A Vital Part of Creating a Safe and Healthy Society: Adolescent Friendly Health Services


  • Hüseyin Dağ
  • Hasan Dursun

Received Date: 16.01.2023 Accepted Date: 23.01.2023 Eur Arc Med Res 2023;39(1):1-5

Adolescence, which the World Health Organization defines as the period between the ages of 10 and 19, is characterized by several physiological, psychological, and emotional changes. Adolescents might experience some specific issues during this time. Supporting adolescents during this time helps them deal with these issues more successfully. Adolescents may continue to lack strong problem-solving skills since they cannot locate appropriate health facilities despite some of the health issues they encounter on a global scale. Thus, the idea of “adolescent friendly health services” becomes more significant. With the aid of adolescent health services, we hope to accomplish our three key objectives. With the help of these services, investments are made in today’s teenagers, tomorrow’s adults, and consequently the future generations. Adolescent-friendly healthcare services should be regarded as acceptable, equitable, accessible, appropriate, and effective. However, to anticipate mortality and morbidity risks, psychosocial evaluation, a crucial part of adolescent-friendly health services, must be carried out using the acronym home, education/employment, eating, activities, drugs, sexuality, suicidal ideation and safety.

Keywords: Adolescent friendly health services, adolescent, HEEADSSS, psychosocial assessment


Adolescence is a transitional stage that encompasses the transition from childhood to adulthood. The World Health Organization (WHO) specifies this age range as 10 to 19. The preparation for maturity happens throughout this time on a physical, emotional, and psychological level. As a result, these periods have their own issues. This period is also defined as the storm and stress period (1,2).

Over 3 billion of the 7.2 billion people around the world, or 42% of the total population, are under the age of 25. Between the ages of 10 and 19, 1.2 billion of these young individuals are adolescents (3). The Turkish Statistical Institute reports that children make up 27.5% of Turkey’s population, and young people make up 15.1% of the country’s population (4). Adolescents make up approximately 1 in 6 of the world’s population. Among the major causes of death for teenagers are car accidents, suicide, STDs, and maternity issues. Disability-adjusted life years (DALYs), sometimes referred to as the reduction in healthy life years lost to illness, disability, and early death, dropped by 17% globally but only by approximately 8% among teenagers. Although iron deficiency and traffic accidents are the main causes of DALYs in our country, depression and anxiety are also among the most frequent causes (5). In China and around the world, more research on adolescents is needed in this area.

Although they require health services, adolescents with several issues may be slightly cautious when receiving them. They believe that the healthcare options presently available are insufficient for them. It has been discovered that adolescents receive care considerably more readily when health services are set up with adolescent perspectives and needs in mind (6). Adolescent friendly health services (AFHS) were created as a result of this circumstance.

Features and Importance of AFHS

AFHS are a concept and an endeavor to improve health practices to better meet the needs of young people, according to the World Health Organization. The World Health for Adolescents report, released in 2014, demonstrated that without parallel expenditures in adolescent health, significant gains from investments in mother and child health programs are at risk of being lost. According to the most recent data, approximately 5,000 teenagers pass away every day from conditions that can usually be avoided. Teenagers should therefore unwaveringly and consistently be given attention. The sustainable development targets for the period of 2016 to 2030 are centered on investments in adolescents. It is well established that several important risk factors for future adult diseases start during youth. As a result, investing in adolescent health helps current and future generations of adults as well as adolescents (7,8).

A consensus was reached in Geneva in 2002, and it defined adolescent-friendly health services. Countries are free to modify this as they see fit. These services should be accessible, equitable, acceptable, appropriate, and effective (9-16).

Accessible: Adolescent-friendly clinics should be built where young people can go without feeling uncomfortable. It should not be near any locations where teenagers would be frightened, including delivery rooms. Centers for integrated counseling and therapy should coexist. The duration of the workday has to be appropriate. Waiting periods need to be reduced.

Equitable: All adolescents in need should receive assistance. These services should be provided without discrimination against immigrants, the homeless, homeless children, individuals of different sexual orientations, people with chronic illnesses, and people with disabilities. It is vital to reevaluate health inequality indicators.

Acceptable: Healthcare practitioners should meet the needs of young patients. Confidentiality and respect are the two key criteria. It is the fundamental tenet of both professional ethics and human rights legislation. Expectations should be taken into account when creating guidelines.

Appropriate: Harmful practices must be avoided, and necessary attention should be given. Teenagers should have waiting rooms prepared with age-appropriate banners and posters. Additionally, adolescents should be included in choosing the times for check-ups and examinations.

Effective: Care services should include stimulating, preventive, and healing components. Adolescent-related concerns should be approached on all fronts. A multidisciplinary team should offer appropriate consultation and assistance. Accurately rendered services must be offered. Adolescents’ opinions should be sought. The locations where these services can be offered are crucial factors. For these services, hospitals on their own are insufficient. Every location where teenagers can go should be viewed as a potential chance to offer services. The locations where AFHS can be offered are summarized in Table 1.

AFHS must offer the proper protocols and have medical personnel who are educated in this area. Adolescent-friendly health policies are required to provide these services. Without the necessary legal support, sustainability cannot be achieved by healthcare practitioners alone. However, in addition to sound health policy, non-governmental group help is crucial. For the fundamental aims of adolescent health, many elements must cooperate. The departments of adolescent health at Hacettepe University and Istanbul University have PhD programs in place to train medical professionals who will provide AFHS in our nation. They are significant although there are not enough skilled specialists in the field of adolescent health. The facilities that will offer this service need to play a therapeutic role as well as one in preserving and enhancing the adolescent’s health. Unfortunately, we were unable to locate any research on whether the facilities in our nation are adolescent-friendly in the literature. AFHS are not being provided at the level that is expected, according to research conducted in several countries where they are being implemented. Therefore, it is crucial to prioritize adolescent-friendly health services for young people to accomplish sustainable development goals (17,18).

To meet international targets for adolescent health, investment in adolescent health is crucial. To meet its 2030 goals for adolescent health, the WHO has developed the Global Accelerated Action for the Health of Adolescents (2016-2030). This guide offers a wealth of knowledge, including the most recent statistics on the primary costs of teenage diseases and injuries, to policymakers, practitioners, researchers, educators, donors, and non-governmental organizations. It signifies a paradigm shift in how we consider and prepare for adolescent health (19,20).

The WHO-coordinated guide was created with the active involvement of governments, academic institutions, non-governmental organizations, United Nations agencies, and -most importantly- adolescents. In the past, attention was drawn to STDs so that the necessary investments in adolescents could be made. While emphasizing the adolescent health approach in all policies, this guide contends that there are good enough logical grounds to focus just on adolescent health. This manual has a few fundamental sections, which are listed in Table 2.

Adolescent psychosocial assessment following fundamental methods is a crucial part of adolescent-friendly health services. Adolescents are assessed psychosocially using the HEADSSS acronym, which is outlined in Table 3. In this interview, there are certain fundamental questions that should be raised. The family can participate in the interview for the first five minutes to get to know them and observe their dynamics. The interviews lasted approximately 45 to 60 minutes. The adolescent should then be interviewed after the family has received the relevant explanations. Adolescents place a high value on privacy in regard to personal topics; as a result, secrecy should be given to the adolescent and upheld, “saved in life-threatening situations and judicial scenarios”, so that the adolescent can speak freely during the interview. It is crucial that the doctors conducting this interview possess the fundamental skills for effective communication. There should be calm and two-way communication. The patients needed to be given the chance to explain themselves. Approaching the patient with respect is important. Open-ended questions should be used when taking a history. They can be asked questions such as, “Can you tell me a little about your home life?” “Who do you live with?” and “Can you tell me about your friends?” Using the abbreviation HEADSSS, the questions should be put in sequence from broad to specific. However, it would be best to save some inquiries for last because we believe they will make the adolescent feel quite uncomfortable. More precise inquiries are simple to make once the crucial connection of trust has been built. If we first build a trusting relationship, the patient will be more likely to disclose any hidden agendas they may have (21-30). The infant and child follow-up protocols of the Turkish public health institution were modified as “infant, child, and adolescent follow-up protocols” in our nation with the awareness that adolescent health is the most crucial step of sustainable development on a worldwide scale (30). A psychosocial assessment using the HEADSSS at least three times during adolescence is one of these follow-up strategies. Although this is a significant breakthrough, it is still problematic in practice to give teenagers a 45-60 minute psychosocial evaluation. The inclusion of this issue in the health practice communique and the resulting establishment of a legal basis will be a significant step in preserving and enhancing teenage health.

Some risk factors associated with adolescents can be discovered using the psychosocial assessment outlined in Table 3, and an opportunity to offer required counseling and preventative health services is also captured. Adolescents can easily access standard pediatric outpatient clinics and basic healthcare services through our health system. Even if these services are crucial, they might not be enough in actuality. Because of this, it is critical to offer these treatments while promoting “AFHS”. The advice provided in Table 4 below is crucial to achieve this.


Therefore, without adolescent health services, it will be impossible to achieve the 2030 sustainable development goals set forth by the WHO and to create a healthy society concurrently. For the triple advantage (adolescents, adults, future generations) to be realized, these services must be properly provided, supported by child-friendly health policies and current guidelines, and made available across the nation.


Peer-review: Internally peer-reviewed.

Authorship Contributions

Surgical and Medical Practices: H.D., Ha.D., Concept: H.D., Ha.D., Design: H.D., Ha.D., Data Collection or Processing: H.D., Analysis or Interpretation: H.D., Ha.D., Literature Search: H.D., Writing: H.D., Ha.D.

Conflict of Interest: No conflict of interest was declared by the authors.

Financial Disclosure: The authors declared that this study received no financial support.


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