Making Health Services Adolescent-Friendly in Northeastern Peninsular Malaysia: A Mixed-Methods Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Quantitative Phase
2.3. Qualitative Phase
2.4. Ethical Considerations
3. Results
3.1. Quantitative Phase
3.2. Qualitative Phase
3.3. Theme 1: Commitment and Priority from Healthcare Providers’ Perspective towards Adolescent-Friendly Health Services
3.3.1. Self-Commitment of Healthcare Providers to Provide Adolescent-Friendly Health Services
“For me, it (the success of adolescent-friendly health services) really depends on staff commitment. The number of staff and patient attendance in a clinic do not influence much. In doing something, we must have passion. If FMS (family medicine specialists) and MO (medical officers) were the only ones interested in the program (adolescent-friendly health services), but not other healthcare staff, these health services definitely cannot succeed.”(P2)
“The success of adolescent-friendly clinic does not really depend on the type of clinics. If our staffs are very committed and passionate about adolescent health services, they surely can implement it in any clinic settings.”(F2)
3.3.2. Prioritization by Top Managers towards the Implementation of Adolescent-Friendly Health Services at Ground Level
“We still could not see the importance of adolescent health services. We don’t see adolescents as a group of people who needed care. Secondly, we focus too much on dengue fever, non-communicable diseases, diabetes, hypertension and heart problems. These are the problems that received more emphasis than adolescent health problems.”(F1)
“I think more emphasis on adolescent health should be given by the higher authority … Through the audits (monitoring) done by higher authority, we will be able to pinpoint our weaknesses in the implementation process. From the audit findings, we can improve our services quality. If there is no audit or supervision, any program (health services) will fade away in time.”(F3)
3.4. Theme 2: Organizational Supports to Advocate Adolescent-Friendly Health Services
3.4.1. Capacity Building to Ensure Competency of Healthcare Providers in Providing Adolescent-Friendly Health Services
“We know that adolescents are not easy to be approached … So, if there is trained staff (on adolescent health management) and dedicated team in each clinic, surely adolescents will continue coming to the clinic. If staffs are not well-trained, they will not know the right way to engage with adolescents. Some staff even talked to adolescents in rude manner. This is very unwelcoming for them. Certainly adolescents will not come to this clinic again.”(P1)
“As for training (on adolescent health services), it is inadequate. Staffs from my clinic were only trained once at the district level. And at state level, training is only held once a year.”(F5)
3.4.2. Financial Aid to Sustain the Implementation of Adolescent-Friendly Health Services
“I think budget should be provided from higher authority. This is because as for now, adolescent health program does not have special budget allocation. If we were to organize adolescent health promotional activities especially outside of our clinic, we really need enough budget allocation.”(A4)
“We need support which include financial support. To organize seminar, promotional activities and training sessions, we need adequate budget. If budget is enough, then it is easy for us to do any program. We need special budget to redecorate our clinic and to add more IEC materials (to suit adolescents’ need).”(F5)
3.5. Theme 3: Appropriate Clinic Settings for Adolescent-Friendly Health Services
3.5.1. Providing Adequate Privacy for Adolescents at Clinics
“If we have private room for adolescents, there will be no disturbance from other patients. When we have this kind of privacy, we can do consultation with teenagers in more detailed and focused way. Teenagers will be more confident (to share their secret) if only both of us (healthcare provider and teenager) are in the room. Otherwise, if other patients share the same room, teenager will not openly share their problems.”(A3)
3.5.2. Allocating a Dedicated Team for Adolescent Health Services at Clinics
“By having a special team (for adolescent health services), patient’s flow of management from the point of registration until consultation session will be more smooth. Adolescents do not have to wait so long to see doctor, and this is more convenient for them. Besides, this team will manage adolescents’ appointment and will facilitate follow-up session with them. This will surely attract more adolescent clients to the clinic.”(M5)
3.5.3. Implementing Family-Doctor Concept (FDC) at Healthcare Facilities
“In clinic with FDC, staffs work by zone, and they personally know well all clients in their respective zone, regardless of children, adolescents, adults or elderly clients. Thus, it is much easier for us to tackle their problems since we know so much about them and their family members. Personalized care is better with FDC system. So logically, FDC would help our health services to be more adolescent-friendly.”(P1)
3.6. Theme 4: External Supports for Adolescent Health Promotional Activities
3.6.1. Inter-Agencies Collaboration in Promoting Adolescent Health Services
“Collaboration with them (other agencies) is important because we lack manpower. LPPKN (The National Population and Family Development Board) and ReHAK (Reproductive Health Association of Kelantan) can help us during promotional activities if we invite them. They have many modules and IEC materials (pertaining to adolescent health) which can be used during our promotional activities.”(M2)
“Secondly, we have to collaborate with other agencies in doing health promotion, especially schools. Schools are very important since majority of the adolescents are school-goers. So we can use school as a platform for us to reach adolescents and inform them about the availability of adolescent health services at our clinic.”(N3)
3.6.2. Community Involvement in Adolescent Health Promotion
“We ought to have good rapport with the community, especially with the parents so that they will encourage their teenage children to join our program (adolescent-friendly health services).”(M1)
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variables | Simple Linear Regression | Multiple Linear Regression | |||
---|---|---|---|---|---|
Crude b (95% CI) | p-Value | Adjusted b (95% CI) | t-Stat | p-Value | |
Number of healthcare providers | 0.37 (0.20,0.54) | <0.001 | 0.06 (−0.23,0.35) | 0.40 | 0.690 |
Daily patients’ attendance | 0.04 (0.02,0.05) | <0.001 | −0.007 (−0.03,0.02) | −0.53 | 0.598 |
Type of clinic | |||||
Universal | 1.00 | 1.00 | |||
Intermediate | 7.35 (1.45,13.26) | 0.015 | 0.29 (−4.26,4.86) | 0.13 | 0.896 |
Advanced | 19.51 (12.13,26.89) | <0.001 | 0.93 (−8.37,10.23) | 0.19 | 0.843 |
Availability of family medicine specialist at clinic | |||||
No | 1.00 | 1.00 | |||
Yes | 13.44 (7.43,19.45) | <0.001 | −0.50 (−6.67,5.66) | −0.16 | 0.871 |
Availability of highly trained healthcare provider in adolescent health management | |||||
No | 1.00 | 1.00 | |||
Yes | 14.98 (9.99,19.96) | <0.001 | 5.64 (1.54,9.73) | 2.68 | 0.007 |
Availability of private room or space for counseling session | |||||
No | 1.00 | 1.00 | |||
Yes | 15.65 (9.89,21.40) | <0.001 | 5.66 (1.45,9.87) | 2.68 | 0.009 |
Availability of dedicated team in charge of adolescent health services. | |||||
No | 1.00 | 1.00 | |||
Yes | 19.23 (14.65,23.82) | <0.001 | 9.07 (4.68,13.47) | 4.12 | <0.001 |
Availability of promotional activities to promote adolescent health services to adolescents and community | |||||
No | 1.00 | 1.00 | |||
Yes | 21.23 (16.65,25.82) | <0.001 | 13.11 (8.46,17.75) | 5.62 | <0.001 |
Variables | Frequency (%) |
---|---|
Age (year) * | 46 (16) |
Working experience (year) * | 20 (14) |
Gender | |
Male | 6 (26.1) |
Female | 17 (73.9) |
Education level | |
Diploma level | 8 (34.8) |
Bachelor’s degree | 7 (30.4) |
Master’s degree | 8 (34.8) |
Job title | |
Public health physician | 3 (13.1) |
Family medicine specialist | 5 (21.7) |
Medical officer | 6 (26.1) |
Assistant medical officer | 4 (17.4) |
Nurse | 5 (21.7) |
Categories | Themes |
---|---|
| Theme 1: Healthcare providers’ commitment and prioritization towards adolescent-friendly health services. |
| Theme 2: Organizational supports to advocate adolescent-friendly health services. |
| Theme 3: Appropriate clinic settings for adolescent-friendly health services. |
| Theme 4: External supports for adolescent health promotional activities. |
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Share and Cite
Awang, H.; Ab Rahman, A.; Sukeri, S.; Hashim, N.; Nik Abdul Rashid, N.R. Making Health Services Adolescent-Friendly in Northeastern Peninsular Malaysia: A Mixed-Methods Study. Int. J. Environ. Res. Public Health 2020, 17, 1341. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17041341
Awang H, Ab Rahman A, Sukeri S, Hashim N, Nik Abdul Rashid NR. Making Health Services Adolescent-Friendly in Northeastern Peninsular Malaysia: A Mixed-Methods Study. International Journal of Environmental Research and Public Health. 2020; 17(4):1341. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17041341
Chicago/Turabian StyleAwang, Hafizuddin, Azriani Ab Rahman, Surianti Sukeri, Noran Hashim, and Nik Rubiah Nik Abdul Rashid. 2020. "Making Health Services Adolescent-Friendly in Northeastern Peninsular Malaysia: A Mixed-Methods Study" International Journal of Environmental Research and Public Health 17, no. 4: 1341. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17041341