Purpose: This systematic review examines how marginalized young people access and engage with health services and navigate health-care systems in high-income countries. Methods: Medline, CINAHL, PsychInfo, The University of Sydney Library database, and Google Scholar were searched to identify qualitative and quantitative original research, published from 2006 to 2017, that focused on selected definitions of marginalized young people (12 to 24 years), their parents/carers, and/or health professionals working with these populations. A thematic synthesis was undertaken identifying themes across and between groups on barriers and/or facilitators to access, engagement, and/or navigation of health-care systems. Results: Of 1,796 articles identified, 68 studies in the final selection focused on marginalized young people who were homeless (n = 20), living in rural areas (n = 14), of refugee background (n = 11), gender and/or sexuality diverse (n = 11), indigenous (n = 4), low income (n = 4), young offenders (n = 2), or living with a disability (n = 2). Studies were from the United States, Australia, Canada, United Kingdom, New Zealand, and Portugal, including 44 qualitative, 16 quantitative, and 8 mixed-method study types. Sample sizes ranged from 3 to 1,388. Eight themes were identified relating to ability to recognize and understand health issues; service knowledge and attitudes toward help seeking; structural barriers; professionals’ knowledge, skills, attitudes; service environments and structures; ability to navigate the health system; youth participation; and technology opportunities. Conclusions: Marginalized young people experience barriers in addition to those common to all young people. Future studies should consider the role of technology in access, engagement, and health system navigation, and the impact of intersectionality between marginalized groups. © 2017 The Society for Adolescent Health and Medicine

Youth-friendly health services access to health care Marginalized youth Technologies Health system navigation Young people Adolescents

Health Personnel patient care rural area social exclusion refugee lowest income group offender population indigenous people developing country health care personnel face to face support group human health service Developed Countries health status priority journal Internet qualitative research health personnel attitude high income country Young Adult Humans psychology Adolescent sexual orientation Review professional knowledge qualitative analysis quality control Social Marginalization Health Knowledge, Attitudes, Practice organization and management help seeking behavior thematic analysis social participation health care access age global health sample size disability health care system skill quantitative analysis Delivery of Health Care medical decision making parental attitude systematic review attitude to health health practitioner homelessness caregiver Health Services Accessibility health care delivery parent