Fiona Robards

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.

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.

Access 3 project protocol: young people and health system navigation in the digital age: a multifaceted, mixed methods study

Background The integration of digital technology into everyday lives of young people has become widespread. It is not known whether and how technology influences barriers and facilitators to healthcare, and whether and how young people navigate between face-to-face and virtual healthcare. To provide new knowledge essential to policy and practice, we designed a study that would explore health system access and navigation in the digital age. The study objectives are to: (1) describe experiences of young people accessing and navigating the health system in New South Wales (NSW), Australia; (2) identify barriers and facilitators to healthcare for young people and how these vary between groups; (3) describe health system inefficiencies, particularly for young people who are marginalised; (4) provide policy-relevant knowledge translation of the research data. Methods and analysis This mixed methods study has four parts, including: (1) a cross-sectional survey of young people (12–24 years) residing in NSW, Australia; (2) a longitudinal, qualitative study of a subsample of marginalised young people (defined as young people who: identify as Aboriginal and/or Torres Strait Islander; are experiencing homelessness; identify as sexuality and/or gender diverse; are of refugee or vulnerable migrant background; and/or live in rural or remote NSW); (3) interviews with professionals; (4) a knowledge translation forum. Ethics and dissemination Ethics approvals were sought and granted. Data collection commenced in March 2016 and will continue until June 2017. This study will gather practice and policy-relevant intelligence about contemporary experiences of young people and health services, with a unique focus on five different groups of marginalised young people, documenting their experiences over time. Access 3 will explore navigation around all levels of the health system, determine whether digital technology is integrated into this, and if so how, and will translate findings into policy-relevant recommendations.

Marginalised young people’s healthcare journeys: Professionals’ perspectives:

Introduction: The pursuit of social justice includes a commitment to health equity for marginalised young people. Health professionals are central to marginalised young people’s engagement and access to health care and their navigation of health systems. They are also uniquely positioned to shed insight into structures and inefficiencies within the health system, including the role of technology, and to advocate for system change. Methods: This qualitative cross-sectional study employed in-depth semi-structured interviews with 22 health service managers and experienced clinicians to better understand service providers’ perspectives. The sampling frame comprised professionals from different sectors and levels of the health system. Analysis used Grounded Theory methods. Results: Three major themes were identified in the data: (1) intersectionalities – understanding the complexity of multiple disadvantage; (2) health system fragmentation – leading to inefficiencies, inertia and advocacy; and (3) services needing to be ‘turned on their head’ – rethinking service delivery and models of care. Conclusion: A better understanding of marginalised young people’s healthcare experiences, including the complexities of multiple disadvantage, and how this contributes to health inequalities could lead to more welcoming and respectful services. Services can reconceptualise their roles by reaching out to young people, both physically and online, to make the navigation of the health system easier. Marginalised young people’s healthcare journeys can be supported by advocates that help them navigate the health system.