‘Be nice to us, we’re still learning’: an online survey of young people in Hawkes Bay, New Zealand, about unmet need for sexual health care and improving access to services
Sally B. Rose
A * , Susan M. Garrett A , Eileen M. McKinlay A and Sonya J. Morgan A
+ Author Affiliations
- Author Affiliations
A Department of Primary Health Care and General Practice, University of Otago, Wellington, PO Box 7343, Wellington South 6242, New Zealand.
Sexual Health 18(5) 394-404 https://doi.org/10.1071/SH21092
Submitted: 3 May 2021 Accepted: 27 July 2021 Published: 4 November 2021
© 2021 The Author(s) (or their employer(s)). Published by CSIRO Publishing
Abstract
Background: Young people need equitable access to high-quality sexual and reproductive health care to enjoy good sexual health.
Methods: This online survey of people aged 15–24 years in a defined region of New Zealand asked about unmet need for sexual health care and sought views on improving access to sexual health care.
Results: Five hundred participants took part in the study between August and October 2020, of whom 60% were female, 25% were of Māori (indigenous) ethnicity, and 21.4% were gender and/or sexuality diverse. Sixty percent had ever received sexual health care (300/500), and 74.3% received it from a general practice clinic (223/300). Overall, 41% (204/500) reported they needed, but had not received sexual health care in the past (‘unmet need’). Reasons for unmet need included being shy, embarrassed or ashamed (74.5%, 152/204), fear of judgment by clinic staff (42.6%, 87/204), cost (32.8%, 67/204), concerns about confidentiality (28.9%, 59/204), and not knowing where to go (24%, 49/204). Māori participants were more likely to report not knowing where to go (32.1% vs 20%, P = 0.04). Participants identified the need to reduce stigma, normalise sexual health care, improve convenience, affordability and awareness of services as key to improving access. Reassurance about confidentiality and being treated with kindness, empathy and respect were deemed critical to service acceptability.
Conclusions: Action is urgently needed at policy, funding and practice levels to improve access to services by: reducing societal stigma, normalising discussions around sexual health, improving affordability and raising awareness of services. Quality improvement is also needed in general practice to ensure young people can routinely access youth-friendly sexual and reproductive health care.
Keywords: acceptability, access, health services, patient satisfaction, primary care, STIs, survey, youth.
References
[1] World Health Organization. Global health sector strategy on sexually transmitted infections 2016–2021. Towards ending STIs. 2016. Available at https://www.who.int/reproductivehealth/publications/rtis/ghss-stis/en/[2] Keller L.. Reducing STI cases: young people deserve better sexual health information and services. Guttmacher Policy Review 2020; 23 1–7.
[3] World Health Organization. Fact sheets on sustainable development goals: health targets. Sexual and reproductive health 2017. Available at http://www.euro.who.int/__data/assets/pdf_file/0005/348008/Fact-sheet-SDG-SRH-FINAL-04-09-2017.pdf?ua=1 [Verified 12 March 2021]
[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 https://www.who.int/reproductivehealth/publications/adolescence/9789241503594/en/ [Verified 18 October 2021]
[5] Laski L. Expert consultative group for every woman every child on adolescent, health. Realising the health and wellbeing of adolescents. Br Med J 2015; 351 h4119
| Expert consultative group for every woman every child on adolescent, health. Realising the health and wellbeing of adolescents.Crossref | GoogleScholarGoogle Scholar |
[6] Bender SS, Fulbright YK. Content analysis: a review of perceived barriers to sexual and reproductive health services by young people. Eur J Contracept Reprod Health Care 2013; 18 159–67.
| Content analysis: a review of perceived barriers to sexual and reproductive health services by young people.Crossref | GoogleScholarGoogle Scholar | 23527736PubMed |
[7] Newton-Levinson A, Leichliter JS, Chandra-Mouli V. Sexually transmitted infection services for adolescents and youth in low- and middle-income countries: perceived and experienced barriers to accessing care. J Adolesc Health 2016; 59 7–16.
| Sexually transmitted infection services for adolescents and youth in low- and middle-income countries: perceived and experienced barriers to accessing care.Crossref | GoogleScholarGoogle Scholar | 27338664PubMed |
[8] Denison HJ, Bromhead C, Grainger R, Dennison EM, Jutel A. Barriers to sexually transmitted infection testing in New Zealand: a qualitative study. Aust NZJ Public Health 2017; 41 432–37.
| Barriers to sexually transmitted infection testing in New Zealand: a qualitative study.Crossref | GoogleScholarGoogle Scholar |
[9] Kennedy EC, Bulu S, Harris J, Humphreys D, Malverus J, Gray NJ. ‘Be kind to young people so they feel at home’: a qualitative study of adolescents’ and service providers’ perceptions of youth-friendly sexual and reproductive health services in Vanuatu. BMC Health Serv Res 2013; 13 455
| ‘Be kind to young people so they feel at home’: a qualitative study of adolescents’ and service providers’ perceptions of youth-friendly sexual and reproductive health services in Vanuatu.Crossref | GoogleScholarGoogle Scholar | 24176059PubMed |
[10] Price MJ, Ades AE, Soldan K, Welton NJ, Macleod J, Simms I, et al. The natural history of Chlamydia trachomatis infection in women: a multi-parameter evidence synthesis. Health Technol Assess 2016; 20 1–250.
| The natural history of Chlamydia trachomatis infection in women: a multi-parameter evidence synthesis.Crossref | GoogleScholarGoogle Scholar | 27007215PubMed |
[11] Centers for Disease Control and Prevention. Chlamydia - CDC fact sheet. Facts and Brochures. 2021. Available at http://www.cdc.gov/std/chlamydia/STDFact-chlamydia-detailed.htm [Verified 2 March 2021]
[12] Centers for Disease Control and Prevention. Gonorrhoea - CDC fact sheet. Facts and Brochures. 2021. Available at http://www.cdc.gov/std/gonorrhea/STDFact-gonorrhea-detailed.htm [Verified 2 March 2021]
[13] Ministry of Health. Primary health care subsidies and services. 2020. Available at https://www.health.govt.nz/our-work/primary-health-care/primary-health-care-subsidies-and-services/. [Verified 2 March 2021]
[14] The Institute of Environmental Science and Research Ltd. New Zealand sexually transmitted infection (STI) surveillance dashboard. 2021. Available at https://www.esr.cri.nz/our-services/consultancy/public-health/sti/ [Verified 20 June 2021]
[15] Rose SB, Garrett SM, McKinlay EM, Morgan SJ. Access to sexual healthcare during New Zealand’s COVID-19 lockdown: cross-sectional online survey of 15–24-year-olds in a high deprivation region. BMJ Sex Reprod Health 2021; 47 277–84.
| Access to sexual healthcare during New Zealand’s COVID-19 lockdown: cross-sectional online survey of 15–24-year-olds in a high deprivation region.Crossref | GoogleScholarGoogle Scholar | 33737316PubMed |
[16] Rose SB, Garrett SM, McKinlay EM, Morgan SJ. Experience of sexual healthcare by Māori and non-Māori young people: an online survey of 15–24 year olds in Hawkes Bay, New Zealand. Int J Sex Health 2021; 1–12.
| Experience of sexual healthcare by Māori and non-Māori young people: an online survey of 15–24 year olds in Hawkes Bay, New Zealand.Crossref | GoogleScholarGoogle Scholar |
[17] Statistics New Zealand. Age and sex by ethnic group (grouped total responses), for census night population counts, 2006, 2013, and 2018 Censuses. 2021. Available at http://nzdotstat.stats.govt.nz/wbos/Index.aspx?DataSetCode=TABLECODE8317# [Verified 2 April 2021]
[18] Ministry of Health. Population of Hawke’s Bay DHB. 2021. Available at https://www.health.govt.nz/new-zealand-health-system/my-dhb/hawkes-bay-dhb/population-hawkes-bay-dhb [Verified 2 April 2021]
[19] Ministry of Health. HISO 10001:2017 Ethnicity Data Protocols. Wellington: Ministry of Health; 2017. Available at https://www.health.govt.nz/publication/hiso-100012017-ethnicity-data-protocols [Verified 12 March 2021]
[20] Peiris-John R, Farrant B, Fleming T, Bavin, L, Archer D, Crengle S, Clark T. Youth19 Rangatahi Smart Survey, initial findings: access to health services. Youth19 research group, New Zealand: The University of Auckland and Victoria University of Wellington; 2020. Available at https://www.youth19.ac.nz/publications [Verified 2 March 2021]
[21] Denny S, Farrant B, Cosgriff J, Harte M, Cameron T, Johnson R, et al. Forgone health care among secondary school students in New Zealand. J Prim Health Care 2013; 5 11–8.
| Forgone health care among secondary school students in New Zealand.Crossref | GoogleScholarGoogle Scholar | 23457690PubMed |
[22] Howarth AR, Day S, Greene L, Ward H. ‘They made me feel comfortable’: a comparison of methods to measure patient experience in a sexual health clinic. BMC Health Serv Res 2017; 17 325
| ‘They made me feel comfortable’: a comparison of methods to measure patient experience in a sexual health clinic.Crossref | GoogleScholarGoogle Scholar | 28476173PubMed |
[23] Mazur A, Brindis CD, Decker MJ. Assessing youth-friendly sexual and reproductive health services: a systematic review. BMC Health Serv Res 2018; 18 216
| Assessing youth-friendly sexual and reproductive health services: a systematic review.Crossref | GoogleScholarGoogle Scholar | 29587727PubMed |
[24] Tipene J, Green A. He Pukenga Korero: Rangatahi and STIs in the Waikato. 2017. Available at http://tewhariki.org.nz/assets/He-Pukenga-Korero-Final-Report-31-Aug-2017.pdf [Verified 1 March 2021]
[25] Veale J, Byrne J, Tan KKH, Guy S, Yee A, Nopera TM-L, et al. Counting ourselves: the health and wellbeing of trans and non-binary people in Aotearoa New Zealand. 2019. Available at https://countingourselves.nz/wp-content/uploads/2020/01/Counting-Ourselves_Report-Dec-19-Online.pdf [Verified 10 April 2021]
[26] Cormack D, Stanley J, Harris R. Multiple forms of discrimination and relationships with health and wellbeing: findings from national cross-sectional surveys in Aotearoa/New Zealand. Int J Equity Health 2018; 17 26
| Multiple forms of discrimination and relationships with health and wellbeing: findings from national cross-sectional surveys in Aotearoa/New Zealand.Crossref | GoogleScholarGoogle Scholar | 29454356PubMed |
[27] Came H, McCreanor T, Manson L. Upholding Te Tiriti, ending institutional racism and Crown inaction on health equity. NZ Med J 2019; 132 61–6.
[28] Health Quality & Safety Commission. A window on the quality of Aotearoa New Zealand’s health care 2019 – a view on Māori health equity|He matapihi ki te kounga o ngā manaakitanga ā-hauora o Aotearoa 2019 – he tirohanga ki te ōritenga hauora o te Māori. 2019. Available at https://www.hqsc.govt.nz/assets/Health-Quality-Evaluation/PR/Window_2019_web_final.pdf [Verified 12 April 2021]
[29] Martel R, Crawford R, Riden H. ‘By the way….how’s your sex life?’ – A descriptive study reporting primary health care registered nurses engagement with youth about sexual health. J Prim Health Care 2017; 9 22–8.
| ‘By the way….how’s your sex life?’ – A descriptive study reporting primary health care registered nurses engagement with youth about sexual health.Crossref | GoogleScholarGoogle Scholar | 29530184PubMed |
[30] Hussein J, Ferguson L. Eliminating stigma and discrimination in sexual and reproductive health care: a public health imperative. Sex Reprod Health Matters 2019; 27 1–5.
| Eliminating stigma and discrimination in sexual and reproductive health care: a public health imperative.Crossref | GoogleScholarGoogle Scholar | 31884899PubMed |
[31] McKinlay E, Morgan S, Garrett S, Dunlop A, Pullon S. Young peoples’ perspectives about care in a youth-friendly general practice. J Prim Health Care 2021; 13 157–64.
| Young peoples’ perspectives about care in a youth-friendly general practice.Crossref | GoogleScholarGoogle Scholar | 34620297PubMed |
[32] Royal New Zealand College of General Practitioners. Cornerstone. 2021. Available at https://www.rnzcgp.org.nz/quality/cornerstone/practices.php [Verified 12 April 2021]
[33] Ludlam AH, Saxton PJ, Dickson NP, Hughes AJ.. General practitioner awareness of sexual orientation among a community and internet sample of gay and bisexual men in New Zealand. J Prim Health Care 2015; 7 204–12.
| General practitioner awareness of sexual orientation among a community and internet sample of gay and bisexual men in New Zealand.Crossref | GoogleScholarGoogle Scholar | 26437044PubMed |
[34] New Zealand Sexual Health Society. Principles of sexual health care. 2017. Available at http://www.nzshs.org/guidelines.html [Verified 1 March 2021]
[35] Pedersen ER, Kurz J. Using Facebook for health-related research study recruitment and program delivery. Curr Opin Psychol 2016; 9 38–43.
| Using Facebook for health-related research study recruitment and program delivery.Crossref | GoogleScholarGoogle Scholar | 26726313PubMed |
