Adolescent health needs, accessibility of services, depression and quality of the life by assisting in the development of community partnerships

Abstract

Objectives: 1) to determine the nature and extent of existing governmental and non-governmental services for adolescents, including community organizations; 2) to determine health service needs and utilization of existing health services focusing on geographic accessibility, availability, affordability and acceptability of adolescents by gender and stage of adolescence; 3) to compare the health service needs and utilization of existing health services between males/females and stages of adolescence; 4) to measure the level of depression using the Center for Epidemiologic Studies Depression Scale (CES-D); 5) to define the meaning of Quality of Life(QoL) as perceived by adolescents; 6) to measure the quality of life of adolescents using the modified WHO-QoL instrument; and 7) to develop an intervention /evaluation program to improve access and use of health services, and the quality of life of adolescents, through community partnerships. Methods: This study adopted an exploratory and descriptive design with both qualitative and quantitative methods. A questionnaire was administered to 871 randomly sampled adolescents aged 12-22 years. The data were analyzed using content analysis for qualitative data, and the chi-square test and logistic regression for quantitative data. Results: The sample population was composed of more females than males (57.2 vs. 42.8%). The subjects’ ages ranged from early adolescent (12-13 years; 23.3%), mid adolescent (14-17 years; 48.2%) and late adolescent (18-22 years; 28.5%) with a mean age of 15 years (S.D.=2.82). The majority (97.8%) were single and most (78.3%) were enrolled in school. In terms of physical health, only 5.9% reported chronic disease. In contrast, their mental health fared much worse, with one third of the subjects having depressive symptoms. Moreover, gender differences existed in depressive symptoms in all subjects, and early and mid-adolescents (P = <.001, .027, .002, respectively), and females were more likely than males to have depressive symptoms. About 19.0% of subjects reported experience of sexual activity. Most of the sex partners were their lovers, and of those, only 12.6% indicated constant condom use. Almost three-fourths (71.8%) of the subjects reported their QoL to be moderate, and no gender difference was found. The top ten adolescent health needs/problems (excluding gender issues) were: 1) acne; 2) unintended pregnancy; 3) amphetamine addiction; 4) heroin addiction; 5) induced abortion; 6) stress; 7) brawling (fighting); 8) smoking; 9) alcohol, and 10) rape. Gender differences were found for 8 of these 10 issues, where smoking seemed to be the only health need/problem expressed equally by both genders. Moreover, an age group difference was found for "smoking” ( P =.019). The qualitative study revealed that there were gaps, fragmentation, and redundancy in the existing health services. Most of the participants agreed to work together as a community partnership to improve adolescent health accessibility. The determinants of health service utilization/accessibility for all subjects were “guardian’s occupation”, and “chance to meet a doctor at the health facilities”. In analyzing the differences in these determinants, between gender and age group, the following were found: (1) for gender difference, “guardian’s occupation” was a more important determinant for males, whereas “chance to meet a doctor at the health facilities” was more important for females; and (2) for differences among age groups, early adolescents identified “convenience of time for visiting health facilities”, “current education”, “knew about health facilities in the community” as the most important determinants, whereas mid-adolescents said that “knew about household expense” was the most important determinant; for late adolescents, “guardian’s occupation”, “knew about health facilities in the community”, and “age” were the most important determinants. In terms of health service utilization, the percentage of subjects utilizing services for the top ten health problems was less than 60%, and males utilized health services less than females. Among males, health service utilization for being injured during a brawl, smoking, alcohol and stress, was less than 30%. Among females, health service utilization for stress and depression was less than 25%. As an important component of this study, the stakeholders, based on the study results, collectively developed common objectives and a plan of action for their community intervention programs. The group indicated a need for improvement of services related to sexual and reproductive health, mental health and substance abuse among adolescents. In future research, social accessibility and related social issues should be reviewed. In moving forward, participatory action research is needed to create trust in partnership, and to pool and share manpower and physical resources. Subsequent research and interventions would maximize their benefits by selecting a prime mover as the project leader, who would be instrumental in mobilizing the stakeholders to work together toward a healthy community for adolescents.