School‑Based Health Service Utilization in Cape Breton

Implications for Adolescent Health Service Delivery

Investigators: J. Gahagan (Principal), D. Langille, G. Flowerdew, and J. DeRoche

Despite calls for increased knowledge about males’ use of health services, little is known about how adolescent males access and use such services. During adolescence, males are at greater risk than females for alcohol use, accidental trauma, and violence, including self-harm. Males also contribute to the spread of sexually transmitted infections and unintended pregnancy, issues which can have major implications for females. Children do not differ by sex in use of health services, and studies on adult health-care use show that adult males use health care services less often than adult females. Thus, the decline in health-care use by males appears to begin sometime during adolescence. Designed to address factors which might act as barriers to adolescents seeking health services, Nova Scotia has a network of school-based and school-linked youth health services which number about 40, of which 36 are located in schools. School-based health centres (SBHCs) range from full service models to only one aspect of care (e.g., mental health), and Nova Scotia has a wide range of models. In Cape Breton, SBHCs provide physical, mental, reproductive and preventive health services to students at four high schools in four different communities. However, research has shown that male students use SBHCs far less than females, even when at risk for such health concerns as substance use and depression. The Cape Breton District Health Authority (CBDHA) is concerned about males’ lack of use of SBHCs and has partnered with our research team to provide information for making decisions about SBHC services. This exploratory project will use both quantitative and qualitative methods to understand the contextual factors associated with adolescent males’ health seeking behaviours in order to answer the following questions:

  1. What are males’ perceptions of health service needs, acceptability of SBHC services, and barriers to/facilitators for SBHC use; and how does female use of SBHCs interact with male use?
  2. How do these perceptions and interactions affect actual utilization and intention to use of SBHCs by males?

We will use mixed methods of data collection following an iterative approach whereby each methodology will be used to help inform the other. Data will be analyzed and interpreted as components of a body of information to be shared with our partners in CBDHA. Initially, interviews with key informants, including educators and service providers, as well as youth of both sexes, will be conducted to explore the context of males’ use of SBHCs, providing a basis for more interviews of students of both sexes. Focus groups of youth, service providers and educators will then be used to help with interpreting these interviews. Based on this qualitative work, a self-completion survey will explore male students’ perceptions of factors related to their use of SBHCs. After all data have been analyzed we will conduct workshops with health care providers and educators to produce recommendations for policy makers based on the results. Greater understanding of factors related to males’ use of SBHCs is needed to improve care to male adolescents. The information generated by this research will be helpful locally, provincially and nationally in addressing concerns about male health care system use.

Funding provided by the Nova Scotia Health Research Foundation for $126,859 (September 2007 - August 2010).