Creating connections: Strategies to improve adolescent boys’ access and engagement with school-based health services
Lisa Hutchinson
School Based Youth Health Nurse, Queensland Health; Research Centre for Clinical and Community Practice Innovations, School of Nursing and Midwifery, Griffith University, Gold Coast QLD
Winsome St John
Associate Professor, Research Centre for Clinical and Community Practice Innovations, School of Nursing and Midwifery, Griffith University, Gold Coast QLD
PP: 258 - 268
Abstract
The aim of this grounded theory study was to investigate strategies used by school-based nurses to promote adolescent boys' access to and engagement with school-based health services. Interviews were conducted with ten school nurses in South-East Queensland, Australia. The central process identified was Creating connections, encompassing three inter-related sub-processes: Facilitating communication, Mediating contextual issues and Bridging cultural issues. These processes incorporate strategies that highlight ways school nurses can engage with boys, individually and collectively, to promote and facilitate help-seeking from school-based health services. Findings inform practice and guidelines for improving boys' access to school-based health services.
Keywords
adolescent boys, school health services, access, engagement, communication, connections
Article Text
Adolescents, particularly boys, commonly engage in risk-taking behaviors that may compromise their short- and long-term health and wellbeing. They face issues such as substance use, sexual behaviors, eating disorders, delinquency, violence, stress and depression (Barnes, Walsh, Courtney & Dowd 2004b; Quine et al 2003), the latter being a significant cause of morbidity and mortality during adolescence (Atkinson, Schattner & Margolis 2003). Viner and Barker (2005) highlighted the strong continuities between adolescent and adult health, and asserted adolescence is a critical period for engaging young people in health promoting behaviors. A number of Australian states have initiated secondary school-based youth health nurse services to address adolescent health.
The School Based Youth Health Nurse (SBYHN) service in Queensland, Australia, is a program aiming to promote adolescents' health and wellbeing and provide timely support (Barnes, Courtney, Pratt & Walsh 2004a). Guided by a Health Promoting Schools approach (Queensland Health 2006), the SBYHN program facilitates whole of school health and wellbeing through: health promotion activities; health education; resource provision; support for health-focused curriculum development; formation of partnerships between the school and the broader community; and individual health consultations with students, parents and members of the school community.
Timely access to primary health care services is important for adolescent boys who have a greater propensity to engage in risk-taking behaviors, may be less well equipped to make informed health decisions (Courtenay 2003), and be less likely to exhibit conventional signs of mental ill health, because depressive symptoms may be masked by disruptive behaviours and substance abuse (Wignall 2006). Despite important health needs, boys under-utilize the SBYHN service. This is consistent with findings in other settings indicating that adolescent boys access formal help services much less frequently than girls and have more negative attitudes toward help-seeking (Booth et al 2004; Schonert-Reichl & Muller 2006).
Boys will often project a tough and confident image to adhere to conventional norms of masculinity, however beneath this façade many may be lonely, sad and confused (Martino & Pallotta-Chiarolli 2001; Pollack 1999). Lloyd (2002) interviewed 25 young men aged 15 to 22 years who expressed a common belief that showing feelings was embarrassing, and displaying emotion would lead to vulnerability and a lack of control. While some boys were willing to talk about their feelings, many found it difficult. Kraemer (2000) argued that gender socialisation results in boys having difficulty discerning how they feel, making them less likely to ask for help when they need it. Rickwood, Deane, Wilson and Ciarrochi (2005) investigated factors affecting help-seeking amongst young people for mental health problems and reported that emotional competence levels were significantly related to help-seeking behaviour, and that boys in particular have difficulty recognising their emotional state, and may have limited ability to express how they are feeling.
Although studies have explored specific barriers to adolescent boys' help seeking and their access to primary health care services (Bernard et al 2004; Booth et al 2004; Freak, Barley & Kent 2007; Gleeson, Robinson & Neal,2002; Kang et al 2006; Kay et al 2006; Kuhl, Jarkon-Horlick & Morrisey 1997; Lindsay & Kalafat 1998; Rickwood et al 2005; Timlin-Scalera, Ponterotto, Blumberg & Jackson 2003; Wilson & Deane 2001), few have explored approaches to overcoming these barriers. Freak et al (2007) called on researchers to explore how professional helpers could work more effectively with young people. This study answers this call by investigating the processes and strategies used by nurses to address barriers to boys' access to and engagement with school-based youth health services.
Aim of study
The aim of this study was to explore the processes and strategies used to promote boys' access to and engagement with SBYHN services.
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