NHS Health Scotland

 

Evidence
 

Sexual and reproductive health services are evidence informed, person-centered and proportionate to the needs of young people.

Link through the outcomes (2b)

Evidence-informed, person-centered sexual health and reproductive services which are accessible, relevant and proportionate to need will contribute young peold having a greater awareness of, and confidence to access, reproductive, sexual health and other services. This will lead to greater and more sustained access to services, improved knowledge and skills about contraception, sexual negotiation, and ultimately an increase in postive sexual behaviour.

Youth-friendly and person-centered services will also contribute to an increase in the number of young people with additional health and social needs being identified and supported to access and maintain contact with appropriate health and social care.

Both these outcomes will ultimately contribute to a reduction in pregnancies and subsequent unintented pregnancies and improved health, social and economic outcomes for young people.

Summary

Youth-friendly services

  • There is review-level evidence that young people experience a range of personal and service barriers to accessing services. (1, 2)
  • NICE and WHO guidance recommends the provision of youth-friendly services. (3,4)
  • There is review-level evidence that youth-friendly services increase access to services, and limited but promising evidence that youth-friendly services may contribute to reduced sexual risk behaviour. (5)

Tailored services for socially disadvantaged young people

  • Proportionate universalism is an important contributor to reducing health inequalities and NICE Public Health Guidance recommends tailoring sexual health services for socially disadvantaged young people.(3)

  • There is review-level evidence that targeted outreach programmes, some specifically targeting socially disadvantaged young people, can increase access to services. (6)

  • There is some evidence from the USA that targeted intensive community based interventions which include sexual health services are effective in improving sexual behaviour and reducing pregnancy; however transferability to the UK is questionable. (7)

  • There is limited highly processed evidence about interventions specifically targeting looked-after and accommodated young people, homeless young people and young people from various black and ethnic minority communities. Interventions targeting multiple risk behaviours and needs may be most appropriate for homeless young people. (8,9,10)

Contraceptive services

  • Review-level evidence from qualitative research indicates that young people have gaps in their knowledge about sexual activity and contraception – including emergency contraception (EC) and where to access contraception.(1)

  • Review-level evidence suggests that outreach services may increase access to and maintained contact with sexual health services, although the extent to which this impacts on sexual health behaviour and pregnancy is unclear.(6)

  • There is inconsistent evidence about the effectiveness of comprehensive multi-component programmes. Some evidence suggests they may be effective in reducing pregnancy but that the provision of Long Acting Reversible Contraception (LARC) was the most important factor.(6)

  • Review-level evidence suggests that interventions that include discussion and demonstration of condoms are effective in engaging young people in services and increasing use of condoms, and that some interventions that use additional services to increase contraceptive use may be effective. (6)

  • There is strong evidence that LARC is the most effective and cost-effective form of contraception. NICE guidance outlines a range of recommendations for the provision of LARC. (11)

School based / linked health services

  • Systematic reviews suggest there is reasonable evidence that school-based or school-linked health services may contribute to reduced levels of sexual activity and delay sexual initiation and are not associated with increased sexual activity. However there is a relatively small body of high quality research.(12, 13) There is good evidence that on-site dispensing of condoms is associated with greater provision of condoms, though impact on use has not been fully evaluated. (12, 13)

  • There is good evidence to suggest that a range of personal and service-based factors influence access to and use of school based / linked health services by young people. (12.,14)

  • Based on the available evidence, key characteristics have been proposed to inform service development and evaluations. (12)

Community based interventions

  • There is promising evidence that Carrera, an intensive community based youth development programme, may be effective in reducing pregnancy and improving sexual behaviour. A UK adaptation of this model reported negative impacts, though these may be explained by the weak study design and poor implementation fidelity. (7)

HIIA note:

The evidence includes research on the views of and programmes targeting socially disadvantaged young people and those from particularly vulnerable populations.

 

References:

  1. Baxter S, Blank l. Payne N et al. A review of the effectiveness and cost effectiveness of contraceptive services and interventions to encourage use of those services for socially disadvantaged young people: views review. Sheffield: University of Sheffield School of Health and Related Research (ScHARR); 2010. Available at: http://www.nice.org.uk/guidance/ph51/evidence (accessed 3 June 2015).

  2. Ambresin AE, Bennett K, Patton GC et al. Assessment of youth-friendly health care: a systematic review of indicators drawn from young people’s perspectives. Journal of Adolescent Health 2013; 52: 670–681.

  3. National Institute for Health and Care Excellence. NICE Public Health Guidance 51: Contraceptive services with a focus on young people up to the age of 25. London: National Institute for Health and Care Excellence; 2014. Available at : http://www.nice.org.uk/guidance/PH51 (accessed 3 June 2015).

  4. World Health Organization. Making health services adolescent friendly: developing national quality standards for adolescent-friendly health services. Geneva: World Health Organization; 2012. Available at: http://www.who.int/maternal_child_adolescent/documents/adolescent_friendly_services/en (accessed 3 June 2015).

  5. Tylee A, Haller DM, Graham T et al. Youth-friendly primary-care services: how are we doing and what more needs to be done? Lancet 2007; 969: 1565– 1573.

  6. Blank L, Payne, N, Guillaume L et al. A review of the effectiveness and cost- effectiveness of contraceptive services and interventions to encourage use of those services for socially disadvantaged young people: services and interventions in healthcare settings. Sheffield: University of Sheffield School of Health and Related Research (ScHARR); 2010. Available at: http://www.nice.org.uk/guidance/ph51/evidence (accessed 3 June 2015).

  7. Blank L, Payne, N, Guillaume L et al. A review of the effectiveness and cost- effectiveness of contraceptive services and interventions to encourage use of those services for socially disadvantaged young people: services and interventions in community settings. Sheffield: University of Sheffield School of Health and Related Research (ScHARR); 2010. Available at: http://www.nice.org.uk/guidance/ph51/evidence (accessed 3 June 2015).

  8. Jones L, Bates G, Downing J et al. A review of the effectiveness and cost- effectiveness of alcohol and sex and relationship education for all children and young people aged 5 to 19 years in community settings: final report. Liverpool: John Moores University Centre for Public Health; 2010. Available at: http://www.nice.org.uk/guidance/gid-phg0/documents/pshe-evidence-review-community2 (accessed 3 June 2015).

  9. Naranbhai V, Abdool Karim Q, Meyer-Weitz A. Interventions to modify sexual risk behaviours for preventing HIV in homeless youth (Review). The Cochrane Library 2011, Issue 1. Cochrane Collaboration; 2011.

  10. Coren E, Hossain R, Pardo Pardo J et al. Interventions for promoting reintegration and reducing harmful behaviour and lifestyles in street- connected children and young people (Review). The Cochrane Library 2013 Issue 2. Cochrane Collaboration; 2013.

  11. National Institute for Health and Care Excellence. Long-acting reversible contraception: NICE Clinical Guideline 30. Available at: https://www.nice.org.uk/guidance/cg30/chapter/1-Recommendations (accessed 3 June 2015).

  12. Owen J, Carroll C, Cooke J et al. School-linked sexual health services for young people (SSHYP): a survey and systematic review concerning current models, effectiveness, cost-effectiveness and research opportunities. Health Technol Assess 2010; 14(30).

  13. Blank L, Payne, N, Guillaume L et al. A review of the effectiveness and cost- effectiveness of contraceptive services and interventions to encourage use of those services for socially disadvantaged young people: Services and interventions in educational settings. Sheffield: University of Sheffield School of Health and Related Research (ScHARR); 2010. Available at : http://www.nice.org.uk/guidance/ph51/evidence (accessed 3 June 2015).

  14. Mason-Brooks AJ, Crisp C, Momberg M et al. A systematic review of the role of school-based healthcare in adolescent sexual, reproductive, and mental health. Systematic Reviews: 2012; 1(49).