Health Surveillance: What Adolescents Expect

Abstract

Involve adolescents and knowing what to expect from a health surveillance query, rather than decide for them without the consult, is of paramount importance. To know the opinion of adolescents about health surveillance query. Cross-sectional study of qualitative nature and phenomenological approach. There were semi-structured interviews in a non-probabilistic convenience sample of 14 adolescents, aged 15 to 17 years old, attending high school. After the content analysis of the responses, it was found that teens put the emphasis on prevention, there were no differences between the two sample groups. The query should be preventive and about health promotion; the theme that adolescents seem to consider most important is to address sexuality (affections, contraception and STI); professional mentioned was a nurse with specialized training; although they prefer the free time, they like to a fixed schedule to answer questions and education sessions for health; as to the operation site, said the school.

Keywords: Adolescents, health surveillance

Introduction

The Adolescent Health Surveillance Consultation assumes great importance and complexity, representing many times to health professionals a real challenge. In this period the individual undergoes profound hormonal, physical and psychological changes. It is true that health does not depend solely on the provision of care, yet it is undeniable the impact of surveillance actions in this age group, since health and adolescent welfare are today seen as key elements of human development (Prazeres, 1998).

Currently, programs and projects in health of adolescents have acquired great importance. Throughout history, only in the late 60 WHO began to face this age group more attentively. In Portugal, it was in the late 70's began to be addressed health issues of adolescents. Since then, there has been a growing concern in the organization of services: The National Health Plan 2012/2016, (DGS 2012), describes the strategic guidelines and measures necessary for the care of young people from 10 to 24 years.

The vertiginous changes in society difficult by adults the understanding of what are the needs, problems and circumstances of life of contemporary youth. In the health field, should give particular attention to this phenomenon. There is therefore the need of adopting intervention strategies for adolescents, that meet the new social realities of this age group (Prazeres, 1998).

According to the same author, to increase the contact of adolescents with health services and improving health care services, they must have several characteristics: Accessibility; Visibility and recognition; Quality; Costs - for teens, gratuity, or the minimum costs in access to care is an important factor approach to health services; Dimension - the services must ensure the comprehensive and continuing care, should also enable effective responses to particular health needs and problems; Coordination; Flexibility and diversity; Privacy, confidentiality and informed consent; Youth participation - it is important to encourage the participation of adolescents in the evaluation and redesign of care. The health care for this age group should follow a multidisciplinary model, which is based on the establishment of a team, where it is up to each professional to ensure quality care. For this to happen it is necessary to favor the sharing of knowledge, as well as achieve a good functional relationship between doctors and nurses, psychologists, nutritionists, social workers and administrative sector, among others.

According to Coates, Beznos and Françoso (2003), the health care professional who provides care for this age group should have the following characteristics: Show real interest in the adolescent problems and perfect identification with their longings and frustrations; Have good scientific, moral, ethical and cultural education; Have good humanistic education; Be knowledgeable of the growth and development process and its variables; Having good knowledge of the main psychological problems that most concern in adolescence; Being able to convey warmth, enthusiasm and empathy; Avoid value judgments; Ensure absolute confidentiality and respect the modesty of young people; Have emotional balance and good physical health; Show accessibility features, tolerance, understanding and honesty.

The nurses in this context, its role is paramount, one of the health professionals who can be trained and able to give proper flow within the health services, establishing the first contact with the teenager and proceeding to the submission, as required detected. Therefore, the nurse plays an important role within the health services being responsible for creating a link between young people and the health unit. The participation of nurses is also essential in education approach to health, activity that can and should be developed not only in health care but also in schools, in the communities and in the most diverse contexts which may be the teenager.

Also Fonseca (2005a) mentions the need for well-trained and motivated, technically competent, and able to communicate with young people, without being patronizing or issuing judgments. Included in the most appropriate professional profile, the following characteristics are: have good capacity of interpersonal communication, being motivated, not to judge, have facility to establish a first contact, be someone whom the young person trusts, are ready to act in best interest of the young, be understanding and competent, being able to provide information and support that facilitates the choice of healthy lifestyles, prove commitment to struggle for health promotion, the prevention and care. For the same author, technical competence must be accompanied by respect and sensitivity to the person and their experiences, considering each teen as a unique and as such should be treated.

In Portugal, the National Health System (NHS), integrates adolescence consultation at the level of primary health care, the National Child and Youth Health Program, in correlation with the School and Reproductive Health Program. The attendance to adolescents should be based on a preventive approach, following periodic reviews of health parameters over the life cycle. The National Child and Youth Health Program (DGS, 2013), guides professionals to provide care to children and youth at the level of preventive care.

The recommended frequency of consultations between the ages of 10 to 18 years of age should be (DGS, 2013): from 11 to 13 years (global health examination); to 15 years and 18 years. However, these guidelines shall conform to particular cases, can be introduced or canceled some queries. The ages listed are not rigid: if the adolescent use the health center for other reasons, shortly before or shortly after the key age, may be made to the consultation indicated that age, also allowing the teen's accessibility to the consultations.

The DGS (2002b, p.5), said: "There is no doubt the impact of surveillance activities of child and adolescent health, relevant and quality. The maintenance and promotion of health of all children and young people is therefore a must for professionals and services. "

However, the importance of involving young people in improving the environment in which it is inserted, it is increasingly recognized. Young won and was awarded the right to rule on the issues that affect them.

They are also experts in their own environments and are best placed to identify not only the problems that affect them but also possible solutions.

Rather than decide about their life without the consult, it is important to get the knowledge of their needs, to draw further adjusted intervention programs, and develop good-practices towards health promotion.

Research questions

Given the above, rise to concern for the starting point of the study: What adolescents expect from Health Surveillance consultation?

Purpose of the study

With the present study aims to: Identify what teenagers, attending the 3rd cycle of basic education and secondary, in public schools located in rural and urban areas, aim of Adolescent Health Surveillance Consultation.

Accordingly, the following objectives were delineated:

• Characterize the sample studied by biographical data collection;
• To analyze the opinion of adolescents about the Adolescent Health Surveillance Consultation;
• Compare the views of teenagers about the Adolescent Health Surveillance consultations, attending a school in an urban and a rural area.

Research methods

Descriptive, cross-sectional and qualitative study with a phenomenological approach, whose population was composed by adolescents attending secondary schools, one from the rural area and other from the urban area, located in the north of Portugal.

The sample, not probabilistic for convenience, consisted of 14 adolescents, aged 15 to 17 years old who were attending one of the years of schooling, from the 10^th to the 12^th grade.

The selection criteria included the place of residence and ease of oral expression, the selection was delegated to the class teacher.

Findings

In an attempt to tailor health services to the real needs of the population it is designed, made up some questions to know the opinion of adolescents.

These results were analyzed by coding operations, resulting in the registration units. Subsequently sent to quantify them, obtaining enumeration units. Finally, we proceeded to the classification and aggregation, which were determined the most relevant categories and sub-categories.

Each interview is identified with a letter: A to L, following the alphabetical order. Interviews A to F were applied to adolescents who attend the school of the rural area. The letters G to L, identify interviews applied to adolescents who attend the school of the urban area.

Register units are identified by their letters identifying the interview where it was harvested.

In order to facilitate the discussion of the following results, this analysis follows the order of the interview questions.

What it is for the adolescent the Adolescent Health Surveillance Consultation?

Following the analysis of the responses to this question emerged four categories: prevention, treatment, supportive relationship and specialized information and six subcategories (see Table 1).

What are the issues that adolescents would like to see addressed in the Consultation?

Following the analysis of the responses to this question, seven categories emerged: sexuality; feeding; interpersonal relations; leisure activities; dependencies; safety / prevention of accidents and professional guidance. Of these categories, subcategories were created (see Table 2).

How adolescents would like it to work the consultation?

With regard to this question, two categories emerged in the light of the responses: Professionals involved; Consultation operation.

The professional category involved seven sub-categories were created:Doctor; Nurse; Psychologist; Nutritionist; Sexologist; Always with the same professional; Different professional (see Table 3).

What is the place where adolescents would like it to work the Consultation?

Conclusions

Consultation should be preventive and about health promotion; the theme that adolescents seem to consider most important to address in the health surveillance consultation is sexuality (affections, contraception and STIs); the professional most mentioned was a nurse with specialized training; although they prefer the free time, they would like a fixed time to answer questions and education sessions for health; as to the operation site, said the school.

Adolescents from rural areas showed a greater concern in obtaining specialized information. There is a full time psychologist in the school of urban area and easier access to information.

Acknowledgements

We would like to show our gratitude to Cristina Lima, Lúcia Oliveira e Paula Henriques for their contribution in the research. Financing CI&DETS, Health School /Polytechic Institute of Viseu

References

• Coates, V.; Beznos, G. W.; Françoso, L. A.(2003). Medicina do adolescente. 2ª ed. São Paulo: Sarvier editora.

• DGS (2013). Plano Nacional de Saúde 2012-2016. Lisboa: Direcção Geral da Saúde. Ministério da Saúde.

• DGS (2013). Programa Nacional de Saúde Infantil e Juvenil. Lisboa: Direcção Geral da Saúde. Ministério da Saúde.

• DGS (2002). Saúde Infantil e Juvenil: Programa Tipo de Actuação. 2ª ed. Lisboa: Direção Geral da Saúde. Ministério da Saúde.

• Fonseca, H. (2005). Compreender os adolescentes: um desafio para pais e educadores. 3ª ed. Lisboa: Editorial Presença.

• Portugal, Ministério da Saúde – Lei 48/90. Lei de Bases da Saúde. Diário da República. Lisboa: I Série (195) 24 de Agosto 1990, p. 3452-3464.

• Prazeres, V. (1998). Saúde dos adolescentes: princípios orientadores. Lisboa: Direção Geral da Saúde.