Unlocking potential: developing innovative adolescent screening visits for health promotion, prevention and treatment in low-resource settings

In adolescence, health-related behaviours are adopted that will have substantial positive or negative impacts on the individual's short- and long-term health, educational attainment, and employment prospects. However, in most low-income countries few adolescents have any contact with health services, especially for health promotion and disease prevention, and services are not always appropriate for their needs. Due to resource constraints there is often limited capacity to provide high-quality youth-friendly health services. Technological advances provide opportunities to deliver services and information away from traditional clinical settings, hence reducing barriers such as cost or confidentiality. Adolescents may be particularly receptive to digital platforms that allow them to self-manage their health and well-being.

What is Y-Check?
The programme screens and treats/refers adolescents for common conditions through health check-ups in younger (10-14y) and older (15-19y) adolescents. Adolescents are only screened for conditions with an accurate and acceptable test and a locally accessible effective intervention e.g. mental health, HIV, vision and hearing, anaemia.

What exactly has been done so far?
We developed, pilot-tested, implemented and evaluated the innovative Y-Check programme and an accompanying digital platform in Zimbabwe. Check-up visits took place at schools for younger and older adolescents, and in the community for older adolescents. The youth-friendly digital platform reduced the workload of staff by allowing adolescents to self-screen using questionnaires (e.g. mental health, risk behaviours) and pre-existing apps (to test hearing, eyesight).

What were the main outcomes?
Answers to the following questions – Do adolescents attend the screening and referral appointments? What impact do visits have on their health and education? How much does it cost for an adolescent to be screened and to obtain the recommended care for a condition? Is this a good value for money?

What is innovative about this study?
The approach is innovative and novel, because, few LMICs currently provide check-up visits for adolescents and in countries where they are provided, the visits don't always meet the needs of adolescents e.g. don't include mental health screening. This proposal takes the innovative and bold step of moving from condition-specific health programming towards an adolescent-centered approach focusing on what matters most to adolescents. This is the first empirical study to have investigated the effectiveness and cost-effectiveness of multi-component adolescent health check-ups.
Specific innovations:
– Youth Researchers participated in a human-centered design approach to intervention development
– Digital platform on which adolescents completed some of the health screening activities, saving consultation time and improving the quality and efficiency of data collection
– Novel adolescent engagement activities including crowdsourcing contests

Why Zimbabwe?
Zimbabwe is an ideal location for Y-Check with great potential for scale-up given the close collaboration between the Biomedical Research and Training Institute and the Ministries of Health and Education, the emphasis on prevention within the 2018 School Health Policy, and the absence of other good ways to screen and refer adolescents. In other African settings, there is considerable interest in adolescent check-ups and the model has recently been adapted and implemented in Tanzania and Ghana.

In this next phase, we propose to conduct additional data analysis and mathematical modelling to decide on the best content and format for a Phase 2 Y-Check intervention, to design a rigorous evaluation study to determine the Phase 2 interventions' effectiveness, and to estimate the potential longer-term impact of prevention interventions in adolescence.