Public Youth Health Care: outgrowing inequity. A participative action research study.
Public health in The Netherlands is a field of practice dealing with wicked problems in a constantly changing context. The increasing complexity of public health problems and societal organisation, begs for professionals with diverse perspectives and skills to understand and translate knowledge. Training medical doctors in public health to become physician scientists will strengthen the capabilities of the workforce which is so urgently needed in public health.
Youth Health Care (YHC) is a specific part of public health in the Netherlands, aiming to reach every child with primary preventive health care. This goal starts before birth and lasts until young adulthood (18 or 23 years of age). A basic YHC program is offered to every child, with add ons when indicated. Still, health disparities and disparities in access to care start before birth. Early on, YHC loses connection with the population, quickly accumulating to 9% at the age of 2 years. Availability of YHC services is guided by numbers of children living in a municipality, rather than their potential needs for health and prevention and that of their families. This is an approach based on equality – universal offer of a care program for health and prevention – rather than equity – offering a program acknowledging that different people need different approaches to reach similar results.
Health disparities
To decrease health disparities, people with lesser chances on good health outcome need to be able to make use of preventive health care at least as much as people with better chances to begin with. However, many socio-economic factors influencing health also influence possibility to access health care and connect with care professionals. Chronic stress in the family, poverty and diminished health literacy are examples of such factors. When groups of the general population are lost to follow up so easy, knowledge on how to (re)connect to these these people is scarce.
Objectives
The goal of this project is to study the population lost to follow up and which families in this group are particularly vulnerable for unfortunate health outcome. As they are the families YHC wants to reach in order to decrease health disparities, the subsequent goal is to learn how to (re)connect with them. As a result, the reach of YHC of the present day will increase, adding families that appear hard to reach nowadays to the total population reached.
Approach
The RE-AIM framework will be used to outline this project. RE-AIM is an acronym for Reach, Efficacy, Adoption, Implementation and Maintenance. It can be used to evaluate public health programs and interventions, in order to improve public health relevance and population health. It can also be used to plan and improve programs and interventions.
First, we will study the current Reach of YHC in a quantitative study. To improve the reach, a literature study will be undertaken on how to connect to families YHC finds hard to reach. The findings of this literature study will be applied when connecting with one or more communities. Together with these communities, a participative action research (PAR) approach will be applied.
To study the Efficacy of YHC from the perspectives of parents, youth and professionals, a needs assessment aimed at connection between professionals and parents and youth will be performed. Translating these needs into experimental new practice, means YHC is adjusted or re-designed locally in a community by parents, youth and professionals in co-production. This allows for studying of Adoption of the new practice by the professionals offering YHC.
Also, Implementation of the new practice of YHC by professionals and use by the target population of parents and youth, is studied.
In order to enhance Maintenance, strategies will be applied during the translation/design phase of the project. The PAR approach includes a continuous sharing of knowledge and (possibly changing) perspectives between professionals, parents and youth.