Implementation and evaluation of the Y-Check comprehensive adolescent health check-up intervention in Zimbabwe: a pre−post mixed-methods study

Fig. 1. Y-Check intervention. Flowchart showing the participant flow and services provided during the check-up visit. aCommunity only (16–19 years). b15–19 years. cHEEADSSS, oral hygiene, sleep and epilepsy. dThird BP measurement, ear exam +/– wax removal. eOral hygiene, sleep, physical activity, mental health and nutrition. fOral care, menstrual hygiene and health (females only), and condoms (16–19 years, community only). Sh, Schistosoma haematobium; CT, Chlamydia trachomatis; NG, Neisseria gonorrhoeae; MUAC, mid-upper arm circumference; BP, blood pressure; HEEADSSS, home environment, education/employment, eating, peer-related activities, drugs, sexuality, suicide/depression and safety; TV, Trichomonas vaginalis; VMMC, voluntary medical male circumcision; HIV, human immunodeficiency virus; STI, sexually transmitted infection.

Fig. 2. Proportion (95% confidence interval) of participants screening positive for the issue who received appropriate on-the-spot care and/or completed appropriate referral before the date of the follow-up visit by issue. Data are presented for total population of n = 2,094 adolescents (n = 1,069 10–14 years, n = 1,025 15–19 years). Vertical gray lines separate issues (conditions/behaviors) by care management groups: Group 1, on-the-spot care only; Group 2, on-the-spot care with referral if necessary; Group 3, referral with or without on-the-spot care. Error bars represent 95% confidence intervals. Definitions of conditions and behaviors are provided in Supplementary Table 4.

Fig. 3. Relative difference in individual outcomes among 10–14-year-olds (n = 1,028) comparing before and after the intervention (prevalence ratio and 95% confidence interval). Prevalence ratio (PR) was derived from generalized linear models fitting population-averaged panel data, adjusted for within-location correlation. A PR greater than 1.0 indicates an improvement at follow-up. Error bars represent 95% confidence intervals (CIs). Definitions of evaluation outcomes are provided in Supplementary Table 5. CRAFFT, Car, Relax, Alone, Forget, Friends/Family, Trouble questionnaire for substance use risk in adolescents. ‘Health checks are worthwhile’ was defined as rating 5 on a scale of 1–5 in response to the question ‘How worthwhile do you think getting your health checked is?’. See Supplementary Table 3a,c for further details on each secondary outcome prevalence at baseline and at follow-up, difference in proportions and PR (95% CI).

Fig. 4. Relative difference in individual outcomes among 15–19-year-olds (n = 815) comparing before and after the intervention (prevalence ratio and 95% confidence interval). PR was derived from mixed-effects generalized linear model fitting population-averaged panel data, adjusting for the random effects of location. A PR greater than 1.0 indicates an improvement at follow-up. Error bars represent 95% CIs. Definitions of evaluation outcomes are provided in Supplementary Table 5. CRAFFT, Car, Relax, Alone, Forget, Friends/Family, Trouble questionnaire for substance use risk in adolescents. Condom use and effective contraception were asked only in sexually active adolescents in the community setting; effective contraception outcome is shown for females only. ‘Health checks are worthwhile’ was defined as rating 5 on a scale of 1–5 in response to the question ‘How worthwhile do you think getting your health checked is?’. See Supplementary Table 3b,d for further details on each secondary outcome prevalence at baseline and at follow-up, difference in proportions and PR (95% CI).

Extended Data Fig. 1. Study profile. Flowchart showing recruitment and follow-up of study participants.