title: Measuring adolescent friendly health services in India: A scoping review of evaluations.
abstract: BACKGROUND
  Initiatives to promote adolescent friendly health services (AFHS) have been taking place in India and many low- and middle-income countries for nearly two decades. Evaluations of these initiatives have been placed in the public arena from time to time, but little is known about what they say about the overall situation on AFHS in India. This study aimed to describe how efforts to provide AFHS in India have been evaluated, how well they have been evaluated, and what their findings and implications are.
  
  
  METHODS
  We conducted a scoping review of evaluations of AFHS initiatives in India from 2000 to 2014. An electronic search was carried out in Medline and EMBASE. A manual search of grey literature was also performed, and experts were contacted in order to obtain additional manuscripts and reports.
  
  
  RESULTS
  Thirty evaluation reports were identified representing a broad geographic distribution. Evaluations have focused on government-sponsored AFHS programmes or independent non-governmental organization (NGO) initiatives to strengthen government services. The evaluations primarily measured programme outputs (e.g. quality and service utilization) and health behavioural outcomes (e.g. condom use). Study designs were commonly descriptive or quasi-experimental. Most evaluations found improvement in quality and utilization of services, and some demonstrated an increase in adolescent knowledge or health behaviours. Few measured positive project/programme results such as older age at first pregnancy. Strengths of evaluations were clear objectives, frequent use of multiple data sources, and assessment of programmatic outputs as well as health outcomes. Weaknesses were lack of consistency and quality.
  
  
  CONCLUSIONS
  Our findings confirm that a number of evaluations of AFHS initiatives in India have been carried out. They point to service quality and in behavioural improvements in adolescents. However, their lack of consistency hinders comparison across sites, and their uneven quality means that their findings need to be interpreted with caution.
authors.affiliation: Department of Pediatrics, University of Colorado School of Medicine, 13123 East 16th Avenue, Box B025, Aurora, CO, USA. andrea.hoopes@childrenscolorado.org.
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Hoopes
authors.affiliation: Department of Community Medicine, Maulana Azad Medical College, New Delhi, India.
authors.forename: Paras
authors.initials: P
authors.lastname: Agarwal
authors.affiliation: Department of Community and Behavioral Health, Colorado School of Public Health, 13001 E. 17th Place, B119, Bldg 500, Room, E3345A, Aurora, USA.|Anschutz Medical Campus, Aurora, CO, 80045, USA.
authors.forename: Sheana
authors.initials: S
authors.lastname: Bull
authors.affiliation: Division of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211, Geneva 27, Switzerland.
authors.forename: Venkatraman
authors.initials: V
authors.lastname: Chandra-Mouli
mesh_terms: D000293:Adolescent; D006296:Health Services / Q000592:standards*; D006297:Health Services Accessibility; D006801:Humans; D007194:India; D009313:National Health Programs / Q000592:standards*; D009938:Organizations / Q000592:standards; D015397:Program Evaluation; D034121:Reproductive Health Services / Q000592:standards*; D012725:Sexual Behavior
keywords: Adolescent friendly health services; Adolescent sexual and reproductive health; Contraception; India; Programme evaluation; Reproductive health services; Systematic review