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

Awareness and utilization of Swedish youth clinics among migrants enrolled in Swedish language programmes: a cross-sectional study

BACKGROUND

Previous research has highlighted inequalities in access to Swedish youth clinics (YCs). These inequalities exist not only between non-migrant and young migrant populations but also within various migrant groups.

OBJECTIVES

To assess awareness and utilization of Swedish YCs among migrants enrolled in Swedish language programmes and explore associated factors.

METHODS

This cross-sectional study involved 1,112 migrants aged 15-65. The analytical sample included 642 (57%) participants who answered the main outcome question about awareness of YCs. Descriptive statistics, bivariate, and multivariate log-binomial regression analyses using a Bayesian approach were applied to summarize the data and identify factors associated with awareness and utilization of YCs among migrants.

RESULTS

The results revealed that 30% of all participants and 40% of the participants aged 15-25 years had heard of YCs. Additionally, 23% of the target group (15-25 years) had ever visited one. During descriptive and bivariate analyses, socio-demographic variations were evident in YCs' awareness and utilization. However, in multivariate analyses, only the associations between awareness and year of arrival, and YCs' utilization and year of arrival and type of residence permit, remained statistically significant.

CONCLUSION

This study highlights the level of awareness of YCs among migrants attending Swedish language programmes and their utilization by those aged 15-25 years, potentially impacting their access to crucial services and resources. Targeted interventions and sustainable strategies beyond one-time interventions are essential to address the specific needs of different socio-demographic groups and ensure equitable access to YCs' information and services.

Young People's Trust in Digital Sexual Healthcare: A Narrative Review

Objectives

Trust has been identified as a key factor associated with supporting access to sexual health interventions and digital healthcare. We aimed to explore and synthesize factors that may cultivate trust for young people (10-24-year-old) when accessing digital sexual healthcare.

Methods

A total of 5950 articles were extracted from 5 databases (Scopus, PubMed, Embase, PsycINFO and CINAHL) and independently assessed for relevance by two researchers. Trust descriptions were analyzed using a narrative synthesis approach, extracted tabularly and synthesized into themes through conceptual mapping.

Results

Thirteen papers between 2011 and 2021 from the United States (n = 5), Australia (n = 3), United Kingdom (n = 2), Canada (n = 2), and Netherlands (n = 1) were reviewed. Young people (n = 462), varying in gender identity and sexuality, were aged between 14 and 29 years old. Four areas cultivating trust in digital sexual healthcare were described: (1) Esthetics, language, tone: Trusted digital sexual healthcare was easy to navigate, had limited sexually explicit content or pop-up ads, was not overly teen-friendly and used a professional tone and language, reflecting communication reportedly expected from healthcare providers. (2) Privacy, anonymity, safety: Safety features that preserved young people's anonymity were important for their trust, particularly amid fear of shame or stigma. (3) Authors' expertise, authenticity, reputation: Personal accounts online which reflected the young person's own lived experience were trusted for topics considered subjective (e.g., dating and relationships). (4) Consistency: Cross-checking personal accounts and scientific information to confirm the consistency of content helped with young people's evaluation of trust.

Conclusions

Considering the factors cultivating trust when designing digital sexual health interventions may improve access and use. However, given the nuance in lived experience and needs, young people should be meaningfully engaged in the design of digital sexual health interventions. Particularly as sexual health intervention and resources are increasingly being delivered and accessed online by young people.

Widening the scope of mental health with a 'youth centred' approach: a qualitative study involving health care professionals in Sweden's youth clinics

PURPOSE

The aim of this study was to explore how health care providers at youth clinics (YCs) in Sweden engage with, focus on, and navigate across the mental health youth space, while upholding the core bedrock principle of "youth-centeredness".

METHODS

Qualitative interviews were conducted with 21 health care professionals working in three YCs located in three different regions of Sweden. Data were analysed using reflexive thematic analysis informed by the work of Braun and Clarke.

RESULTS

The three themes were: 1) "youth mission-at the core of the YCs" work and challenged by a stronger involvement in mental ill health'; 2) "YCs" unique and complementary role in the youth mental health system: a holistic perspective, team work, and a focus on normalization', and 3) "Caught between a rock and a hard place: to treat at a care level that is not optimal for the young users" needs or to refer within an unreliable system'.

CONCLUSION

This study reflects the individuality and key features of YCs, their widening roles within the mental health sphere, and the challenges faced in maintaining and expanding the characteristic "youth-centred" approach while expanding their work with mental health.

Young people with migration experience and their (non) encounters with Swedish sexual and reproductive health services and information: An explorative study

Although a growing body of literature has focused on the experience of young people with migration experience with Swedish sexual and reproductive health (SRH) services, there is a lack of deep qualitative exploration. The study aims to explore the encounters of young people with migration experience with SRH services and their understandings of factors that affect their use of these services. The findings of this study were drawn from 18 interviews conducted between October 2021 and May 2023 in Southern Sweden. A combination of convenient and snowball sampling strategies was used. Participants included in the study self-identified as Middle Eastern, migrated to Sweden, and were aged between 17 and 26. Data were analyzed using reflexive thematic analysis approach. Three themes were generated during the analysis. The first SRH services: dual perceptions and experiences shows how participants had ambivalent perceptions of SRH services, mainly the youth clinic. Some perceived the youth clinic as a stigmatized place associated with shame and SRH concerns like unwanted pregnancy and sexually transmitted infections, while others viewed the youth clinic as a safe space. The negative perceptions along with the difficulties with accessing the youth clinic contributed to low service use. The second Sexuality education: an eye-opener or a joke? reflects participants' both positive and negative experiences and attitudes when receiving sexuality education in schools. The third SRH information: beyond formal services and education captures participants' ways of accessing SRH information that go beyond information provided at the traditional SRH services and sexuality education in schools. These sources include the family, friends, and the internet. The study points to the need for multicomponent strategies to improve the accessibility of SRH services and draws attention to the importance of challenging norms related to Swedishness in sexuality education to foster the engagement of youth with migration experience and ensure their sexual citizenship.

Searching for effective strategies to reach boys and young men; a mixed-methods study protocol for youth clinics in Sweden

BACKGROUND

Efforts to engage boys and young men in sexual and reproductive health (SRH) services in Sweden remain limited, with only a small proportion accessing youth clinics, the primary providers of such services. Existing initiatives are often ad-hoc and lack institutionalization within public policy and practice. This study aims to identify feasible and effective interventions to improve boys' and young men's access to youth clinics in Sweden.

METHODS

Employing a mixed-methods approach, this study investigates interventions, strategies, and factors influencing access to SRH services for boys and young men in Sweden. Firstly, a systematic literature review will be conducted to identify evaluated interventions globally. Secondly, strategies to attracts boys and young men in youth clinics in Sweden will be mapped. Thirdly, case studies in two regions in Sweden - chosen for their demographic and geographic diversity - will be conducted interviewing healthcare providers, managers, policymakers, and boys and young men. Lastly, Q-methodology will be used to rank all identified strategies. Healthcare providers and managers will rank these strategies based on their perceived effectiveness and feasibility while boys and young men will rank the interventions based on perceived effectiveness.

DISCUSSION

The added value of this project is generating robust evidence regarding boys and young men's involvement in SRH services, especially their access to youth clinics. This is crucial for (1) developing gender-sensitive services and service delivery models that effectively promote young men's SRH; (2) informing future young men's health policies ensuring that their unique SRH concerns are addressed; and (3) improving young men's participation in SRH provision. This will ultimately foster a culture of shared responsibilities and advance gender equality.

"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.

Sexual and Reproductive Health and Rights for Young Migrants in Sweden: An Ideal-Type Analysis Exploring Regional Variations of Accessible Documents

Objectives: This study aims to map sexual and reproductive health and rights (SRHR) policies, strategies, and interventions targeting young migrants and describe the patterns of organisation, resources, and services across Sweden's 21 regions. Methods: We conducted a document analysis of accessible online documents on SRHR policies, strategies, and interventions targeting young migrants in Sweden's 21 regions. We used ideal-type analysis of the documents to create a typology, which formed the basis of a ratings system illustrating variations in organisation, resources, and services across regions. Results: Findings suggest that efforts aimed at addressing young migrants' SRHR are fragmented and unequal across regions. While SRHR policies and strategies are commonplace, they routinely lack specificity. Available resources vary depending on region and resource type. Additionally, information and interventions, although common, do not consistently meet the specific needs of migrant youths. Conclusion: This study suggests that fragmented efforts are fuelling geographic inequalities in fulfilling SRHR among young migrants. There is an urgent need to improve national coordination and collaboration between national and local actors in SRHR efforts targeting young migrants to ensure equity.

Implementing digital sexual and reproductive health care services in youth clinics: a qualitative study on perceived barriers and facilitators among midwives in Stockholm, Sweden

BACKGROUND

Digital health care services have the potential to improve access to sexual and reproductive health care for youth but require substantial implementation efforts to translate into individual and public health gains. Health care providers are influential both regarding implementation and utilization of the services, and hence, their perceptions of digital health care services and the implementation process are essential to identify and address. The aim of this study was to explore midwives' perception of digital sexual and reproductive health care services for youth, and to identify perceived barriers and facilitators of the implementation of digital health care provision in youth clinics.

METHODS

We performed semi-structured interviews with midwives (n = 16) working at youth clinics providing both on-site and digital sexual and reproductive health care services to youth in Stockholm, Sweden. Interview data were analyzed using a content analysis approach guided by the Consolidated Framework for Implementation Research (CFIR).

RESULTS

Midwives acknowledged that the implementation of digital health care improved the overall access and timeliness of the services at youth clinics. The ability to accommodate the needs of youth regarding their preferred meeting environment (digital or on-site) and easy access to follow-up consultations were identified as benefits of digital health care. Challenges to provide digital health care included communication barriers, privacy and confidentiality concerns, time constraints, inability to offer digital appointments for social counselling, and midwives' preference for in person consultations. Experiencing organizational support during the implementation was appreciated but varied between the respondents.

CONCLUSION

Digital sexual and reproductive health care services could increase access and are valuable complements to on-site services in youth clinics. Sufficient training for midwives and organizational support are crucial to ensure high quality health care. Privacy and safety concerns for the youth might aggravate implementation of digital health care. Future research could focus on equitable access and youth' perceptions of digital health care services for sexual and reproductive health.

Exploring barriers and strategies for improving sexual and reproductive health access for young men in Sweden: Insights from healthcare providers in youth clinics

METHODS

Youth clinics in Sweden are not reaching young men to the same extent as young women. We conducted a qualitative study to explore healthcare providers' (HCPs) perspectives on the barriers to young men's access to sexual and reproductive health (SRH) services and how youth clinics can better accommodate the needs of young men. We used thematic analysis to analyze eight interviews with nine HCPs (three men and six women).

RESULTS

We developed three themes: 1) It's about the youth clinics and those working in them-the clinics suffered from low organizational support, which affected their ability to accommodate young men's needs and were perceived as "girls' clinics". Midwifery, which is the main profession of HCPs working with SRH in the clinics, was perceived as a women's profession for women's SRH; 2) It's not all about the youth clinics-young men were perceived as lacking essential knowledge about SRH and gender norms were preventing young men from visiting youth clinics; 3) Organizational strategies for improving access-the participants discussed strategies to attract young men, including separate reception for young men, hiring more male staff, having higher age limits for young men, and digital solutions to address privacy concerns.

CONCLUSION

There is a need for societal efforts to increase young men's knowledge about SRH and improve their access to SRH services. Several strategies can be adapted by youth clinics to attract more young men but there is need for further research to design and evaluate such interventions.

Unveiling Realities: Exploring and Uncovering Young Adults' Views on Navigating Confidentiality and Disclosure in Healthcare Settings in Bangalore, Southern India

Introduction Research on the healthcare available to young adults in India is negligible. There is little to no data available to describe the Indian young adults' knowledge and attitude toward a doctor-patient interaction and their perceptions on what might be a barrier to confidentiality. Young adults in India, often face the unique dilemma of being old enough to make their own medical decisions and yet often finding themselves without the freedom or knowledge to do so. Understanding factors that young adults perceive to be affecting confidentiality and a barrier in their healthcare checkups can greatly improve the quality of healthcare provided to them. Objective The objective of the study was to assess knowledge and attitudes among young adults in Bangalore City regarding the maintenance of confidentiality by a doctor while seeking healthcare and to identify perceived factors the young adults believed to be affecting confidentiality and information disclosure when seeking healthcare.  Method A cross-sectional, descriptive study was carried out using multi-stage random sampling. Four colleges were randomly selected from four geographic zones in Bangalore City (North, East, South, and West). The investigators developed a 30-question questionnaire, comprising sections on patient details, perceptions regarding confidentiality, factors influencing history disclosure, etc., which was validated by a panel of four faculty members from one para-clinical and two clinical departments each, belonging to the investigators' medical college. Subsequently, a pilot study with 33 participants was conducted and a sample size of 60 was arrived at assuming an 83.87% favorable knowledge regarding the right to refuse to disclose information to a doctor, with a 95% confidence interval and a 10% absolute allowable error. Further validation was done following the pilot study. Student lists from the chosen colleges were obtained, and the required sample size was distributed based on probability proportional to size (PPS): 19, 19, 12, and 10 participants from the respective colleges. Random number tables were utilized to select the required number of participants from the student population. The participants of the pilot study were not included in the study. The questionnaire was administered digitally by the investigators, and in cases where a student declined to participate, an alternative participant was chosen using random number tables.  Results Results demonstrate that 21.7% (13) of respondents were unaware that a doctor is legally bound to keep details of the visit confidential. A total of 93.3% (56) of the respondents report that a parent/guardian plays an active role in their doctor's visit. Only 16.7% (10) of respondents strongly agreed that they felt comfortable enough to have an honest conversation with their doctor. Respondents report that they were most likely to withhold history regarding sexual practices (55%), alcohol use (35%), and smoking (31.7%). Conclusion  Healthcare providers should take all possible measures to ensure confidential and quality care to the vulnerable young adult population. Breach of confidentiality, often in the form of a parent or guardian being present during the history-taking process. can be a barrier to building good rapport and negatively impact the doctor-patient relationship.