Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Glob Health Action. 2012;5. doi: 10.3402/gha.v5i0.18748. Epub 2012 Jul 30.
Despite evidence showing that adolescent-friendly health services (AFSs) increase young people's access to these services, health systems across the world are failing to integrate this approach. In Latin America, policies aimed at strengthening AFS abound. However, such services are offered only in a limited number of sites, and providers' attitudes and respect for confidentiality have not been addressed to a sufficient extent.
The aim of this study was to explore the mechanisms that triggered the transformation of an 'ordinary' health care facility into an AFS in Ecuador. For this purpose, a realist evaluation approach was used in order to analyse three well-functioning AFSs. Information was gathered at the national level and from each of the settings including: (i) statistical information and unpublished reports; (ii) in-depth interviews and focus group discussions with policy makers, health care providers, users and adolescents participating in youth organisations and (iii) observations at the health care facilities. Thematic analysis was carried out, driven by the realist evaluation approach, namely exploring the connections between mechanisms, contexts and outcomes.
The results highlighted that the development of the AFSs was mediated by four mechanisms: grounded self-confidence in trying new things, legitimacy, a transformative process and an integral approach to adolescents. Along this process, contextual factors at the national and institutional levels were further explored.
The Ministry of Health of Ecuador, based on the New Guidelines for Comprehensive Care of Adolescent Health, has started the scaling up of AFSs. Our research points towards the need to recognise and incorporate these mechanisms as part of the implementation strategy from the very beginning of the process. Although contextually limited to Ecuador, many mechanisms and good practices in these AFS may be relevant to the Latin American setting and elsewhere.
尽管有证据表明，青少年友好型卫生服务（AFS）可以增加年轻人获得这些服务的机会，但世界各地的卫生系统仍未能将这种方法融入其中。在拉丁美洲，旨在加强 AFS 的政策比比皆是。然而，这种服务仅在有限的几个地点提供，并且提供者的态度和对保密性的尊重还没有得到充分解决。
本研究旨在探讨在厄瓜多尔，将“普通”卫生保健机构转变为 AFS 的触发机制。为此，采用了现实主义评估方法来分析三个运作良好的 AFS。在国家层面以及每个环境中收集了信息，包括：（i）统计信息和未发表的报告；（ii）与政策制定者、卫生保健提供者、使用者以及参加青年组织的青少年进行的深入访谈和焦点小组讨论；（iii）在卫生保健机构进行的观察。通过现实主义评估方法进行了主题分析，即探索机制、背景和结果之间的联系。
结果强调，AFS 的发展是由四个机制介导的：尝试新事物的基础自信、合法性、变革过程和对青少年的整体方法。在此过程中，进一步探讨了国家和机构层面的背景因素。
厄瓜多尔卫生部根据《青少年健康综合护理新指南》，已经开始扩大 AFS 的规模。我们的研究表明，有必要在一开始就认识到并纳入这些机制，作为实施策略的一部分。尽管在厄瓜多尔范围内存在局限性，但这些 AFS 中的许多机制和良好做法可能与拉丁美洲的情况和其他地方相关。
