Strengthening the quality of adolescent primary healthcare in South Africa: preliminary work on a complex public health intervention

加强南非青少年初级卫生保健的质量：复杂公共卫生干预措施的初步工作

• 批准号: MR/T040289/1
• 负责人: Lara Fairall
• 金额: $ 52.68万
• 依托单位: University of Cape Town
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2022
• 资助国家: 英国
• 起止时间: 2022 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FT040289%2F1
• 关键词: Strengthening; quality; adolescent; primary; healthcare

Adolescence is a formative phase of life which shapes the health and well-being of an individual for adulthood. In South Africa, adolescents are experiencing large and growing burdens of disease with high rates of communicable diseases (like HIV and TB), pregnancy, obesity, mental illness and trauma. Government policies to support adolescent healthcare have been widely implemented, however, challenges remain in how such policies are operationalised to strengthen adolescent healthcare: primary care clinics report low attendance of adolescents and school health reviews show low service provision. The Knowledge Translation Unit in Cape Town has developed the PACK Adolescent guide and training programme to support primary care clinicians (nurses and doctors) with tools to meet the needs of adolescents. The aim of this study is to understand the status of adolescent healthcare in primary care clinics and schools in order to refine and adapt PACK Adolescent to meet the needs of adolescents and the challenges faced by clinicians in providing care to this underserved grouped. Once refined, we shall pilot and evaluate PACK Adolescent in schools and clinics to see what more we need to do to optimise PACK Adolescent and what we need to alter about the delivery of adolescent healthcare to enable its use in primary care clinics and schools in other settings.From the outset, the design of this study involved the input of adolescents themselves, primary care clinicians and policymakers in health and education sectors during a stakeholder workshop. Throughout the grant's duration, stakeholder input and co-production will characterise the study through theory of change workshops and an advisory board. The study seeks to assess adolescent primary health care in six clinics and twelve schools in the Western Cape province of South Africa through a facility questionnaire to determine various aspects of adolescent healthcare services and the clinical characteristics of adolescents using these services. We shall observe the processes that adolescents follow to receive health care, including their consultations with clinicians. Focus group discussions with school and clinic managers, clinicians, community-based organisations, policymakers and adolescents will provide a broad understanding of existing adolescent health care. We shall then refine the PACK Adolescent guide and training programme following a theory of change workshop (a workshop intended to develop a system of ideas to explain how we think change happens in the area we want to address, and how we intend to work to influence these changes) with key stakeholders. The adapted intervention will then be piloted and evaluated in the six clinics and twelve linked schools (primary and secondary). Through observations of the use of PACK Adolescent and resultant changes to the clinical pathway for adolescents as well as interviews with adolescents, clinic clinicians and school health nurses we will see how PACK Adolescent meets the needs of adolescents and clinicians along with the challenges to its use. A survey questionnaire completed by clinicians in schools and clinics along with routine health data will help us to assess its impact. The outcomes of the study will provide an understanding of adolescent primary healthcare across schools and clinics. It will allow us to identify the minimum system strengthening components needed to support adolescent healthcare in an integrated way in both health and education sectors. We shall share these outcomes with participating schools and clinics, as well as the Departments of Health and Education in the province and nationally. They will inform the design of a future study evaluating whether PACK Adolescent leads to improved outcomes for young people.

青春期是人生的一个形成阶段，它塑造了一个人成年后的健康和福祉。在南非，青少年正承受着巨大且不断增长的疾病负担，传染病（如艾滋病毒和结核病）、怀孕、肥胖、精神疾病和创伤的发病率很高。政府支持青少年保健的政策得到了广泛实施，然而，在如何实施这些政策以加强青少年保健方面仍然存在挑战：初级保健诊所报告说，青少年的出勤率很低，学校保健审查显示，服务提供率很低。开普敦的知识转化股制定了PACK青少年指南和培训方案，为初级保健临床医生（护士和医生）提供工具，以满足青少年的需求。本研究的目的是了解青少年保健在初级保健诊所和学校的地位，以完善和适应PACK青少年，以满足青少年的需求和临床医生在提供护理，这个服务不足的群体所面临的挑战。一旦完善，我们将在学校和诊所试点和评估PACK Adolescent，看看我们还需要做些什么来优化PACK Adolescent，以及我们需要改变青少年保健的提供，使其能够在其他环境中的初级保健诊所和学校使用。从一开始，这项研究的设计就涉及青少年自己的投入，在利益攸关方研讨会期间，卫生和教育部门的初级保健临床医生和决策者。在整个赠款期间，利益相关者的投入和共同制作将通过变革理论研讨会和咨询委员会来支持这项研究。该研究旨在评估青少年初级卫生保健在6个诊所和12所学校在南非西开普省通过设施问卷调查，以确定青少年医疗保健服务的各个方面和青少年使用这些服务的临床特征。我们将观察青少年接受保健的过程，包括他们与临床医生的协商。与学校和诊所管理人员，临床医生，社区组织，政策制定者和青少年的焦点小组讨论将提供对现有青少年卫生保健的广泛了解。然后，我们将在与主要利益相关者举行变革理论研讨会（旨在开发一个想法系统的研讨会，以解释我们认为变革如何发生在我们想要解决的领域，以及我们打算如何影响这些变革）之后，完善PACK青少年指南和培训计划。然后，将在六个诊所和十二所联系学校（小学和中学）试行和评估经过调整的干预措施。通过观察PACK Adolescent的使用及其对青少年临床路径的变化，以及对青少年、临床医生和学校保健护士的采访，我们将了解PACK Adolescent如何满足青少年和临床医生的需求沿着使用时面临的挑战。由学校和诊所的临床医生沿着完成的调查问卷以及常规健康数据将有助于我们评估其影响。这项研究的结果将提供跨学校和诊所的青少年初级保健的理解。它将使我们能够确定在卫生和教育部门以综合方式支持青少年保健所需的最低系统加强组成部分。我们将与参与的学校和诊所以及省和全国的卫生和教育部门分享这些成果。他们将为未来的研究设计提供信息，以评估PACK青少年是否会改善年轻人的结果。