Essential Training Package for HPV Vaccine Introduction
Module 7
Taking care of adolescent patients
GardasilTM
Learning objectives
 At the end of the module, the participants will be
able to:
– Describe what we mean by adolescence
– Understand how adolescent development and
adolescents’ characteristics may affect their health and
health behaviors including vaccination
– Understand key issues to consider when taking care of
adolescent patients
 Duration
– 60'
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Taking care of adolescent patients, Module 7 GardasilTM | 24 July 2016
Key issues
1 What is special about
adolescence?
2 How do characteristics of
adolescents affect my work?
3
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How to take care of
adolescent patients?
Taking care of adolescent patients, Module 7 GardasilTM | 24 July 2016
Definition of adolescence
 WHO definitions:
–
–
–
–
Under-five child 0-4 years
Older child 5-9 years
Adolescent 10-19 years
Young person 10-24 years
 UNICEF definition of the child
– Child from 0 up to 18 years
(as per Convention on the Rights of the Child)
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Taking care of adolescent patients, Module 7 GardasilTM | 24 July 2016
Adolescent development
Physical
Psychological
Growth, sexual
maturation and brain
development
Social
Adolescent
development
Health
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Taking care of adolescent patients, Module 7 GardasilTM | 24 July 2016
Physical maturation
Puberty involves changes in the body that lead to full growth
and sexual maturation:
– physical and psychological changes enabling reproduction
– activation of a complex neuro-endocrinal network that regulates
changes in the whole body including in the brain
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Taking care of adolescent patients, Module 7 GardasilTM | 24 July 2016
Sexual maturation
 Onset of puberty typically occurs between 9-13 years old
in girls and 10-14 years old in boys
maturation
A child
5 - 7 years old
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Taking care of adolescent patients, Module 7 GardasilTM | 24 July 2016
A physically mature adolescent girl
15 to 17 years
Brain maturation
 Many brain changes occur during adolescence
 Profound changes occur in:
– brain connections
– signalling mechanisms
– the pre-frontal cortex
 The pre-frontal cortex is responsible for:
– organizational ability
– strategic thinking
– impulse control
 Brain changes are affected by social influences
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Taking care of adolescent patients, Module 7 GardasilTM | 24 July 2016
Psychological development
Cognitive changes
 A shift from ‘concrete’ to ‘abstract’ thought:
–
–
–
–
Using hypotheses and deductive reasoning
Visualizing the future and planning ahead
Reflecting on one's thinking and learning from this
Thinking beyond conventional limits
 Occurs at a variable rate
 Highly influenced by the social and cultural context
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Taking care of adolescent patients, Module 7 GardasilTM | 24 July 2016
Social development
Identity formation occurs through
adolescence:
– Who am I?
– What is my place in the world?
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Taking care of adolescent patients, Module 7 GardasilTM | 24 July 2016
What is special about adolescence?
 A time of rapid physical and psychological (cognitive and
emotional) growth and development
 A time in which new capacities are developed
 A time of changing social relationships, expectations, roles
and responsibilities
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Taking care of adolescent patients, Module 7 GardasilTM | 24 July 2016
In your point of view…
What are typical characteristics
of adolescents?
Believe they
are
invulnerable
Risk taking
Don’t want to
listen to
parents
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Oriented on
here and now,
not on future
Insecure
Influenced by
peers
Vulnerable
Taking care of adolescent patients, Module 7 GardasilTM | 24 July 2016
How do characteristics of adolescents
affect my work? (1/2)
Characteristics
“Believe they are invulnerable”
“Risk taking”
Implications for HPV vaccine
We may need to motivate the adolescent girl to
get vaccinated"
Engage in smoking, even though they have
heard it is bad for health
“Oriented on here and now, not on
future”
Fear of pain now may be far more immediate
threat than cancer in 20 years
“Influenced by peers”
Be aware that “impressions” regarding
vaccination - like fear of fainting or pain may
spread very rapidly among adolescents
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Taking care of adolescent patients, Module 7 GardasilTM | 24 July 2016
How do characteristics of adolescents
affect my work? (2/2)
Characteristics
“Don’t want to listen to parents”
“Increasingly (feeling)
independent”
“Insecure”
“Vulnerable”
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Implications for HPV vaccine
Adolescents may have a different opinion from
parents on vaccination
A young girl who missed school vaccination
may feel shy to walk into a health facility. She
will not be sure if she is allowed to, whether
the health worker will give it to her, and if so
what it will cost
Girls who are disabled, or work as domestic
workers are more at risk of early unprotected
sex and exposure to HPV infection. Such
vulnerable girls often have less access to HPV
vaccination if health workers do not reach out
to them
Taking care of adolescent patients, Module 7 GardasilTM | 24 July 2016
What should you do in this scenario?
A 12 year old girl comes to
the school on the first
vaccination day. She clearly
has the consent of the
parents to be vaccinated,
but when it is her turn to be
vaccinated she refuses.
What should you do?
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Taking care of adolescent patients, Module 7 GardasilTM | 24 July 2016
What do I need to know and do
differently if my patient is
13 and not 3 years old ?
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Taking care of adolescent patients, Module 7 GardasilTM | 24 July 2016
What do I need to know and do differently
if my patient is 13, not 3 years old?
1.
Establishing rapport
2.
Taking a history of the presenting problem or concern
3.
Going beyond the presenting problem or concern
4.
Doing a physical examination
5.
Communicating the diagnosis, explaining its implications
and discussing the treatment options
6.
Dealing with laws and policies that affect your work
7.
Using the opportunity of the contact to inform, educate
and, where possible, counsel
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Taking care of adolescent patients, Module 7 GardasilTM | 24 July 2016
Prevention messages for cervical cancer
to give to girls and boys
 You can protect yourselves against cervical cancer by
getting vaccinated against HPV infections (girls aged 9-13
years old)
 Use condoms to prevent against unwanted pregnancy and
sexually transmitted infections
 Consider male circumcision to reduce the risk you and
your partner get sexually transmitted infections (boys)
 Do not start smoking or other forms of tobacco use, or stop
tobacco use
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Taking care of adolescent patients, Module 7 GardasilTM | 24 July 2016
Key messages
 Adolescence is a special phase marked by rapid changes in
physical, psychological and social development  opportunity
and risk
 Adolescents have some characteristics that make them different
from younger children and adults
 Characteristics of adolescents may have implications for health
related behaviours and for the way we provide health services,
including vaccination
 Need to take into account adolescents' evolving capacity, their
growing desire for autonomy, and be aware of implications of
their age for the informed consent process
 When you develop a trusted relationship with an adolescent
client, you can pass important prevention messages
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Taking care of adolescent patients, Module 7 GardasilTM | 24 July 2016
End of module
Thank you
for your attention!
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Taking care of adolescent patients, Module 7 GardasilTM | 24 July 2016
References
 Orientation programme on adolescent health for healthcare providers. WHO, 2006
 Adolescent job aid. A handy desk reference tool for
primary level health workers. WHO, 2010
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Taking care of adolescent patients, Module 7 GardasilTM | 24 July 2016