Anonymity and confidentiality are the key priorities for young people using contraceptive health services, a systematic review has found. Non-judgemental staff and accessibility are also deemed important.

This systematic review examined selected qualitative research that looked at views of young people and providers in the UK regarding contraceptive services. Quality of papers was assessed using NICE criteria for qualitative studies. Data from each paper were extracted to establish core themes, which were further analysed and synthesised using a constant comparison method.

Because it was a qualitative review, there were no comparisons based on measured outcome and no weighted findings according to sample size or study design.

A total of 59 papers met the inclusion criteria. Forty five papers provided qualitative or mixed method data and 14 reported survey findings. Using NICE criteria, eight papers were rated as high quality, 26 as good and 11 poor. Analysis and synthesis of the data produced seven key themes:

• Perception of services: young people placed particular importance on what services were called; they perceived ‘clinic' as somewhere only girls go and ‘family planning' a service for older couples or married women. GP services were regarded as lacking in confidentiality and they viewed the receptionist as a barrier to making an appointment. The views on GP services varied: some were concerned that information might reach their parents whereas others reported a preference for GP services compared with school-based services.
• Accessibility: convenient opening hours; young people preferred after-school hours or Saturdays; being in a preferred location (they differed in preference for near or away from home but more preferred town centres) and fitting in with their lifestyle are important elements of access. Young people had no preference between appointment or drop-in systems; but for the latter, they would not be prepared to wait more than 15 minutes.
• Embarrassment: this seems to be a recurrent theme in most studies. Embarrassment felt by young people when accessing contraceptive services appears to be the most significant barrier for services to overcome, the reviewers comment.
• Anonymity and confidentiality: nine papers reported that young people have fears of being seen and recognised by someone and their anonymity being compromised, especially in smaller rural communities. Some studies suggest they would prefer to use numbers rather than names, services where it is not possible to identify a reason for the visit, and having separate waiting rooms for men and women.
• Clinic environment: six papers report views about the clinic environment. Young people disliked a clinic environment, preferring a more homely and cosy space resembling a communal living space.
• The consultation: 12 papers reported respectful and non-judgemental staff being highly valued by young people. They also preferred staff that were ‘easy to talk to' and ‘got straight to the point'.
• Service organisation: five papers reported staff concerns around limited resources for contraceptive services. There were also issues around lack of staff training as a barrier to high-quality service provision.

Teenagers often find it daunting to access health services which might explain the emergence of young people specific services that provide one-stop sexual health services.

The Department for Education has examined the services for young people; it linked different types of delivery to varying success rates on teenage pregnancy across the UK and expressed concerns about the disparity in services across different areas of the country.

The findings in this review reinforce the You're Welcome quality criteria issued by the Department of Health, best practice guidance which highlights accessibility, confidentiality, the environment and trained staff as key features of an effective service.

Although some of these criteria are specific to the wishes of young people in the context of accessing sexual health, it would not be unreasonable to expect other patient groups to expect the same from their sexual health service. If we get it right for young people, we might get it right for everyone else.

Dr Richard Ma