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Seeking young people's views of primary care

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VOL: 98, ISSUE: 24, PAGE NO: 37

Sue Linnell, BSc, RGN, RM, is research associate, Centre for Health Policy and Practice, Staffordshire University

Most young people have quite specific views about Pop Idol, but do they have clear opinions about their local health services, and are they ever asked? Involving patients in all aspects of health is a government priority (Department of Health, 2000). It follows that if a health service is aimed specifically at young people, such as school nursing or adolescent family planning, the involvement of young patients should be a priority (Children and Young People's Unit, 2001).

Most young people have quite specific views about Pop Idol, but do they have clear opinions about their local health services, and are they ever asked? Involving patients in all aspects of health is a government priority (Department of Health, 2000). It follows that if a health service is aimed specifically at young people, such as school nursing or adolescent family planning, the involvement of young patients should be a priority (Children and Young People's Unit, 2001).

However, youth involvement is a rare phenomenon. A recent survey found that if young people are asked their views, they are usually only asked once and their influence on services remains minimal (Chambers et al, 2001). All public services were reviewed and health settings were found to be particularly neglectful about involving young patients. Staffordshire University, in partnership with South Stoke Primary Care Trust (PCT), aimed to redress this neglect.

Young people's views were needed in particular about local health clinics and practices, and about how they could better meet young people's needs. Primary care staff felt that young patients were not using their services for contraceptive advice and help, and saw this as a waste of resources, when health centres and practices remained the nearest and most convenient point of contact.

Evidence of high local teenage conception rates supported these beliefs, which were shared by many health professionals. In the period 1994-1997 North Staffordshire had a teenage conception rate of 14.1 per 1,000, while the national average was 9.1 per 1,000 (North Staffordshire Sexual Health Partnership, 2001). One of the highest ranked wards was in South Stoke PCT's catchment area.

The young people were initially asked to fill in a questionnaire, which asked them about their experiences of visiting the doctor's surgery and offered suggestions for improvements. One-hundred questionnaires were distributed through 10 participating practices and a response rate of 31% was achieved.

The findings
There were more female than male respondents (61% female, 39% male), and 68% were aged 13-17 years. Most had visited surgeries in recent months (78% within six months or less.)

Respondents were positive about the service they received, with 36% saying they were 'very satisfied', 48% 'satisfied', and 16% describing the service as 'fair'. Sixty-one per cent said they would visit the surgery on their own for appointments, 42% would attend for contraceptive advice, 39% for contraceptives, 58% for skin problems and 10% for smoking advice. Sixty-seven per cent believed that the staff would not divulge any information to their parents.

Making the surgery more young-person-friendly
The questionnaire included four suggestions for making surgeries more friendly to young people, and respondents were asked to rank them. The most popular suggestion was to provide young-person-only slots (64%), followed by 'being more careful with information about you' (58%), providing an information booklet about surgeries (48%) and offering priority after-school slots for young people during general surgery hours (48%). Respondents also volunteered their own suggestions (Box 1).

This project could have concluded at this stage, but staff wanted to know more about the young people's ideas. Fifteen respondents had volunteered for further contact, and were asked to attend a focus group at a sports centre.

The focus group
The group was used to highlight findings from the questionnaire and revisit the main themes. The young people went into more depth about some of the problems they found in visiting local practices (Box 2).

As the group progressed, the participants asked many questions about local health services, which the facilitators answered. The participants found this useful and felt that this information should be available to all young people. The group wanted to design a leaflet to allay other young people's fears about visiting a health professional. They examined national and local health leaflets, and made decisions about layout and what information to include (Box 3). A draft leaflet was generated during this meeting. After the meeting, all local health professionals mentioned in the leaflet were consulted about the accuracy of the information in the draft version. The aim was to produce a practical health leaflet for young people, and these were presented in the leaflet as 'top tips' (Box 4).

Some issues that the young people had raised could not be resolved, such as reducing the age of staff. However, the young people and professionals worked together and developed solutions to some issues.

Another focus group took place, in which the final touches were made to the leaflet. The young people also planned media coverage and the launch of the leaflet.

School nurses have since conducted an evaluation of the leaflet. They acted as gatekeepers, distributing the 3,000 leaflets to students in six schools. The leaflets were generally well received. The main themes are summarised in Box 5.

Conclusion
This small project brought together many agencies in one community and gave professionals a fresh insight into their services. The project showed that when young people were asked about health issues they did have opinions. Involving young people requires time and commitment but if everyone has a shared focus, it produces real and useful results.

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