The programme Yuva Spandana is the first ever state-level mental health promotion program in India, developed in-line with the National Youth Policy- 2012. The current paper aimed at understanding factors which contribute to increase clientele to Yuva Spandana Kendras. As a result, we identified factors that enable service utilization by the beneficiaries in the community. Our study revealed that it is essential to
- address more than one issue for which the services are available within the program while sensitizing beneficiaries;
- conduct more sensitization programs to parents groups;
- make reminder calls to beneficiaries who requested support through feedback forms, to fix appointment at YSK;
- provide referral letter to beneficiaries to seek services at resource mapped individual/organizations and
- ensure internet availability in YSK in order to increase beneficiary attendance at YSKs
In this study, a systematic, objective assessment of factors affecting client attendance was done by developing a conceptual framework through stakeholder consultations. Our study utilized program data collected utilizing a specifically developed computerized management information system (CMIS) that captures data in real time. This study utilized program data from multiple sources. Data quality is ensured within the program by stringent methodology incorporated right from the stage of training of YSs and YPs to routine monitoring of data (both during data collection and entry). YSs and YPs who enter data on CMIS are rigorously trained in both capturing and entering data in CMIS. Data related training is an important part of both basic and refresher training schedules of the program. Besides in-house trainings, program staff provides support for field level data management during their field visits. Monitoring and Evaluation Officer of the program along with Field Coordinator and Field Liaison Officers closely monitor all data entered in CMIS on a day-to-day basis. Program Coordinator and Principal Investigator of the program supervise this process of data monitoring regularly. All these ensure real-time data collection with minimal errors in data entry.
Activities conducted to develop the conceptual framework were scientific and comprehensive thus; the results of the study can be generalized to all Yuva Spandana Kendras across Karnataka. In addition, stakeholder involvement in designing the study is likely to ensure stakeholder participation. It is likely to facilitate the field team to utilize these results and own future interventions based on these results. Intervening on these factors could improve client attendance for the program in future.
One of the factors affecting beneficiary attendance in YSKs in Karnataka was addressing multiple issues during a sensitisation program. Addressing multiple issues ensures that there is something for every beneficiary at YSK. During these sensitization programs, YPs broadly address 6 issues covering the entire gamut of youth issues. 4 Hence, when YPs address multiple issues as part of sensitization programs, youth with any issue/s are sensitized about their issue and encouraged to visit YSK thereby increasing beneficiary attendance.
YPs conduct sensitization program at field level for different groups such as youth clubs, students, parents, teachers etc. 4 It was observed that, conducting sensitization programs for parents increase beneficiaries to YSKs. In the Indian context, parents are the key decision makers in the family. Although it seems that the youth are independent, when it is the question of seeking support or care, the youth are under the control of their parents or caretakers in India. Hence, focusing on sensitising parents would bring their children to YSKs. 5
YPs collect feedback forms from participants after the sensitization program. Our study found that making reminder calls to schedule appointments to YSK following sensitization program increases beneficiary attendance. This helps in rapport and confidence building among potential beneficiaries. For the beneficiary, receiving a reminder call post sensitization program is likely to reinforce the fact that “there is somebody who is willing to listen to me and help me with my problems” –a message that is shared as part of the sensitization program. Usage of technology for increasing service utilization of programs is the need of the hour. 6,7
Yuva Samalochakas provide guidance to beneficiaries who come to YSKs and refer them to an appropriate referral institution for further help. Our results reveal that referrals to resource mapped services bring beneficiaries to YSKs. This process provides an opportunity to showcase services available at YSK through beneficiaries themselves and thereby promoting cross referrals. It also provides evidence to resource mapped organisations about an ongoing successful program.
It was observed that having internet connection during 2017 is a significant factor affecting client attendance. Having internet connection in YSK ensures that district teams at YSK are well supported by core team at NIMHANS enabling the district teams to confidently handle clients at YSK.
Univariate Simple Linear Regression analysis showed 27 variables to be significant. However, only 5 factors were found to be statistically significant in multivariate analysis. The variables which were significant in univariate analysis might seem to be less important compared to the five factors significant in multivariate analysis in increasing clients. However, this might not be true. Logically, given the robust monitoring and supervision in-built into the program, an analysis done as part of the routine monitoring and evaluation in July 2017 8 revealed that availability of YSs in YSK; potential beneficiaries agreeing to visit YSK during phone call following sensitisation programs; focusing on teachers and youth in sensitisation programs; and sensitisation programs and friends as source of referral increased beneficiary attendance. 8 Other sources of information and challenges and difficulties faced during sensitisation programs decreased client attendance. Learning from this previous evaluation, helped us intervene (Eg- focussing on teachers through sensitization program) on these factors. These might have made these program components/ exposure variables insignificant at this stage of the program. This is known to happen as part of evolution of the program. However, these would still be relevant as activities of the program and needs to be part of the routine monitoring and supervision along with a special focus on the five factors identified in this study.
This study is not without limitations. Other relevant factors affecting beneficiary attendance such as quality aspects of sensitization programs, guidance and client satisfaction levels are not considered in the current study. Since, majority of programs are focussed on student population, it is obvious that majority of the beneficiaries attending YSKs are students. Hence the generalisability of the results to other beneficiaries is questionable.