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Introduction Poor mental health in young people has become a growing problem globally over the past decades. However, young people have also been shown to underutilize available healthcare resources. The World Health Organisation (WHO) has formulated guidelines for youth-friendly health services (YFHSs) to increase youth participation in healthcare. Still, little is known about how young people using these services perceive mental health, indicating a knowledge gap concerning the subjective evaluation of their mental health. Aim To investigate how young people visiting youth health clinics (YHC) perceive the concept of mental health and factors they view as central to maintaining mental health. Methods In total 21 interviews were carried out, 16 in 2018, and 5 in 2023 to assure no changes in findings after the COVID-19 pandemic. Subjects were recruited during visits to youth health clinics (YHCs) in mid-Sweden and were aged 15–23 years. Recruitment strived to achieve heterogeneity in the sample concerning gender, sexual orientation, gender identity and age. Interviews were transcribed and analysed using qualitative content analysis. Findings Findings of the analysis revealed two themes, “Mental health is helped and hindered by the surroundings” and “Mental health is difficult to understand and difficult to achieve”. The participants described their health as highly dependent on their social surroundings, and that these are important to maintaining health but may also affect health negatively. They described mixed experiences of the health care services and mentioned prerequisites for seeking care for mental health problems such as accessibility and respect for their integrity, including the right to turn down offered treatment. The informants also viewed mental health as an ongoing undertaking that one must work for, and that it is sometimes difficult to know what constitutes mental health. They also expressed a need from healthcare services to enquire about their health, and to show an active interest in how they are doing. Conclusions Findings underline the need of young people’s individual needs to be met in the healthcare system and their vulnerability to their social surroundings. Health status assessments in young people should consider social and individual factors to fully capture mental health.

Background Electronic Patient-Reported Outcomes (ePROs) have potential to improve health outcomes and healthcare. The development of health-technology applications, such as ePROs, should include the potential users and be theoretically grounded. Swedish Youth Health Clinics (YHCs) offer primarily sexual and psychological healthcare for young people aged 12 to 25 years old. Young people in healthcare settings are considered a vulnerable group. The development of a collection of Patient-Reported Outcomes (PROs) in an Electronic Health Report Form (eHRF) for identifying health and health-related problems in young people, was preceded by a qualitative interview study, exploring young people’s views on using an eHRF at YHCs and which questions about health an eHRF should contain. The aim of the current study was to develop and evaluate the usability of an eHRF prototype for identifying health and health-related problems in young people visiting YHCs. Methods This study used a participatory design. During the development, an expert panel consisting of eight researchers and one Information Technology worker, participated. A wide literature search was performed to find PROs to construct an eHRF prototype to cover health areas. A mixed methods usability evaluation included 14 participants (young people, healthcare professionals, and an expert panel). Results The development resulted in an eHRF prototype, containing ten reliable and valid health questionnaires addressing mental-, physical-, and sexual health and social support, a self-efficacy question, and background questions, in total 74 items. The interviews in the usability evaluation resulted in three categories describing the usability of the eHRF: ‘Captures the overall health of young people but needs clarification’, ‘Fun, easy, and optional and will keep young people’s interest’, and ‘Potential contribution to improve the health consultation’. The quantitative results support the usability of the eHRF for YHCs. Conclusions The participatory approach contributed to development of the eHRF prototype to cover health areas adapted for the target population. The usability evaluation showed that the eHRF was usable and had the potential for self-reflection and contributions to cooperation between young people and healthcare professionals during the health consultation.

Background Because poor health in youth risk affecting their entry in adulthood, improved methods for their early identification are needed. Health and welfare technology is widely accepted by youth populations, presenting a potential method for identifying their health problems. However, healthcare technology must be evidence-based. Specifically, feasibility studies contribute valuable information prior to more complex effects-based research. The current study assessed the process, resource, management, and scientific feasibility of the Youth Health Report System prototype, developed within a youth health clinic context in advance of an intervention study. Methods This mixed-methods feasibility study was conducted in a clinical setting. The process, resource, management, and scientific feasibility of the Youth Health Report System were investigated, as recommended in the literature. Participants were youth aged 16–23 years old, attending a youth health clinic, and healthcare professionals from three clinics. The youth participants used their smart phones to respond to Youth Health Report System health questions and healthcare professionals used their computer to access the results and for registration system entries. Qualitative data were collected from interviews with healthcare professionals, which were described with thematic analysis. Youth participants’ quantitative Youth Health Report System data were analyzed for descriptive statistics. Results Feasibility analysis of qualitative data from interviews with 11 healthcare professionals resulted in three themes: We expected it could be hard ; Information and routines helped but time was an issue ; and The electronic case report form was valuable in the health assessment. Qualitative data were collected from the Youth Health Report System. A total of 54 youth participants completed the evaluation questionnaire, and healthcare professionals retrieved information from, and made post-appointment system entries. Quantitative results revealed few missing items and acceptable data variability. An assessment template of merged qualitative and quantitative data guided a consensus discussion among the researchers, resulting in acceptable feasibility. Conclusions The process-, resource-, management-, and scientific feasibility aspects were acceptable, with some modifications, strengthening the potential for a successful Youth Health Report System intervention study.

Background Young people in different healthcare settings are positive about using electronic patient-reported outcomes (ePROs), which are meant to increase the effectiveness and safety of interventions from the patient’s perspective. Sweden offers free healthcare to young people aged 12–25 years at 275 youth health clinics (YHCs), whose goals are to strengthen young people and promote sexual, physical, and mental health. YHCs need effective ways to identify the overall picture of young people’s health and health-related problems. To our knowledge, there is no ePRO for YHCs that provides an overview of young people’s health from several health perspectives. The aim of this study was to explore young people’s view on content and design of an ePRO to provide an overview of their health and health related problems when visiting a YHC, and their opinion on what healthcare needs to consider when using the ePRO. This was an explorative qualitative study. The participants were included from five YHCs, in different socioeconomic areas in central Sweden. Fifteen participants were included: 10 girls, three boys, and two non-binary participants with an age range of 16–22 years. Data were collected using a semi-structured interview guide and individual interviews, and inductive content analysis was performed. Results One main theme, “ePRO created based on my needs is worth using” and two sub-themes, “Appealing content and design” and “Trusting healthcare”, emerged. The participants wanted that an ePRO should include overall questions about mental-, physical-, and sexual health and social support. Participants also believed the ePRO must disclose the risks of self-harm or suicide. The participants noted the importance of emotional and digital security when using the ePRO and having a confidential conversation with a healthcare provider. To share health information means to trust to gain health. Conclusions The study participants' views on content and design can form the basis for designing an ePRO for young people. Their thoughts on safety and treatment in healthcare can be considered in the development process. This study is the starting point for developing an ePRO for young people at YHCs.

ABSTRACT Aim To test and describe the reliability, content and construct validity for the Norwegian translated version of the Safety Attitudes Questionnaire—Ambulatory Version (SAQ‐A) in child and youth health clinics and school health services. Design A validation study addressing reliability, content and construct validity. Methods The SAQ‐A was used to measure five factors: teamwork climate, safety climate, job satisfaction, perceptions of management and working conditions. Research has indicated that the sixth SAQ factor, stress recognition, contributes poorly to the safety climate construct, and it was therefore excluded from the final hypothesised model. An online version of the SAQ‐A was used for the data collection. Content validity was addressed. Furthermore, construct validity and reliability were analysed using corrected item total correlation and confirmatory factor analysis (CFA) and assessing internal consistency (Cronbach's alpha). The COSMIN reporting guideline was used as a framework and reference for designing and reporting quality domains in this study of measurement properties in line with the EQUATOR guidelines. Results A total of 361 respondents (45% of the invitees) completed the survey. Of these, 307 responses were included in the CFA. The content validity for the SAQ‐A was evaluated as good in the child and youth clinics and school health services context. The CFA indicated a satisfactory model fit (ꭓ2/df, root mean square error of approximation [RMSEA], PCLOSE and Hoelter 0.05). However, the Comparative Fit Index (CFI) was not satisfactory. The internal consistency of the five included factors ranged from α ≥ 0.70–0.81. Conclusion This study indicated that the reliability, content and construct validity of the SAQ‐A, with five factors, is adequate for measuring healthcare professionals safety climate in child and youth health clinics and school health services in Norway. Public Contribution The content analysis was carried out in collaboration with an interdisciplinary user group including 10 healthcare professionals.

Aims: High alcohol consumption and use of illicit drugs among young people is of great concern and there is a need to identify arenas where this group can be reached by preventive measures. The aim of the present study was to study prevalence of risky alcohol consumption, illicit drug use, and risky sexual behaviour (RSB) among young people visiting youth health clinics in Stockholm county. Another aim was to explore the association between risky alcohol consumption, illicit drug use and RSB. Methods: During autumn 2016, an anonymous questionnaire comprising questions about alcohol, illicit drugs and risky sexual behaviour was given to visitors at 11 youth health clinics in Stockholm county. Results: A total of 328 youths (M = 18.8 years, 89% girls) answered the questionnaire. Results show that 61.7% had risky alcohol consumption and 41.8% had tried illicit drugs. Risky sexual behaviour was more prevalent among respondents with risky alcohol consumption, and it was more common among non-students than students. Conclusions: Findings indicate that a large proportion of visitors at youth health clinics in Stockholm county has a risky alcohol consumption and experiences of other drugs, and also that risky alcohol consumption is associated with three of five RSB outcomes. Non-students seemed to be a particularly exposed risk group with regard to both risky alcohol consumption and RSB. Overall, the results indicate that youth health clinics are an important arena for alcohol prevention.

Background Rates of homelessness have been increasing in recent years, thereby necessitating a more direct approach to treating this complex social problem. Homeless youth have disproportionately high rates of untreated mental health problems and are therefore particularly vulnerable to the effects of homelessness during the transition period from adolescence to adulthood. Methods The study team developed a shelter-based clinic and collected clinical measures on youth who attended this clinic from October 2016 through June 2018. Results Youth attended an average number of three sessions, but there was a significant drop in follow-up after the first (intake) appointment. Depression, anger, and adjustment disorder emerged as the most common presenting mental health concerns identified by clinicians in the intake appointment, and trauma was identified as a significant complaint for those youth who returned for a second session. Conclusion Mental health care is needed in this population, but future studies should explore alternative approaches to retaining homeless youth in treatment and in designing targeted trauma-informed interventions.

The aim of this study was to explore how health care providers at youth clinics (YCs) in Sweden engage with, focus on, and navigate across the mental health youth space, while upholding the core bedrock principle of \"youth-centeredness\". Qualitative interviews were conducted with 21 health care professionals working in three YCs located in three different regions of Sweden. Data were analysed using reflexive thematic analysis informed by the work of Braun and Clarke. The three themes were: 1) \"youth mission-at the core of the YCs\" work and challenged by a stronger involvement in mental ill health'; 2) \"YCs\" unique and complementary role in the youth mental health system: a holistic perspective, team work, and a focus on normalization', and 3) \"Caught between a rock and a hard place: to treat at a care level that is not optimal for the young users\" needs or to refer within an unreliable system'. This study reflects the individuality and key features of YCs, their widening roles within the mental health sphere, and the challenges faced in maintaining and expanding the characteristic \"youth-centred\" approach while expanding their work with mental health.

[This corrects the article DOI: 10.1371/journal.pone.0240033.].[This corrects the article DOI: 10.1371/journal.pone.0240033.].

A meta-analysis was conducted to examine the relative rates of youth mental health service utilization across settings among the general population and among those with elevated mental health symptoms or clinical diagnoses. Rates of school-based mental health were compared to outpatient, primary care, child welfare, juvenile justice, and inpatient. Nine studies presented rates of mental health service use for general-population youth in the U.S., and 14 studies presented rates for youth with elevated symptoms or clinical diagnoses. Random effects meta-analysis was used to calculate mean proportions of youth receiving care in each sector. Of general population youth, 7.28% received school mental health services. Rates for other sectors are as follows: 7.26% in outpatient settings, 1.76% in primary care, 1.80% in inpatient, 1.35% in child welfare, and 0.90% juvenile justice. For youth with elevated mental health symptoms or diagnoses, 22.10% of youth were served by school-based mental health services, 20.56% outpatient settings, 9.93% primary care, 9.05% inpatient, 7.90% child welfare, and 4.50% juvenile justice. Schools and outpatient settings are the most common loci of mental health care for both the general population and samples of youth with elevated symptoms or clinical diagnoses, although substantial amounts of care are also provided in a range of other settings. Results hold potential for informing resource allocation, legislation and policy, intervention development, and research. Given that mental health services are delivered across many settings, findings also point to the need for interconnection across child-serving sectors, particularly schools and outpatient clinics.