The acceptability and utility of Indigenous youth health assessments: A narrative systematic review

The acceptability and utility of Indigenous youth health assessments: A narrative systematic review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The acceptability and utility of Indigenous youth health assessments: A narrative systematic review Jed Fraser, Deborah Askew, Ray Mahoney, Geoffrey Spurling This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1394523/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The time between childhood and adulthood is when an individual acquires the physical, cognitive, social, and economic resources that are foundational to health and wellbeing later in life. The psychological and physiological transitions of youth are compounded by profound transitions in social role, including those related to employment, education, and family role. Additionally, Indigenous youth are developing their cultural identity while also contending with challenges of ongoing colonisation and everyday lived experiences of racism which negatively impacts their health and wellbeing. A comprehensive assessment of Indigenous youths’ health and wellbeing could enable early diagnosis and respond to physical and mental ill health concerns. This narrative systematic review synthesizes evidence about the acceptability and utility of primary health care-based health assessments for improving the health and wellbeing of Indigenous youth. Methods: A systematic search strategy was applied to 20 electronic databases (four bibliographic and 16 grey literature). Studies were included if they reported on health assessments conducted in primary health care with youth aged 12–24 years who were Indigenous to Australia, New Zealand, Canada, United States of America (USA), Taiwan, and the arctic regions of Scandinavia and Russia. Two independent reviewers performed the study selection, quality appraisal and data extraction. A narrative synthesis was undertaken. Results: Of the 3061 unique studies identified, seven met the eligibility criteria and were included: four mixed-methods studies, two qualitative studies and one quantitative study. Included studies showed youth health assessments were useful for making new diagnoses, detecting social and emotional wellbeing concerns, and some biomedical parameters. Co-created health assessments with Indigenous youth conducted by clinicians familiar to community were well accepted. Digital health assessments administered using an electronic tablet provide advantages. No health outcomes were reported. Additionally, no health assessments addressed the impacts of colonisation and racism. Conclusion: There is insufficient evidence to make firm conclusions about benefits of health assessments; however, health assessments can be useful for detecting new diagnoses and concerns regarding social determinants of health and social and emotional wellbeing. Future development of Indigenous youth health assessments needs to involve Indigenous youth’s perspectives, ideas and, interpretations of health. Youth health assessments Indigenous: holistic primary health care appropriateness Figures Figure 1 Background Youth, the period between childhood and adulthood, is marked by significant psychological and biological development, the scale of which is second only to early childhood [ 1 , 2 ]. During this time, which we define as people aged 12–24 years, individuals acquire the physical, cognitive, social and economic resources that influence identity formation, and lay the foundation for health and wellbeing later in life [ 1 , 3 ]. Social determinants of health have a critical influence on youth health [ 4 ]. Advantageous conditions such as income, education, supportive family, social support, safe neighborhood environment and encouraging school ethos positively influence youth health [ 4 ]. Conversely, factors such as family breakdown, physical and sexual abuse, neglect, poverty, and homelessness negatively impact youth health, and particularly mental health [ 5 ]. Psychosocial issues, coupled with experimentation and risk taking that is characteristic of this time in life, make a significant and largely preventable contribution to disease burden [ 6 – 8 ]. Risk taking behaviours in youth include substance use, unprotected sexual intercourse, alcohol use, poor nutritional intake, low levels of exercise, injury, and violence, and frequently co-occur [ 9 – 11 ]. In high income countries, mental health and substance use disorders are the leading cause of morbidity in children and youth, and account for one quarter of all years living with a disability in this age group [ 12 ]. Indigenous youth go through the same psychological and physiological changes as non-Indigenous youth, and can draw on deep wells of cultural knowledge, family connection, and connection to the lands of which they are the traditional custodians [ 13 , 14 ]. However, they also contend with the impacts of ongoing colonisation including racism, cultural oppression and dispossession, forced assimilation, discrimination, and socioeconomic and political disadvantage [ 15 , 16 ]. Thus, Indigenous youth are at greater risk of psychological distress and mental health issues, which contributes to higher rates of substance misuse, violence, and suicide which, in turn, leads to even higher rates of psychological distress [ 16 ]. Primary health care (PHC) is often where Indigenous youth first link with the health system as independent agents, and therefore it has a critically important role in identifying and ameliorating psychological distress, mental illness, and risky behaviours [ 17 – 19 ]. But, youth are infrequent attenders at PHC and do not usually seek help for psychosocial issues [ 20 ] which makes each interaction an important opportunity for preventative health care or interventions for health and wellbeing concerns. Screening for mental health and risky behaviours has been associated with improvements in substance abuse, risky sexual behaviours, stress, exercise and sleep [ 21 ] and regular screening of youth for a range of health and lifestyle issues has been recommended by the American Academy of Pediatrics, and the Royal Australian College of General Practitioners [ 22 , 23 ]. PHC-based health assessments have been proposed as a mechanism to improve access to recommended regular screening and preventative healthcare for Indigenous people [ 24 ]. Health assessments, defined as a comprehensive assessment to detect and manage risk factors [ 25 ] are a common element of health care in some countries such as Australia [ 26 ], but the uptake of government funded health assessments in Australia by Aboriginal and Torres Strait Islander youth remains low [ 27 ]. Although Indigenous youth typically underutilise PHC services, a PHC-based health assessment that addresses their health priorities and is underpinned by Indigenous conceptions of health may benefit those who do use these services. This systematic review of PHC-based, Indigenous youth health assessments synthesises evidence about the utility and acceptability of PHC-based health assessments for improving the health and wellbeing of Indigenous youth. Methods We used the Joanna Briggs Institute (JBI) approach for conducting systematic narrative reviews [ 28 ] and report this review according to the Preferred Reporting Items for Systematic research and Meta-analyses (PRISMA) statement [ 29 ]. Search strategy The search strategy, developed in conjunction with a librarian experienced in systematic reviews, was constructed in three parts: the setting, the population of interest and the intervention. We searched the following databases: PubMed, CINAHL, Embase and Scopus via EBSCOHOST to identify text that contained key words in the title and abstract. The search strategy for each database is available in Table S1. We searched reference lists and forward searched the included studies for any additional studies. Keywords were used to search grey literature databases including “health check”, “health assessment” and youth. Grey literature databases and search terms are reported in Table S2. Study inclusion and exclusion Papers were included if the majority (over 50%) of participants were 12–24 years of age (inclusive), and were Indigenous to Australia (Aboriginal and/or Torres Strait Islander), New Zealand (Māori), Canada (First Nations, Inuit and Métis), United States of America (USA) (American Indian, Native Alaskan and Native Hawaiian), arctic regions of Sweden, Norway, Finland and Russia (Sάmi) and Taiwan. In addition, papers were included if they had a larger age range (e.g., 15–54 years of age), but the paper specifically reported on youth. Papers that included non-Indigenous and Indigenous populations within the age range were included if data on Indigenous youth were presented separately. We did not exclude papers based on language and considered both published and unpublished studies. A ‘health assessment’ was defined as a comprehensive and holistic review of an Indigenous youth’s health, and therefore, only studies reporting on health assessments that covered a minimum of two health domains (multidomain) were included. Here, domains were defined as a single social determinant of health, mental health condition or biomedical measure involving a single bodily system. Studies were included where health assessments were conducted in PHC, or in other settings if overseen by PHC services. For example, a health assessment undertaken at a community event or school and facilitated by PHC service staff was considered for inclusion. Studies using primary research methods to investigate use of an Indigenous youth health assessment were eligible for inclusion. Papers that failed to meet the inclusion criteria were excluded from the analysis. Study selection Peer-reviewed papers detected using database searching were imported to the bibliographic software Endnote 20 (Clarivate Analytics; Philadelphia, USA) by one reviewer (JF) and duplicates removed. Studies were then assessed for inclusion based on title and abstracts by two reviewers (JF and GS). The full text publications of potentially eligible papers were then retrieved and assessed against the inclusion criteria in accordance with the PRISMA statement [ 29 ]. Any inconsistencies or disagreements were discussed and resolved by the reviewers. Study quality assessment Papers selected for inclusion were assessed using the Mixed Methods Appraisal Tool [ 30 ](Table S3). The same two reviewers (JF and GS) who conducted the study selection also independently reviewed included studies using the appropriate critical appraisal tools. Again, disagreements between the reviewers were resolved through discussion. Studies were not excluded based on quality appraisal. Data extraction strategy The data extraction tool was customised and piloted to ensure information, extracted independently by JF and GS, responded to the review’s aims. The extracted data included: (1) study type; (2) countries and settings where studies were conducted; (3) setting in which the health assessments were administered; (4) participant demographics; (5) description of the health assessment and who administered it; and (6) effectiveness of the health assessment (total mortality, hospitalisation, disability, new diagnosis, morbidity and quality of life, referrals, follow up, brief intervention, and social and cultural determinants of health). Data synthesis and presentation Due to the heterogeneity of the included studies, meta-analysis was not appropriate. Instead, we conducted a narrative synthesis of the extracted data, analysed according to this review’s research aims. Results Study selection Initial searching yielded 3352 records. Once duplicates were removed, we reviewed the titles and abstracts of 3061 studies, and of these, 28 full-text articles were retrieved for further review and seven met the inclusion criteria [ 5 , 31 – 36 ]. The study selection process is detailed in the PRISMA flow diagram (Fig. 1 ). Study characteristics Characteristics of included studies are presented in Table 1. Four mixed methods [ 31 – 33 , 35 ] two qualitative studies [ 5 , 34 ] and one quantitative study [ 36 ], published from 2014 to 2019, were included. Four studies were conducted in Australia [ 5 , 32 , 33 , 36 ], two in New Zealand [ 31 , 35 ] and one in the USA [ 34 ]. The health assessments were conducted within PHC services in the four Australian studies [ 5 , 32 , 33 , 36 ], the two New Zealand studies used high schools with co-located PHC clinics [ 31 , 35 ], whilst the American study was led by the San Diego American Indian Health Center [ 34 ]. Health Domains Included studies measured quality of life, social and cultural determinants of health, and various biomedical measures (Table 1). Regarding quality of life measures, only Barraza et al. [ 34 ] reported quality-of life measures using qualitative data. This study reported a health assessment which helped youth learn about their inner self and how to obtain mental, physical, emotional and spiritual balance, and set health goals [ 34 ]. No studies reported assessing quality of life using quantitative measures. The two New Zealand studies used YouthCHAT which measured social and cultural determinants of health, including smoking, gambling, alcohol or other substance misuse, depression, anxiety, exposure to abuse, physical inactivity, problems at home and safety (Table 1) [ 31 , 35 ]. Four studies used a Young Person’s Check (YPC) to measure biomedical domains of health including medical history, physical examination, pathology testing for routine biochemistry or haematology, sexual health screening, mental health, viral hepatitis serology, strongyloides serology, body mass index, glucose and lipid profile, urinary albumin creatine ratio, temperature, teeth status, hearing health status, and skin assessment [ 5 , 32 , 33 , 36 ]. Administration of health assessments Youth health assessments were administered in a variety of different ways. Included studies reported on health assessments administered by Indigenous Health Workers [ 5 , 32 , 33 , 36 ], nursing staff [ 31 – 33 , 35 , 36 ], general practitioners [ 33 , 35 ], and one study was wholly self-administered [ 34 ] (Table 1). More than half of the health assessments were administered using digital technology (four out of seven) whereby youth inputted data using either a desktop computer in one study [ 5 ] or electronic tablets [ 31 , 33 , 35 ] (Table 1). The studies from New Zealand used a self-administered assessment on an electronic tablet that provided a summary of issues to the nurse and/or doctor for reference during the subsequent consultation [ 31 , 35 ]. The four Australian studies all utilised Aboriginal Health Workers to administer the health assessments [ 5 , 32 , 33 , 36 ] and one also used a nurse and a Life Promotion Officer to administer the aPHQ-9, a screening tool for psychological distress [ 32 ]. The Maari Ma Health Aboriginal Corporation used a self-administered health assessment delivered using an electronic tablet with a Youth Health Worker available for support [ 33 ]. Fagan et al. reported using four to six team members including district health staff and public health nurses to deliver health assessments [ 36 ]. Two of the seven studies administered the health assessment using pen and paper: one of these was completed by the youth [ 34 ], and the other by health professionals [ 32 ]. Table 1. Characteristics of included studies Citation Indigenous people & Country Study objective Study Design Sample size, age range Setting Health Domains Who conducted the health assessment Thabrew et al 2019 [31] Māori youth; New Zealand To compare the performance and acceptability of YouthCHAT with HEEADSSS 1 Mixed methods: RCT 3 and qualitative study. 129 high school students aged 13-14 years PHC 2 clinic co-located in a high school Smoking, drinking alcohol, recreational drugs, HEAADSSS 1 , depression. Nurse Harris et al 2018 [32] Aboriginal and Torres Strait Islander youth; Australia To describe the 2016 Young Person’s Check (YPC 4 ) event and to determine the prevalence of depressive symptoms in young people Mixed methods: cross-sectional with youth & qualitative study with PHC service staff. 350 youth aged 13-25 years PHC 2 service Mental health, physical health including clinical measures and health risk behaviours. Aboriginal Health Worker, nurse, Health Promotion Officer. Maari Ma Corporation 2018 [33] Aboriginal youth; Australia To determine the acceptability of the TickiT psychosocial assessment tool Mixed methods: cross-sectional & qualitative interviews with youth & clinic staff. 78 youth aged 12-18 years completed the TickiT during their annual youth health check; 11 youth were interviewed PHC 2 service Psychosocial, biomedical health and health risk behaviours. Aboriginal Health Worker, nurse, General Practitioner. Goodyear-Smith et al 2016 [35] Māori youth; New Zealand To assess the utility and acceptability of YouthCHAT program for youth and health service staff and build a framework for subsequent roll-out. Mixed methods: cross-sectional and focus groups & interviews with youth & staff 30 youth aged 12-18 years PHC 2 clinic co-located in a high school Sexual health, substance use/misuse, mental health, gambling, exposure to abuse, anger control and physical activity. Nurse and doctor Barraza 2016 [34] Native American youth: USA To develop and pilot a strength-based, holistic, and youth-friendly self-assessment tool grounded in the medicine wheel. Qualitative study with focus groups 70 youth aged 12-17 years Health Center. Fresno Mental, physical, emotional, and spiritual health. Self-administered Nori et al 2013 [5] Aboriginal youth; Australia To develop and implement an evidence-informed, culturally valid Aboriginal & Torres Strait Islander Youth Health Check & an accompanying Youth Health Audit tool. Qualitative study with focus groups 30 youth aged 12-24 years. Urban, rural, and remote settings Social and emotional wellbeing, clinical assessment. Aboriginal Health Worker Fagan et al 2013 [36] Aboriginal and Torres Strait Islander youth; Australia To describe the implementation and selected outcomes of the YPC 4 . Cross-sectional 3083 youth aged 15-24 years PHC 2 service Sexually transmitted infections, body mass index, blood glucose and lipid profile, urinary albumin creatine ratio. Aboriginal Health Worker, district health staff, public health nurses 1 HEEADSSS = Home, education, eating, activities, drugs and alcohol, suicide and depression, sexuality, and safety assessment 2 PHC = Primary Health Care 3 RCT = Randomised Controlled Trial 4 YPC = Young Person’s Check Risk of Bias within included studies The methodological quality of studies was analysed by study design and the quantitative and qualitative components of the mixed methods studies were assessed separately in addition to assessing the study as a whole [ 30 ] (Table 2). Although many included studies had methodological limitations, none were excluded based on methodological quality. Four studies lacked a clear statement of the research aims and research question rendering it difficult to determine the appropriateness of the study design [ 5 , 32 , 34 , 36 ]. Cross-sectional data relevant to this review were extracted from a cohort study, and while this study did not address confounding factors, it was otherwise judged to have low risk of bias [ 36 ]. Two cross-sectional studies also did not identify confounding factors or use strategies to deal with confounding factors [ 32 , 35 ] (Table 2). The quantitative component of the Maari Ma study used a cross-sectional design [ 33 ]. There were relatively fewer youth aged 15–18 years, compared to youth aged 12–14 years. Therefore, older age groups are likely to be underrepresented raising concerns of bias [ 33 ]. The study by Harris et al. [ 32 ] included 40% of the population of Aboriginal youth in Yarrabah, Australia, attending the Young Person’s Check (YPC) with smaller numbers completing the depression screen [ 37 ]. There was no further information about those who did not attend the YPC, therefore, we were unable to evaluate responder bias for this study [ 32 ]. The single randomised controlled trial (RCT) was found to be low risk of bias notwithstanding a lack of blinding for participants and for researchers conducting the health assessment [ 31 ] (Table 2). All but one [ 36 ] of the included studies used qualitative methods, and the critical appraisal for each study is shown in Table 2. Three of the included studies satisfied all criteria [ 31 , 33 , 35 ] whereas the other studies lacked methodological rigor [ 5 , 32 , 34 ]. Furthermore, authors of these studies did not culturally position themselves in the research. Three of the four mixed methods studies were considered to have high methodological rigor [ 31 , 33 , 35 ], but one study scored lower owing to concerns about the reporting of their qualitative components [ 32 ]. Risk of bias across all included studies Of the seven studies, most had methodological weaknesses, and therefore caution is needed when interpreting the results. This review included no studies from Canada, Indigenous Taiwanese, or the Sámi people. Four of the seven studies were from Australia [ 5 , 32 , 33 , 36 ], most likely because the Australian Government funds Aboriginal and Torres Strait Islander health assessments annually through the Medicare Benefits Schedule across the life course where the other countries do not. Therefore, the included studies did not represent all the populations of interest. Furthermore, most studies included small numbers of participants, and most studies did not have a clear research question (four out of seven) [ 5 , 32 , 34 , 36 ]. Key findings of included studies We found a diversity of health assessments which were developed in different ways for specific communities, adapted from previously developed tools, and with varying levels of co-creation with youth including Indigenous youth. We report outcomes regarding the detection of new diagnoses, morbidity and social determinants of health. We also report the key qualitative findings from included studies. None of the included studies reported on the impact of the health assessment on health outcomes. New diagnosis and morbidity New diagnosis was an outcome measure in four of the seven studies (Table 3 ). Sexually transmitted infections (STIs) were newly diagnosed in 547/3083 participants (18%) in one study [ 36 ] and in 11/30 participants (37%) in another study [ 35 ]. Thabrew et al. reported new diagnoses of problems with eating or weight were reported in 70/110 participants (63%), physical inactivity in 43/110 participants (39%) and concerns about sexual health in 24/110 participants (22%) [ 31 ]. Harriss et al. reported new diagnoses of psychological distress in 42/350 participants (24%) [ 32 ] (Table 3 ).Goodyear-Smith et al. [ 35 ] found 6/30 participants (20%) had depression and 11/30 (37%) had anxiety. Thabrew et al. [ 31 ] reported 11/110 participants (10%) with depression and anxiety. Social determinants of health The proportions of youth affected by social determinants of health, presented in Table 3 , were measured by the two New Zealand studies using the Home, Education, Eating, Activities, Drugs and alcohol, Suicide and depression, Sexuality, and Safety assessments (HEEADSSS) and/or YouthCHAT tools [ 31 , 35 ]. Table 3 New diagnoses, morbidity, and social determinants of health measured in the included studies. Citation New Diagnoses Physical and/or psychological ill-health Social determinants of health Illness n/N (%) Social determinant n/N (%) Fagan et al., 2013 [ 36 ] STIs 547/3083 (18%) Not measured Harriss et al., 2018 [ 32 ] Psychologic distress (moderate to severe) 42/350 (24%) Not measured Thabrew et al., 2019 [ 31 ] Problems with eating or weight Substance misuse: YouthCHAT 70/110 (64%) YouthCHAT 10/110 (9%) HEEADSSS 1 25/110 (23%) HEEADSSS 1 10/110 (9%) Mental distress: Problems at home: YouthCHAT 11/110 (10%) YouthCHAT 30/110 (27%) HEEADSSS 1 30/110 (27%) HEEADSSS 1 29/110 (26%) Sexual health: Safety: YouthCHAT 24/110 (22%) YouthCHAT 65/110 (59%) HEEADSSS 1 10/110 (9%) HEEADSSS 1 17/110 (15%) Physical Inactivity: YouthCHAT 43/110 (39%) HEEADSSS 1 21/110 (19%) Goodyear-Smith et al., 2016 [ 35 ] STIs 11/30 (37%) Smoking 13/30 (43%) Depression 6/30 (20%) Gambling 3/30 (10%) Anxiety 11/30 (37%) Using alcohol or other drugs 23/30 (77%) Exposure to abuse 5/30 (17%) 1 Home, education, eating, activities, drugs and alcohol, suicide and depression, sexuality, and safety assessment Quantitative synthesis None of the quantitative indicators measured strengths. Four studies reported new diagnoses which were detected in 17%-90% of health assessments, and these diagnoses represented morbidity in the form of psychological distress, STI’s and substance use (Table 3 ) [ 31 , 32 , 35 , 36 ]. Two included studies reported on social determinants of health including substance use, gambling, exposure to abuse, concerns about safety and problems at home (Table 3 ) [ 31 , 35 ]. Qualitative synthesis Included studies with a qualitative component used interviews and focus groups to ask staff and youth their views on the acceptability of youth health assessments [ 5 , 31 – 35 ]. Key areas of importance to youth and staff included descriptions of co-creation of health assessments with Indigenous youth and staff; the importance of the type of health professionals administering the health assessment; using an electronic tablet and; the addition of a ‘help question’. Health assessment development The health assessments used in the included studies were either co-created with Indigenous youth [ 5 , 34 ], youth in general [ 31 , 35 ], or community members [ 32 , 36 ] (Table 4 ). Barraza et al. conducted focus groups with Indigenous youth to co-create a self-assessment tool [ 34 ]. Nori et al. facilitated eight community meetings with Aboriginal youth to co-create a health assessment that was youth friendly, and culturally valid and specific [ 5 ]. Key health factors identified by the youth included cultural connection, concerns about safety, sexual health, social and emotional wellbeing, smoking and substance use. Youth who participated in the implementation of the health assessment found it to be acceptable and important with no dissatisfaction [ 5 ]. Two other studies reported on the co-creation of health assessments with an uncertain number of Indigenous youth [ 31 , 35 ]. The study by Goodyear-Smith et al. adapted YouthCHAT from the generic eCHAT health assessment through input from, and piloting by, adolescents over approximately nine months [ 35 ]. Clinic staff asked for modifications of YouthCHAT, including the addition of sexual health questions [ 35 ]. The study conducted by the Maari Ma Health Aboriginal Corporation [ 33 ] relied on the TickiT assessment which is a HEEADSSS assessment on an electronic tablet. TickiT was deployed in Broken Hill, Australia, but developed with young non-Indigenous people in Canada [ 33 ]. Two health assessments conducted in Far North Queensland, Australia, were developed specifically for Indigenous youth without documented consultation or co-design with youth [ 32 , 36 ]. The study by Fagan et al. reported that the local Public Health Unit were interested in targeted STI screening for Aboriginal and Torres Strait Islander youth with a subsidiary aim of screening for chronic diseases [ 36 ]. Harriss et al. reported on a health assessment conducted in the Aboriginal community of Yarrabah where, responding to community concerns, the health assessment was expanded in 2014 to include mental health. The health service collaborated with researchers to trial the inclusion of a depression screen, the aPHQ-9 [ 32 ]. Digital technology for administering health assessments using electronic tablets Four studies, using self-administered digital technology for the administration of the health assessment, reported that youth found the apparent privacy and confidentiality enabled by this approach increased their willingness to disclose sensitive information regarding body weight, sexual health, and safety concerns like bullying and violence [ 5 , 31 , 33 , 35 ]. For clinicians, health assessments using digital technology with electronic tablets led to quicker administration and assisted subsequent face-to-face questions. YouthCHAT, administered via an electronic tablet was unanimously supported by clinicians and youth [ 31 , 35 ]. YouthCHAT helped youth identify health issues and discuss these with their doctor. Clinicians felt that YouthCHAT was acceptable to youth because it was electronic and reinforced their privacy [ 35 ]. The study by the Maari Ma Health Aboriginal Corporation, 2018, also reported positive results for youth disclosing health information using self-administered digital technology with nine of the 11 youth interviewed in this study feeling comfortable answering questions using TickiT [ 33 ]. Nori et al. used both a digital and paper-based health assessment template [ 5 ]. The digital health assessment was completed on a computer by the youth with assistance available from a health professional or carer [ 5 ]. Without exception, youth preferred the digital version of the health assessment, and especially preferred options like tick boxes rather than open-ended written text boxes [ 5 ]. These results are consistent with findings from Goodyear-Smith et al. who found that health screening provided consistent results, lead to more disclosure, reduced staff time, and allowed youth to structure thoughts and prioritise the issues they wanted help with [ 35 ]. Barriers to digital health assessments included concerns around connectivity [ 31 , 33 ], internet speed [ 33 ], and literacy and language [ 5 , 31 , 33 , 35 ]. Help question findings The YouthCHAT studies utilised a ‘help question’ that asked youth if they wanted help today or in the future for each domain screened [ 31 , 35 ].The ‘help question’ supports the conversation between the youth and the clinician about health issues that the youth would like to be addressed and facilitates shared decision making [ 31 ]. In addition, Goodyear-Smith et al. (2016) reported that the help question allowed the youth to request intervention for detected health issues without the potential awkwardness of face-to-face dialogue [ 35 ]. Acceptability Overall, the health assessments were generally well accepted (Table 4 ). Youth in the study by Barraza et al. described the self-administered health assessment as positive, fun, and enjoyable, and different to what they normally experienced in health and prevention programs. They felt that it helped them learn what area of health they need to improve on [ 34 ]. Nori et al. found that youth and community members found the health assessment to be acceptable and important, with no disapproval around discussions of cultural connections, safety concerns, sexual health, social and emotional wellbeing, smoking and substance use [ 5 ]. In addition, the youth believed that health professionals administering the health assessment should be upfront when asking questions in these domains, but be respectful and mindful of cultural taboos, and ensure confidentiality [ 5 ]. The key areas identified by Goodyear-Smith et al. suggest that the youth liked that the self-administered YouthCHAT kept them busy in the waiting room and gave them time to reflect on their responses [ 35 ]. Māori youth found this health assessment acceptable, and they felt clinicians knew what their health concerns were before walking through the consultation door [ 35 ]. Furthermore, clinicians felt it was easier to facilitate discussions and identify health concerns because youth had made this information available through the health assessment [ 35 ]. Thabrew et al. compared acceptability of YouthCHAT and HEEADSSS for youth and three school nurses [ 31 ]. After completing the two health assessments a subset of youth completed an acceptability survey on paper, and interviews were conducted with the three school nurses [ 31 ]. The results from 21 youth surveys indicated that both self-administered YouthCHAT and self-administered HEEADSSS were equally acceptable. However, nurses found YouthCHAT easier to answer in digital format, faster to administer than HEEADSSS, provided more health information and helped with subsequent answering of face-to-face questions [ 31 ]. The study at the Maari Ma Health Aboriginal Corporation used TickiT. All youth health clinic staff reported that self-administered TickiT was acceptable and appropriate for Aboriginal youth in Broken Hill [ 33 ]. Most youth were able to answer the questions on the electronic tablet without any assistance and the evaluation found that TickiT had strong acceptability from staff and Aboriginal youth [ 33 ]. Harriss et al. reported an evaluation of a Young Persons’ Check (YPC) in Yarrabah, Australia with the added mental health screening. The addition of the aPHQ-9, a psychological distress tool which was later adapted to the ‘Yarrabah aPHQ-8’ was well-accepted by staff and participating youth [ 32 ]; however, only 35% of youth completed the screening tool suggesting that there were barriers to the deployment of this screening tool [ 32 ]. Table 4 Qualitative synthesis Study (date) Development of Health Assessment Acceptability Thabrew 2019 [ 31 ] Consultation with youth Self-administered YouthCHAT and self-administered HEEADSSS 1 well accepted digitally and paper-based form respectively. Harriss 2018 [ 32 ] Consultation with community and health workers. There were concerns about the acceptability of the ninth question in the aPHQ-9 2 . The YPC along with the aPHQ-8 3 was acceptable. Maari Ma (Corporation, 2018) [ 33 ] Selected tool had been developed in consultation with Canadian youth. Aboriginal youth in Broken Hill were not consulted about its use The paper-based health assessment and self-administered TickiT assessment delivered by electronic tablets were well accepted Goodyear-Smith 2016 [ 35 ] Consultation with youth The self-administered YouthCHAT assessment delivered by electronic tablet was well accepted. Barraza 2016 [ 34 ] Co-creation with Native American youth The paper-based self-assessment tool was well accepted and enjoyable. Nori 2013 [ 5 ] Co-creation with Aboriginal youth Youth preferred the digital version of the Youth Health Check compared to the paper-based version. 1 Home, education, eating, activities, drugs and alcohol, suicide and depression, sexuality, and safety assessment 2 Adapted Patient Health Questionnaire – 9 3 Yarrabah Adapted Patient Health Questionnaire − 8 Discussion Main findings Health assessments for Indigenous youth have been studied in three countries: Australia (four studies) [ 5 , 32 , 33 , 36 ]; New Zealand (two studies) [ 31 , 35 ] and the USA (one study) [ 34 ]. Youth health assessments were most frequently used to detect psychological distress, sexual health concerns, and adverse social determinants of health. One health assessment measured strengths including how youth could find life balance according to an adapted Medicine Wheel [ 34 ]. None of the included studies measured health outcomes following administration of the health assessment. Cultural identity, impacts of colonisation and experience of racism, while being critical to health and wellbeing of youth, were absent in the health assessments. Health assessments were conducted using both paper-based and digital technology. Digital technology was preferred owing to youth often being familiar with electronic tablets, the opportunity to respond to sensitive health questions in private (self-administration), and quicker health assessment administration with real time information accessible to the clinician [ 5 , 31 , 35 ] compared to paper-based assessment. However, health assessments delivered using digital technology also presented problems with internet connectivity and language especially when youth completed digital health assessment templates without support [ 35 ]. Generally, youth health assessments were well accepted. However, the only youth health assessment which was described as enjoyable by youth was also the only health assessment to measure strengths [ 34 ], and was one of only two health assessments co-created with Indigenous youth [ 5 , 34 ]. Strengths and weaknesses of the study To our knowledge, this is the first review of the characteristics, utility, and acceptability of Indigenous youth health assessments. The search strategy for this review involved a thorough search of online databases and grey literature, instilling confidence that relevant studies were not missed. Another important strength of this review is its authorship by an Indigenous young person (JF), so all the included data have been analysed and reported through this lens (Box 1). Limitations of this review include the sparsity of literature from the target countries. Six of the seven included studies were from Australia and New Zealand with no studies meeting inclusion criteria from Canada, Taiwan or the arctic region Sami people, limiting generalisability of findings. Of the included studies, many had significant methodological and reporting limitations including a majority lacking a reported research question. There was heterogeneity of included studies regarding populations studied, health assessments used, and the domains of health that were assessed. While this heterogeneity gives insights into various approaches to youth health assessments, it is difficult to draw definitive conclusions. Some studies did not report on effectiveness outcomes at all, and none measured health outcomes following a health assessment. In addition, none of the included studies reports on the impacts of colonisation and racism. Finally, only one of the youth health assessments evaluated strengths. Systematic reviews of health assessments Previous systematic reviews of health assessments for whole populations reported on the value of health assessments for reducing morbidity and mortality. One such high quality review, published in 2007, included 23 observational studies and 10 RCTs [ 38 ]. Boulware et al. found that health assessment had benefits in some clinical services and reduced patient worry, but no conclusions could be drawn about their effectiveness for reducing mortality [ 38 ]. A Cochrane systematic review of health assessments, published in 2012, included 16 RCTs and over 180,000 participants from a number of different countries and found no benefit for morbidity and mortality [ 39 ]. Krogsbøll et al. credibly recommended against routine health assessments in healthy adults aged under 65 years [ 39 ]. However, reviews of health assessments conducted in general practice [ 25 ] have found tangible benefits such as improvements in some cardiovascular risk indicators [ 25 ]. While this review has limitations owing to the limited numbers and quality of included studies and cannot make conclusions about the effectiveness of health assessments for reducing morbidity or mortality in Indigenous youth, it is the only systematic review of health assessments for Indigenous youth and provides useful insights regarding what is acceptable and useful for Indigenous youth. Meaning of the study: possible mechanisms and implications for clinicians or policymakers This review has identified that health assessments specific to young Indigenous people can provide an opportunity to document their strengths, identify concerns regarding their social and emotional wellbeing, identify risk factors for chronic disease, and identify challenging social determinants of health. Early intervention and prevention strategies for youth can substantially improve the outlook of youth health [ 40 ]. For health professionals to provide appropriate intervention, assessments must give an accurate and holistic picture of the young person and their life [ 41 ]. Involvement of Indigenous youth in the co-creation of health assessment increased their acceptability. Health assessments were more acceptable when co-created with Indigenous youth, when they are self-administered or administered by Indigenous clinicians known to the participants compared to administration by non-Indigenous clinicians not known to the community. Digitalised self-administered health assessments may facilitate disclosure of challenging, personal and sensitive information about self-harm, emotional wellbeing, sexual health and substance use compared with a paper-based template completed with a clinician [ 42 ]. Furthermore, self-administered questionnaires may increase youth confidence that confidentiality will be respected. Importantly, if youth feel safe enough to disclose sensitive health information it can allow for early intervention, prevention strategies and referrals. Conversely, when youth have confidentiality concerns about a health service, they are less likely to seek care which can negatively impact their health [ 43 ]. Indigenous youth have criticised appropriation of cultural knowledge by the health system where there has not been local community input and the diversity of Indigenous cultures have not been sufficiently accounted for [ 44 ]. Health assessments should be able to be implemented or adapted into a more culturally appropriate tool for assessing youth health, but also rigorous enough to ensure they are measuring intended health domains. This recommendation also highlights the importance of building trusting relationships between the clinician and the youth [ 45 – 47 ], and how vital the Indigenous health workforce is for Indigenous peoples [ 48 , 49 ]. Policy makers need to support the co-creation and evaluation of Indigenous health assessments specifically for youth. For example, the Royal Australian College of General Practitioners has now published a health assessment template specifically for young Aboriginal and Torres Strait Islander people following consultation, and it is promoted on the Australian Department of Health Website [ 50 ]. The health assessment is only the first step in providing care [ 51 ] – improvements in health outcomes requires appropriate funding and services to support management and follow up of identified issues and concerns [ 52 ]. Inquiring about intimate health issues raises patient expectations and requires the health service to respond [ 51 ] because not responding could perpetuate more harm than not screening at all [ 53 ]. Conclusion This review demonstrates that primary health care-based health assessments can be an acceptable and useful means of documenting strengths, risk factors and social determinants of health concerning Indigenous youth; however, no data on health outcomes following health assessments were reported. There was limited research regarding Indigenous youth health priorities and Indigenous youth views on health assessments. Acceptability of health assessments for Indigenous youth was most likely when they were co-created with Indigenous youth, adapted to local community needs, delivered by Indigenous Health Workers familiar with Indigenous youth, and used a combination of self-administered digital technology and face to face contact. Research assessing the feasibility and effectiveness of Indigenous youth health assessments is also required. Future research could also focus on appropriate self-administered digital technology to facilitate Indigenous youth health assessments. In addition, research focusing on youth health priorities and what youth want and expect from primary health care would be benefit for Indigenous youth health assessments. Box 1 Author’s narrative (JF) As a proud Aboriginal youth, with connections with the Bidjara and Mandandanji nations from South Western Queensland on the continent known as Australia and the lead author of this review, there were moments that resonated with me. In today’s society, there are growing concerns about racism, mental health, and behavioural risk issues for Indigenous youth; however, these needs are not being met, particularly in the mainstream public and primary health care systems. I have been to primary health care services for the Australian government’s annual Indigenous health assessments; however, I believe currently they don’t meet health needs of youth. For young Aboriginal and Torres Strait Islander people accessing primary health care there is already associated stigma. You are either accessing health care because you’re “womba” (something wrong with your head or crazy e.g., mental illness) or for a STI check. This stigma is exacerbated via the reports, journal articles and strategies that focus on the deficit-based statistics of young Aboriginal and Torres Strait Islander people. The current health assessment should shift to a health assessment that is driven by youth self-determination, and that meets their health needs. I understand the need to screen for biomedical factors, but there is limited screening on cultural and gender identity, impacts of racism and the social determinants of health. A health assessment that identifies these risks, but importantly identifies strengths of youth can reinforce self-determination and assist with exercising sovereignty. Co-creating and implementing a health assessment with youth can assist with identifying the factors that youth find important along with clinicians’ expertise for the biomedical factors that are also important. However, health assessments and screening are only the first step. There needs to be infrastructure, resources and services implemented in primary health care to which youth can be referred when a problem is identified, along with follow up. An example could be a young person questioning their identity. Having a place or somewhere to go to such as Elders or other young Indigenous people to talk to can help that young person navigate their identity which can be a strength for their health and wellbeing. The health assessment should be holistic and be underpinned by the Indigenous conceptions of health rather than focusing on just the biomedical components of health. This can include identifying the strengths in the community where the primary health care service can refer to for cultural support. As an Aboriginal youth, I can see the benefits of an e-health assessment particularly for privacy and disclosing health information. Having a digital health assessment that is holistic, comprehensive and is based on youth health priorities could be a beneficial way for youth to engage with primary health care. In addition, the ‘help question’ that YouthCHAT utilises could be a strategy to encourage youth to ask questions about their health concerns. Generally, I would not go to primary care unless there is something I want to get checked. Therefore, having the ‘help question’ allows the individual to ask for the specific health issue as well as doing it privately. In conclusion, I can see the potential benefits of an Indigenous youth health assessment and support the idea of that being in a digital format. However, youth should be involved in the development of health assessments as youth know their health the best and can ensure that the assessment meets youth health priorities. Declarations Ethics approval and consent to participate Ethics approval was not sought as no primary data was collected. This study is a systematic review of existing research. Consent for publication Not applicable. Availability of data materials Data for this project is stored at the Australian e-Health Research Centre (AeHRC)- Commonwealth Scientific and Industrial Research Organisation (CSIRO). Surgical, Treatment and Rehabilitation Service (STARS) building, 246 Herston Road, Herston, Queensland, Australia, 4029. Competing interests The authors declare that they have no competing interests. Funding This work was supported by the National Health and Medical Research Council (NHMRC) Emerging Leader Fellowship grant (APP1173857). Author’s contributions JF: designed the search terms with a university librarian; conducted a systematic literature search; conducted title and abstract screen, full text screen, data extraction; conducted literature review; data analysis; led the writing of the manuscript, prepared figures and references. DA: reviewed drafts of manuscript; edited manuscript, prepared figures and tables, and edited references. RM: edited manuscript, provided cultural oversight of the study. GS: conducted a systematic literature search; conducted title and abstract screen, full text screen, data extraction; conducted literature review; data analysis, prepared tables and edited manuscript. Acknowledgements Lars Eriksson (Academic Liaison Librarian) from the University of Queensland. Author’s information 1 The University of Queensland. General Practice Clinical Unit. Surgical Treatment and Rehabilitation Service (STARS), 296 Herston road, Herston, QLD, 4059. [email protected] 2 The University of Queensland. General Practice Clinical Unit. Level 8, Health Sciences Bl, Building (16/910), RBWH ,Herston Qld 4029 Australia. [email protected] 3 CSIRO. Surgical Treatment and Rehabilitation Service (STARS), 296 Herston road, Herston, QLD, 4059. [email protected] 4 The University of Queensland. General Practice Clinical Unit. Level 8, Health Sciences Bl, Building (16/910), RBWH , Herston Qld 4029 Australia. [email protected] References Patton GC, Sawyer SM, Santelli JS, Ross DA, Afifi R, Allen NB, Arora M, Azzopardi P, Baldwin W, Bonell C. Our future: a Lancet commission on adolescent health and wellbeing. The Lancet 2016, 387:2423–2478. Viner RM, Ozer EM, Denny S, Marmot M, Resnick M, Fatusi A, Currie C. Adolescence and the social determinants of health. The Lancet 2012, 379:1641–1652. Azzopardi P, Blow N, Purcell T, Brown N, Ritchie T, Brown A. Investing in the health of Aboriginal and Torres Strait Islander adolescents: a foundation for achieving health equity. Med J Aust 2020, 212:202–204. e201. Currie C, Zanotti C, Morgan A, Currie D, De Looze M, Roberts C, Samdal O, Smith OR, Barnekow V. Social determinants of health and well-being among young people. Health Behaviour in School-aged Children (HBSC) study: international report from the 2009, 2010:271. Nori A, Piovesan R, O'Connor J, Graham A, Shah S, Rigney D, McMillan M, Brown N. 'Y Health-Staying Deadly': an Aboriginal youth focussed translational action research project. Australian Primary Health Care Research Institute (APHCRI), The Australian National University 2013. Steinberg L. A social neuroscience perspective on adolescent risk-taking. Developmental Review 2008, 28:78–106. Pehlivan N, Brown E, Sanchez AYA, McMillan F, Moore D, Bhaduri A, Monson K, Badcock P, Thompson K, Killackey E. What impact does illness severity have on the sexual health of young people affected by mental health disorders? A comparison of inpatients and outpatients. Australasian Psychiatry 2020:1039856220960373. Dick B, Ferguson BJ. Health for the world's adolescents: a second chance in the second decade. J Adolesc Health 2015, 56:3–6. Patton GC, Coffey C, Cappa C, Currie D, Riley L, Gore F, Degenhardt L, Richardson D, Astone N, Sangowawa AO. Health of the world's adolescents: a synthesis of internationally comparable data. The Lancet 2012, 379:1665–1675. Patton GC, Olsson CA, Skirbekk V, Saffery R, Wlodek ME, Azzopardi PS, Stonawski M, Rasmussen B, Spry E, Francis K. Adolescence and the next generation. Nature 2018, 554:458–466. Catalano RF, Fagan AA, Gavin LE, Greenberg MT, Irwin Jr CE, Ross DA, Shek DT. Worldwide application of prevention science in adolescent health. The Lancet 2012, 379:1653–1664. Erskine H, Moffitt TE, Copeland W, Costello E, Ferrari A, Patton G, Degenhardt L, Vos T, Whiteford H, Scott J. A heavy burden on young minds: the global burden of mental and substance use disorders in children and youth. Psychol Med 2015, 45:1551–1563. Haswell MR, Blignault I, Fitzpatrick S, Jackson Pulver L: The social and emotional wellbeing of Indigenous youth: Reviewing and extending the evidence and examining its implications for policy and practice. NSW, Australia: Muru Marri, School of Public Health and Community Medicine, UNSW; 2013. Tremblay M, Baydala L, Littlechild R, Chiu E, Janzen T. Promoting the strengths and resilience of an Indigenous community through photovoice. Paediatr Child Health 2018, 23:247–254. Gracey M, King M. Indigenous health part 1: determinants and disease patterns. The Lancet 2009, 374:65–75. Australian Indigenous HealthInfoNet.Children & young people 2020.[ https://healthinfonet.ecu.edu.au/learn/health-topics/healing/children-young-people/] . Accessed 8th Aug; 2020. Tylee A, Haller DM, Graham T, Churchill R, Sanci LA. Youth-friendly primary-care services: how are we doing and what more needs to be done? The Lancet 2007, 369:1565–1573. Wilson CJ, Rickwood D, Deane FP. Depressive symptoms and help-seeking intentions in young people. Clinical Psychologist 2007, 11:98–107. Zieve GG, Richardson LP, Katzman K, Spielvogle H, Whitehouse S, McCarty CA. Adolescents’ perspectives on personalized e-feedback in the context of health risk behavior screening for primary care: qualitative study. J Med Internet Res 2017, 19:e261. Bailey V, Baker A, Cave L, Fildes J, Perrens B, Plummer J, Wearring A: Mission Australia’s 2016 youth survey report. Mission Australia; 2016. Webb MJ, Kauer SD, Ozer EM, Haller DM, Sanci LA. Does screening for and intervening with multiple health compromising behaviours and mental health disorders amongst young people attending primary care improve health outcomes? A systematic review. BMC Fam Pract 2016, 17:1–12. American Academy of Pediatrics: Bright futures: guidelines for health supervision of infants, children, and adolescents . 4th ed. edn. Elk Grove Village, IL: National Center for Education in Maternal and Child Health and Georgetown University; 2008. Royal Australian College of General Practitioners: Guidelines for preventive activities in general practice. 9th Ed edition. East Melbourne, Vic: Royal Australian College of General Practitioners; 2016. Mayers NR, Couzos S. Towards health equity through an adult health check for Aboriginal and Torres Strait Islander people. Med J Aust 2004, 181:531–532. Si S, Moss JR, Sullivan TR, Newton SS, Stocks NP. Effectiveness of general practice-based health checks: a systematic review and meta-analysis. BJGP 2014, 64:e47-e53. Holland W. Periodic Health Examination– A brief history and critical assessment. Eurohealth 2010, 15:16. Australian Institute of Health and Welfare: Aboriginal and Torres Strait Islander adolescent and youth health and wellbeing 2018. Cat. no. IHW 202. Canberra: AIHW; 2018. Aromataris E MZ.JBI Manual For Evidence Synthesis 2020.[ https://synthesismanual.jbi.global . https://doi.org/10.46658/JBIMES-20-01] . Accessed 2nd Feb; 2020. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009, 6:e1000097. Hong QN, Fàbregues S, Bartlett G, Boardman F, Cargo M, Dagenais P, Gagnon M-P, Griffiths F, Nicolau B, O’Cathain A. The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. Educ Inf 2018, 34:285–291. Thabrew H, D'Silva S, Darragh M, Goldfinch M, Meads J, Goodyear-Smith F. Comparison of YouthCHAT, an Electronic Composite Psychosocial Screener, With a Clinician Interview Assessment for Young People: Randomized Trial. J Med Internet Res 2019, 21:e13911. Harriss LR, Kyle M, Connolly K, Murgha E, Bulmer M, Miller D, Munn P, Neal P, Pearson K, Walsh M. Screening for depression in young Indigenous people: building on a unique community initiative. Aust J Prim Health 2018, 24:343–349. Maari Ma Health Aboriginal Corporation.Maari Ma TickiT Evaluation Report 2018.[ http://maarima.com.au/uploads/documents/Maari%20Ma%20TickiT%20Evaluation%20Report.pdf] . Accessed 8th Aug; 2020. Barraza R. Indigenous youth-developed self-assessment: the Personal Balance Tool. American Indian and Alaska Native Mental Health Research 2016, 23:1. Goodyear-Smith F, Corter A, Suh H. Electronic screening for lifestyle issues and mental health in youth: a community-based participatory research approach. BMC Medical Inform 2016, 16:1–8. Fagan P, Cannon F, Crouch A. The young person check: screening for sexually transmitted infections and chronic disease risk in remote Aboriginal and Torres Strait Islander youth. Aust NZ J Public Health 2013, 37:316–321. Getting it Right Collaborative Group, Hackett ML, Teixeira-Pinto A, Farnbach S, Glozier N, Skinner T, Askew DA, Gee G, Cass A, Brown A. Getting it Right: validating a culturally specific screening tool for depression (aPHQ‐9) in Aboriginal and Torres Strait Islander Australians. Med J Aust 2019, 211:24–30. Boulware LE, Marinopoulos S, Phillips KA, Hwang CW, Maynor K, Merenstein D, Wilson RF, Barnes GJ, Bass EB, Powe NR. Systematic review: the value of the periodic health evaluation. Ann of Intern Med 2007, 146. Krogsbøll LT, Jørgensen KJ, Larsen CG, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis. BMJ 2012, 345. McGorry PD, Purcell R, Goldstone S, Amminger GP. Age of onset and timing of treatment for mental and substance use disorders: implications for preventive intervention strategies and models of care. Curr Opin Psychiatry 2011, 24. Leavey JE, Flexhaug M, Ehmann T. Review of the literature regarding early intervention for children and adolescents aged 0–15 experiencing a first-episode psychiatric disturbance. Early Interv Psychiatry 2008, 2. Ho J, Fong CK, Iskander A, Towns S, Steinbeck K. Digital psychosocial assessment: An efficient and effective screening tool. J Padiatr Child Health 2020, 56. Romanelli LH, Landsverk J, Mass J, Levitt LKL, Hurley MM, Bellonci C, Gries LT, Pecora PJ, Peter S. Best practices for mental health in child welfare: Screening, assessment, and treatment guidelines. Mental Health Services for Children Placed in Foster Care: An Overview of Current Challenges 2009, 88:189–212. Blanchet-Cohen N, McMillan Z, Greenwood M. Indigenous youth engagement in Canada’s health care. Pimatisiwin 2011, 9:87–111. Kirmayer L, Simpson C, Cargo M. Healing traditions: Culture, community and mental health promotion with Canadian Aboriginal peoples. Australasian Psychiatry 2003, 11:S15-S23. Warwick S, Atkinson D, Kitaura T, LeLievre M, Marley JV. Young Aboriginal People's Perspective on Access to Health Care in Remote Australia: Hearing Their Voices. PCHP 2019, 13:171–181. Ralph S, Ryan K. Addressing the mental health gap in working with indigenous youth: Some considerations for non-Indigenous psychologists working with Indigenous youth. Australian Psychol 2017, 52:288–298. Lai GC, Taylor EV, Haigh MM, Thompson SC. Factors affecting the retention of indigenous Australians in the health workforce: a systematic review. Int J Environ Res Public Health 2018, 15:914. Jongen C, McCalman J, Campbell S, Fagan R. Working well: strategies to strengthen the workforce of the Indigenous primary healthcare sector. BMC Health Serv Res 2019, 19:1–12. Royal Australian College of General Practitioners.Resources to support health checks for Aboriginal and Torres Strait Islander people 2020.[ https://www.racgp.org.au/the-racgp/faculties/atsi/guides/2019-mbs-item-715-health-check-templates] . Accessed 9th Sept; 2021 Glasner J, Baltag V, Ambresin A-E. Previsit Multidomain Psychosocial Screening Tools for Adolescents and Young Adults: A Systematic Review. J Adolesc Health 2020. Dutton T, Stevens W, Newman J. Health assessments for Indigenous Australians at Orange Aboriginal Medical Service: health problems identified and subsequent follow up. Aust J Prim Health 2016, 22:233–238. Bradford S, Rickwood D. Young people’s views on electronic mental health assessment: prefer to type than talk? JCFS 2015, 24:1213–1221. Additional Declarations No competing interests reported. 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During this time, which we define as people aged 12\u0026ndash;24 years, individuals acquire the physical, cognitive, social and economic resources that influence identity formation, and lay the foundation for health and wellbeing later in life [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Social determinants of health have a critical influence on youth health [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Advantageous conditions such as income, education, supportive family, social support, safe neighborhood environment and encouraging school ethos positively influence youth health [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Conversely, factors such as family breakdown, physical and sexual abuse, neglect, poverty, and homelessness negatively impact youth health, and particularly mental health [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePsychosocial issues, coupled with experimentation and risk taking that is characteristic of this time in life, make a significant and largely preventable contribution to disease burden [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Risk taking behaviours in youth include substance use, unprotected sexual intercourse, alcohol use, poor nutritional intake, low levels of exercise, injury, and violence, and frequently co-occur [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In high income countries, mental health and substance use disorders are the leading cause of morbidity in children and youth, and account for one quarter of all years living with a disability in this age group [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIndigenous youth go through the same psychological and physiological changes as non-Indigenous youth, and can draw on deep wells of cultural knowledge, family connection, and connection to the lands of which they are the traditional custodians [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, they also contend with the impacts of ongoing colonisation including racism, cultural oppression and dispossession, forced assimilation, discrimination, and socioeconomic and political disadvantage [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Thus, Indigenous youth are at greater risk of psychological distress and mental health issues, which contributes to higher rates of substance misuse, violence, and suicide which, in turn, leads to even higher rates of psychological distress [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrimary health care (PHC) is often where Indigenous youth first link with the health system as independent agents, and therefore it has a critically important role in identifying and ameliorating psychological distress, mental illness, and risky behaviours [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. But, youth are infrequent attenders at PHC and do not usually seek help for psychosocial issues [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] which makes each interaction an important opportunity for preventative health care or interventions for health and wellbeing concerns. Screening for mental health and risky behaviours has been associated with improvements in substance abuse, risky sexual behaviours, stress, exercise and sleep [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and regular screening of youth for a range of health and lifestyle issues has been recommended by the American Academy of Pediatrics, and the Royal Australian College of General Practitioners [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. PHC-based health assessments have been proposed as a mechanism to improve access to recommended regular screening and preventative healthcare for Indigenous people [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Health assessments, defined as a comprehensive assessment to detect and manage risk factors [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] are a common element of health care in some countries such as Australia [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], but the uptake of government funded health assessments in Australia by Aboriginal and Torres Strait Islander youth remains low [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough Indigenous youth typically underutilise PHC services, a PHC-based health assessment that addresses their health priorities and is underpinned by Indigenous conceptions of health may benefit those who do use these services. This systematic review of PHC-based, Indigenous youth health assessments synthesises evidence about the utility and acceptability of PHC-based health assessments for improving the health and wellbeing of Indigenous youth.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eWe used the Joanna Briggs Institute (JBI) approach for conducting systematic narrative reviews [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] and report this review according to the Preferred Reporting Items for Systematic research and Meta-analyses (PRISMA) statement [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSearch strategy\u003c/h2\u003e \u003cp\u003eThe search strategy, developed in conjunction with a librarian experienced in systematic reviews, was constructed in three parts: the setting, the population of interest and the intervention. We searched the following databases: PubMed, CINAHL, Embase and Scopus via EBSCOHOST to identify text that contained key words in the title and abstract. The search strategy for each database is available in Table S1. We searched reference lists and forward searched the included studies for any additional studies. Keywords were used to search grey literature databases including \u0026ldquo;health check\u0026rdquo;, \u0026ldquo;health assessment\u0026rdquo; and youth. Grey literature databases and search terms are reported in Table S2.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy inclusion and exclusion\u003c/h2\u003e \u003cp\u003ePapers were included if the majority (over 50%) of participants were 12\u0026ndash;24 years of age (inclusive), and were Indigenous to Australia (Aboriginal and/or Torres Strait Islander), New Zealand (Māori), Canada (First Nations, Inuit and M\u0026eacute;tis), United States of America (USA) (American Indian, Native Alaskan and Native Hawaiian), arctic regions of Sweden, Norway, Finland and Russia (Sάmi) and Taiwan. In addition, papers were included if they had a larger age range (e.g., 15\u0026ndash;54 years of age), but the paper specifically reported on youth. Papers that included non-Indigenous and Indigenous populations within the age range were included if data on Indigenous youth were presented separately. We did not exclude papers based on language and considered both published and unpublished studies.\u003c/p\u003e \u003cp\u003eA \u0026lsquo;health assessment\u0026rsquo; was defined as a comprehensive and holistic review of an Indigenous youth\u0026rsquo;s health, and therefore, only studies reporting on health assessments that covered a minimum of two health domains (multidomain) were included. Here, domains were defined as a single social determinant of health, mental health condition or biomedical measure involving a single bodily system.\u003c/p\u003e \u003cp\u003eStudies were included where health assessments were conducted in PHC, or in other settings if overseen by PHC services. For example, a health assessment undertaken at a community event or school and facilitated by PHC service staff was considered for inclusion.\u003c/p\u003e \u003cp\u003eStudies using primary research methods to investigate use of an Indigenous youth health assessment were eligible for inclusion. Papers that failed to meet the inclusion criteria were excluded from the analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy selection\u003c/h2\u003e \u003cp\u003ePeer-reviewed papers detected using database searching were imported to the bibliographic software Endnote 20 (Clarivate Analytics; Philadelphia, USA) by one reviewer (JF) and duplicates removed. Studies were then assessed for inclusion based on title and abstracts by two reviewers (JF and GS). The full text publications of potentially eligible papers were then retrieved and assessed against the inclusion criteria in accordance with the PRISMA statement [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Any inconsistencies or disagreements were discussed and resolved by the reviewers.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStudy quality assessment\u003c/h2\u003e \u003cp\u003ePapers selected for inclusion were assessed using the Mixed Methods Appraisal Tool [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e](Table S3). The same two reviewers (JF and GS) who conducted the study selection also independently reviewed included studies using the appropriate critical appraisal tools. Again, disagreements between the reviewers were resolved through discussion. Studies were not excluded based on quality appraisal.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData extraction strategy\u003c/h2\u003e \u003cp\u003e The data extraction tool was customised and piloted to ensure information, extracted independently by JF and GS, responded to the review\u0026rsquo;s aims. The extracted data included: (1) study type; (2) countries and settings where studies were conducted; (3) setting in which the health assessments were administered; (4) participant demographics; (5) description of the health assessment and who administered it; and (6) effectiveness of the health assessment (total mortality, hospitalisation, disability, new diagnosis, morbidity and quality of life, referrals, follow up, brief intervention, and social and cultural determinants of health).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData synthesis and presentation\u003c/h2\u003e \u003cp\u003eDue to the heterogeneity of the included studies, meta-analysis was not appropriate. Instead, we conducted a narrative synthesis of the extracted data, analysed according to this review\u0026rsquo;s research aims.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStudy selection\u003c/h2\u003e \u003cp\u003eInitial searching yielded 3352 records. Once duplicates were removed, we reviewed the titles and abstracts of 3061 studies, and of these, 28 full-text articles were retrieved for further review and seven met the inclusion criteria [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR32 CR33 CR34 CR35\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The study selection process is detailed in the PRISMA flow diagram (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStudy characteristics\u003c/h2\u003e \u003cp\u003eCharacteristics of included studies are presented in Table\u0026nbsp;1. Four mixed methods [\u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] two qualitative studies [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] and one quantitative study [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], published from 2014 to 2019, were included. Four studies were conducted in Australia [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], two in New Zealand [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] and one in the USA [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The health assessments were conducted within PHC services in the four Australian studies [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], the two New Zealand studies used high schools with co-located PHC clinics [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], whilst the American study was led by the San Diego American Indian Health Center [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003eHealth Domains\u003c/h2\u003e \u003cp\u003eIncluded studies measured quality of life, social and cultural determinants of health, and various biomedical measures (Table\u0026nbsp;1). Regarding quality of life measures, only Barraza et al. [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] reported quality-of life measures using qualitative data. This study reported a health assessment which helped youth learn about their inner self and how to obtain mental, physical, emotional and spiritual balance, and set health goals [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. No studies reported assessing quality of life using quantitative measures.\u003c/p\u003e \u003cp\u003eThe two New Zealand studies used YouthCHAT which measured social and cultural determinants of health, including smoking, gambling, alcohol or other substance misuse, depression, anxiety, exposure to abuse, physical inactivity, problems at home and safety (Table\u0026nbsp;1) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Four studies used a Young Person\u0026rsquo;s Check (YPC) to measure biomedical domains of health including medical history, physical examination, pathology testing for routine biochemistry or haematology, sexual health screening, mental health, viral hepatitis serology, strongyloides serology, body mass index, glucose and lipid profile, urinary albumin creatine ratio, temperature, teeth status, hearing health status, and skin assessment [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003eAdministration of health assessments\u003c/h2\u003e \u003cp\u003eYouth health assessments were administered in a variety of different ways. Included studies reported on health assessments administered by Indigenous Health Workers [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], nursing staff [\u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], general practitioners [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], and one study was wholly self-administered [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] (Table\u0026nbsp;1). More than half of the health assessments were administered using digital technology (four out of seven) whereby youth inputted data using either a desktop computer in one study [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] or electronic tablets [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] (Table\u0026nbsp;1). The studies from New Zealand used a self-administered assessment on an electronic tablet that provided a summary of issues to the nurse and/or doctor for reference during the subsequent consultation [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The four Australian studies all utilised Aboriginal Health Workers to administer the health assessments [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] and one also used a nurse and a Life Promotion Officer to administer the aPHQ-9, a screening tool for psychological distress [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. The Maari Ma Health Aboriginal Corporation used a self-administered health assessment delivered using an electronic tablet with a Youth Health Worker available for support [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Fagan et al. reported using four to six team members including district health staff and public health nurses to deliver health assessments [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Two of the seven studies administered the health assessment using pen and paper: one of these was completed by the youth [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], and the other by health professionals [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" valign=\"top\" width=\"99.38574938574939%\"\u003e\u003cstrong\u003eTable 1. Characteristics of included studies\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"0.6142506142506142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.722222222222221%\"\u003e\n \u003cp\u003eCitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.188034188034187%\"\u003e\n \u003cp\u003eIndigenous people \u0026amp; Country \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.14102564102564%\"\u003e\n \u003cp\u003eStudy objective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.508547008547009%\"\u003e\n \u003cp\u003eStudy Design\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.324786324786325%\"\u003e\n \u003cp\u003eSample size, age range\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.867521367521368%\"\u003e\n \u003cp\u003eSetting\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.782051282051283%\"\u003e\n \u003cp\u003eHealth Domains\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"24.465811965811966%\"\u003e\n \u003cp\u003eWho conducted the health assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.722222222222221%\"\u003e\n \u003cp\u003eThabrew et al 2019\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[31]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.188034188034187%\"\u003e\n \u003cp\u003eMāori\u0026nbsp;youth; New Zealand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.14102564102564%\"\u003e\n \u003cp\u003eTo compare the performance and acceptability of YouthCHAT with HEEADSSS\u003csup\u003e1\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.508547008547009%\"\u003e\n \u003cp\u003eMixed methods: RCT\u003csup\u003e3\u003c/sup\u003e and qualitative study.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.324786324786325%\"\u003e\n \u003cp\u003e129 high school students aged 13-14 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.867521367521368%\"\u003e\n \u003cp\u003ePHC\u003csup\u003e2\u003c/sup\u003e clinic co-located in a high school\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.782051282051283%\"\u003e\n \u003cp\u003eSmoking, drinking alcohol, recreational drugs, HEAADSSS\u003csup\u003e1\u003c/sup\u003e, depression.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"24.465811965811966%\"\u003e\n \u003cp\u003eNurse\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.722222222222221%\"\u003e\n \u003cp\u003eHarris et al 2018\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[32]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.188034188034187%\"\u003e\n \u003cp\u003eAboriginal and Torres Strait Islander youth; Australia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.14102564102564%\"\u003e\n \u003cp\u003eTo describe the 2016 Young Person\u0026rsquo;s Check (YPC\u003csup\u003e4\u003c/sup\u003e) event and to determine the prevalence of depressive symptoms in young people\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.508547008547009%\"\u003e\n \u003cp\u003eMixed methods:\u003c/p\u003e\n \u003cp\u003ecross-sectional with youth \u0026amp; qualitative study with PHC service staff. \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.324786324786325%\"\u003e\n \u003cp\u003e350 youth aged 13-25 years\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.867521367521368%\"\u003e\n \u003cp\u003ePHC\u003csup\u003e2\u003c/sup\u003e service\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.782051282051283%\"\u003e\n \u003cp\u003eMental health, physical health including clinical measures and health risk behaviours.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"24.465811965811966%\"\u003e\n \u003cp\u003eAboriginal Health Worker, nurse, Health Promotion Officer.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.722222222222221%\"\u003e\n \u003cp\u003eMaari Ma Corporation 2018\u0026nbsp;[33]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.188034188034187%\"\u003e\n \u003cp\u003eAboriginal youth; Australia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.14102564102564%\"\u003e\n \u003cp\u003eTo determine the acceptability of the TickiT psychosocial assessment tool\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.508547008547009%\"\u003e\n \u003cp\u003eMixed methods: cross-sectional \u0026amp; qualitative interviews with youth \u0026amp; clinic staff.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.324786324786325%\"\u003e\n \u003cp\u003e78 youth aged 12-18 years completed the TickiT during their annual youth health check; 11 youth were interviewed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.867521367521368%\"\u003e\n \u003cp\u003ePHC\u003csup\u003e2\u003c/sup\u003e service\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.782051282051283%\"\u003e\n \u003cp\u003ePsychosocial, biomedical health and health risk behaviours.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"24.465811965811966%\"\u003e\n \u003cp\u003eAboriginal Health Worker, nurse, General Practitioner.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.722222222222221%\"\u003e\n \u003cp\u003eGoodyear-Smith et al 2016\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[35]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.188034188034187%\"\u003e\n \u003cp\u003eMāori\u0026nbsp;youth; New Zealand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.14102564102564%\"\u003e\n \u003cp\u003eTo assess the utility and acceptability of YouthCHAT program for youth and health service staff and build a framework for subsequent roll-out. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.508547008547009%\"\u003e\n \u003cp\u003eMixed methods:\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ecross-sectional and focus groups \u0026amp; interviews with youth \u0026amp; staff\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.324786324786325%\"\u003e\n \u003cp\u003e30 youth aged 12-18 years\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.867521367521368%\"\u003e\n \u003cp\u003ePHC\u003csup\u003e2\u003c/sup\u003e clinic co-located in a high school\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.782051282051283%\"\u003e\n \u003cp\u003eSexual health, substance use/misuse, mental health, gambling, exposure to abuse, anger control and physical activity.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"24.465811965811966%\"\u003e\n \u003cp\u003eNurse and doctor \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.722222222222221%\"\u003e\n \u003cp\u003eBarraza 2016\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[34]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.188034188034187%\"\u003e\n \u003cp\u003eNative American youth: USA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.14102564102564%\"\u003e\n \u003cp\u003eTo develop and pilot a strength-based, holistic, and youth-friendly self-assessment tool grounded in the medicine wheel.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.508547008547009%\"\u003e\n \u003cp\u003eQualitative study with focus groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.324786324786325%\"\u003e\n \u003cp\u003e70 youth aged 12-17 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.867521367521368%\"\u003e\n \u003cp\u003eHealth Center. Fresno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.782051282051283%\"\u003e\n \u003cp\u003eMental, physical, emotional, and spiritual health.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"24.465811965811966%\"\u003e\n \u003cp\u003eSelf-administered\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.722222222222221%\"\u003e\n \u003cp\u003eNori et al 2013\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.188034188034187%\"\u003e\n \u003cp\u003eAboriginal youth; Australia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.14102564102564%\"\u003e\n \u003cp\u003eTo develop and implement an evidence-informed, culturally valid Aboriginal \u0026amp; Torres Strait Islander Youth Health Check \u0026amp; an accompanying Youth Health Audit tool.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.508547008547009%\"\u003e\n \u003cp\u003eQualitative study with focus groups\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.324786324786325%\"\u003e\n \u003cp\u003e30 youth aged 12-24 years.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.867521367521368%\"\u003e\n \u003cp\u003eUrban, rural, and remote settings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.782051282051283%\"\u003e\n \u003cp\u003eSocial and emotional wellbeing, clinical assessment.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"24.465811965811966%\"\u003e\n \u003cp\u003eAboriginal Health Worker\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.722222222222221%\"\u003e\n \u003cp\u003eFagan et al 2013\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[36]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.188034188034187%\"\u003e\n \u003cp\u003eAboriginal and Torres Strait Islander youth; Australia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.14102564102564%\"\u003e\n \u003cp\u003eTo describe the implementation and selected outcomes of the YPC\u003csup\u003e4\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.508547008547009%\"\u003e\n \u003cp\u003e\u0026nbsp;Cross-sectional \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.324786324786325%\"\u003e\n \u003cp\u003e3083 youth aged 15-24 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.867521367521368%\"\u003e\n \u003cp\u003ePHC\u003csup\u003e2\u003c/sup\u003e service\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.782051282051283%\"\u003e\n \u003cp\u003eSexually transmitted infections, body mass index, blood glucose and lipid profile, urinary albumin creatine ratio.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"24.465811965811966%\"\u003e\n \u003cp\u003eAboriginal Health Worker, district health staff, public health nurses\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" width=\"82.39740820734342%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003cstrong\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003eHEEADSSS = Home, education, eating, activities, drugs and alcohol, suicide and depression, sexuality, and safety assessment\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e2\u003c/sup\u003e PHC = Primary Health Care\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e3\u003c/sup\u003eRCT = Randomised Controlled Trial\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e4\u003c/sup\u003eYPC = Young Person\u0026rsquo;s Check\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"17.602591792656586%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eRisk of Bias within included studies\u003c/h2\u003e \u003cp\u003eThe methodological quality of studies was analysed by study design and the quantitative and qualitative components of the mixed methods studies were assessed separately in addition to assessing the study as a whole [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] (Table\u0026nbsp;2). Although many included studies had methodological limitations, none were excluded based on methodological quality. Four studies lacked a clear statement of the research aims and research question rendering it difficult to determine the appropriateness of the study design [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCross-sectional data relevant to this review were extracted from a cohort study, and while this study did not address confounding factors, it was otherwise judged to have low risk of bias [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Two cross-sectional studies also did not identify confounding factors or use strategies to deal with confounding factors [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] (Table\u0026nbsp;2). The quantitative component of the Maari Ma study used a cross-sectional design [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. There were relatively fewer youth aged 15\u0026ndash;18 years, compared to youth aged 12\u0026ndash;14 years. Therefore, older age groups are likely to be underrepresented raising concerns of bias [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The study by Harris et al. [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] included 40% of the population of Aboriginal youth in Yarrabah, Australia, attending the Young Person\u0026rsquo;s Check (YPC) with smaller numbers completing the depression screen [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. There was no further information about those who did not attend the YPC, therefore, we were unable to evaluate responder bias for this study [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. The single randomised controlled trial (RCT) was found to be low risk of bias notwithstanding a lack of blinding for participants and for researchers conducting the health assessment [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] (Table\u0026nbsp;2).\u003c/p\u003e \u003cp\u003eAll but one [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] of the included studies used qualitative methods, and the critical appraisal for each study is shown in Table\u0026nbsp;2. Three of the included studies satisfied all criteria [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] whereas the other studies lacked methodological rigor [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Furthermore, authors of these studies did not culturally position themselves in the research.\u003c/p\u003e \u003cp\u003eThree of the four mixed methods studies were considered to have high methodological rigor [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], but one study scored lower owing to concerns about the reporting of their qualitative components [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eRisk of bias across all included studies\u003c/h2\u003e \u003cp\u003eOf the seven studies, most had methodological weaknesses, and therefore caution is needed when interpreting the results. This review included no studies from Canada, Indigenous Taiwanese, or the S\u0026aacute;mi people. Four of the seven studies were from Australia [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], most likely because the Australian Government funds Aboriginal and Torres Strait Islander health assessments annually through the Medicare Benefits Schedule across the life course where the other countries do not. Therefore, the included studies did not represent all the populations of interest. Furthermore, most studies included small numbers of participants, and most studies did not have a clear research question (four out of seven) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eKey findings of included studies\u003c/h2\u003e \u003cp\u003eWe found a diversity of health assessments which were developed in different ways for specific communities, adapted from previously developed tools, and with varying levels of co-creation with youth including Indigenous youth. We report outcomes regarding the detection of new diagnoses, morbidity and social determinants of health. We also report the key qualitative findings from included studies. None of the included studies reported on the impact of the health assessment on health outcomes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eNew diagnosis and morbidity\u003c/h2\u003e \u003cp\u003eNew diagnosis was an outcome measure in four of the seven studies (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Sexually transmitted infections (STIs) were newly diagnosed in 547/3083 participants (18%) in one study [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] and in 11/30 participants (37%) in another study [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Thabrew et al. reported new diagnoses of problems with eating or weight were reported in 70/110 participants (63%), physical inactivity in 43/110 participants (39%) and concerns about sexual health in 24/110 participants (22%) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Harriss et al. reported new diagnoses of psychological distress in 42/350 participants (24%) [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e3\u003c/span\u003e).Goodyear-Smith et al. [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] found 6/30 participants (20%) had depression and 11/30 (37%) had anxiety. Thabrew et al. [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] reported 11/110 participants (10%) with depression and anxiety.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eSocial determinants of health\u003c/h2\u003e \u003cp\u003eThe proportions of youth affected by social determinants of health, presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e3\u003c/span\u003e, were measured by the two New Zealand studies using the Home, Education, Eating, Activities, Drugs and alcohol, Suicide and depression, Sexuality, and Safety assessments (HEEADSSS) and/or YouthCHAT tools [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNew diagnoses, morbidity, and social determinants of health measured in the included studies.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCitation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003eNew Diagnoses\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003ePhysical and/or psychological ill-health\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eSocial determinants of health\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eIllness\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en/N\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eSocial determinant\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003en/N\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFagan et al., 2013 [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSTIs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e547/3083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eNot measured\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHarriss et al., 2018 [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePsychologic distress (moderate to severe)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42/350\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eNot measured\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eThabrew et al., 2019 [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eProblems with eating or weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eSubstance misuse:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eYouthCHAT\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70/110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eYouthCHAT\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10/110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eHEEADSSS\u003c/em\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25/110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eHEEADSSS\u003c/em\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10/110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eMental distress:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eProblems at home:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eYouthCHAT\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11/110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eYouthCHAT\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e30/110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(27%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eHEEADSSS\u003c/em\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30/110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eHEEADSSS\u003c/em\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e29/110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(26%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eSexual health:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eSafety:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eYouthCHAT\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24/110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eYouthCHAT\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e65/110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(59%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eHEEADSSS\u003c/em\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10/110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eHEEADSSS\u003c/em\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e17/110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(15%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ePhysical Inactivity:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eYouthCHAT\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43/110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eHEEADSSS\u003c/em\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21/110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGoodyear-Smith et al., 2016 [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSTIs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11/30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13/30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6/30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGambling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3/30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11/30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUsing alcohol or other drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23/30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eExposure to abuse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5/30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003e1\u003c/sup\u003e Home, education, eating, activities, drugs and alcohol, suicide and depression, sexuality, and safety assessment\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eQuantitative synthesis\u003c/h2\u003e \u003cp\u003eNone of the quantitative indicators measured strengths. Four studies reported new diagnoses which were detected in 17%-90% of health assessments, and these diagnoses represented morbidity in the form of psychological distress, STI\u0026rsquo;s and substance use (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e3\u003c/span\u003e) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Two included studies reported on social determinants of health including substance use, gambling, exposure to abuse, concerns about safety and problems at home (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e3\u003c/span\u003e) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eQualitative synthesis\u003c/h2\u003e \u003cp\u003eIncluded studies with a qualitative component used interviews and focus groups to ask staff and youth their views on the acceptability of youth health assessments [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR32 CR33 CR34\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Key areas of importance to youth and staff included descriptions of co-creation of health assessments with Indigenous youth and staff; the importance of the type of health professionals administering the health assessment; using an electronic tablet and; the addition of a \u0026lsquo;help question\u0026rsquo;.\u003c/p\u003e \u003cdiv id=\"Sec21\" class=\"Section3\"\u003e \u003ch2\u003eHealth assessment development\u003c/h2\u003e \u003cp\u003eThe health assessments used in the included studies were either co-created with Indigenous youth [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], youth in general [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], or community members [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Barraza et al. conducted focus groups with Indigenous youth to co-create a self-assessment tool [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Nori et al. facilitated eight community meetings with Aboriginal youth to co-create a health assessment that was youth friendly, and culturally valid and specific [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Key health factors identified by the youth included cultural connection, concerns about safety, sexual health, social and emotional wellbeing, smoking and substance use. Youth who participated in the implementation of the health assessment found it to be acceptable and important with no dissatisfaction [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTwo other studies reported on the co-creation of health assessments with an uncertain number of Indigenous youth [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The study by Goodyear-Smith et al. adapted YouthCHAT from the generic eCHAT health assessment through input from, and piloting by, adolescents over approximately nine months [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Clinic staff asked for modifications of YouthCHAT, including the addition of sexual health questions [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The study conducted by the Maari Ma Health Aboriginal Corporation [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] relied on the TickiT assessment which is a HEEADSSS assessment on an electronic tablet. TickiT was deployed in Broken Hill, Australia, but developed with young non-Indigenous people in Canada [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTwo health assessments conducted in Far North Queensland, Australia, were developed specifically for Indigenous youth without documented consultation or co-design with youth [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The study by Fagan et al. reported that the local Public Health Unit were interested in targeted STI screening for Aboriginal and Torres Strait Islander youth with a subsidiary aim of screening for chronic diseases [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Harriss et al. reported on a health assessment conducted in the Aboriginal community of Yarrabah where, responding to community concerns, the health assessment was expanded in 2014 to include mental health. The health service collaborated with researchers to trial the inclusion of a depression screen, the aPHQ-9 [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section3\"\u003e \u003ch2\u003eDigital technology for administering health assessments using electronic tablets\u003c/h2\u003e \u003cp\u003eFour studies, using self-administered digital technology for the administration of the health assessment, reported that youth found the apparent privacy and confidentiality enabled by this approach increased their willingness to disclose sensitive information regarding body weight, sexual health, and safety concerns like bullying and violence [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. For clinicians, health assessments using digital technology with electronic tablets led to quicker administration and assisted subsequent face-to-face questions. YouthCHAT, administered via an electronic tablet was unanimously supported by clinicians and youth [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. YouthCHAT helped youth identify health issues and discuss these with their doctor. Clinicians felt that YouthCHAT was acceptable to youth because it was electronic and reinforced their privacy [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The study by the Maari Ma Health Aboriginal Corporation, 2018, also reported positive results for youth disclosing health information using self-administered digital technology with nine of the 11 youth interviewed in this study feeling comfortable answering questions using TickiT [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Nori et al. used both a digital and paper-based health assessment template [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The digital health assessment was completed on a computer by the youth with assistance available from a health professional or carer [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Without exception, youth preferred the digital version of the health assessment, and especially preferred options like tick boxes rather than open-ended written text boxes [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. These results are consistent with findings from Goodyear-Smith et al. who found that health screening provided consistent results, lead to more disclosure, reduced staff time, and allowed youth to structure thoughts and prioritise the issues they wanted help with [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Barriers to digital health assessments included concerns around connectivity [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], internet speed [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], and literacy and language [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eHelp question findings\u003c/h2\u003e \u003cp\u003eThe YouthCHAT studies utilised a \u0026lsquo;help question\u0026rsquo; that asked youth if they wanted help today or in the future for each domain screened [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].The \u0026lsquo;help question\u0026rsquo; supports the conversation between the youth and the clinician about health issues that the youth would like to be addressed and facilitates shared decision making [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In addition, Goodyear-Smith et al. (2016) reported that the help question allowed the youth to request intervention for detected health issues without the potential awkwardness of face-to-face dialogue [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section3\"\u003e \u003ch2\u003eAcceptability\u003c/h2\u003e \u003cp\u003eOverall, the health assessments were generally well accepted (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Youth in the study by Barraza et al. described the self-administered health assessment as positive, fun, and enjoyable, and different to what they normally experienced in health and prevention programs. They felt that it helped them learn what area of health they need to improve on [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Nori et al. found that youth and community members found the health assessment to be acceptable and important, with no disapproval around discussions of cultural connections, safety concerns, sexual health, social and emotional wellbeing, smoking and substance use [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In addition, the youth believed that health professionals administering the health assessment should be upfront when asking questions in these domains, but be respectful and mindful of cultural taboos, and ensure confidentiality [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe key areas identified by Goodyear-Smith et al. suggest that the youth liked that the self-administered YouthCHAT kept them busy in the waiting room and gave them time to reflect on their responses [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Māori youth found this health assessment acceptable, and they felt clinicians knew what their health concerns were before walking through the consultation door [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Furthermore, clinicians felt it was easier to facilitate discussions and identify health concerns because youth had made this information available through the health assessment [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThabrew et al. compared acceptability of YouthCHAT and HEEADSSS for youth and three school nurses [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. After completing the two health assessments a subset of youth completed an acceptability survey on paper, and interviews were conducted with the three school nurses [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The results from 21 youth surveys indicated that both self-administered YouthCHAT and self-administered HEEADSSS were equally acceptable. However, nurses found YouthCHAT easier to answer in digital format, faster to administer than HEEADSSS, provided more health information and helped with subsequent answering of face-to-face questions [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study at the Maari Ma Health Aboriginal Corporation used TickiT. All youth health clinic staff reported that self-administered TickiT was acceptable and appropriate for Aboriginal youth in Broken Hill [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Most youth were able to answer the questions on the electronic tablet without any assistance and the evaluation found that TickiT had strong acceptability from staff and Aboriginal youth [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHarriss et al. reported an evaluation of a Young Persons\u0026rsquo; Check (YPC) in Yarrabah, Australia with the added mental health screening. The addition of the aPHQ-9, a psychological distress tool which was later adapted to the \u0026lsquo;Yarrabah aPHQ-8\u0026rsquo; was well-accepted by staff and participating youth [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]; however, only 35% of youth completed the screening tool suggesting that there were barriers to the deployment of this screening tool [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQualitative synthesis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy (date)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDevelopment of Health Assessment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAcceptability\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThabrew 2019 [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConsultation with youth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSelf-administered YouthCHAT and self-administered HEEADSSS\u003csup\u003e1\u003c/sup\u003e well accepted digitally and paper-based form respectively.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHarriss 2018 [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConsultation with community and health workers.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThere were concerns about the acceptability of the ninth question in the aPHQ-9\u003csup\u003e2\u003c/sup\u003e. The YPC along with the aPHQ-8\u003csup\u003e3\u003c/sup\u003e was acceptable.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaari Ma (Corporation, 2018) [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelected tool had been developed in consultation with Canadian youth. Aboriginal youth in Broken Hill were not consulted about its use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe paper-based health assessment and self-administered TickiT assessment delivered by electronic tablets were well accepted\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGoodyear-Smith 2016 [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConsultation with youth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe self-administered YouthCHAT assessment delivered by electronic tablet was well accepted.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarraza 2016 [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCo-creation with Native American youth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe paper-based self-assessment tool was well accepted and enjoyable.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNori 2013 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCo-creation with Aboriginal youth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYouth preferred the digital version of the Youth Health Check compared to the paper-based version.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003csup\u003e1\u003c/sup\u003e Home, education, eating, activities, drugs and alcohol, suicide and depression, sexuality, and safety assessment\u003c/p\u003e \u003cp\u003e\u003csup\u003e2\u003c/sup\u003e Adapted Patient Health Questionnaire \u0026ndash; 9\u003c/p\u003e \u003cp\u003e\u003csup\u003e3\u003c/sup\u003e Yarrabah Adapted Patient Health Questionnaire \u0026minus;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003eMain findings\u003c/h2\u003e \u003cp\u003eHealth assessments for Indigenous youth have been studied in three countries: Australia (four studies) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]; New Zealand (two studies) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] and the USA (one study) [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Youth health assessments were most frequently used to detect psychological distress, sexual health concerns, and adverse social determinants of health. One health assessment measured strengths including how youth could find life balance according to an adapted Medicine Wheel [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. None of the included studies measured health outcomes following administration of the health assessment. Cultural identity, impacts of colonisation and experience of racism, while being critical to health and wellbeing of youth, were absent in the health assessments.\u003c/p\u003e \u003cp\u003eHealth assessments were conducted using both paper-based and digital technology. Digital technology was preferred owing to youth often being familiar with electronic tablets, the opportunity to respond to sensitive health questions in private (self-administration), and quicker health assessment administration with real time information accessible to the clinician [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] compared to paper-based assessment. However, health assessments delivered using digital technology also presented problems with internet connectivity and language especially when youth completed digital health assessment templates without support [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGenerally, youth health assessments were well accepted. However, the only youth health assessment which was described as enjoyable by youth was also the only health assessment to measure strengths [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], and was one of only two health assessments co-created with Indigenous youth [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and weaknesses of the study\u003c/h2\u003e \u003cp\u003e To our knowledge, this is the first review of the characteristics, utility, and acceptability of Indigenous youth health assessments. The search strategy for this review involved a thorough search of online databases and grey literature, instilling confidence that relevant studies were not missed. Another important strength of this review is its authorship by an Indigenous young person (JF), so all the included data have been analysed and reported through this lens (Box 1).\u003c/p\u003e \u003cp\u003eLimitations of this review include the sparsity of literature from the target countries. Six of the seven included studies were from Australia and New Zealand with no studies meeting inclusion criteria from Canada, Taiwan or the arctic region Sami people, limiting generalisability of findings. Of the included studies, many had significant methodological and reporting limitations including a majority lacking a reported research question. There was heterogeneity of included studies regarding populations studied, health assessments used, and the domains of health that were assessed. While this heterogeneity gives insights into various approaches to youth health assessments, it is difficult to draw definitive conclusions. Some studies did not report on effectiveness outcomes at all, and none measured health outcomes following a health assessment. In addition, none of the included studies reports on the impacts of colonisation and racism. Finally, only one of the youth health assessments evaluated strengths.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eSystematic reviews of health assessments\u003c/h2\u003e \u003cp\u003ePrevious systematic reviews of health assessments for whole populations reported on the value of health assessments for reducing morbidity and mortality. One such high quality review, published in 2007, included 23 observational studies and 10 RCTs [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Boulware et al. found that health assessment had benefits in some clinical services and reduced patient worry, but no conclusions could be drawn about their effectiveness for reducing mortality [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. A Cochrane systematic review of health assessments, published in 2012, included 16 RCTs and over 180,000 participants from a number of different countries and found no benefit for morbidity and mortality [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Krogsb\u0026oslash;ll et al. credibly recommended against routine health assessments in healthy adults aged under 65 years [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. However, reviews of health assessments conducted in general practice [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] have found tangible benefits such as improvements in some cardiovascular risk indicators [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. While this review has limitations owing to the limited numbers and quality of included studies and cannot make conclusions about the effectiveness of health assessments for reducing morbidity or mortality in Indigenous youth, it is the only systematic review of health assessments for Indigenous youth and provides useful insights regarding what is acceptable and useful for Indigenous youth.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eMeaning of the study: possible mechanisms and implications for clinicians or policymakers\u003c/h2\u003e \u003cp\u003e This review has identified that health assessments specific to young Indigenous people can provide an opportunity to document their strengths, identify concerns regarding their social and emotional wellbeing, identify risk factors for chronic disease, and identify challenging social determinants of health. Early intervention and prevention strategies for youth can substantially improve the outlook of youth health [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. For health professionals to provide appropriate intervention, assessments must give an accurate and holistic picture of the young person and their life [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInvolvement of Indigenous youth in the co-creation of health assessment increased their acceptability. Health assessments were more acceptable when co-created with Indigenous youth, when they are self-administered or administered by Indigenous clinicians known to the participants compared to administration by non-Indigenous clinicians not known to the community. Digitalised self-administered health assessments may facilitate disclosure of challenging, personal and sensitive information about self-harm, emotional wellbeing, sexual health and substance use compared with a paper-based template completed with a clinician [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Furthermore, self-administered questionnaires may increase youth confidence that confidentiality will be respected. Importantly, if youth feel safe enough to disclose sensitive health information it can allow for early intervention, prevention strategies and referrals. Conversely, when youth have confidentiality concerns about a health service, they are less likely to seek care which can negatively impact their health [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIndigenous youth have criticised appropriation of cultural knowledge by the health system where there has not been local community input and the diversity of Indigenous cultures have not been sufficiently accounted for [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Health assessments should be able to be implemented or adapted into a more culturally appropriate tool for assessing youth health, but also rigorous enough to ensure they are measuring intended health domains. This recommendation also highlights the importance of building trusting relationships between the clinician and the youth [\u003cspan additionalcitationids=\"CR46\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e], and how vital the Indigenous health workforce is for Indigenous peoples [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePolicy makers need to support the co-creation and evaluation of Indigenous health assessments specifically for youth. For example, the Royal Australian College of General Practitioners has now published a health assessment template specifically for young Aboriginal and Torres Strait Islander people following consultation, and it is promoted on the Australian Department of Health Website [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. The health assessment is only the first step in providing care [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e] \u0026ndash; improvements in health outcomes requires appropriate funding and services to support management and follow up of identified issues and concerns [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Inquiring about intimate health issues raises patient expectations and requires the health service to respond [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e] because not responding could perpetuate more harm than not screening at all [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis review demonstrates that primary health care-based health assessments can be an acceptable and useful means of documenting strengths, risk factors and social determinants of health concerning Indigenous youth; however, no data on health outcomes following health assessments were reported. There was limited research regarding Indigenous youth health priorities and Indigenous youth views on health assessments. Acceptability of health assessments for Indigenous youth was most likely when they were co-created with Indigenous youth, adapted to local community needs, delivered by Indigenous Health Workers familiar with Indigenous youth, and used a combination of self-administered digital technology and face to face contact. Research assessing the feasibility and effectiveness of Indigenous youth health assessments is also required. Future research could also focus on appropriate self-administered digital technology to facilitate Indigenous youth health assessments. In addition, research focusing on youth health priorities and what youth want and expect from primary health care would be benefit for Indigenous youth health assessments.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBox 1 Author\u0026rsquo;s narrative (JF)\u003c/p\u003e \u003cp\u003eAs a proud Aboriginal youth, with connections with the Bidjara and Mandandanji nations from South Western Queensland on the continent known as Australia and the lead author of this review, there were moments that resonated with me. In today\u0026rsquo;s society, there are growing concerns about racism, mental health, and behavioural risk issues for Indigenous youth; however, these needs are not being met, particularly in the mainstream public and primary health care systems.\u003c/p\u003e \u003cp\u003eI have been to primary health care services for the Australian government\u0026rsquo;s annual Indigenous health assessments; however, I believe currently they don\u0026rsquo;t meet health needs of youth. For young Aboriginal and Torres Strait Islander people accessing primary health care there is already associated stigma. You are either accessing health care because you\u0026rsquo;re \u0026ldquo;womba\u0026rdquo; (something wrong with your head or crazy e.g., mental illness) or for a STI check. This stigma is exacerbated via the reports, journal articles and strategies that focus on the deficit-based statistics of young Aboriginal and Torres Strait Islander people. The current health assessment should shift to a health assessment that is driven by youth self-determination, and that meets their health needs. I understand the need to screen for biomedical factors, but there is limited screening on cultural and gender identity, impacts of racism and the social determinants of health. A health assessment that identifies these risks, but importantly identifies strengths of youth can reinforce self-determination and assist with exercising sovereignty. Co-creating and implementing a health assessment with youth can assist with identifying the factors that youth find important along with clinicians\u0026rsquo; expertise for the biomedical factors that are also important.\u003c/p\u003e \u003cp\u003eHowever, health assessments and screening are only the first step. There needs to be infrastructure, resources and services implemented in primary health care to which youth can be referred when a problem is identified, along with follow up. An example could be a young person questioning their identity. Having a place or somewhere to go to such as Elders or other young Indigenous people to talk to can help that young person navigate their identity which can be a strength for their health and wellbeing. The health assessment should be holistic and be underpinned by the Indigenous conceptions of health rather than focusing on just the biomedical components of health. This can include identifying the strengths in the community where the primary health care service can refer to for cultural support.\u003c/p\u003e \u003cp\u003eAs an Aboriginal youth, I can see the benefits of an e-health assessment particularly for privacy and disclosing health information. Having a digital health assessment that is holistic, comprehensive and is based on youth health priorities could be a beneficial way for youth to engage with primary health care. In addition, the \u0026lsquo;help question\u0026rsquo; that YouthCHAT utilises could be a strategy to encourage youth to ask questions about their health concerns. Generally, I would not go to primary care unless there is something I want to get checked. Therefore, having the \u0026lsquo;help question\u0026rsquo; allows the individual to ask for the specific health issue as well as doing it privately. In conclusion, I can see the potential benefits of an Indigenous youth health assessment and support the idea of that being in a digital format. However, youth should be involved in the development of health assessments as youth know their health the best and can ensure that the assessment meets youth health priorities.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eEthics approval was not sought as no primary data was collected. This study is a systematic review of existing research.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eAvailability of data materials\u003c/h2\u003e\n\u003cp\u003eData for this project is stored at the Australian e-Health Research Centre (AeHRC)- Commonwealth Scientific and Industrial Research Organisation (CSIRO). Surgical, Treatment and Rehabilitation Service (STARS) building, 246 Herston Road, Herston, Queensland, Australia, 4029. \u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThis work was supported by the National Health and Medical Research Council (NHMRC) Emerging Leader Fellowship grant (APP1173857).\u003c/p\u003e\n\u003ch2\u003eAuthor\u0026rsquo;s contributions\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eJF: designed the search terms with a university librarian; conducted a systematic literature search; conducted title and abstract screen, full text screen, data extraction; conducted literature review; data analysis; led the writing of the manuscript, prepared figures and references. DA: reviewed drafts of manuscript; edited manuscript, prepared figures and tables, and edited references. RM: edited manuscript, provided cultural oversight of the study. GS: conducted a systematic literature search; conducted title and abstract screen, full text screen, data extraction; conducted literature review; data analysis, prepared tables and edited manuscript.\u003c/p\u003e\n\u003ch2\u003e\u0026nbsp;Acknowledgements\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eLars Eriksson (Academic Liaison Librarian) from the University of Queensland.\u003c/p\u003e\n\u003ch2\u003eAuthor\u0026rsquo;s information\u003c/h2\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eThe University of Queensland. General Practice Clinical Unit. Surgical Treatment and Rehabilitation Service (STARS), 296 Herston road, Herston, QLD, 4059. \u003ca href=\"mailto:[email protected]\"\[email protected]\u003c/a\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eThe University of Queensland. General Practice Clinical Unit. Level 8, Health Sciences Bl, Building (16/910), RBWH ,Herston \u0026nbsp;Qld \u0026nbsp;4029 Australia. \u003ca href=\"mailto:[email protected]\"\[email protected]\u003c/a\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3\u003c/sup\u003eCSIRO. Surgical Treatment and Rehabilitation Service (STARS), 296 Herston road, Herston, QLD, 4059. \u003ca href=\"mailto:[email protected]\"\[email protected]\u003c/a\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e4\u003c/sup\u003eThe University of Queensland. General Practice Clinical Unit. Level 8, Health Sciences Bl, Building (16/910), RBWH , Herston \u0026nbsp;Qld \u0026nbsp;4029 Australia. \u003ca href=\"mailto:[email protected]\"\[email protected]\u003c/a\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePatton GC, Sawyer SM, Santelli JS, Ross DA, Afifi R, Allen NB, Arora M, Azzopardi P, Baldwin W, Bonell C. Our future: a Lancet commission on adolescent health and wellbeing. The Lancet 2016, 387:2423\u0026ndash;2478.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eViner RM, Ozer EM, Denny S, Marmot M, Resnick M, Fatusi A, Currie C. Adolescence and the social determinants of health. The Lancet 2012, 379:1641\u0026ndash;1652.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAzzopardi P, Blow N, Purcell T, Brown N, Ritchie T, Brown A. Investing in the health of Aboriginal and Torres Strait Islander adolescents: a foundation for achieving health equity. Med J Aust 2020, 212:202\u0026ndash;204. e201.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCurrie C, Zanotti C, Morgan A, Currie D, De Looze M, Roberts C, Samdal O, Smith OR, Barnekow V. Social determinants of health and well-being among young people. \u003cem\u003eHealth Behaviour in School-aged Children (HBSC) study: international report from the\u003c/em\u003e 2009, 2010:271.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNori A, Piovesan R, O'Connor J, Graham A, Shah S, Rigney D, McMillan M, Brown N. 'Y Health-Staying Deadly': an Aboriginal youth focussed translational action research project. \u003cem\u003eAustralian Primary Health Care Research Institute (APHCRI), The Australian National University\u003c/em\u003e 2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteinberg L. A social neuroscience perspective on adolescent risk-taking. Developmental Review 2008, 28:78\u0026ndash;106.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePehlivan N, Brown E, Sanchez AYA, McMillan F, Moore D, Bhaduri A, Monson K, Badcock P, Thompson K, Killackey E. What impact does illness severity have on the sexual health of young people affected by mental health disorders? A comparison of inpatients and outpatients. Australasian Psychiatry 2020:1039856220960373.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDick B, Ferguson BJ. Health for the world's adolescents: a second chance in the second decade. J Adolesc Health 2015, 56:3\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatton GC, Coffey C, Cappa C, Currie D, Riley L, Gore F, Degenhardt L, Richardson D, Astone N, Sangowawa AO. Health of the world's adolescents: a synthesis of internationally comparable data. The Lancet 2012, 379:1665\u0026ndash;1675.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatton GC, Olsson CA, Skirbekk V, Saffery R, Wlodek ME, Azzopardi PS, Stonawski M, Rasmussen B, Spry E, Francis K. Adolescence and the next generation. Nature 2018, 554:458\u0026ndash;466.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCatalano RF, Fagan AA, Gavin LE, Greenberg MT, Irwin Jr CE, Ross DA, Shek DT. Worldwide application of prevention science in adolescent health. The Lancet 2012, 379:1653\u0026ndash;1664.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErskine H, Moffitt TE, Copeland W, Costello E, Ferrari A, Patton G, Degenhardt L, Vos T, Whiteford H, Scott J. A heavy burden on young minds: the global burden of mental and substance use disorders in children and youth. Psychol Med 2015, 45:1551\u0026ndash;1563.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaswell MR, Blignault I, Fitzpatrick S, Jackson Pulver L: The social and emotional wellbeing of Indigenous youth: Reviewing and extending the evidence and examining its implications for policy and practice. NSW, Australia: Muru Marri, School of Public Health and Community Medicine, UNSW; 2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTremblay M, Baydala L, Littlechild R, Chiu E, Janzen T. Promoting the strengths and resilience of an Indigenous community through photovoice. Paediatr Child Health 2018, 23:247\u0026ndash;254.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGracey M, King M. Indigenous health part 1: determinants and disease patterns. The Lancet 2009, 374:65\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAustralian Indigenous HealthInfoNet.Children \u0026amp; young people 2020.[\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://healthinfonet.ecu.edu.au/learn/health-topics/healing/children-young-people/]\u003c/span\u003e\u003cspan address=\"https://healthinfonet.ecu.edu.au/learn/health-topics/healing/children-young-people/]\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 8th Aug; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTylee A, Haller DM, Graham T, Churchill R, Sanci LA. Youth-friendly primary-care services: how are we doing and what more needs to be done? The Lancet 2007, 369:1565\u0026ndash;1573.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilson CJ, Rickwood D, Deane FP. Depressive symptoms and help-seeking intentions in young people. Clinical Psychologist 2007, 11:98\u0026ndash;107.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZieve GG, Richardson LP, Katzman K, Spielvogle H, Whitehouse S, McCarty CA. Adolescents\u0026rsquo; perspectives on personalized e-feedback in the context of health risk behavior screening for primary care: qualitative study. J Med Internet Res 2017, 19:e261.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBailey V, Baker A, Cave L, Fildes J, Perrens B, Plummer J, Wearring A: Mission Australia\u0026rsquo;s 2016 youth survey report. Mission Australia; 2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWebb MJ, Kauer SD, Ozer EM, Haller DM, Sanci LA. Does screening for and intervening with multiple health compromising behaviours and mental health disorders amongst young people attending primary care improve health outcomes? A systematic review. BMC Fam Pract 2016, 17:1\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Academy of Pediatrics: \u003cem\u003eBright futures: guidelines for health supervision of infants, children, and adolescents\u003c/em\u003e. 4th ed. edn. Elk Grove Village, IL: National Center for Education in Maternal and Child Health and Georgetown University; 2008.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoyal Australian College of General Practitioners: Guidelines for preventive activities in general practice. 9th Ed edition. East Melbourne, Vic: Royal Australian College of General Practitioners; 2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMayers NR, Couzos S. Towards health equity through an adult health check for Aboriginal and Torres Strait Islander people. Med J Aust 2004, 181:531\u0026ndash;532.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSi S, Moss JR, Sullivan TR, Newton SS, Stocks NP. Effectiveness of general practice-based health checks: a systematic review and meta-analysis. BJGP 2014, 64:e47-e53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolland W. Periodic Health Examination\u0026ndash; A brief history and critical assessment. Eurohealth 2010, 15:16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAustralian Institute of Health and Welfare: Aboriginal and Torres Strait Islander adolescent and youth health and wellbeing 2018. Cat. no. IHW 202. Canberra: AIHW; 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAromataris E MZ.JBI Manual For Evidence Synthesis 2020.[\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://synthesismanual.jbi.global\u003c/span\u003e\u003cspan address=\"https://synthesismanual.jbi.global\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.46658/JBIMES-20-01]\u003c/span\u003e\u003cspan address=\"10.46658/JBIMES-20-01]\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 2nd Feb; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009, 6:e1000097.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHong QN, F\u0026agrave;bregues S, Bartlett G, Boardman F, Cargo M, Dagenais P, Gagnon M-P, Griffiths F, Nicolau B, O\u0026rsquo;Cathain A. The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. Educ Inf 2018, 34:285\u0026ndash;291.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThabrew H, D'Silva S, Darragh M, Goldfinch M, Meads J, Goodyear-Smith F. Comparison of YouthCHAT, an Electronic Composite Psychosocial Screener, With a Clinician Interview Assessment for Young People: Randomized Trial. J Med Internet Res 2019, 21:e13911.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarriss LR, Kyle M, Connolly K, Murgha E, Bulmer M, Miller D, Munn P, Neal P, Pearson K, Walsh M. Screening for depression in young Indigenous people: building on a unique community initiative. Aust J Prim Health 2018, 24:343\u0026ndash;349.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaari Ma Health Aboriginal Corporation.Maari Ma TickiT Evaluation Report 2018.[\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://maarima.com.au/uploads/documents/Maari%20Ma%20TickiT%20Evaluation%20Report.pdf]\u003c/span\u003e\u003cspan address=\"http://maarima.com.au/uploads/documents/Maari%20Ma%20TickiT%20Evaluation%20Report.pdf]\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 8th Aug; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarraza R. Indigenous youth-developed self-assessment: the Personal Balance Tool. American Indian and Alaska Native Mental Health Research 2016, 23:1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoodyear-Smith F, Corter A, Suh H. Electronic screening for lifestyle issues and mental health in youth: a community-based participatory research approach. BMC Medical Inform 2016, 16:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFagan P, Cannon F, Crouch A. The young person check: screening for sexually transmitted infections and chronic disease risk in remote Aboriginal and Torres Strait Islander youth. Aust NZ J Public Health 2013, 37:316\u0026ndash;321.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGetting it Right Collaborative Group, Hackett ML, Teixeira-Pinto A, Farnbach S, Glozier N, Skinner T, Askew DA, Gee G, Cass A, Brown A. Getting it Right: validating a culturally specific screening tool for depression (aPHQ‐9) in Aboriginal and Torres Strait Islander Australians. Med J Aust 2019, 211:24\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoulware LE, Marinopoulos S, Phillips KA, Hwang CW, Maynor K, Merenstein D, Wilson RF, Barnes GJ, Bass EB, Powe NR. Systematic review: the value of the periodic health evaluation. Ann of Intern Med 2007, 146.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKrogsb\u0026oslash;ll LT, J\u0026oslash;rgensen KJ, Larsen CG, G\u0026oslash;tzsche PC. General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis. BMJ 2012, 345.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcGorry PD, Purcell R, Goldstone S, Amminger GP. Age of onset and timing of treatment for mental and substance use disorders: implications for preventive intervention strategies and models of care. Curr Opin Psychiatry 2011, 24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeavey JE, Flexhaug M, Ehmann T. Review of the literature regarding early intervention for children and adolescents aged 0\u0026ndash;15 experiencing a first-episode psychiatric disturbance. Early Interv Psychiatry 2008, 2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHo J, Fong CK, Iskander A, Towns S, Steinbeck K. Digital psychosocial assessment: An efficient and effective screening tool. J Padiatr Child Health 2020, 56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRomanelli LH, Landsverk J, Mass J, Levitt LKL, Hurley MM, Bellonci C, Gries LT, Pecora PJ, Peter S. Best practices for mental health in child welfare: Screening, assessment, and treatment guidelines. Mental Health Services for Children Placed in Foster Care: An Overview of Current Challenges 2009, 88:189\u0026ndash;212.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlanchet-Cohen N, McMillan Z, Greenwood M. Indigenous youth engagement in Canada\u0026rsquo;s health care. Pimatisiwin 2011, 9:87\u0026ndash;111.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKirmayer L, Simpson C, Cargo M. Healing traditions: Culture, community and mental health promotion with Canadian Aboriginal peoples. Australasian Psychiatry 2003, 11:S15-S23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWarwick S, Atkinson D, Kitaura T, LeLievre M, Marley JV. Young Aboriginal People's Perspective on Access to Health Care in Remote Australia: Hearing Their Voices. PCHP 2019, 13:171\u0026ndash;181.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRalph S, Ryan K. Addressing the mental health gap in working with indigenous youth: Some considerations for non-Indigenous psychologists working with Indigenous youth. Australian Psychol 2017, 52:288\u0026ndash;298.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLai GC, Taylor EV, Haigh MM, Thompson SC. Factors affecting the retention of indigenous Australians in the health workforce: a systematic review. Int J Environ Res Public Health 2018, 15:914.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJongen C, McCalman J, Campbell S, Fagan R. Working well: strategies to strengthen the workforce of the Indigenous primary healthcare sector. BMC Health Serv Res 2019, 19:1\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoyal Australian College of General Practitioners.Resources to support health checks for Aboriginal and Torres Strait Islander people 2020.[\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.racgp.org.au/the-racgp/faculties/atsi/guides/2019-mbs-item-715-health-check-templates]\u003c/span\u003e\u003cspan address=\"https://www.racgp.org.au/the-racgp/faculties/atsi/guides/2019-mbs-item-715-health-check-templates]\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 9th Sept; 2021\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGlasner J, Baltag V, Ambresin A-E. Previsit Multidomain Psychosocial Screening Tools for Adolescents and Young Adults: A Systematic Review. J Adolesc Health 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDutton T, Stevens W, Newman J. Health assessments for Indigenous Australians at Orange Aboriginal Medical Service: health problems identified and subsequent follow up. Aust J Prim Health 2016, 22:233\u0026ndash;238.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBradford S, Rickwood D. Young people\u0026rsquo;s views on electronic mental health assessment: prefer to type than talk? \u003cem\u003eJCFS\u003c/em\u003e 2015, 24:1213\u0026ndash;1221.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Youth, health assessments, Indigenous: holistic, primary health care, appropriateness ","lastPublishedDoi":"10.21203/rs.3.rs-1394523/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1394523/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground:\u003c/p\u003e\u003cp\u003eThe time between childhood and adulthood is when an individual acquires the physical, cognitive, social, and economic resources that are foundational to health and wellbeing later in life. The psychological and physiological transitions of youth are compounded by profound transitions in social role, including those related to employment, education, and family role. Additionally, Indigenous youth are developing their cultural identity while also contending with challenges of ongoing colonisation and everyday lived experiences of racism which negatively impacts their health and wellbeing. A comprehensive assessment of Indigenous youths’ health and wellbeing could enable early diagnosis and respond to physical and mental ill health concerns. This narrative systematic review synthesizes evidence about the acceptability and utility of primary health care-based health assessments for improving the health and wellbeing of Indigenous youth.\u003c/p\u003e\u003cp\u003eMethods:\u003c/p\u003e\u003cp\u003eA systematic search strategy was applied to 20 electronic databases (four bibliographic and 16 grey literature). Studies were included if they reported on health assessments conducted in primary health care with youth aged 12–24 years who were Indigenous to Australia, New Zealand, Canada, United States of America (USA), Taiwan, and the arctic regions of Scandinavia and Russia. Two independent reviewers performed the study selection, quality appraisal and data extraction. A narrative synthesis was undertaken.\u003c/p\u003e\u003cp\u003eResults:\u003c/p\u003e\u003cp\u003eOf the 3061 unique studies identified, seven met the eligibility criteria and were included: four mixed-methods studies, two qualitative studies and one quantitative study. Included studies showed youth health assessments were useful for making new diagnoses, detecting social and emotional wellbeing concerns, and some biomedical parameters. Co-created health assessments with Indigenous youth conducted by clinicians familiar to community were well accepted. Digital health assessments administered using an electronic tablet provide advantages. No health outcomes were reported. Additionally, no health assessments addressed the impacts of colonisation and racism.\u003c/p\u003e\u003cp\u003eConclusion:\u003c/p\u003e\u003cp\u003eThere is insufficient evidence to make firm conclusions about benefits of health assessments; however, health assessments can be useful for detecting new diagnoses and concerns regarding social determinants of health and social and emotional wellbeing. Future development of Indigenous youth health assessments needs to involve Indigenous youth’s perspectives, ideas and, interpretations of health.\u003c/p\u003e","manuscriptTitle":"The acceptability and utility of Indigenous youth health assessments: A narrative systematic review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-03-16 16:04:32","doi":"10.21203/rs.3.rs-1394523/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8e76ad7a-82ac-43c3-929c-b86223c75bea","owner":[],"postedDate":"March 16th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-03-16T16:04:33+00:00","versionOfRecord":[],"versionCreatedAt":"2022-03-16 16:04:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1394523","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1394523","identity":"rs-1394523","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}