Adolescent Health Services Research Articles

Diagnostic trajectories of mental disorders in children and adolescents: a cohort study.

Mental disorders in children and adolescents may follow different trajectories, such as remission, change of diagnosis, or addition of two or more comorbid diagnoses, showing a heterotypic pattern. This study aims to describe the main diagnostic trajectories across a broad range of mental disorder diagnostic categories, from childhood to adolescence and from adolescence to young adulthood in a clinical population. A prospective study was conducted among a clinical sample of children and adolescents who were aged 3-17years at the face-to-face baseline interview. Electronic health records of these participants were reviewed 10years later. The diagnostic stability over time was examined using the kappa coefficient, and factors associated with stability were explored using simple logistic regression. The study included a sample of 691 participants. The kappa coefficient for diagnostic stability across all diagnoses was 0.574 for the transition from childhood to adulthood, 0.614 from childhood to adolescence, and 0.733 from adolescence to adulthood. Neurodevelopmental diagnoses had the highest stability. Factors associated with higher diagnostic stability included family history of mental disorders, receiving psychopharmacological treatment, and symptom severity at baseline. We found a variable diagnostic stability across different diagnoses and age categories. The different life transitions represent complex periods that should not be overlooked from a clinical standpoint. An appropriate transition from child and adolescent mental health services to adult mental health services may have a positive impact on children and adolescents with mental disorders.

Understanding healthcare services response to technology - assisted child sexual abuse: A freedom of information study

BackgroundThe reported rates of technology-assisted child sexual abuse (TA-CSA) have increased in the last decade. It is unclear how services are currently responding to cases of child sexual abuse that involve an online element. ObjectiveThe aim of this study is to understand the current framework of support offered by National Health Service (NHS) UK Child and Adolescent Mental Health Services (CAMHS) and Sexual Assault Referral Centres (SARC) for cases involving TA-CSA. This includes understanding if a services' current assessment tools refer to TA-CSA, whether interventions address TA-CSA, and assessing what training for TA-CSA is offered to practitioners. SettingSixty-eight NHS Trusts with either an affiliated CAMHS or SARC. MethodA Freedom of Information Act request was sent to NHS Trusts. Under this Act, the Trust had 20 working days to respond to the request, which included 6 questions. Results86 % Trusts (42 CAMHS and 11 SARC) responded to the request. Of the responses, 54 % CAMHS and 55 % SARC offer relevant training to practitioners. 59 % CAMHS and 28 % SARC provide tools for their initial assessment that reference online life. No Trust provided a clear treatment approach for TA-CSA, with 35 % CAMHS and 36 % SARC responding that treatment would address the mental health needs of the young person. ConclusionsThere is a need for a nationwide understanding of how to clearly define TA-CSA in policies and how to approach TA-CSA during an initial assessment. Further, a consistent approach on how to equip practitioners with tools to support individuals who have experienced TA-CSA is urgently needed.

Clinicians’ perceptions of the mental health needs of young people in alternative provision educational settings: An exploratory qualitative analysis

ABSTRACT It is estimated that 1 in 2 young people who are educated in Alternative Provision (AP) educational settings have social, emotional and mental health difficulties. However, the extent to which the mental health needs of these young people are currently being met by Child and Adolescent Mental Health Services (CAMHS) is less clear. In this qualitative study, semi-structured interviews were conducted with 15 CAMHS practitioners who had worked with young people educated in AP settings to explore secondary health care service engagement. We analysed the data using thematic analysis. Findings suggest that young people educated in AP settings have complex mental health needs for which they are currently not receiving adequate support, due to shortcomings within AP schools and numerous external barriers to care. Implications for clinicians and service commissioners include a need for further integration between CAMHS and education services, and better quality support across AP settings.

Service Users Experience in the Use of Tele-Psychiatry in Child and Adolescent Mental Health Services in NHS Orkney

Aims/BackgroundNear Me is a tele-psychiatry platform for conducting video consultation appointment in Child and Adolescent Mental Health Services (CAMHS) in NHS Orkney (NHSO). This model of consultation was introduced in NHSO CAMHS during the COVID-19 pandemic. The performance in offering effective clinical intervention in the domains of quality of care will determined through the experiences of both users and providers of care in this respect.To assess the perception and experiences of service users (clinicians, patients and their families) on the use of Near Me in NHS Orkney Child and Adolescent Mental Health Services by applying the domains of quality of care as a measure. To enable all stakeholders (policy planners, users and providers) to identify gaps and barriers in the use of Near Me and to inform change in practice.MethodsA survey was developed using the Telehealth Usability Questionnaire which is a validated tool to generate responses on the key domains of quality of care measures of appropriateness, reliability, access, timeliness, usefulness, effectiveness, interaction, quality, efficiency, safety, satisfaction and possibility of future use for both users and providers of care.The survey was made available on social media platforms including websites and online adverts for clinicians, patients and their families in Orkney to complete for a period for 10 weeks.Results28 responses were received with 14 completed responses (6 staffs & 8 patients and families) and 14 uncompleted responses (4 staffs and 10 patients & families).A mean rank test was applied to appropriately evaluate the responses received.Over 50% of respondents show high level of satisfaction in the use of tele-psychiatry services in all domains of quality of care in Orkney NHS CAMHS.Access, timeliness and safety are highly positively rated by both clinicians and service users.Improvement in network connections, improved coordination and understanding of technology will enhance the service.Better understanding of the handling of technical problems in tele-psychiatry services should be addressedReduction of in-person interactions was identified by some respondents as concern.Conclusion/recommendationTele-psychiatry is highly useful and accepted as revealed by the survey but network connections for the Near me platform needs to be improved. Face to face consultations should not be discounted and should be available where possible for better engagement.As the first survey of the use of tele-psychiatry in NHS Orkney, this study will serve to establish a baseline for future evaluation of tele psychiatry services in NHS Orkney CAMHS.

A Service Evaluation of Referrals to Sheffield Community Child and Adolescent Mental Health Services (CAMHS) by Ethnicity and Areas of Deprivation

AimsTo investigate disparities in the number and outcome of referrals to Sheffield Community Child and Adolescent Mental Health Services from different ethnic groups and areas of deprivationMethodsThe authors reviewed the the 2021 census data for Sheffield and grouped Sheffield into 3 areas of deprivation (low, medium, and high) based on Index of Multiple Deprivation (IMD 2019 Rank).Reasons and outcome of referrals to Sheffield Community CAMHS for the months of March and April 2022 were analysed by ethnicity and deprivation,ResultsOur study shows that, compared to their white counterpart, Black and Asian children and young people (CYP) were markedly under-represented in CAMHS referrals, whilst CYP of mixed ethnicities were over-represented. Of this group, Asian and mixed ethnicity CYP were less likely to have referrals accepted. Similarly, CYP from areas of high deprivation were also less likely to be accepted into the community CAMHS service. While anxiety was the most common reason for referral, CYP from areas of high deprivation were 3 times more likely to be referred for behavioural difficulties than CYP from areas of low deprivation.ConclusionOur study highlighted that black ethnicities are disproportionately underrepresented in CAMHS referrals. Furthermore, children and young people from an Asian background are not only underrepresented in the number of referrals but also in the proportion of referrals accepted. Similarly, it is reported that CYP from deprived backgrounds are more likely to experience barriers to accessibility to mental health services, and this was also evident from our evaluation.Black and Asian CYP continue to be under-represented in CAMHS services as are CYP from deprived communities. However, these ethnic groups present the highest reported mental health difficulties at adulthood. More research is therefore needed in this area, to identify the specific barriers to accessing mental health care in Sheffield Community CAMHS, so as to allow the provision of culturally appropriate mental health services for the ethnic and high derivation groups.

Trainee Led Quality Improvement Addressing Lack of Transparency in Referral Processes for Psychiatric Reviews in the Maudsley Adolescent Mental Health Service

AimsThe Specialist Adolescent Mental Health Service at the Maudsley Hospital provides multi-disciplinary mental health care to adolescents in London. There is currently no policy by which non-medical members of the multi-disciplinary team can request a psychiatric review for their patients. Staff feedback revealed problems with the medical review referral process to be a lack of clarity on how to make referrals, and a lack of transparency (e.g. referral outcome, approximate waiting time).This projected aimed to improve the clarity of the process for requesting psychiatric reviews and to develop skills in leadership as a future child psychiatrist.MethodsWe designed and introduced a referral form and integrated waiting list. Next we developed a policy document for making referrals. Finally we modified the referral form so that when submitted, it automatically updated the integrated waiting list. At the outset and after each intervention we resurveyed the staff.ResultsAt the outset 71% of staff reported finding the process somewhat unclear, while 29% reported finding the referral process neither clear nor unclear. Following the final change 100% staff each reported finding the process very clear or somewhat clear.ConclusionThe changes we implemented resulted in a clearer and more transparent referral process for medical reviews. We anticipate that this improved staff satisfaction will equally translate into some benefits for patient care, such as more clarity around when a medical review can be expected and what it might entail.

Pendampingan Peningkatan Kapasitas Kader Posyandu Remaja Uswatun Hasanah Desa Cikunir Wilayah Kerja Puskesmas Singaparna

Introduction: Adolescent Reproductive Health Service is an activity and/or a series of activities aimed at adolescents in the context of maintaining reproductive health.Youth Integrated Service Post (Posyandu) is a form of Community-Based Health Efforts (UKBM) that is managed and organized from, by, for and with the community, including youth, in the implementation of health development, in order to empower the community and provide convenience in obtaining health services for adolescents to improve health status and adolescent healthy life skills. In Cikunir Village, Singaparna District, Tasikmalaya Regency, there is a youth Posyandu which has been running for 2 years. Based on information from youth cadres, there are 3 cadres who are not active. In this regard, it is necessary to recruit new youth cadres and enhance the capacity of youth cadres to increase their role in the implementation of youth posyandu. Objective: The purpose of this service was The purpose of this service was increase the capacity of youth posyandu cadres in managing posyandu.The target of the activity included youth posyandu cadres, prospective youth posyandu cadres from each hamlet and youth posyandu working groups in Cikunir village. Method: This public service was conducted by Observational method. Result: The results of the activity obtained increased knowledge of cadres about adolescent reproductive health counseling materials and increased youth skills in implementing the 5 table posyandu system and examination anthropometry. Conclusion: Cadre assistance is able to improve the knowledge and skills of cadres in the implementation of the Youth Integrated Service Post.

Peran Komunikasi Orang Tua terhadap Kesehatan Reproduksi pada Remaja

This study aims to examine whether parental communication in adolescent reproductive health services plays a role in encouraging adolescents to utilize sexual and reproductive health services. This research method uses Literature Review with JBI (Joanna Briggs Institute) Critical Appraisal. Family”, “Health Services,” “Reproductive Health,” Sexual and Reproductive Health.” The research results show that the influence of parents to be able to encourage access to reproductive health services is the lack of parental education, adequate family economy, living with parents, and the lack of facilities provided by the local government. In conclusion, teenagers must involve parents in sexual and reproductive health communication with adolescents because they can encourage youth-friendly health services and prevent sexual and reproductive health outcomes and harmful behavior among adolescent students.
 
 Keywords: Family, Reproductive Health, Sexual Health Reproductive Health, Sexual Health

Impact of COVID-19 Pandemic on Outpatient Child and Adolescent Mental Health Service at a Tertiary Care Hospital of Pakistan

Objective: to determine the impact of COVID-19 on mental health care service provision and the pattern of morbidity presenting to out-patient child psychiatry services in Pakistan.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Child and Adolescent Mental Health Unit, Institute of Psychiatry, Rawalpindi Pakistan, Medical university, from Jan 2019 to Dec 2020.
 Methodology: Hospital records for the years 2019 and 2020 were used to get data on the total number of Out-Patient Department (OPD) visits in both years, and Departmental OPD records were used to extract data on all new patients.
 Results: Two thousand two hundred thirty-two OPD visits were recorded in 2019 versus 536 in 2020, a 76% decline. Eight hundred fifty-six new patients were seen in 2019 vs 259 in 2020. The detailed OPD record analysis revealed that the predominant age group reporting was adolescents in both years. 377(44%) patients reported with behavioural problems in 2019 vs 138(53.3%) in 2019. Pharmacological management plans were used in 138(16.1%) in 2019 vs 66(25.5%) in 2019. Common Diagnoses seen in both years were not significantly different, (p=0.087). OPD records were found to have an increase in the “not mentioned category”, thus reflecting declined quality of record keeping.
 Conclusion: The COVID-19-related lockdown and pandemic led to a sharp decline in out-patient visits and deterioration and record-keeping quality. The number of children and adolescents presenting with behavioural problems increased, but the common diagnoses remained similar.Keywords: COVID-19, Child and adolescent mental health service, Child psychiatry, Pandemic, School closure.

CAMHS Clinician Attitudes to Borderline Personality Disorder in Adolescence Across Scotland.

Child and Adolescent Mental Health Service (CAMHS) clinicians have been reported to hold negative views toward the diagnosis of borderline personality disorder (BPD) in adolescence. We aimed to reevaluate with the expectation that recent advances have nurtured more positive attitudes. One hundred ninety clinicians working across CAMHS in Scotland completed a 16-item electronic survey of attitudes to BPD, derived from the Attitudes and Skills Questionnaire. Eighty-three percent of psychiatrists, 72% of nurses, and 37% of psychologists surveyed agreed that BPD is a valid diagnosis in adolescence, and 92%, 74%, and 44%, respectively, were willing to make this diagnosis. CAMHS clinicians were more optimistic compared with clinicians working in adult mental health services. CAMHS clinicians' responses may indicate increased acceptance of BPD in the adolescent population. There is a thirst for workforce education and training. Consideration should be taken to actively move the focus of identification and diagnosis of BPD into CAMHS rather than the current culture of late diagnosis.

Improving Collaboration Between Youth Peer Support Workers and Non-peer Colleagues in Child and Adolescent Mental Health Services

The involvement of youth peer workers (YPSWs) in child and adolescent mental health services (CAMHS) stimulates hope, destigmatization, and more culturally and developmentally appropriate support. Nevertheless, the collaboration between YPSWs and non-peer colleagues remains challenging, as it requires services to embed a new type of expert into practice. To stimulate the involvement of YPSWs in practice, this study reports on 27 semi-structured interviews with YPSWs and non-peer colleagues to provide insight into the barriers and facilitators in the collaboration process. The study took place in the Netherlands. A total of 10 interviews with YPSWs, and 17 interviews with non-peer colleagues in different healthcare occupations in CAMHS were conducted. Overall, the participants perceived relatively more barriers compared to facilitators in the collaboration process. Barriers to operate efficiently with YPSWs in multidisciplinary teams included: condescending attitudes and professional stigma towards YPSWs; concerns for YPSW boundaries; bureaucratic and clinical language usage by non-peer colleagues; conflicts due to different sets of expertise; and, lack of role clarity and guidelines for YPSWs. To improve the partnership between YPSWs and non-peer colleagues, participants described the importance of supervision and monitoring of YPSW activities. Moreover, participants also stressed the need for clear guidelines, and introduction and evaluation sessions to facilitate the collaboration process. While YPSWs seem to be an asset to CAMHS, there are a number of barriers to overcome. To overcome these barriers, organizational commitment, supervision (especially from peer colleagues), flexibility by non-peer colleagues, training non-peer staff to support YPSWs, and consistent evaluation of the implementation of YPSWs in services is recommended.

Paternal Communication and Sexual Health Clinic Visits Among Latino and Black Adolescent Males With Resident and Nonresident Fathers

PurposeLatino and Black adolescent males experience sexual health inequities, and their engagement in sexual health services remains low. Parents shape adolescent sexual health behavior and other youth outcomes. However, the role of Latino and Black fathers in promoting male adolescent sexual health is understudied, in part because about one in four fathers resides apart from their children and nonresident fathers are presumed to be less influential. We examined associations of paternal communication with sexual health service use and perceived paternal role modeling among Latino and Black adolescent males with resident and nonresident fathers. MethodsWe recruited 191 Latino and Black adolescent males aged 15–19 years and their fathers in the South Bronx, New York City, using area sampling methods; dyads completed surveys. We estimated bivariate and adjusted associations of paternal communication with adolescent male sexual health service use and perceived paternal role modeling using logistic and linear regressions. Effect measure modification by paternal residence was assessed. ResultsA unit increase on a five-point paternal communication scale was associated with approximately twice and 1.7 times the likelihood of clinical sexual health service use during adolescent males' lifetime and in the past 3 months, respectively; there was no significant effect measure modification by paternal residence. Paternal communication was associated with increased levels of perceived paternal role modeling and usefulness of paternal advice, with stronger associations for nonresident fathers. DiscussionBoth resident and nonresident Latino and Black fathers warrant greater consideration as partners in promoting male adolescent sexual health service use.

Quality of sexual and reproductive health services for adolescents and young people in public health facilities in Southwest Nigeria: A Mystery client study

Quality of sexual and reproductive health services for adolescents and young people in public health facilities in Southwest Nigeria: A Mystery client study

Development of the Adolescent Health Services Quality of Care Index for Mystery Client Studies

Development of the Adolescent Health Services Quality of Care Index for Mystery Client Studies

Validation of the Adolescent Health Quality of Care (AHQOC) index for mystery client studies.

The Adolescent Health Quality of Care (AHQOC) index is a tool designed to evaluate the quality of facility-based adolescent sexual and reproductive health (ASRH) services. This descriptive cross-sectional study aimed to validate the AHQOC index in 27 primary and secondary public health facilities located in a rural and an urban local government area (LGA) of Ogun State, Nigeria. To conduct the study, 12 mystery clients (MCs) were recruited and performed 144 visits to the health facilities. The MCs were young males and females who were seeking information on premarital sex, pregnancy prevention, sexually transmitted infections (STIs), and contraception. The validity, and reliability of the AHQOC index were evaluated using exploratory factor analysis, Cronbach's Alpha, and intra-class correlation coefficient tests. The Kaiser-Meyer-Olkin test result for the initial 37-item pool was 0.7169, and the final tool retained 27 items with a Cronbach's Alpha of 0.80. Two subscales of the index had Cronbach's Alpha of 0.76 and 0.85. The intra-rater consistency assessed by the intra-class correlation coefficient was 0.66 (0.10-0.92) p = 0.001 for the urban LGA and 0.72 (0.37-0.91) p = 0.001 for the rural LGA. Positive and statistically significant relationships were observed between the full scales and subscales and the validity item (MC ranking of health worker on proficiency from 1 to 10). The results of this study demonstrate that the validated AHQOC index is a valuable tool for assessing the quality of ASRH services in public health facilities.

Impact of Maternal Mental Illness on the Mothers and the Children: A 7-9 Years Follow-Up Study

The Psychiatry Research and Motherhood (PRAM) study is a cohort of 300 pregnant women (and their babies), half of whom had a mental disorder (major depression or bipolar disorder) in their personal history or during pregnancy. Mothers were assessed in pregnancy, and both mothers and babies were assessed in the first year postpartum; additional data is currently been collected as follow-up of these mothers and their children again, now that children are aged between 7 and 9. Our published findings show that women who suffer from a mental disorder, even if preceding pregnancy, have difficulties in the interaction with their infant in the first year of life, which then continues to be present 7-9 years later. In fact, in analysing the data at age 7-9 that we have so far, we have found that when compared with children in the control group, children born from mothers who were depressed in pregnancy showed higher levels of non-secure attachment, indicating difficulties in their relationship with the mothers. 23% of these children were also referred to child and adolescent mental health services compared to only 8% of children in the control group. Cortisol secreted in saliva during a stressor task was more pronounced in the children born from depressed mothers; furthermore, female children within this group demonstrated reduced performance at cognitive tests of memory and attention. The data we've collected indicates that mental health problems measurable in children at around the age of 7-8 can be predicted by maternal depression during pregnancy, or a difficult mother-infant interaction in the first year of life.

Key informant perspectives on policy- and service-level challenges and opportunities for delivering adolescent and youth-friendly health services in public health facilities in a Nigerian setting

Key informant perspectives on policy- and service-level challenges and opportunities for delivering adolescent and youth-friendly health services in public health facilities in a Nigerian setting

Amygdala Response to Fear in Boys With Conduct Problems Following Parent Training: Considering Heterogeneity

Conduct problems (CPs) in childhood, such as conduct disorder and oppositional defiant disorder, are among the most prevalent mental health disorders in childhood and a leading cause for referral to child and adolescent mental health services ( 1 Fairchild G. Hawes D.J. Frick P.J. Copeland W.E. Odgers C.L. Franke B. et al. Conduct disorder. Nat Rev Dis Primers. 2019; 5: 43 Crossref PubMed Scopus (152) Google Scholar ). The 2019 Global Burden of Disease Study found that for the 0- to 14-year-old age category, CPs have now become the leading cause of burden among mental disorders, in terms of both disability-adjusted life years and years lived with disability ( 2 GBD 2019 Mental Disorders CollaboratorsGlobal, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry. 2022; 9: 137-150 Abstract Full Text Full Text PDF PubMed Scopus (502) Google Scholar ). Crucially, various prospective longitudinal studies have shown that the negative outcomes observed in youth persist into adulthood and cover a similar range of domains. Importantly, the worst outcomes in adulthood are experienced by those whose CP symptoms persist ( 1 Fairchild G. Hawes D.J. Frick P.J. Copeland W.E. Odgers C.L. Franke B. et al. Conduct disorder. Nat Rev Dis Primers. 2019; 5: 43 Crossref PubMed Scopus (152) Google Scholar ). SEE CORRESPONDING ARTICLE ON PAGE 50 SEE CORRESPONDING ARTICLE ON PAGE 50 Selective Amygdala Hypoactivity to Fear in Boys With Persistent Conduct Problems After Parent TrainingBiological PsychiatryVol. 94Issue 1PreviewParenting interventions reduce antisocial behavior (ASB) in some children with conduct problems (CPs), but not others. Understanding the neural basis for this disparity is important because persistent ASB is associated with lifelong morbidity and places a huge burden on our health and criminal justice systems. One of the most highly replicated neural correlates of ASB is amygdala hypoactivity to another person’s fear. We aimed to assess whether amygdala hypoactivity to fear in children with CPs is remediated following reduction in ASB after successful treatment and/or if it is a marker for persistent ASB. Full-Text PDF Open Access

COVID-19 and Adolescent Outpatient Mental Health Service Utilization

ObjectiveThe COVID-19 pandemic created challenges in accessing mental health (MH) services when adolescent well-being declined. Still, little is known about how the COVID-19 pandemic affected outpatient MH service utilization for adolescents. MethodsRetrospective data were collected from electronic medical records of adolescents aged 12–17 years at Kaiser Permanente Mid-Atlantic States, an integrated health care system from January 2019 to December 2021. MH diagnoses included anxiety, mood disorder/depression, anxiety and mood disorder/depression, attention-deficit/hyperactivity disorder, or psychosis. We used interrupted time series analysis to compare MH visits and psychopharmaceutical prescribing before and after the COVID-19 onset. Analyses were stratified by demographics and visit modality. ResultsThe study population of 8121 adolescents with MH visits resulted in a total of 61,971 (28.1%) of the 220,271 outpatient visits associated with an MH diagnosis. During 15,771 (7.2%) adolescent outpatient visits psychotropic medications were prescribed. The increasing rate of MH visits prior to COVID-19 was unaffected by COVID-19 onset; however, in-person visits declined by 230.5 visits per week (P < .001) from 274.5 visits per week coupled with a rise in virtual modalities. Rates of MH visits during the COVID-19 pandemic differed by sex, mental health diagnosis, and racial and ethnic identity. Psychopharmaceutical prescribing during MH visits declined beyond expected values by a mean of 32.8 visits per week (P < .001) at the start of the COVID-19 pandemic. ConclusionsA sustained switch to virtual visits highlights a new paradigm in care modalities for adolescents. Psychopharmaceutical prescribing declined requiring further qualitative assessments to improve the quality of access for adolescent MH.

The role of gender inequities in women's access to reproductive health services: a population-level study of Simiyu Region Tanzania

BackgroundAmref Health Africa, with support from Global Affairs Canada, examines if women's access to reproductive health services in Tanzania is affected by Gender social norms, decision-making power, roles and responsibility, and access to resources in relation to the utilization of reproductive Health Services in Tanzania. A Gender Need Assessment (GNA) was conducted in five districts in ' 'Tanzania Simiyu Region to improve the infrastructure, supply, quality, and demand for integrated Reproductive, Maternal, Newborn, and Child and Adolescent Health (RMNCAH), Nutrition, and Water, Sanitation, and Hygiene (WASH) services. The analysis identifies gender as a fundamental maternal and child health driver through existing gender inequality at the household and community levels that dictates women's status.MethodsThe qualitative assessment involved data collected from gender- and age-desegregated focus group discussions (FGDs) and in-depth interviews (IDIs) of key informants in three districts; Bariadi, Busega, and Meatu, in Simiyu region, Tanzania. Participants comprised 8-10 married women and men, unmarried women and men, and adolescent boys and girls. A total of 129 participants were involved in the FGDs.ResultsThis paper reports the critical drivers influencing gender inequality in Simiyu by detailing how Gender inequality affected women's access to reproductive health care in relation to; gender social norms, decision-making power, access to resources at the household and community level, roles and responsibilities, including men's and 'boys' roles are more valued than the roles and responsibilities of women and girls resulted to limited free time to do things for themselves, such as visiting the health facilities for RMNCAH.ConclusionsThis paper explored gender-based enablers and/or barriers influencing women and girls' realization of their sexual and reproductive health and rights. It was found that social norms, decision-making powers, and lack of access to and control over resources presented as key barriers. In contrast, continuous community sensitization and increased scope of women's participation in decision-making served as enabling environment to overcome gender inequities that influence woman's use of RMNCAH services in Tanzania. Such insights will shape interventions geared towards valuing differences in a manner that overcome gender inequities that influence woman's use of RMNCAH services in Tanzania.