How marginalised young people navigate the Australian health system

The research program that forms the foundation of this thesis examined the ways in which young people aged 12–24 years access, navigate and experience the Australian health system. It is the first research program to explore in both depth and breadth young people’s access to all parts of the health system and to consider the experience of multiple marginalised groups. This body of work includes two components: 1. An international systematic review examining How marginalized young people access, engage with and navigate healthcare systems in the digital age. 2. A report on Access 3, a multifaceted, mixed methods project funded by NSW Health to inform the development of youth health policy. The systematic review identified that marginalised young people accessing healthcare experience barriers additional to those common to all young people. To date, the literature has examined marginalised groups individually, and few studies have focused on health system navigation or the role of technology. The Access 3 project involved four parts: • Study 1 – a cross-sectional survey exploring barriers to healthcare access for young people • Study 2 – in-depth, longitudinal, qualitative interviews with marginalised young people who are living in rural/remote areas; experiencing homelessness; Aboriginal and/or Torres Strait Islander; sexuality and/or gender diverse; and/or have a refugee background; • Study 3 – a cross-sectional qualitative study to explore the views of healthcare professionals; and • a Policy Translation Forum to identify policy solutions. The outcomes of this body of work include a series of publications of significance to clinicians, policymakers, young people and their advocates. Research outcomes include a direct impact on the NSW Youth Health Framework 2017-2024. The research increases our understanding of how marginalised young people navigate the Australian health system within the digital age

Enhancing youth health in primary care : lessons learned from general practitioners

Primary care represents a fundamental component of the health system, particularly for young people. However, youth access to primary care is less than ideal. To optimize clinician capacity to promote youth health, an interactive training module was developed and tailored to the needs of general practitioners. As part of an exploratory study, 11 participants were interviewed to determine the perceived capacity of the module to promote youth-friendly primary care. Findings suggest the module can enhance clinician skills, knowledge, and confidence to promote youth health; however, it has a limited ability to inform how organizational capacity might be bolstered—this includes the development of interagency networks. In this epoch of primary care reform, these findings are important for two key reasons. First, they reveal the need to bolster clinicians' perceived ability to use youth healthcare skills; second, they highlight the complementary importance of organizational support to ensure and sustain youth-friendly practices. The article concludes with a discussion of key implications for policymakers, practitioners, and researchers

How professional identity shapes youth healthcare

Purpose – The primary care sector is experiencing considerable change. How change and uncertainty are accommodated by the professional identity of medicine has not been examined. The purpose of this paper is to address the youth healthcare as an exemplar as this field is often a source of uncertainty for general practitioners (GPs). Design/methodology/approach – Using heterogeneity sampling, 22 GPs participated in focus groups to explore perceptions of youth healthcare, factors that help and hinder it, and training needs. Analysis of the research material was guided by a theoretical model on professional identity. Findings – GPs described tensions that challenged their professional identity – the challenges of working with young people and their complex issues, the extent to which youth healthcare sits within the purview of general practice, and the scope of training required. These tensions appeared to destabilise professional identity. Some participants had customised their identity by enriching understandings of and approach to general practice. Participants also reported work customisation as a way of managing the complex demands of the general practice role. Deepened insight appeared to bolster perceived capacity to support a complex patient cohort. Research limitations/implications – Participants are not representative of the primary care sector – furthermore, the methodology limits the generalisability of the findings. Practical implications – To bolster youth health, mere clinician training is insufficient. Youth health requires explicit support from governments and training providers to be incorporated into the healthcare landscape. Originality/value – This study extends current research on professional identity by examining youth healthcare within the changing context of primary care

'Adolescence is difficult, some kids are difficult' : general practitioner perceptions of working with young people

General practitioners (GPs) are the health care providers from which young people are most likely to seek help. However, the rate at which young people access GPs is less than ideal. Four focus groups were conducted with groups of GPs in New South Wales to inform the development of a GP training program on youth health. Analysis of the focus group interviews yielded three themes that describe the context in which GPs work with young people, how GPs see young people and their work with them, and GPs’ expressed training preferences. GPs described working with young people as difficult, which in turn suggests that the self-efficacy of GPs may need to be addressed in training and resource development. GPs also described systemic barriers to working with young people that can be addressed through training, advocacy and policy development

What helps and hinders GP-capacity to support young people?

General Practitioners (GPs) are the clinicians young people are most likely to access. However, the rate at which they do this is less than ideal, especially in light of the health and mental health issues they experience. The purpose of this study is to optimise GP-capacity to promote youth health. This was addressed by conducting four focus groups with GPs to identify the factors that help and hinder this capacity. Findings suggest that the participants considered working with young people to be challenging. This was largely because of: (1) communication difficulties; (2) the complexity of youth health; (2) limited time; and (3) limited networks to draw on. These findings suggest that interventions to promote GP-capacity may prove more effective if these four factors are addressed. Although training might alleviate the communication difficulties, systemic change is required to optimise and sustain youth health

Beyond Bandaids: Understanding the Role of School Nurses in NSW: Summary Report

The World Health Organisation (1992) suggests that people’s health behaviours are determined by the context in which they live their everyday lives. This would include the settings in which people live, work and seek leisure. Given the substantial time children and young people spend at school, it is realistic to assume that schools play a major role in determining such health behaviours. In support of this, Stewart-Brown (2006) presented research findings which indicate that school based health promotion is an effective means of promoting youth health. Schools have been found to have a major protective influence across a number of health issues, including mental health, healthy eating and physical activity (Stewart-Brown, 2006). Good health has also been correlated with more successful learning (NSW Health Department, 2000); again indicating the importance of ensuring good health during childhood and adolescence. School nursing plays a vital role in providing this health promotion within schools