Challenges experienced by nurses in implementing Adolescent and Youth Friendly Services in clinics of the Limpopo province.

Background: Effective implementation of Adolescent and Youth Friendly Services (AYFS) that are accessible, acceptable and effective for diverse youth population groups is significant to enhancing youth health. Because of various factors, improving youth health is a challenge in clinics in rural areas. Aim: This study aims to explore and understand the challenges nurses experience while implementing AYFS programmes in Kganya local area clinics of the Capricorn district, Limpopo province, South Africa. Setting: The study was conducted in the clinics of Kganya local area of Capricorn district, Limpopo province, South Africa. Method: A qualitative, phenomenological, exploratory, descriptive design is employed in this study. Twelve nurses were selected using purposive sampling. Data were collected through semi-structured interviews with an interview guide. Notably, data were analysed using Tesch's open coding method. Results: Two themes emerge from this study: 'Challenges experienced related to the implementation of Adolescent and Youth Friendly Services' and 'Suggestions to improve Adolescent and Youth Friendly Services'. Conclusion: The results of this study confirm that nurses experience diverse challenges while implementing AYFS. Challenges include a lack of trained staff and material resources and the negative attitudes of adolescents, parents and community members. Contributions: This study's findings might help identify the gaps in implementing the AYFS programmes. The findings may assist policymakers and the National Department of Health (NDoH) to monitor and review the effectiveness of the AYFS programme standards.

Characterizing models of adolescent and youth-friendly health services in sub-Saharan Africa: a scoping review.

This scoping review provides an up-to-date overview of the evidence on adolescent and youth-friendly health services (AYFHS) in sub-Saharan African countries. We conducted a search of four databases and grey literature sources to identify English language publications from January 1, 2005, to December 14th, 2022. The review synthesized evidence on the models and characteristics of AYFHS, the application of World Health Organization (WHO) standards, and whether AYFHS have improved young people's health outcomes. In total, 77 sources were included in the review, representing 47 AYFHS initiatives spanning 19 countries, and three multi-country reports. Most commonly, AYFHS were delivered in public health facilities and focused on sexual and reproductive health, with limited application of WHO standards. Some evidence suggested that AYFHS increased young people's health service utilization and contraceptives uptake. There is a clear need to strengthen and develop innovative and multi-pronged approaches to delivering and evaluating AYFHS in this region.

Youth-friendly services was the magic: Experiences of adolescent girls and young women in the community PrEP study, South Africa.

Adherence to daily oral pre-exposure prophylaxis (PrEP) for HIV prevention has been challenging for adolescent girls and young women (AGYW). As part of The Community PrEP Study (CPS), AGYW were randomised to HIV-prevention empowerment counselling (intervention) or basic medication pick-up (control). In this qualitative sub-study, we interviewed AGYW participants (n = 39) to explore PrEP use and study experiences by study arm, and study staff (n = 7) to explore study implementation, site environment, and participant engagement. Data were thematically analysed using a constant comparison approach. Comparative matrices assessed similarities and differences in study experiences and PrEP support preferences. Friendly, non-judgmental, non-stigmatizing study staff were described as central to participant's positive experiences. Participants highly valued CPS staff's holistic health support (e.g. physical and psycho-social). Intervention participants described empowerment counselling as helpful in supporting PrEP disclosure. However, control participants also described disclosing PrEP use to trusted individuals. Participants and staff recommended public-sector PrEP services provide holistic, confidential, and integrated sexual and reproductive health services, and community sensitisation. An adolescent and youth-friendly environment was the primary factor motivating AGYW's study engagement. While HIV-prevention empowerment counselling was well received, welcoming, respectful and non-judgmental staff may be the 'secret sauce' for implementing effective PrEP services to AGYW.

Factors influencing the utilisation of Youth Friendly Health Services in Blantyre, Malawi.

Background: Usage of Youth Friendly Health Services (YFHSs) remains unsatisfactory in sub-Saharan Africa despite global agreements on the utilisation of these services among the youths. Aim: The aim of the study was to identify factors that influence the utilisation of YFHSs in Blantyre, Malawi. Setting: Four health centres in Blantyre, Malawi. Methods: A descriptive quantitative research design using multistage sampling was used to randomly sample (N = 293) unmarried youths and collect data using a structured questionnaire. Data were analysed using a computerised statistical package for social sciences (SPSS) version 26. Chi-square (χ²) was used to test the significance of the association between variables, and the p-value (p < 0.05) was considered significant. Regression analysis was used to examine the influence of independent variables on the utilisation of the services. Results: Less than half of the respondents have ever accessed YFHSs (43%). The Chi-square test showed that the following variables had a significant association with utilisation of the services (p < 0.05): gender, age, knowledge, signage, printed health education materials, provider attitudes and being shy or fear of being seen at the services. Conclusion: Age, knowledge, signpost, printed health education materials, provider attitudes and being shy or fear of being seen at the YFHSs are factors that influenced the utilisation of the services. Working on these factors would help to increase utilisation. Contribution: The study findings will help to fill the gap in the provision of YFHSs and thus increase utilisation of the services.

"It's about how you take in things with your brain" - young people's perspectives on mental health and help seeking: an interview study.

INTRODUCTION: Poor mental health in young people has become a growing problem globally over the past decades. However, young people have also been shown to underutilize available healthcare resources. The World Health Organisation (WHO) has formulated guidelines for youth-friendly health services (YFHSs) to increase youth participation in healthcare. Still, little is known about how young people using these services perceive mental health, indicating a knowledge gap concerning the subjective evaluation of their mental health. AIM: To investigate how young people visiting youth health clinics (YHC) perceive the concept of mental health and factors they view as central to maintaining mental health. METHODS: In total 21 interviews were carried out, 16 in 2018, and 5 in 2023 to assure no changes in findings after the COVID-19 pandemic. Subjects were recruited during visits to youth health clinics (YHCs) in mid-Sweden and were aged 15-23 years. Recruitment strived to achieve heterogeneity in the sample concerning gender, sexual orientation, gender identity and age. Interviews were transcribed and analysed using qualitative content analysis. FINDINGS: Findings of the analysis revealed two themes, "Mental health is helped and hindered by the surroundings" and "Mental health is difficult to understand and difficult to achieve". The participants described their health as highly dependent on their social surroundings, and that these are important to maintaining health but may also affect health negatively. They described mixed experiences of the health care services and mentioned prerequisites for seeking care for mental health problems such as accessibility and respect for their integrity, including the right to turn down offered treatment. The informants also viewed mental health as an ongoing undertaking that one must work for, and that it is sometimes difficult to know what constitutes mental health. They also expressed a need from healthcare services to enquire about their health, and to show an active interest in how they are doing. CONCLUSIONS: Findings underline the need of young people's individual needs to be met in the healthcare system and their vulnerability to their social surroundings. Health status assessments in young people should consider social and individual factors to fully capture mental health.

CyberRwanda's Pathway to Impact: Results From a Cluster-Randomized Trial of Adolescent Family Planning Knowledge, Beliefs, Self-Efficacy, and Behavior.

PURPOSE: CyberRwanda is a digital health intervention designed to increase knowledge of family planning and reproductive health (FP/RH) and access to youth-friendly services in Rwanda. METHODS: Sixty schools in eight districts were randomized 1:1:1 to one of two CyberRwanda implementation models-self-service (tablet-only) or facilitated (tablet, activity booklet, peer facilitators)-or to control. Students aged 12-19 years were randomly selected to participate. Baseline and 12-month midline surveys assessed intermediate (secondary) outcomes of FP/RH and HIV knowledge, attitudes/beliefs, self-efficacy, and behavior. Prevalence differences (PDs) were estimated using generalized linear mixed models. RESULTS: There were 5,767 midline participants (51% female, mean/median age: 16 years, 29.9% sexually active). Those in CyberRwanda schools had higher knowledge of emergency contraception (57.3% vs. 47.5%, PD: 0.09, 95% confidence interval [CI]: 0.05-0.13); greater confidence in providing consent (73.3% vs. 68.1%, PD: 0.05, 95% CI: 0.01-0.08), negotiating partner's contraceptive use (88.3% vs. 85.0%, PD: 0.03, 95% CI: 0.01-0.06), and accessing/using contraceptive services (95.6% vs. 91.8%, PD: 0.03, 95% CI: 0.02-0.05); and more favorable views on FP/RH services (54.5% vs. 48.5%, PD: 0.06, 95% CI: 0.02-0.11) and condoms (76.9% vs. 71.3%, PD: 0.06, 95% CI: 0.03-0.08) compared to control. No significant differences in HIV/fertility knowledge, confidence in accessing HIV testing, or condom use were observed. DISCUSSION: CyberRwanda increased FP/RH knowledge, supportive attitudes/beliefs, self-efficacy, and behavior at 12 months. The 24-month endline analysis will reveal whether CyberRwanda's benefits on intermediate outcomes result in changes to the primary outcomes, including contraception use and childbearing.

What's holding back youth-friendly health services in Blantyre, Malawi? A qualitative exploration.

The use of Youth Friendly Health Services remains sub-optimal in Sub-Saharan Africa despite global agreements on the same. The aim of this study was to explore barriers to utilization of Youth Friendly Health Services in Blantyre, Malawi. This was a qualitative study drawing on three focus group discussions of youths aged 10 to 24 (N=24) and individual interviews with Youth Friendly Health Service providers from four health facilities (N=6). Thematic analysis by Braun and Clark 2006 was used to analyse collected data. Seven themes emerged from the findings: frequent stockouts of medical supplies, lack of entertainment, sporting activities and supporting equipment, lack of dedicated space for Youth Friendly Health Services, lack of knowledge, financial constraints, misconceptions, and distance to the health facilities. Addressing these barriers would increase the utilization of Youth Friendly Health Services and, in turn, increase contraceptive uptake, hence reducing unintended pregnancies and their associated complications.

Le recours aux services de santé adaptés aux jeunes reste sous-optimal en Afrique subsaharienne malgré les accords mondiaux en la matière. Le but de cette étude était d'explorer les obstacles à l'utilisation des services de santé adaptés aux jeunes à Blantyre, au Malawi. Il s'agissait d'une étude qualitative s'appuyant sur trois discussions de groupe de jeunes âgés de 10 à 24 ans (N=24) et des entretiens individuels avec des prestataires de services de santé adaptés aux jeunes de quatre établissements de santé (N=6). L'analyse thématique réalisée par Braun et Clark 2006 a été utilisée pour analyser les données collectées. Sept thèmes ont émergé des résultats : ruptures de stock fréquentes de fournitures médicales, manque de divertissements, d'activités sportives et d'équipements de soutien, manque d'espace dédié aux services de santé adaptés aux jeunes, manque de connaissances, contraintes financières, idées fausses et distance par rapport aux établissements de santé. S'attaquer à ces obstacles augmenterait l'utilisation des services de santé adaptés aux jeunes et, par conséquent, augmenterait le recours à la contraception, réduisant ainsi les grossesses non désirées et leurs complications associées.

Youths with disabilities: Utilization and predictors of Youths Friendly Reproductive Health Services in Dessie City Administration, North East Ethiopia, 2021: A cross-sectional study.

Background and Aims: Younger generations with disabilities are more likely to be affected and have severe difficulties receiving specific services. Ethiopia is no exception to the global trend of poverty-stricken countries with a higher frequency of illness or disability. This study aimed to assess the utilization of Youths Friendly Reproductive Health Services (YFRHS) and predictors among youths with disabilities in Dessie City, North East, Ethiopia, 2021. Methods: A community-based, cross-sectional study was conducted. Data were collected from the literature using questionnaires. Bivariable analysis was performed for each independent variable with a p < 0.25 on the data imported to multivariate logistic regression analysis. Adjusted odds ratio (AOR) with a 95% confidence interval (95% CI) at a 5% level of significance has measured the strength of association between utilization of youth-friendly reproductive services among disabilities and independent variables. Results: Of 423 participants, 91% responded. About 42% of participants had used YFRHS. Youths in the age group of 20-24 years were 2.8 times more likely to use such services than 15-19-year-olds (AOR = 2.8, 95% CI: [1.04, 7.44]). Disabled youths living alone were 3.6 times more likely to use the services than those with parents (AOR = 3.6, 95% CI: [1.36, 9.35]). Youths with a visual impairment were 80% less likely to use the services than youths with hearing impairments (AOR = 0.2, 95% CI: [0.18, 0.30]), and disabled youths with poor knowledge were 90% less likely to use the services than participants with good knowledge (AOR = 0.1, 95% CI: [0.01, 0.61]) were statistically significant. Conclusion: The utilization of YFRHS among youths with disabilities in Dessie Town was low. Participants aged 20-24 years, who lived alone, had visual impairment, and had poor knowledge, were found to be significantly associated.

Youth perspectives of working with near peer youth lay counsellors: The Safe Haven Pilot.

Youth living with HIV (YLWH) have higher rates of common mental disorders (CMDs) when compared with HIV-negative youth. We adapted the Friendship Bench to create a problem solving-based counselling intervention in Botswana delivered by near peer youth lay counsellors for YLWH called Safe Haven. In August 2020, and from June to August 2021, we conducted 22 semistructured interviews with youth aged 13-25 years with mild-to-moderate symptoms of CMDs. Two independent coders carried out an inductive thematic analysis of the transcribed interviews with discrepancies discussed to consensus. Safe Haven was seen as largely acceptable among the youth. Youth felt Safe Haven was a place where they had freedom of expression and could receive practical advice from well-trained and approachable counsellors. Trained youth lay peer counsellors show promise to meet the mental health needs of mild and moderately symptomatic youth, where mental health professionals are in short supply.

Determinants of the utilization of youth-friendly sexual and reproductive health services in public secondary schools of Kogi State, Nigeria: an explorative study.

BACKGROUND: This study explored the factors associated with the utilization of Youth-Friendly Sexual Reproductive Health (YFSRH) services among school-going Nigerian adolescents. METHODS: This cross-sectional study employed a mixed method involving school-going students attending five public secondary schools in Kogi State, Nigeria. Descriptive statistics were used to determine the patterns of utilisation of YFSRH services, whereas inferential statistics were performed to determine factors associated with utilization of YFSRH services. Qualitative data were analysed by thematic analyses of records using an inductive analysis. RESULTS: One in two secondary school-going students had used the YFSRH services. Most of the participants had poor awareness of YFSRH services and limited access to YFSRH services. While gender positively predicted the utilisation of YFSRH services among secondary school-going students (aOR = 5.7; 95% CI: 2.4-8.95, p = 0.001), we found that age (aOR = 0.94; 95% CI: 0.67-0.99, p = < 0.001), and religious beliefs (aOR = 0.84; 95% CI: 0.77-0.93, p = 0.001) showed a negative relationship with the utilization of YFSRH services. CONCLUSIONS: Our findings highlight the influence of gender, age, and religion on utilizing YFSRH services. This study recommends the inclusion of sexuality education into secondary school-going student's curricula, in order to create awareness about the benefit of utilization of sexual and reproductive health services, and this is to encourage young people to utilize the YFSRH services.

Youth friendly reproductive health service utilization and its associated factors among secondary school students, East Belesa district, northwest, Ethiopia, 2022.

BACKGROUND: Youths are people aged between 15 and 24 years. Globally, there were 37.7 million people living with HIV/AIDS, and 90% occur among youths. Despite enormous efforts made in Ethiopia to improve the reproductive health of the youth the utilization is still low. There is no study conducted on YFRHS utilization and associated factors among youths in East Belesa. Therefore, this study is aimed to assess YFRHS utilization and its associated factors among secondary school youths in East Belesa district. OBJECTIVE: To assess the prevalence of youth friendly reproductive health service utilization and associated factors among secondary school students in East Belesa district, Ethiopia, 2022. METHOD: Institution based cross-sectional study design was used with a total sample size of 347 youths in East Belesa schools from May 23 to June 12, 2022. Stratified simple random sampling was employed. Data were entered using EpiData and analyzed using Stata version 14. Descriptive statistics and Logistic regression were done to describe and identify factors associated with reproductive health services utilization. A P-value of less than 0.05 was considered to declare a level of significance. RESULTS: A total of 346 students participated in the study with a response rate of 99.8%.the magnitude of youth friendly reproductive health service utilization was 28.9% (24.3, 33.9). Being married (AOR = 0.27, 95%CI: 0.14, 0.52), mothers attended higher education (AOR = 1.40, 95%CI: 1.87, 4.95), availability (AOR = 2.58. 95%CI: 1.29, 5.16) and students who had never discussed about reproductive issues with their families (AOR = 0.18, 95%CI: 0.07, 0.49) were significantly associated with youth friendly service utilization. Therefore, behavior change communication interventions targeted at advancing mothers' knowledge, encouraging open discussion between parents and children, and enhancing the availability of youth friendly services are important to enhance youth friendly service utilization.

Quality of sexual and reproductive health services for adolescents and young people in public health facilities in Southwest Nigeria: a mystery client study.

BACKGROUND: To support the policy drive for the promotion of sexual and reproductive health (SRH) of adolescents and young people (AYP), it is necessary to understand the characteristics of the existing SRH services available to them. OBJECTIVE: To assess the provision and experiences of care in SRH services for AYP in a Nigerian setting. METHODS: Twelve male and female mystery clients (MCs) conducted 144 visits at 27 selected primary and secondary health facilities in two Local Government Areas (LGA) in Ogun State, Nigeria. A 27-item adolescent quality of care (AHQOC) index with a Cronbach's Alpha of 0.7 was used to obtain a quality-of-care score for each clinic visit. Linear panel-data random-effects regression models using the generalised least square estimator were used to assess quality associated factors. Sentiment analysis was done on the qualitative narrative summaries provided by MCs after each visit. RESULTS: There was an absence of the use of educational materials during the 60.4% of the visits. The MCs' medical history (90.3%), social record (63.9%), sexual/reproductive history (53.5%), and contraceptive experience (66.0%) were not obtained in most of the visits. Female MC visits had a lower AHQOC index rating on average compared to males (ß=-0.3, CI -1.6 - 1.0 p = 0.687), rural health facilities had a lower AHQOC index rating on average compared to urban (ß=-2.7, CI -5.1 - -0.2, p = 0.031), and a higher ranking of the health worker on the scale of 1-10 corresponded to a higher AHQOC index of the MC visit (ß = 1.9, CI 1.6-2.1, p < 0.001). There were more positive than negative sentiments about the clinic encounters. CONCLUSION: This study found gaps in the competencies of the health workers, non-usage of educational materials in clinic encounters with young people, as well as the differential perception of quality of care by male and female AYP.

Provider-client rapport in pre-exposure prophylaxis delivery: a qualitative analysis of provider and client experiences of an implementation science project in Kenya.

Daily oral pre-exposure prophylaxis (PrEP) is being incorporated into services frequented by adolescent girls and young women (AGYW) in sub-Saharan Africa who are at a significant risk of HIV. In non-PrEP studies, positive provider-client rapport has been shown to improve patient decision-making and use of medication in clinical care. We examined AGYW and healthcare provider (HCP) perspectives on the value of and strategies for building positive provider-client rapport. We conducted in-depth interviews from January 2018 to December 2019 with 38 AGYW and 15 HCPs from two family planning clinics in Kisumu, Kenya where PrEP was being delivered to AGYW as part of the Prevention Options for Women Evaluation Research (POWER) study. We used semi-structured interview guides and audio-recorded interviews with participant consent. Verbatim transcripts were analysed using thematic content analysis. HCPs and AGYW emphasised the importance of positive provider-client rapport to meet AGYW support needs in PrEP service delivery. HCPs described how they employed rapport-building strategies that strengthened AGYW PrEP uptake and continuation, including: (1) using friendly and non-judgmental tones; (2) maintaining client confidentiality (to build client trust); (3) adopting a conversational approach (to enable accurate risk assessment); (4) actively listening and tailoring counselling (to promote client knowledge, skills, and self-efficacy); and (5) supporting client agency. Positive provider-client relationships and negative experiences identified in this analysis have the potential to facilitate/deter AGYW from using PrEP while at risk. The strategies to enhance provider-client rapport identified in this study could be integrated into PrEP provider training and delivery practices.

Youth friendly services utilization and associated factors among school youths in North Shewa Zone, Amhara Region, Ethiopia: A mixed-method study.

Objective: To assess youth friendly services utilization and associated factors among school youths in North Shewa zone, Ethiopia, 2020. Methods: Institution-based cross-sectional study complemented with qualitative inquiry was conducted from 25 February to 20 March 2020. Multistage and purposive sampling technique was used. A total of 605 randomly selected students were recruited. Seven in-depth interviews and four focus group discussions were conducted for qualitative study. p-value < 0.05 and adjusted odds ratio with 95% confidence interval were computed to measure the strength of associations between variables. Qualitative data were transcribed verbatim, analyzed manually, and presented in narration. Result: One hundred ninety-five (32.7%, 95% confidence interval: 29.0%, 36.6%) respondents had used youth friendly services during the survey. Educational level of father (can read and write) (adjusted odds ratio = 3.12, 95% confidence interval: (1.47, 6.65)), being knowledgeable about reproductive health issues (adjusted odds ratio = 4.84, 95% confidence interval: (2.77, 8.47)), discussion on reproductive health issues (adjusted odds ratio = 2.50, 95% confidence interval: (1.49, 4.19)), having sexual exposure (adjusted odds ratio = 3.37, 95% confidence interval: (1.54, 7.39)), perceiving oneself as risky for acquiring HIV/AIDS (adjusted odds ratio = 4.49, 95% confidence interval: (2.63,7.65)), history of sexually transmitted infections (adjusted odds ratio = 4.40, 95% confidence interval: (1.61, 12.04)), favorable attitude toward service providers (adjusted odds ratio = 2.20, 95% confidence interval: (1.16, 4.17)), and ever supported to use the services (adjusted odds ratio = 4.18, 95% confidence interval: (2.51, 6.97)) were factors associated with youth friendly services utilization. Conclusion: Compared with previous findings, youth friendly services utilization in the study area was relatively low. Knowledge on reproductive health issues, sexual exposure, perceiving as risky of acquiring HIV, history of sexually transmitted infection, ever supported to use the services, and attitude of youth toward youth friendly service providers were among factors associated with youth friendly services utilization. Health facilities and schools should work coordinately to scale up youth friendly services utilization.

A safe place - Adolescents' and young adults' perceptions of youth clinics in northern Sweden.

BACKGROUND/OBJECTIVE: Adolescents and young adults are a diverse group with varied health needs. In Sweden, youth clinics are critical for improving their sexual, reproductive, mental, and general health. The aim of this qualitative study was to gain a deeper understanding of key conditions needed for youth friendliness, and to better understand youth-friendly health services from the perspective of adolescents and young adults in northern Sweden. METHODS: Information was collected through focus group discussions and interviews with 23 adolescents and young adults (aged 16 to 25) at youth clinics in each of the four northernmost regions of Sweden. Interviews were analysed inductively using Braun and Clarke's thematic analysis. RESULTS: Three themes and six sub-themes emerged. A safe, empowering and holistic space, outlines how youth-friendly physical spaces and staff contributed to a sense of safety in contrast to other healthcare facilities. The theme Youth clinics are accessible - but reaching out is challenging, refers to low thresholds for visiting youth clinics and perceived barriers to access. The third theme "You feel a bit vulnerable" - the importance of privacy, highlights privacy dimensions and young people's vulnerability when their privacy is compromised. CONCLUSION: Adolescents and young adults perceived youth clinics as being youth-friendly. Key conditions for youth friendliness were safety, respect, a holistic and empowering approach, accessibility, and privacy. Youth-friendly opening hours and outreach to specifically target groups with access barriers are needed. Young people should be involved in the development of equitable youth-friendly health services.

Care friendliness in adolescent sexual and reproductive health services in Mexico and a characterisation of their clients.

BACKGROUND: Sexual and reproductive health (SRH) is a very important issue in public health programs in low -and middle-income countries (LMICs). Health services that meet specific and differentiated needs of adolescents are increasingly relevant in LMICs. To provide quality services, it is necessary to know the profile of its users and the perspective that adolescents have about SRH services aimed at them. METHODS: We conducted a cross-sectional analysis of primary data from a survey of 489 adolescents recruited in 11 primary-care facilities in the state of Morelos, Mexico. We followed the guidelines outlined in the World Health Organization Quality Assessment Guidebook: A guide to assessing health services for adolescent clients. Data on friendliness of services were obtained through 70 questions divided into 18 characteristics which, in turn, were grouped into five domains: equity, accessibility, acceptability, appropriateness, and effectiveness. The "friendliness" (a proxy for quality of care) of services was measured according to an additive index of friendliness (FI) ranging from 0 (no friendliness) to 1 (maximum friendliness). We also described the socio-demographic, SRH, and service utilization profiles of clients. RESULTS: The health services analysed were characterised as having low levels of accessibility (FI = 0.62) and effectiveness (FI = 0.77), moderate acceptability (FI = 0.84), and high levels of appropriateness (FI = 0.93) and equity (FI = 0.92). Of the total number of adolescents surveyed, 51% stated that they had initiated a sexual life, 37% did not use any method of protection during their first sexual intercourse and 64% of the adolescents had already experienced a pregnancy. CONCLUSIONS: It is essential to improve the accessibility and effectiveness dimensions of adolescent-friendly services in Mexico. This requires the implementation of strategies specifically designed to promote well-informed, planned and healthy sexual behaviours that avert risk and vulnerability. Strategies need to consider the profile of the adolescent client population.

Utilization of youth-friendly reproductive health service and associated factors among youth in Aleta Wondo town, southern Ethiopia, 2020.

Background: Youth faces various sexual and reproductive health problems in developing countries like Ethiopia. Major health problems like unintended pregnancy, unsafe abortion, and sexually transmitted infections are common among youth in Ethiopia. This study aimed to determine the level of utilization of youth-friendly reproductive health services and associated factors among youth in Aleta Wondo town, southern Ethiopia, from 20 to 30 June 2020. Methods: A community-based cross-sectional study was conducted among youths of Aleta Wondo town from 20 to 30 June 2020. A total of 421 study participants were selected from households of selected kebeles in the town by using a systematic random sampling method. Data were collected using structured pretested face-to-face interviewer-administered questionnaires. The data were entered using Epi-data version 4.4.2 and exported to SPSS version 25 for analysis. Bivariate and multivariate logistic regression models were used to determine factors significantly associated with the utilization of youth-friendly reproductive health services. Adjusted odds ratio and 95% confidence interval with p value of <0.05 were considered to declare statistical significance. Results: The level of utilization of youth-friendly reproductive health services was 32.8% (95% confidence interval = 28.0%-37.0%). Youth-friendly service utilization was significantly associated with being female gender (adjusted odds ratio = 2.20, 95% confidence interval = 1.34-3.62), living alone (adjusted odds ratio = 2.99, 95% confidence interval = 1.48-5.77), who had not ever discussed with their parents (adjusted odds ratio = 0.46, 95% confidence interval = 0.27-0.81), have visited service required and missed service (adjusted odds ratio = 1.96, 95% confidence interval = 1.19-3.24), and have sexual partner (adjusted odds ratio = 4.52, 95% confidence interval = 2.75-7.44). Conclusion: Youth-friendly reproductive health service utilization among youth Aleta Wondo town was low. Factors like gender, current living place, have ever discussed in reproductive health issues with their parents, have visited health facility and missed service, and having sexual partner were predictors of youth-friendly service utilization. It is better to work in collaboration with youth clubs and schoolteachers to scale up youth-friendly service.

Elevating the Role of the Outdoor Environment for Adolescent Wellbeing in Everyday Life.

In light of concerns about adolescent mental health, there is a need to identify and examine potential pathways to wellbeing in their daily lives. Outdoor environments can offer multiple pathways to wellbeing through opportunities for restoration, physical activity and socialising. However, urbanisation and new lifestyles revolving around the home and the internet are changing young people's access, use and relationship to the outdoor environment. The authors point out how the research related to adolescents' outdoor environments is generally not treated with the same level of importance or as comprehensively as that for younger children. The aim of this paper is to pave the way for research and planning initiatives on everyday outdoor environments promoting the wellbeing of adolescents and the authors suggest ways in which perspectives from developmental psychology might inform the study of adolescents' outdoor environments. The paper concludes by calling for an elevated focus on the role of outdoor environments in adolescents' everyday lives as a source of wellbeing and more research that makes clear the specific attributes, activities and experiences related to places outdoors which make adolescents feel good.

"Other risks don't stop": adapting a youth sexual and reproductive health intervention in Zimbabwe during COVID-19.

COVID-19 threatens hard-won gains in sexual and reproductive health (SRH) through compromising the ability of services to meet needs. Youth are particularly threatened due to existing barriers to their access to services. CHIEDZA is a community-based integrated SRH intervention for youth being trialled in Zimbabwe. CHIEDZA closed in March 2020, in response to national lockdown, and reopened in May 2020, categorised as an essential service. We aimed to understand the impact of CHIEDZA's closure and its reopening, with adaptations to reduce COVID-19 transmission, on provider and youth experiences. Qualitative methods included interviews with service providers (n = 22) and youth (n = 26), and observations of CHIEDZA sites (n = 10) and intervention team meetings (n = 7). Analysis was iterative and inductive. The sudden closure of CHIEDZA impeded youth access to SRH services. The reopening of CHIEDZA was welcomed, but the necessary adaptations impacted the intervention and engagement with it. Adaptations restricted time with healthcare providers, heightening the tension between numbers of youths accessing the service and quality of service provision. The removal of social activities, which had particularly appealed to young men, impacted youth engagement and access to services, particularly for males. This paper demonstrates how a community-based youth-centred SRH intervention has been affected by and adapted to COVID-19. We demonstrate how critical ongoing service provision is, but how adaptations negatively impact service provision and youth engagement. The impact of adaptations additionally emphasises how time with non-judgemental providers, social activities, and integrated services are core components of youth-friendly services, not added extras.

A national guideline for youth-friendly health services developed by chronically ill young people and health care professionals - a Delphi study.

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.