The quality and effectiveness of interventions that target multiple risk factors among young people: a systematic review

Objective: To identify evaluations of interventions that target multiple risk factors in high‐risk young people, describe their characteristics, critique their methodological quality and summarise their effectiveness. Methods: A search of the literature published between 2009 and 2014 identified 13 evaluations of interventions that targeted multiple risk factors, compared to 95 evaluations that targeted single risk factors. The methodological adequacy of the 13 evaluation studies was analysed using the Quality Assessment Tool for Quantitative Studies and information regarding characteristics and intervention effectiveness was extracted and summarised. Results: There were very few outcome evaluation studies of interventions that targeted multiple risk factors, relative to single risk factors, among high‐risk young people. Of the identified studies, half were methodologically weak. Interventions delivered in community settings targeted a greater number of risk factors, while those delivered in a school or health setting reported a higher proportion of statistically significant outcomes. No economic analyses were conducted. Conclusions and Implications for Public Health: More methodologically rigorous evaluations of interventions targeting multiple risk factors among high‐risk young people are required, especially for those delivered in community settings. Four key areas for improvement are: i) more precisely defining the risk factors experienced by high‐risk young people; ii) achieving greater consistency across interventions; iii) standardising outcome measures; and iv) conducting economic analyses.     

The participation of children and young people in decisions about UK service development

BACKGROUND: The involvement of children and young people in decisions regarding service development is well supported in government policy and underpinned by the UN Convention on the Rights of the Child. Information on the extent, nature and outcomes of children and young people's participation can inform further development in this area. METHODS: Systematic literature searches, plus contact with professional networks, were used to gather and review evidence on children and young people's participation. RESULTS: There is a rapidly developing body of information describing and analysing innovative practices in this field. However, there is also a smaller, but substantial, amount of evidence demonstrating the limited extent of current involvement. A good deal of guidance is now available about how to promote the involvement of children and young people. However, the basis of this advice is not always clear, and more evidence about children's views and their experience of participation in public decision-making is required. Issues identified as barriers to change included adult attitudes and intransigence, lack of training for key adults, lack of clarity leading to tokenism, the nature of organizations (i.e. their formality, complexity, bureaucracy and internal politics) and the short-term nature of much funding. The evidence suggests that good practice includes a listening culture among staff, clarity, flexibility, adequate resources, skills development and training for staff and participating children and young people, inclusion of marginalized groups, feedback and evaluation. There is only limited evidence that children and young people's involvement in public decision-making leads to more appropriate services, although there is evidence that participating children and young people benefit in terms of personal development and that staff and organizations learn more about their views. CONCLUSIONS: The value of the participation of children and young people in public decision-making is now well accepted, and is recognized in the standards set in the Children's National Service Framework. However, there is an urgent need for internal and external evaluations of children's involvement.     

Young people of Chinese origin in western countries: a systematic review of their sexual attitudes and behaviour

People of Chinese origin are a growing population group in western countries. The community is seen to be marginalised, under‐researched and neglected, in fact the least understood ethnic minority. This paper reports on a systematic review of sexual attitudes and behaviour among ethnic Chinese young people (mainly aged 13–25 years) living in western countries. An extensive literature search was conducted to cover the period of 1989 and 2009 using Medline, CINAHL, PsycINFO and ScienceDirect databases. There has been a dearth of literature in this area. However, results from existing literature show that ethnic Chinese youth reported poorer sexual health knowledge than white young people in their host countries, while they were found to be more likely to disapprove of uncommitted sex, be virgins, lose their virginity at a later age and have fewer sexual partners. Factors associated with their sexual attitudes and behaviour have also been identified. Countries like the United Kingdom, United States and Canada have become multicultural societies with many diverse ethnic groups. Without doubt educators and sexual health professionals need to provide sex education and services which should be culturally appropriate to people from diverse ethnic backgrounds. An understanding of their sexual values, sexual behaviour and associated factors is the first step towards achieving this goal.     

Young people's views of mental health education in secondary schools: a Scottish study

Background   This exploratory study used mixed methods to investigate young people's preferences in the delivery of mental health education and to investigate possible age and gender differences.
Method   Information was gathered about the delivery of mental health education in three secondary schools. Nine pupil focus groups were carried out to identify key themes which were then further developed and administered through questionnaires to a larger sample of 773 pupils.
Results   Gender and age differences were found in young people's preferences about who should deliver mental health education, and what, when, where and how this should be delivered.
Conclusion   Mental health education should reflect the needs of young people. Age and gender preferences should be considered when designing these programmes.     

Consulted but not heard: a qualitative study of young people's views of their local health service

Objectives  The objective of this study was to identify what children and young people in a health district in a large urban area experience as positive – and not so positive – about their local health services, in the light of a growing expectation that users play a more central role in the design and delivery of services. Design  A qualitative study incorporating a range of methods, including interviews, play techniques and a website. Setting  Schools, nurseries, community groups, in‐ and outpatient settings in an inner London health authority. Participants  Young people aged between 4 and 19 years, from community (n = 92) and clinical (n = 57) settings. This included ‘hard‐to‐reach’ children, including those leaving care, those in touch with the criminal justice system, asylum seekers, and those with learning disabilities. Results  Alongside planning and environment issues, young people particularly emphasized the impact of communication and relationships with staff on their experience of health services. Discussion and conclusions  Using a range of flexible and age‐appropriate techniques, young people, even those as young as 4 or 5, are able to comment helpfully on their experiences of service provision. What children had to say is revealing but not astonishing to those working in the National Health Service (NHS). Clinicians and managers, to whom our findings were fed back, made this clear. If we have known for so long that the issues raised here are problems, why are we so poor at acting on this knowledge? The authors suggest four explanations.     

''Follow the Fish'': involving young people in primary care in Midlothian

OBJECTIVES: The project aims were to enable young people to contribute their views about health services, to encourage professionals and policy makers to listen to the young people and to stimulate action to address the issues raised. DESIGN: Peer interviews were undertaken by a team of five young people to identify the experience and views of young people of various ages about health services. Drama workshop sessions were conducted with 10-15 young people, encompassing initial issue-identifying activities and group discussion about their own experience of, and views about health services, followed by role-play and improvisation to construct drama scenarios about the issues gathered from the interviews and discussions. SETTING AND PARTICIPANTS: Twenty young people aged 12-16 years from the Mayfield and Gorebridge areas of Midlothian were recruited from Newbattle Community High school. The project was conducted as a voluntary after-school activity for 12 weeks. RESULTS: A drama was constructed from research conducted by young people into the experiences and views of their peer group about health services. A cast of young people performed the drama to an invited audience of 30 health and education professionals and held a post-performance question and answer session with the audience to explore the issues raised. The drama engendered a number of practical outcomes related to improving the usage and experience of health services of young people. CONCLUSIONS: Drama can offer a means to encourage participation, facilitate participants' self-expression and explore health/health service themes and issues. In conjunction with conventional techniques such as interviews and group discussions, a drama project can also be used to communicate the experience, views and needs of the wider client group to service providers and planners. Such initiatives can generate outcomes to improve service users' experience of health services.     

Prioritizing research needs based on a systematic evidence review: a pilot process for engaging stakeholders

Background/context Systematic evidence reviews (SERs) identify knowledge gaps in the literature, a logical starting place for prioritizing future research. Varied methods have been used to elicit diverse stakeholders’ input in such prioritization. Objective To pilot a simple, easily replicable process for simultaneously soliciting consumer, clinician and researcher input in the identification of research priorities, based on the results of the 2009 SER on screening adults for depression in primary care. Methods We recruited 20 clinicians, clinic staff, researchers and patient advocates to participate in a half‐day event in October 2009. We presented SER research methods and the results of the 2009 SER. Participants took part in focus groups, organized by profession; broad themes from these groups were then prioritized in a formal exercise. The focus group content was also subsequently analysed for specific themes. Results Focus group themes generally reacted to the evidence presented; few were articulated as research questions. Themes included the need for resources to respond to positive depression screens, the impact of depression screening on delivery systems, concerns that screening tools do not address comorbid or situational causes of depression and a perceived ‘disconnect’ between screening and treatment. The two highest‐priority themes were the system effects of screening for depression and whether depression screening effectively leads to improved treatment. Conclusion We successfully piloted a simple, half‐day, easily replicable multi‐stakeholder engagement process based on the results of a recent SER. We recommend a number of potential improvements in future endeavours to replicate this process.     

Purchasing services to promote the sexual health of young people - contraceptive care for teenagers: A review of the published literature to inform a Regional Health Gain Investment Programme

Sexually active teenagers need a choice of accessible and acceptableservices to provide contraceptive care and advice. This paperpresents examples of good practice in providing care for youngpeople in community settings in the UK but the same models ofcare could be adopted by other European countries. The publishedliterature suggests that informal and drop-in services are needed,with the guarantee of confidentiality to the young person. Afull range of contraceptive care and sexual health promotionshould be available and staff should have expertise in dealingwith young people. All local agencies should work together toincrease knowledge and uptake of such services. Purchasers andproviders of health care should agree a model of care whichis related to local health needs.     

The burden of proof: The process of involving young people in research

Patient and public involvement in research includes non‐academics working with researchers, on activities from consultative tasks, to joint working, and on user‐led initiatives. Health and social care funding bodies require involvement in research projects. A current debate focuses on a perceived lack of empirical “proof” to demonstrate the impact of involvement upon the quality of research. It is also argued that the working relationships between researchers and those becoming involved need to be understood more fully. These areas are beginning to be reported upon but there are few studies of young people involved in health research. This study describes the experiences of adult academics and young people, working together on a large‐scale, UK health research programme. Using qualitative interview and focus group methods, the aim was to explore participants’ perceptions about the process and outcomes of their work together. The importance of cyclical, dynamic and flexible approaches is suggested. Enablers include having clear mechanisms for negotiation and facilitation, stakeholders having a vision of “the art of the possible,” and centrally, opportunities for face‐to‐face working. What is needed is a continuing discourse about the challenges and benefits of working with young people, as distinct from younger children and adults, understanding the value of this work, without young people having to somehow “prove” themselves. Involvement relies on complex social processes. This work supports the view that an improved understanding of how key processes are enabled, as well as what involvement achieves, is now needed.     

Giving tape recordings or written summaries of consultations to people with cancer: a systematic review

Objective  To examine the effects of providing recordings or summaries of consultations to people with cancer and their families.
Design  Systematic review.
Data sources  MEDLINE, CINAHL, Cancerlit, EMBASE and other electronic bibliographic databases. Bibliographies of relevant papers.
Selection criteria  Randomized and non-randomized controlled trials of the provision of taped recordings or written summaries of consultations to people with cancer and/or their families.
Main results  Eight randomized controlled trials were found, all involving adult participants. No non-randomized controlled trials were found. The quality of the studies was generally poor. Between 83% and 96% of people who received recordings or summaries found them useful to remind them of what was said and/or to inform family members and friends about their illness and treatment. Of seven studies that assessed recall of information given during the consultation, four reported better recall among the groups that received recordings or summaries than among control groups. Receiving a recording or summary had no significant effect on anxiety or depression between the groups. None of the included studies assessed survival or health outcomes other than psychological outcomes.
Conclusions  Wider use of consultation tapes and summary letters could benefit many adults with cancer, without causing additional anxiety or depression, but consideration should be given to individuals' circumstances and preferences.