Department of Primary Health Care and General Practice, University of Otago, Wellington, PO Box 7343, Wellington South 6242, New Zealand.
Sex Health. 2021 Nov;18(5):394-404. doi: 10.1071/SH21092.
Background Young people need equitable access to high-quality sexual and reproductive health care to enjoy good sexual health. Methods This online survey of people aged 15-24years in a defined region of New Zealand asked about unmet need for sexual health care and sought views on improving access to sexual health care. Results Fivehundred participants took part in the study between August and October 2020, of whom 60% were female, 25% were of Māori (indigenous) ethnicity, and 21.4% were gender and/or sexuality diverse. Sixty percent had ever received sexual health care (300/500), and 74.3% received it from a general practice clinic (223/300). Overall, 41% (204/500) reported they needed, but had not received sexual health care in the past ('unmet need'). Reasons for unmet need included being shy, embarrassed or ashamed (74.5%, 152/204), fear of judgment by clinic staff (42.6%, 87/204), cost (32.8%, 67/204), concerns about confidentiality (28.9%, 59/204), and not knowing where to go (24%, 49/204). Māori participants were more likely to report not knowing where to go (32.1% vs 20%, P=0.04). Participants identified the need to reduce stigma, normalise sexual health care, improve convenience, affordability and awareness of services as key to improving access. Reassurance about confidentiality and being treated with kindness, empathy and respect were deemed critical to service acceptability. Conclusions Action is urgently needed at policy, funding and practice levels to improve access to services by: reducing societal stigma, normalising discussions around sexual health, improving affordability and raising awareness of services. Quality improvement is also needed in general practice to ensure young people can routinely access youth-friendly sexual and reproductive health care.
背景
年轻人需要公平获得高质量的性健康和生殖健康护理，以实现良好的性健康。
方法
本研究于 2020 年 8 月至 10 月期间在新西兰一个特定地区，以 15-24 岁的人群为对象，开展了一项在线调查，询问了性健康护理未满足需求情况，并就改善性健康护理获取途径征求了意见。
结果
500 名参与者参加了这项研究，其中 60%为女性，25%为毛利人（土著），21.4%为性别和/或性多样化人群。60%（300/500）的人曾接受过性健康护理，其中 74.3%（223/300）在全科诊所接受护理。总体而言，41%（204/500）的人报告称他们在过去需要但未获得性健康护理（“未满足需求”）。未满足需求的原因包括害羞、尴尬或羞耻（74.5%，152/204）、担心诊所工作人员评判（42.6%，87/204）、费用（32.8%，67/204）、对保密性的担忧（28.9%，59/204）以及不知道去哪里（24%，49/204）。毛利参与者更有可能报告不知道去哪里（32.1%比 20%，P=0.04）。参与者确定需要减少耻辱感、使性健康护理正常化、提高便利性、可负担性和服务意识，以此作为改善获取途径的关键。确保保密性、以友善、同情和尊重的态度对待他们被认为是服务可接受性的关键。
结论
在政策、资金和实践层面上，迫切需要采取行动，通过减少社会耻辱感、使有关性健康的讨论正常化、提高可负担性和提高对服务的认识，来改善服务获取途径。还需要在全科医疗中进行质量改进，以确保年轻人能够常规获得青年友好型性健康和生殖健康护理。
