**This is a longer version of the article published in the Health Service Journal.**

'Mystery shoppers' test services
By Paul Dinsdale

Croydon primary care trust wanted to find out how easy or difficult it was for young people to access sexual health services in its area, particularly in the light of the Department of Health 2003 sexual health strategy.

A survey of 294 young people, aged between 13-19, was carried out to obtain a ‘snapshot picture’ of whether young people knew what services would be available to them if they found themselves in different situations.

The survey found a varied level of awareness among young people about what services were available and where services were located.

To evaluate the level of service being provided by the NHS and other local health services, the PCT, led by research and evaluation specialist Susie Sykes, decided to use a group of ‘mystery shoppers’, who would visit all the possible outlets for sexual health services and report on their ease of access, the quality of service provided and overall satisfaction.

The group of mystery shoppers was recruited through a number of routes, including talks at a local college, through the youth service, a young mums support group, Millennium Volunteers ( a local voluntary group), word of mouth, posters advertising the project and a recruitment evening.

More than 50 young people signed up to be involved in the project and, from these, a group of 20, aged between 13 and 21 was identified. The PCT ensured that the young people were from different backgrounds, so that they accurately represented the local population, with some in college or school, some working and some young mothers.

The services they were asked to access included: an NHS walk-in centre which offered family planning services; a Connexions young people’s clinic; health clinics which offered sexual health services; two genitor-urinary clinics; and a range of local pharmacies.

They were given a range of different scenarios to engage in, such as asking for contraceptive advice, advice on pregnancy and abortion, and advice on sexually transmitted infections.

The results painted a varied picture of how young people were treated by local health services.

One of the main issues which emerged was confidentiality. This was viewed as very important, but not all young people were clear about what their rights were in this area. Some of the shoppers suggested that young patients should be given a card explaining the policy while they wait. It was suggested that the practitioner could then ask if they understood the points and if they have any questions.

The main finding was that most practitioners treated the mystery shoppers with respect and communicated ‘fairly well’ with them. The young people appreciated it when practitioners were polite, kind, friendly and interested in them, but felt uncomfortable when staff were rushed, rude or did nothing to make the experience easier for them beyond giving out basic advice.

The shoppers felt less comfortable talking to reception staff and often felt they were dealt with abruptly and without respect. They wanted staff to be sensitive to the fact that they may have been first-time users and did not know what to do, and that they did not want everyone to know why they were attending the service.

Some young people also found it difficult to get past reception staff and did not actually see a practitioner. Other issues identified were long waiting times; a desire to be treated as equal to older patients; a lack of cross-referral between services, eg, to a GUM clinic if they had had unprotected sex; and a lack of knowledge among reception staff about what services the centre or clinic provided.
For further details contact Susie Sykes, research and evaluation specialist, Croydon PCT, 020 8274 6396.

Resources:
Better prevention, better services, better sexual health
The national strategy for sexual health and HIV, Department of Health, 2001

The national strategy for sexual health and HIV implementation action plan
Department of Health, 2002

Recommended standards for sexual health services
Department of Health, 2005

Effective Sexual Health Promotion Toolkit
Department of Health 2003