King's College London

Strengthening the quality of adolescent primary healthcare in South Africa: preliminary work on a complex public health intervention

PACK (Practical Approach to Care Kit) Youth aims to explore and understand the status of adolescent and youth primary healthcare available in clinics and schools in order to refine and adapt a health systems intervention to meet the needs of adolescents and youth in accessing services and the challenges faced by clinicians in providing care to this underserved grouped. Once refined, we will pilot and evaluate the intervention in schools and clinics to see what more we need to do to optimise PACK Youth and what we need to alter about the delivery of adolescent primary healthcare to enable its use in primary care clinics and schools in other settings.

Our multidisciplinary group of South African and UK researchers will work with youth, clinic and school staff and stakeholders in the Western Cape Department of Health and Western Cape Education Department and National Department of Health and Education to adapt and refine the intervention for these contexts.

A version of PACK Youth was developed in 2019 which was piloted in 10 City of Cape Town primary health care clinics, however limited funding was available for a robust evaluation. The pilot did show its acceptability and feasibility with recommendations on additional content to be included.

The formative phase was aimed at assessing adolescent primary health care in six clinics and twelve schools in the Western Cape province of South Africa through a facility questionnaire to determine various aspects of adolescent healthcare services available and the clinical characteristics of adolescents using these services. We observed the processes that adolescents follow to receive primary health care, including their consultations with clinicians. Focus group discussions were conducted with school and clinic managers, clinicians, community-based organisations, policymakers and adolescents to provide a broad understanding of existing adolescent primary health care.

We have refined the PACK Youth intervention following a theory of change workshop (a workshop intended to develop a system of ideas to explain how we think change happens in the area we want to address, and how we intend to work to influence these changes) with key stakeholders. The adapted intervention is now being implemented and evaluated in the six clinics and twelve linked schools (primary and secondary). Through observations of the use of PACK Youth and resultant changes to the clinical pathway for adolescents as well as interviews with adolescents, clinic clinicians and school staff we will see how PACK Youth meets the needs of adolescents and clinicians along with the challenges to its use. Routine health data will help us assess its impact on youth access to primary healthcare.

The outcomes of the study will provide an understanding of adolescent primary healthcare across schools and clinics. It will allow us to identify the minimum system strengthening components needed to support adolescent healthcare in an integrated way in both health and education sectors.

PACK Youth is run through the Knowledge Translation Unit in Cape Town.

Key partner co-investigators involved:

• Associate Professor Tracey Naledi (Deputy Dean: Health Services, University of Cape Town)
• Associate Professor Catherine Mathews (Chief Specialist Scientist, South African Medical Research Council)
• Professor Max Bachmann (Professor of Health Service Research, University of East Anglia)
• Dr Ruth Cornick (Head of Knowledge Translation, University of Cape Town)
• Dr Robyn Curran (Senior Research Officer, University of Cape Town)
• Ms Christy-Joy Ras (Head of Training & Development, University of Cape Town)
• Ms Sinovuyo Takatshana (Research Officer, University of Cape Town)