Background: Mystery client methodology is a form of participatory research that provides a unique opportunity to monitor and evaluate the performance of health care providers or health facilities from the perspective of the service user. However, there are no systematic reviews that analyse the use of mystery clients in adolescent sexual and reproductive health (ASRH) research and monitoring and evaluation of programmes. Objective: To assess the use of adolescent mystery clients in examining health care provider and facility performance in providing ASRH services in high, middle, and low-income countries. Methods: We carried out a systematic review of published journal articles and reports from the grey literature on this topic from 2000 to 2017 (inclusive). Thirty research evaluations/studies were identified and included in the analysis. We identified common themes through thematic analysis. Results: The findings reveal that researchers and evaluators used mystery client methodology to observe client-provider relationships, and to reduce observation bias, in government or private health facilities, NGOs, and pharmacies. The mystery clients in the evaluations/studies were young people who played varying roles; in most cases, they were trained for these roles. Most reported good experiences and friendly providers; however, some reported lack of privacy and confidentiality, lack of sufficient written/verbal information, and unfavourable experiences such as sexual harassment and judgmental comments. Female mystery clients were more likely than males to report unfavourable experiences. Generally, the methodology was considered useful in monitoring and evaluating the attitudes of health service providers and ASRH service provision. Conclusions: The research evaluations/studies in this review highlight the usefulness of mystery clients as a method to gain insight, from an adolescent perspective, on the quality of ASRH services for research and monitoring and evaluation of programmes.

Mexico's efforts at sexuality education have progressively evolved, from a biological focus in the socialist era in the 1930s, to adding a demographically concerned family planning component in the 1970s and including a wider reproductive health perspective in the 1990s, and finally shifting to a broader sociological context in the early 21st century. Opposition to sexuality education rose steadily in the time period considered, with a growing range of more organized and well-financed actors. Despite this opposition, alliances between academic, government, civil society, and NGO champions have helped ensure sustainability.

El objetivo principal de este estudio fue examinar las propiedades psicométricas de la versión en español de la escala Utrecht de engagementen el trabajo (UWES) en su versión de 17 ítems para la evaluación de trabajadores de la salud en Uruguay. La muestra se compuso de 1324 trabajadores de ambos sexos (63.7% de mujeres) de diferentes instituciones de salud, públicas (45.7%) y privadas (54.3%), de Montevideo y del interior del país (64.4% y 35.6% respectivamente). Los análisis de consistencia interna, mediante coeficiente alfa de Cronbach, revelan niveles satisfactorios de consistencia interna de la escala total y los tres factores, y refuerzan la evidencia de debilidad de dos ítems de la escala. Los análisis de estructura factorial a partir de un análisis factorial confirmatorio, muestran el ajuste medianamente aceptable del modelo trifactorial a los datos, aunque los elevados índices de correlación entre los factores latentes indican que un modelo unifactorial también podría ser aceptable. La evidencia de este estudio sugiere que la versión en español del UWES-17 puede ser un instrumento válido y confiable para la medición del compromiso y sus tres factores en los trabajadores de salud en Uruguay.

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