Platforms for Delivery of Adolescent-Friendly Health Care

There has been a dramatic shift in the type of health issues that affect adolescents across the world, with a resulting requirement for health services to re-orient themselves to address these problems. Sexual and reproductive health is still a major problem in many low- and middle-income countries (LMIC), but is increasingly relevant for unmarried as well as married young women. While undernutrition remains a key problem, the obesity epidemic is increasingly affecting adolescents in LMIC. Mental disorder and risks for later noncommunicable diseases (e.g. tobacco use) typically have their onset during adolescence, and accidents and injuries disproportionately affect the young. Yet, historically, health services in LMIC settings have assumed that adolescence is a healthy period of life, and that adolescents have little need to engage in health services. Adolescent-friendly health care refers to the provision of quality healthcare for adolescents. The goal is that health services are available and able to respond to the changing needs of young people and can actively engage them in their own healthcare, while supporting their parents and carers. Yet there are many barriers. The most important relate to access, acceptability and appropriateness of healthcare. A particular challenge is to provide healthcare that is private and confidential, and that 'goes beyond the presenting complaint' as there is often a gap between the illnesses that young people present with to health services and their wider concerns. Psychosocial history taking is the most effective tool for engaging young people in their health care and identifying the range of health issues they experience. Active engagement helps set expectations around self-management practices, is a prerequisite to behavior change, and a strategy to support future engagement with adult health services. A challenge for health educators and health services is to ensure that the contemporary health workforce is appropriately skilled to provide adolescent-friendly healthcare to all young people and that health services have an appropriate policy framework in place to deliver the health services that young people need. Increasing participation in secondary schools offers an additional platform to deliver primary care services. Beyond this, there is much interest in the role of immunization as a point of contact with health services that could offer a wider range of interventions. Media-based interventions also provide great promise as a platform for health education and behavior change interventions, although trials of media-based interventions are still very limited with modest effect sizes. (C) 2015 Nestec Ltd., Vevey/S. Karger AG, Basel