic regression found that homeless young adults with health insurance were almost 11 times more likely to report past year healthcare utilization. Conclusions Health insurance coverage is the sole variable significantly associated with healthcare utilization among homeless young adults, underlining the importance of insurance coverage within this vulnerable population. Service providers can play an important role by assisting homeless young adults with insurance applications and facilitating connections with regular sources of health care.
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The objective of this study was to assess youth self-reported treatment barriers in the past 12 months to obtain youth's perspective on reasons they seek treatment, do not engage in treatment, or terminate treatment. The present study uses data from the National Comorbidity Survey-Adolescent Supplement (NCS-A), a nationally representative survey administered to youth ages 13-18 that was conducted between February 1, 2001 and January 30, 2004. A total of 10,123 youth participated in the NCS-A study and provided the information on which the current paper draws its data. Within the past 12 months over 63 % of youth reported seeking treatment to manage and cope with emotions. The greatest percentage of youth reported that they did not seek treatment because they wanted to handle the problem on their own (59.3 %). The greatest percentage of youth reported that treatment was terminated because they wanted to handle the problem on their own (57.5 %). Findings suggest professionals need to educate youth about the importance of professional treatment to increase engagement. If providers can motivate youth to see the value of treatment and help them understand that there can be positive outcomes, they may be less likely to terminate prematurely.
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