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. 2021 Oct;69(4):541-548.
doi: 10.1016/j.jadohealth.2020.12.135. Epub 2021 Mar 9.

Assessing Barriers to Effective Coverage of Health Services for Adolescents in Low- and Middle-Income Countries: A Scoping Review

Elizabeth K Stierman  1 , Anna Kalbarczyk  2 , Htet Nay Lin Oo  3 , Theadora Swift Koller  4 , David H Peters  2
Affiliations

Assessing Barriers to Effective Coverage of Health Services for Adolescents in Low- and Middle-Income Countries: A Scoping Review

Elizabeth K Stierman et al. J Adolesc Health. 2021 Oct.

Abstract

Purpose: Understanding barriers to health services, as experienced by adolescents, is important to expand effective and equitable coverage; however, there is limited discussion on methods for conducting barrier assessments and translating findings into action.

Methods: We conducted a scoping review of literature published between 2005 and 2019 on barriers to health services for adolescents in low- and middle-income countries. The review was guided by a framework that conceptualized barriers across multiple dimensions of access (availability, geographic accessibility, affordability, and acceptability), utilization, and effective coverage.

Results: We identified 339 studies that assessed barriers related to at least one dimension of the operational framework. Acceptability (93%) and availability (88%) of health services were the most frequently studied access dimensions; affordability (45%) and geographic access (32%) were studied less frequently. Less than half (40%) of the studies evaluated utilization, and none of the 339 studies assessed effective coverage. Attention to equity stratifiers (e.g., income, disability) was limited. Topics studied reflected only a subset of the major causes of adolescent death and disability.

Conclusions: Holistic, equity-oriented approaches are needed to better understand barriers across multiple dimensions that together determine whether health services are accessible, used, and effectively meet the needs of different adolescent groups.

Keywords: Adolescent health services; Effective coverage; Health equity; Health services accessibility; Low- and middle-income countries; Services utilization.

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Figures

Figure 1
Figure 1
PRISMA diagram for scoping review.
Figure 2
Figure 2
Dimensions of access, utilization, and effective coverage identified by studies in relation to supply and/or demand for adolescent health services.
See this image and copyright information in PMC

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