Adolescent and youth-friendly health interventions in low-income and middle-income countries: a scoping review

Abstract

Background: Adolescents comprise one-sixth of the world's population, yet there is no clear understanding of the features that promote adolescent-friendly services (AFS). The lack of clarity and consistency around a definition presents a gap in health services.

Methods: The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. We conducted a scoping review of peer-reviewed empirical studies to explore AFS in low-income and middle-income countries (LMICs) published between January 2000 and December 2022. The databases searched were CAB Direct (n=11), CINAHL (n=50), Cochrane Databases (n=1103), Embase (n=1164), Global Health Medicus (n=3636) and PsycINFO (n=156). The title, abstract and full text were double screened by three independent reviewers. Three independent reviewers assessed the study's quality using the Joanna Briggs Initiative Quality Appraisal and Cochrane Risk of Bias 2 tools.

Results: We identified the key components, barriers and facilitators of AFS. The following emerged from our review: a non-judgmental environment, culturally appropriate and responsive interventions and a focus on supporting marginalised communities often living in high-poverty settings. Using these components, we have extended guidance around a possible framework and tool assessing quality of AFS.

Interpretation: As LMICs are heterogeneous and unique, it was assumed that the operational definition of 'adolescent-friendly' might vary depending on different contexts, but there must be core components that remain consistent. Possible limitations of our review include a lack of grey literature. Potential future implications include training healthcare providers, testing these attributes for service improvement and future development and localisation of policy guidelines.

Key highlights: Our review has mapped the research framing of AFS and provided a comprehensive review of barriers and facilitators to implementing a holistic outlook of AFS set-up in a tightly controlled research and real-world context. Our paper is one of the few efforts to synthesise behavioural and mental health elements underpinning AFS.

Keywords: Health systems.

Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart. LMICs, low-income and middle-income countries.

Figure 2. Figure to visualise the barriers to studying a youth health intervention in low-income and middle-income countries.

Figure 3. Figure to visualise the facilitators of studying an adolescent health intervention in low-income and middle-income countries.

Figure 4. Network comparison of included studies and policy recommendations. The diagram illustrates how the included studies met the criteria outlined in the policy documents: Global Accelerated Action for the Health of Adolescents (WHO AA-HA), WHO Quality Assessment, UNICEF Second Decade and Path Finder Clinic Assessment. If all the criteria were met, we noted this relationship with a green line if all the criteria were met. If some criteria were met, we illustrated the relationship with a yellow line. As seen in the diagram, the WHO Quality Assessment and UNICEF Second Decade were most compatible with the included studies.

Figure 5. Key attributes and guidance for a possible tool assessing adolescent-friendly services and/or intervention development.