Adolescent and youth-friendly health interventions in low-income and middle-income countries: a scoping review
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. Lessons from adolescent health fields suggest that adolescent mortality causes, especially in low-income and middle-income countries (LMICs), are largely preventable and treatable. Thus, health services that meet specific and differentiated needs of adolescents are increasingly relevant.
Methodology and Search Process
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 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.
The databases searched and the resulting number of studies identified are summarized below:
| Database Name | Results (n) |
|---|---|
| Global Health Medicus | 3636 |
| Embase | 1164 |
| Cochrane Databases | 1103 |
| PsycINFO | 156 |
| CINAHL | 50 |
| CAB Direct | 11 |
Key Components, Barriers, and Facilitators
We identified the key components, barriers and facilitators of AFS. Our review findings are that AFS is about fostering a welcoming and non-judgmental environment, providing culturally appropriate and responsive services, and focused support for marginalised communities as it is especially needed within high-poverty settings. The following core elements emerged from our review:
- A non-judgmental environment
- Culturally appropriate and responsive interventions
- A focus on supporting marginalised communities often living in high-poverty settings
Our study provides in-depth examination of the barriers and facilitators of AFS while mapping the findings of key research studies from LMICs that address AFS in their intervention implementation. Our paper is one of the few efforts to synthesise behavioural and mental health elements underpinning AFS. We would like to underscore that these services need strong and well-planned mental and behavioral health strengthening within LMICs to empower adolescents and youth.
Interpretation and Future Implications
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. Using these components, we have extended guidance around a possible framework and tool assessing quality of AFS. 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.
Potential future implications include training healthcare providers, testing these attributes for service improvement and future development and localisation of policy guidelines. Possible limitations of our review include a lack of grey literature. Ultimately, our review points to synergies that the fields need to create for effective and engaged adolescent friendly services in LMICs. Without cross-sectoral evidence-synthesis, service barriers in low resource settings and vulnerable adolescents youth cannot benefit.