Organization and content of primary care for adolescents – comparison of actual and desired situation

To successfully navigate increasing autonomy, independence and health behaviors in adolescence, accessible adolescent health care services (AHS) are essential. AHS comprise all services in primary care that are aimed at the specific needs of adolescents and can be provided in various settings such as public services, private services, schools and hospitals. In the MOCHA project (Models of Child Health Appraised) we assessed the structure and content of AHS in 30 European countries against the standards in the field of adolescent health services: accessibility, staff attitude, communication, staff competency and skills, confidential and continuous care, age appropriate environment, involvement in health care, equity and respect and a strong link with the community. The results revealed that although half of the 30 countries did adopt adolescent-specific policies, many countries did not meet the current standards of quality health care for adolescents. For example, the ability to provide emergency mental health care is limited. In addition, one third of the countries do not have a formal policy which guarantees the confidentiality of a consult and the possibility to consult a physician without parents knowing. Finally, around half of the countries do not have specialized centers in adolescent health care in order to tackle comprehensive health issues. Access to adolescent health care services needs to be improved for vulnerable adolescents such as migrant adolescents. Schools, ambulatory settings and hospitals should offer accessible, comprehensive health care and a culturally appropriate approach, particularly given the number of migrant adolescents living in EU and EEA countries. Finally, the health care systems should improve their communication strategies, to assist young people in understanding their rights and responsibility in the domain of health, and how and where to access to adequate care.

Effects of peer-led AIDS education aimed at Turkish and Moroccan male immigrants in The Netherlands. A randomised controlled evaluation study

BACKGROUND

An evaluation study was conducted in The Netherlands into acquired immune deficiency syndrome (AIDS) education for immigrants given in their native language by peers. Turkish and Moroccan men were trained to educate people from their own ethnic group. The effect of peer education on the perceived threat of AIDS and beliefs about condom use were studied.

METHODS

Places where male immigrants met, i.e. coffee houses, mosques and bars, were matched and randomly assigned to experimental and control groups. The experimental group filled out a short questionnaire at the end of the education session (post-test), whereas the control group was pre-tested and had the opportunity of following the AIDS education after participation in the questionnaire.

RESULTS

Using multilevel logistic regression analysis, an effect could be established on misunderstandings regarding human immunodeficiency virus (HIV) transmission (OR = 5.9 and 95% CI: 2.3-15.3) and risk appraisal for HIV infection (OR = 2.9 and 95% CI: 1.3-6.3). The perceived benefits of the protective effect of condom use were affected in men 30 years and older, the perceived barrier of diminished satisfaction if using condoms was changed among unmarried men, condom self-efficacy was affected in men who valued peer education as important and an effect on intention to use condoms was found among Moroccans.

CONCLUSION

Continuation of peer-led AIDS education for immigrants and adaption of the message to the needs of specific target groups is recommended.

Intermediates' satisfaction with a loneliness intervention program aimed at older adults: linkage of program plans and users' needs

Intermediates' satisfaction with linkage of program plans and users' needs in the Dutch loneliness intervention program in good company (IGC) was studied. IGC was aimed at prevention and diminishment of loneliness in older adults, aged 55 years and above. Moreover, the objective was to improve helping and cooperation skills of intermediates, i.e. professional workers and volunteers. Different linkage approaches were used successively in three neighbourhoods, varying from top down instrumental to bottom up democratic linkage strategies. The intermediates' satisfaction with these strategies was measured using postal questionnaires, sent about 20 months after the introduction of the program to the three neighbourhoods. Satisfaction was significantly related to the intermediates' subjective evaluation of the linkage approach. Satisfaction was highest in the neighbourhood where the intermediates were consulted most explicitly and where they had a clear voice in the design and organisation of the intervention, using democratic linkage strategies. Satisfaction was clearly associated with the program's success in meeting targets aimed at intermediates. A relationship with effective prevention of loneliness in older adults was not found. It is concluded that the use of democratic linkage strategies, like needs assessments, local action plans and two-way communication between program designers and users, is essential for successful dissemination of health promotion activities.