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Sexual violence (SV) is pervasive on university campuses worldwide, with alarmingly high reported rates in sub-Saharan Africa (SSA). Despite the high reported rates of SV victimization on campuses, existing evidence has not been critically synthesized to give a comprehensive picture of the problem’s extent, common forms, risk factors, and (knowledge about) victims and perpetrators in SSA countries. We aimed to map the existing literature on SV prevalence, types, risk factors, victims, perpetrators, and consequences among university students on campuses in SSA. We included articles focusing on university students from SSA countries published in English or French language from 2014 to 2023. We identified 543 records from nine databases; Academic Search Premier; CINAHL; EMBASE; MEDLINE; PsychINFO; PubMed; Scopus; SocINDEX; and Web of Science, 82 of which met our inclusion criteria. Retrieved articles covered only one-third of the sub-Saharan region, mostly focusing on female students and victims. Prevalence of different forms of SV varied among countries; authors attributed these variations to differences in time frame, forms of SV, how they were defined, and the tools used. Young female students were identified as common victims, while male teachers and students were common perpetrators. We used the socio-ecological model to summarize risk and protective factors associated with SV victimization and listed the health, social, and economic consequences of SV victimization. Despite these consequences, victims rarely seek help, whether from informal sources or authorities. We call for comprehensive studies in SSA that include both genders and focusing on victims and perpetrators, and address service access barriers.

Introduction: Community-based health workers (CBHWs) possess great potential to be the missing link between the community and the formal health system for improving adolescents’ access to sexual and reproductive health and rights (SRHR) information and services. Yet, their role in addressing adolescents’ SRHR within the context of the community-based health system has received very little attention. This paper analyses how CBHWs experience and perceive their role in addressing adolescents’ SRHR needs in rural Zambia, including the possible barriers, dilemmas, and opportunities that emerge as CBHWs work with adolescents.

Methods: Between July and September 2019, we conducted 14 in-depth interviews with 14 community-based health workers recruited across 14 different communities in the central province of Zambia. The interviews were focused on eliciting their experiences and perceptions of providing sexual and reproductive health services to adolescents. Charmaz’s grounded theory approach was used for the analysis.

Results: We present the core category “being both a grandmother and a CBHW”, which builds upon four categories: being educators about sexual and reproductive health; being service providers and a link to SRHR services; being advocates for adolescents’ SRHR; and reporting sexual violence. These categories show that CBHWs adopt a dual role of being part of the community (as a grandmother) and part of the health system (as a professional CBHW), in order to create/maximise opportunities and navigate challenges.

Conclusion: Community-based health workers could be key actors providing context-specific comprehensive SRHR information and services that could span all the boundaries in the community-based health system. When addressing adolescents SRHR, playing dual roles of being both a grandmother and a professional CBHW were sometimes complimentary and at other times conflicting. Additional research is required to understand how to improve the role of CBHWs in addressing adolescents and young people’s sexual and reproductive health.

Background: Youth mental health is a major health concern in almost every country. Mental health accounts for about 13% of the global burden of disease in the 10-to-19-year age group. Still there are significant gaps between the mental health needs of young people and the quality and accessibility of available services. Collaboration between health and social service actors is a recognized way of reducing gaps in quality and access. Yet there is little scientific evidence on how these collaborations are applied, or on the challenges of cross-boundary collaboration in the youth mental health space. This study aims to explore how collaboration is understood and practiced by professionals working in the Swedish youth mental health system.

Methods: We conducted 42 interviews (November 2020 to March 2022) with health and social care professionalsand managers in the youth mental health system in Sweden. Interviews explored participants’ experience andunderstanding of the purpose, realization, and challenges of collaboration. Data were analysed under an emergentstudy design using reflexive thematic analysis.

Results: The analysis produced three themes. The first shows that collaboration is considered as essential andimportant, and that it serves diverse purposes and holds multiple meanings in relation to professionals’ roles andresponsibilities. The second addresses the different layers of collaboration, in relation to activities, relationships, andtarget levels, and the third captures the challenges and criticisms in collaborating across the youth mental healthlandscape, but also in growing possibilities for future development.

Conclusion: We conclude that collaboration serves multiple purposes and takes many shapes in the Swedish youth mental health system. Despite the many challenges, participants saw potential in further building collaboration. Interestingly our participants also raised concerns about too much collaboration. There was scepticism about collaboration directing attention away from young people to the professionals, thereby risking the trust and confidentiality of their young clients. Collaboration is not a panacea and will not compensate for an under-resourced youth mental health system.

Introduction: Many adolescents in low- and middle-income countries face challenges related to sexual and reproductive health and rights, which are exacerbated by gender inequalities. One approach to address these issues is the integration of Comprehensive Sexuality Education (CSE) in schools. However, the process of effectively implementing CSE in these settings is often suboptimal. There is a significant lack of research exploring the specific conditions and methods that effectively lead to enhanced knowledge and improved decision-making in sexuality and gender equality among adolescents through CSE. This realist evaluation protocol will address this gap by exploring how the nature and pattern through which CSE is provided has a) changed adolescents’ knowledge regarding sexuality and gender relations and b) shaped adolescents’ capacity to make positive decisions.

Methods: This study uses a multiple-case design, combining realist evaluation with participatory action research methods to explore Comprehensive Sexuality Education (CSE) integration across multiple levels in Eastern province—from provincial to community levels. Data collection will occur in phases, utilizing interviews, photovoice, drawings, reviews, and observations. The study involves several key steps: 1) identifying challenges to CSE integration, 2) creating an initial theory or action plan that explains how CSE promotes positive decisions among adolescents about sexuality, 3) testing this theory through case studies, and 4) refining the theory and formulating recommendations to improve future CSE integration. Additionally, the study will document informal, contextual, and horizontal factors (ICAMO configurations) that influence the integration of CSE at the school level and affect adolescents' understanding and decision-making regarding sexuality and gender relations.

Discussion: This study will contribute to the development of strategies for effectively facilitating the integration process of similar programmes within the school system. The study will further contribute to methodological development in participatory research driven realist evaluation.

Introduction: Many adolescents in low- and middle-income countries face challenges related to sexual and reproductive health and rights, which are exacerbated by gender inequalities. One approach to address these issues is the integration of Comprehensive Sexuality Education (CSE) in schools. However, the process of effectively implementing CSE in these settings is often suboptimal. There is a significant lack of research exploring the specific conditions and methods that effectively lead to enhanced knowledge and improved decision-making in sexuality and gender equality among adolescents through CSE. This realist evaluation protocol will address this gap by exploring how the nature and pattern through which CSE is provided has a) changed adolescents’ knowledge regarding sexuality and gender relations and b) shaped adolescents’ capacity to make positive decisions.

Methods: This study uses a multiple-case design, combining realist evaluation with participatory action research methods to explore Comprehensive Sexuality Education (CSE) integration across multiple levels in Eastern province—from provincial to community levels. Data collection will occur in phases, utilizing interviews, photovoice, drawings, reviews, and observations. The study involves several key steps: 1) identifying challenges to CSE integration, 2) creating an initial theory or action plan that explains how CSE promotes positive decisions among adolescents about sexuality, 3) testing this theory through case studies, and 4) refining the theory and formulating recommendations to improve future CSE integration. Additionally, the study will document informal, contextual, and horizontal factors (ICAMO configurations) that influence the integration of CSE at the school level and affect adolescents' understanding and decision-making regarding sexuality and gender relations.

Discussion: This study will contribute to the development of strategies for effectively facilitating the integration process of similar programmes within the school system. The study will further contribute to methodological development in participatory research driven realist evaluation.

Introducción: Muchos adolescentes de países de ingresos bajos y medios se enfrentan a retos relacionados con la salud y los derechos sexuales y reproductivos, que se ven exacerbados por las desigualdades de género. Un enfoque para abordar estos problemas es la integración de la Educación Sexual Integral (ESI) en las escuelas. Sin embargo, el proceso de implementación efectiva de la ESI en estos entornos no suele ser óptimo. Hay una falta significativa de investigación que explore las condiciones y métodos específicos que conducen efectivamente a un mayor conocimiento y una mejor toma de decisiones en sexualidad e igualdad de género entre los adolescentes a través de la ESI. Este protocolo de evaluación realista abordará esta carencia explorando cómo la naturaleza y el patrón a través de los cuales se proporciona la ESI han a) cambiado el conocimiento de los adolescentes con respecto a la sexualidad y las relaciones de género y b) moldeado la capacidad de los adolescentes para tomar decisiones positivas.

Métodos: Este estudio utiliza un diseño de casos múltiples, combinando la evaluación realista con métodos de investigación-acción participativa para explorar la integración de la Educación Sexual Integral (ESI) a través de múltiples niveles en la provincia Oriental, desde el nivel provincial hasta el comunitario. La recopilación de datos se realizará por fases, utilizando entrevistas, fotovoz, dibujos, revisiones y observaciones. El estudio consta de varios pasos clave 1) identificar los retos para la integración de la ESI, 2) crear una teoría inicial o plan de acción que explique cómo la ESI promueve decisiones positivas entre los adolescentes sobre la sexualidad, 3) probar esta teoría a través de estudios de casos, y 4) refinar la teoría y formular recomendaciones para mejorar la futura integración de la ESI. Además, el estudio documentará los factores informales, contextuales y horizontales (configuraciones ICAMO) que influyen en la integración de la ESI a nivel escolar y afectan a la comprensión y la toma de decisiones de los adolescentes respecto a la sexualidad y las relaciones de género.

Discusión: Este estudio contribuirá al desarrollo de estrategias para facilitar eficazmente el proceso de integración de programas similares dentro del sistema escolar. El estudio contribuirá además al desarrollo metodológico de la evaluación realista impulsada por la investigación participativa. 

The aim of this study is to analyze the characteristics of feminist peer support in the context of online chat counseling. Based on 15 interviews with female lay supporters associated with a branch of the Swedish women's shelter movement targeting young women, we explore how the digital setting—characterized by distance and anonymity—affects the meaning and doing of feminist support. Our results show that core principles of feminist support—striving for equality and trust, the crafting of safe spaces, and sharing experiences—are all renegotiated and/or accentuated by the digital setting. The chat is experienced as enabling a more equal relationship and a high level of safety. The meaning of safety has largely shifted, however, from being associated with a feminist community to safety associated with solitude and distance. We further show a tension in the respondents’ understanding of shared experiences, stressing both the importance of situated knowledges and the value of not knowing who is seeking or offering support. By combining research and material on feminist support and online youth counseling, the article offers novel perspectives on feminist counseling and social work, the power dimensions of online counseling, and the virtual space as an arena for feminist activism.

Introduction: In Sweden, youth clinics (YCs) address, among other things, issues related to the mental well-being among young people. However, YCs´ impact on their mental health have not been assessed. This study aimed to: i) analyse trends in mental health outcomes (stress, anxiety and psychological distress) among young people in Sweden according to the municipal availability of YCs; and ii) assess the impact on mental health outcomes of the presence of YCs with a first-line mental health (FLMH) assignment and YCs without this assignment, as compared to municipalities without YCs.

Methods: An ecological controlled interrupted time series design was applied. Annual data over 18 years (2004-2021) on self-reported stress, anxiety and psychological distress of individuals aged 16-25 were used. Thus, the mental health outcome trends in municipalities with YCs and those without YCs were compared. The prevalence ratio and their 95% confidence intervals were estimated.

Results: In total, 17,174 young people aged 16–25 participated in the study. A decrease in the reporting of stress, anxiety and psychological distress was observed from 2004 to 2010, followed by an increase in all three outcomes during the period 2011–2021. Trends were not statistically significant different in municipalities with or without YCs (even among YCs with the FLMH assignment). 

Conclusion: The prevalence of mental ill-health has been increasing among young people in Sweden since 2011. While YCs play an important role in the prevention of mental illness, their impact on these trends could not be determined. We recommend that structural factors such as education and the labour market for youth, which are outside the scope of YCs, should be addressed to curb these trends. 

Introducción: En Suecia, las clínicas para jóvenes se ocupan, entre otras cosas, de cuestiones relacionadas con el bienestar mental de los jóvenes. Sin embargo, no se han evaluado las repercusiones de dichos centros en su salud mental. El objetivo de este estudio fue: i) analizar las tendencias en salud mental (estrés, ansiedad y angustia psicológica) entre los jóvenes suecos en función de la disponibilidad municipal de las clínicas juveniles; y ii) evaluar el impacto en salud mental de la presencia de las clínicas juveniles con una asignación específica de salud mental de primera línea (First Line Mental Health en inglés) y aquellas clínicas sin esta asignación, en comparación con municipios que carecende clínicas para jóvenes.

Métodos: Se aplicó un diseño ecológico controlado de series temporales interrumpidas. Se utilizaron datos anuales a lo largo de 18 años (2004-2021) sobre el estrés, la ansiedad y la angustia psicológica auto-percividas por personas de entre 16 y 25 años. Así, se compararon las tendencias de los resultados de salud mental en los municipios con clínicas juveniles con los que no las tenían. Se estimaron la ratio de prevalencia y sus intervalos de confianza del 95

Resultados: En total, 17.174 jóvenes de entre 16 y 25 años participaron en el estudio. Se observó una disminución en la notificación de estrés, ansiedad y angustia psicológica de 2004 a 2010, seguida de un aumento en las tres variables durante el período 2011-2021. Las tendencias no fueron diferentes estadísticamente en los municipios con o sin clínicas juveniles (incluso comparando con las clínicas con la asignación FLMH).

Conclusiones: La prevalencia de una peor salud mental ha ido en aumento entre los jóvenes en Suecia desde 2011. Aunque las clínicas juveniles desempeñan un papel importante en la prevención de las enfermedades mentales, no se ha podido determinar su impacto en estas tendencias. Recomendamos que se aborden factores estructurales como la educación y el mercado laboral de los jóvenes, que están fuera del alcance de las clínicas juveniles, para frenar estas tendencias. 

Purpose: 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".

Methods: 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.

Results: 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'.

Conclusion: 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 article critically analyses the assumptions and effects of the ‘daring to ask approach’ to gender based violence (GBV), as expressed in the policies that govern social services’ work in Sweden. We show how GBV is constituted as a sensitive issue connected with shame and as something that will not be brought up spontaneously; GBV is something that women who had experienced it carry with them as an ‘untouched truth’ waiting to be discovered by social workers while women’s worries about the consequences of telling are not made intelligible. The very speaking as such is seen as emancipatory, and the social worker is understood as a facilitator. With this approach follows standardised questions, aiming for neutrality and equity. However, these are so wide and unspecific, that the risk is that no one thinks the questions are directed to her. By making the assumptions and effects of a seemingly self-evident strategy visible, we demonstrate areas in need of further research and policy development, such as barriers to help-seeking (beyond stigmatisation) and effects of standardisation. This is an important undertaking since without critical scrutiny of the policies there is a risk that stakeholders assume that merely asking will resolve the problem of GBV.

BACKGROUND: Healthcare workers play an important part in the delivery of health insurance benefits, and their role in ensuring service quality and availability, access, and good management practice for insured clients is crucial. Tanzania started a government-based health insurance scheme in the 1990s. However, no studies have specifically looked at the experience of healthcare professionals in the delivery of health insurance services in the country. This study aimed to explore healthcare workers' experiences and perceptions of the provision of health insurance benefits for the elderly in rural Tanzania.

METHODS: An exploratory qualitative study was conducted in the rural districts of Igunga and Nzega, western-central Tanzania. Eight interviews were carried out with healthcare workers who had at least three years of working experience and were involved in the provision of healthcare services to the elderly or had a certain responsibility with the administration of health insurance. The interviews were guided by a set of questions related to their experiences and perceptions of health insurance and its usefulness, benefit packages, payment mechanisms, utilisation, and availability of services. Qualitative content analysis was used to analyse the data.

RESULTS: Three categories were developed that describe healthcare workers´ experiences and perceptions of delivering the benefits of health insurance for the elderly living in rural Tanzania. Healthcare workers perceived health insurance as an important mechanism to increase healthcare access for elderly people. However, alongside the provision of insurance benefits, several challenges coexisted, such as a shortage of human resources and medical supplies as well as operational issues related to delays in funding reimbursement.

CONCLUSION: While health insurance was considered an important mechanism to facilitate access to care among rural elderly, several challenges that impede its purpose were mentioned by the participants. Based on these, an increase in the healthcare workforce and availability of medical supplies at the health-centre level together with expansion of services coverage of the Community Health Fund and improvement of reimbursement procedures are recommended to achieve a well-functioning health insurance scheme.