评估青少年友好型卫生服务：来自南非城市模拟客户研究的年轻人观点
Evaluating youth-friendly health services: young people's perspectives from a simulated client study in urban South Africa.
作者信息
Geary Rebecca S, Webb Emily L, Clarke Lynda, Norris Shane A
机构信息
Department of Infection and Population Health, University College London, London, UK; Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK;
Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
出版信息
Glob Health Action. 2015 Jan 23;8:26080. doi: 10.3402/gha.v8.26080. eCollection 2015.
BACKGROUND
Few§These authors contributed equally to this work. youth-friendly health services worldwide have been scaled up or evaluated from young people's perspectives. South Africa's Youth Friendly Services (YFS) programme is one of the few to have been scaled up. This study investigated young people's experiences of using sexual and reproductive health services at clinics providing the YFS programme, compared to those that did not, using the simulated client method.
DESIGN
Fifteen primary healthcare clinics in Soweto were randomly sampled: seven provided the YFS programme. Simulated clients conducted 58 visits; young men requested information on condom reliability and young women on contraceptive methods. There were two outcome measures: a single measure of the overall clinic experience (clinic visit score) and whether or not simulated clients would recommend a clinic to their peers. The clinic visit score was based on variables relating to the simulated clients' interactions with staff, details of their consultation, privacy, confidentiality, the healthcare workers' characteristics, and the clinic environment. A larger score corresponds to a worse experience than a smaller one. Multilevel regression models and framework analysis were used to investigate young people's experiences.
RESULTS
Health facilities providing the YFS programme did not deliver a more positive experience to young people than those not providing the programme (mean difference in clinic visit score: -0.18, 95% CI: -0.95, 0.60, p=0.656). They were also no more likely to be recommended by simulated clients to their peers (odds ratio: 0.48, 95% CI: 0.11, 2.10, p=0.331). More positive experiences were characterised by young people as those where healthcare workers were friendly, respectful, knew how to talk to young people, and appeared to value them seeking health information. Less positive experiences were characterised by having to show soiled sanitary products to obtain contraceptives, healthcare workers expressing negative opinions about young people seeking information, lack of privacy, and inadequate information.
CONCLUSIONS
The provision and impact of the YFS programme are limited. Future research should explore implementation. Regular training and monitoring could enable healthcare workers to address young people's needs.
背景
全球范围内，从年轻人的角度对青少年友好型卫生服务进行扩大规模或评估的情况很少。这些作者对这项工作贡献相同。南非的青少年友好服务（YFS）项目是少数已扩大规模的项目之一。本研究采用模拟客户法，调查了在提供YFS项目的诊所与未提供该项目的诊所中，年轻人使用性健康和生殖健康服务的经历。
设计
在索韦托随机抽取了15家初级保健诊所：其中7家提供YFS项目。模拟客户进行了58次就诊；年轻男性询问了避孕套可靠性方面的信息，年轻女性询问了避孕方法方面的信息。有两项结果指标：对整体诊所体验的单一衡量指标（诊所就诊评分）以及模拟客户是否会向同龄人推荐该诊所。诊所就诊评分基于与模拟客户与工作人员互动、咨询细节、隐私、保密性、医护人员特征以及诊所环境相关的变量。分数越高，体验越差。采用多层次回归模型和框架分析来调查年轻人的经历。
结果
提供YFS项目的卫生设施给年轻人带来的体验并不比未提供该项目的设施更积极（诊所就诊评分的平均差异：-0.18，95%置信区间：-0.95，0.60，p = 0.656）。模拟客户向同龄人推荐这些诊所的可能性也没有更高（优势比：0.48，95%置信区间：0.11，2.10，p = 0.331）。年轻人认为，更积极的体验特点是医护人员友好、尊重他人、知道如何与年轻人交谈并且似乎重视他们寻求健康信息。不太积极的体验特点是必须出示弄脏的卫生用品才能获得避孕药具、医护人员对寻求信息的年轻人表达负面意见、缺乏隐私以及信息不足。
结论
YFS项目的提供和影响有限。未来的研究应探索其实施情况。定期培训和监测可以使医护人员满足年轻人的需求。
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