Unlocking potential: developing innovative adolescent screening visits for health promotion, prevention and treatment in low-resource settings

在青春期，人们采取的与健康有关的行为将对个人的短期和长期健康、教育成就和就业前景产生重大的积极或消极影响。然而，在大多数低收入国家，很少有青少年接触到保健服务，特别是在促进健康和预防疾病方面，而且服务并不总是适合他们的需要。由于资源限制，提供高质量的方便青年的保健服务的能力往往有限。技术进步提供了在传统临床环境之外提供服务和信息的机会，从而减少了成本或保密性等障碍。青少年可能特别容易接受数字平台，使他们能够自我管理自己的健康和福祉。什么是A-Bit？该方案将通过对青少年（10- 13岁）和青少年（16- 19岁）进行健康检查，对青少年的常见病进行筛查和治疗/转诊。青少年只有在经过准确和可接受的检测和当地可获得的有效干预措施，如精神健康、艾滋病毒、视力和听力、贫血等情况下才能接受筛查。具体会做些什么？我将在津巴布韦开发、试点测试、实施和评估创新的A-EMBA项目和配套的数字平台。将在学校为年幼的青少年进行体检，在社区为年长的青少年进行体检。该平台将减少工作人员的工作量，允许青少年使用问卷（例如心理健康、风险行为）和现有应用程序（测试听力、视力、身体成分）进行自我筛查，并将帮助团队与青少年保持联系，提供有关转诊预约的信息。我会分析通过A-ESTA计划收集到的数据，以提高其未来的可接受性和成本效益。主要成果是什么？对以下问题的回答-青少年是否参加筛查和转诊？探访对他们的健康和教育有什么影响？青少年接受筛查和获得推荐的治疗需要多少钱？这是否物有所值？这项研究有什么创新之处？这一方法具有创新性和新颖性，因为目前很少有低收入国家为青少年提供体检，而在提供体检的国家，体检并不总是满足青少年的需要，例如不包括心理健康检查。这项建议采取了创新和大胆的步骤，从针对具体情况的保健方案转向以健康为中心的办法，重点是对青少年最重要的问题。这是第一项实证研究，调查了多成分的青少年健康检查的有效性和成本效益。具体创新：- 青年研究人员将参与以人为本的干预开发设计方法-青少年将在数字平台上完成一些健康检查活动，节省咨询时间，提高数据收集的质量和效率-创新的青少年参与活动，包括众包竞赛和数字平台中的奖励制度，青少年在完成筛查和/或参加转介访问-机器学习和创新的数据分析，通过提供有针对性的信息和服务，最大限度地提高A-ESTA的效率和参与度为什么选择津巴布韦？津巴布韦是开展A-ESTA的理想地点，鉴于BRTI与卫生部和教育部之间的密切合作，2018年学校卫生政策中对预防的强调，以及缺乏其他筛选和转介青少年的好方法，它具有很大的扩大潜力。在非洲其他地区，人们对青少年体检很感兴趣，津巴布韦的模式有可能在其他地方推广。

In adolescence, health-related behaviours are adopted that will have substantial positive or negative impacts on the individual's short- and long-term health, educational attainment, and employment prospects. However, in most low-income countries few adolescents have any contact with health services, especially for health promotion and disease prevention, and services are not always appropriate for their needs. Due to resource constraints there is often limited capacity to provide high-quality youth-friendly health services. Technological advances provide opportunities to deliver services and information away from traditional clinical settings, hence reducing barriers such as cost or confidentiality. Adolescents may be particularly receptive to digital platforms that allow them to self-manage their health and well-being. What is A-CHECK? The programme will screen and treat/refer adolescents for common conditions through health check-ups in younger (10-13y) and older (16-19y) adolescents. Adolescents will only be screened for conditions with an accurate and acceptable test and a locally accessible effective intervention e.g. mental health, HIV, vision and hearing, anaemia. What exactly will be done? I will develop, pilot-test, implement and evaluate the innovative A-CHECK programme and an accompanying digital platform in Zimbabwe. Check-up visits will take place at schools for younger and in the community for older adolescents. The platform will reduce the workload of staff by allowing adolescents to self-screen using questionnaires (e.g. mental health, risk behaviours) and pre-existing apps (to test hearing, eyesight, body composition), and will help the team to keep in touch with adolescents and provide information on referral appointments. I will analyse the data collected through the A-CHECK programme to improve its future acceptability and cost-effectiveness. What are the main outcomes? Answers to the following questions - Do adolescents attend the screening and referral appointments? What impact do visits have on their health and education? How much does it cost for an adolescent to be screened and to obtain the recommended care for a condition? Is this a good value for money?What is innovative about this study? The approach is innovative and novel, because, few LMICs currently provide check-up visits for adolescents and in countries where they are provided, the visits don't always meet the needs of adolescents e.g. don't include mental health screening. This proposal takes the innovative and bold step of moving from condition-specific health programmes towards an adolescent-centred approach focusing on what matters most to adolescents. This is the first empirical study to have investigated the effectiveness and cost-effectiveness of multi-component adolescent health check-ups. Specific innovations: - Youth Researchers will participate in a human-centred design approach to intervention development- Digital platform on which adolescents will complete some of the health screening activities, saving consultation time and improving the quality and efficiency of data collection- Novel adolescent engagement activities including crowdsourcing contests and a reward system in the digital platform with adolescents gaining points when they complete screening and/or attend referral visits- Machine learning and innovative data analysis to maximise A-CHECK efficiency and engagement by providing targeted messages and servicesWhy Zimbabwe? Zimbabwe is an ideal location for A-CHECK with great potential for scale-up given the close collaboration between BRTI and the Ministries of Health and Education, the emphasis on prevention within the 2018 School Health Policy, and the absence of other good ways to screen and refer adolescents. In other African settings, there is considerable interest in adolescent check-ups and potential for the Zimbabwean model to be adapted elsewhere.