Stierman Elizabeth K, Kalbarczyk Anna, Oo Htet Nay Lin, Koller Theadora Swift, Peters David H
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
J Adolesc Health. 2021 Oct;69(4):541-548. doi: 10.1016/j.jadohealth.2020.12.135. Epub 2021 Mar 9.
Understanding barriers to health services, as experienced by adolescents, is important to expand effective and equitable coverage; however, there is limited discussion on methods for conducting barrier assessments and translating findings into action.
We conducted a scoping review of literature published between 2005 and 2019 on barriers to health services for adolescents in low- and middle-income countries. The review was guided by a framework that conceptualized barriers across multiple dimensions of access (availability, geographic accessibility, affordability, and acceptability), utilization, and effective coverage.
We identified 339 studies that assessed barriers related to at least one dimension of the operational framework. Acceptability (93%) and availability (88%) of health services were the most frequently studied access dimensions; affordability (45%) and geographic access (32%) were studied less frequently. Less than half (40%) of the studies evaluated utilization, and none of the 339 studies assessed effective coverage. Attention to equity stratifiers (e.g., income, disability) was limited. Topics studied reflected only a subset of the major causes of adolescent death and disability.
Holistic, equity-oriented approaches are needed to better understand barriers across multiple dimensions that together determine whether health services are accessible, used, and effectively meet the needs of different adolescent groups.
了解青少年所经历的卫生服务障碍，对于扩大有效且公平的覆盖范围至关重要；然而，关于进行障碍评估以及将评估结果转化为行动的方法，讨论有限。
我们对2005年至2019年间发表的关于低收入和中等收入国家青少年卫生服务障碍的文献进行了范围综述。该综述以一个框架为指导，该框架将障碍概念化为获取（可及性、地理可及性、可负担性和可接受性）、利用和有效覆盖等多个维度。
我们确定了339项评估与操作框架至少一个维度相关障碍的研究。卫生服务的可接受性（93%）和可及性（88%）是研究最频繁的获取维度；可负担性（45%）和地理可及性（32%）的研究较少。不到一半（40%）的研究评估了利用情况，339项研究中没有一项评估有效覆盖情况。对公平分层因素（如收入、残疾）的关注有限。所研究的主题仅反映了青少年死亡和残疾主要原因的一个子集。
需要采用全面、注重公平的方法，以更好地理解多个维度的障碍，这些障碍共同决定了卫生服务是否可及、是否被利用以及是否有效满足不同青少年群体的需求。
