Adolescent Sexual Reproductive Health Services Research Articles

Implementing Quality Improvement Initiatives to Improve the Use of Adolescent- and Youth-Friendly Health Services in Zou, Benin.

In Benin, the unmet need for family planning services is especially high for adolescent girls and youth aged 15-24 years. The Challenge Initiative (TCI) supported the health system to assess and improve the quality of adolescent and youth sexual reproductive health services and enhance contraceptive uptake in 65 service delivery points (SDPs) of the Zou department. Between June 2019 and March 2021, TCI supported the health districts in Zou to train an assessment team to complete 3 cycles of quality assessments (QAs) using a QA checklist adapted to the local context. Based on assessment scores, the SDPs were categorized into poor, moderate, or good to excellent quality. The SDP managers developed remedial action plans after each cycle and for each SDP and followed up with supportive supervision. The first QA cycle showed that 52% of assessed SDPs achieved a good to excellent classification; by the second QA cycle, this reached 74%. However, the quality of adolescent- and youth-friendly health services regressed during the third QA cycle (during COVID-19 pandemic disruptions), when only 40% of SDPs achieved the good to excellent category. Between the first and second QA cycles, contraceptive uptake for adolescents and youth improved in the SDPs that had good or excellent quality of services, compared to the ones that were of lower quality (established significance level of 5% with a P value of .031). Further assessments could deepen our understanding of the internal and external factors that can affect service quality. The findings reinforce the importance of investing in quality improvement strategies to maximize the use of sexual and reproductive health services among adolescents and youth. They also underscore the need for a contextual and nuanced approach to ensure enduring results.

Quality Health Services for Adolescents: Assessing Awareness and Use of Adolescent Sexual Reproductive Health Services in Keta, Ghana.

Although adolescents have access to sexual and reproductive health services, they encounter a variety of obstacles, including limited access to safe abortion and contraceptives, early pregnancy and parenthood, and a high occurrence of sexually transmitted infections. This research assessed the awareness and use of adolescent sexual reproductive health services in the Keta Sub-district of Ghana. A cross-sectional study using a quantitative method of analysis and the administration of a structured questionnaire to 350 adolescents between the ages of 14 and 19 in the Keta Sub-district was conducted. Of the 10 services covering adolescent sexual and reproductive health, 75% of participants were aware only of comprehensive sex education. Only 27% were aware of sexually transmitted infection prevention and care services. Awareness was 13% or lower for the remaining eight services. Only 24% had used an adolescent sexual reproductive health service. Awareness of adolescent sexual reproductive health services and their use is low in the Keta Sub-district. To improve access to sexual and reproductive health information, sub-district health services should create school-based satellite clinics for adolescents. Adolescents' ambassadors should be created to educate peers on adolescent issues, especially sexual and reproductive health.

Assessment of Structural and Process Factors in Delivering Quality Adolescent Sexual and Reproductive Health Services in Ghana.

Sexual and reproductive health services are often underserved to adolescents in many societies. For many of these sexually active adolescents, reproductive health services such as the provision of contraception and treatment for sexually transmitted infections, either are not available or are provided in a way that makes adolescents feel unwelcome and embarrassed. This study assessed the structural and process factors available in delivering quality adolescent sexual and reproductive health (ASRH) services in health facilities across three regions in Ghana. A facility-based descriptive cross-sectional study assessed the structural and process factors available for delivering quality adolescent sexual reproductive health services in 158 selected health facilities across three regions (Oti, Eastern, and Volta) of Ghana. A simple random sampling by balloting was used to select the health facilities and a total of 158 adolescents who used ASRH services in the selected facilities were sampled for an existing interview. The Donabedian model of quality assessment was adopted and modified into an assessment tool and a questionnaire to assess the selected health facilities and respondents. The Statistical Package for the Social Sciences (SPSS) version 20.0 was used to analyze the data collected and the findings presented in the tables. The study found some structural and process barriers that affected the delivery of quality ASRH services in Ghana. A proportion of 85 (53.50%) of the facilities assessed did not have separate spaces for delivering services for adolescents. All 158 health facilities had the National Health Insurance Scheme (NHIS) covering contraceptive/family planning services for adolescents. Most (128, 81.01%) facilities had available educational materials on ASRH but were not made available for take home by adolescents. The findings indicated that most respondents did not require parental, spouse, or guardian consent before using ASRH services. The average waiting time for adolescents to be attended to by service providers was ≤30 minutes. The study found some structural and process barriers that affected the delivery of quality ASRH services in Ghana. ASRH services, particularly contraceptive/family planning services, were well integrated into NHIS to improve access and utilization by adolescents.

Sexual and Reproductive Health Service Provision to Adolescents in Edmonton: A Qualitative Descriptive Study of Adolescents’ and Service Providers’ Experiences

The goal of adolescent sexual reproductive health (SRH) services is to provide information, education and healthcare to promote safe health practices and protect adolescents from negative health outcomes; however, access to timely, effective, and affordable SRH services by adolescents in Edmonton, Canada remains relatively unknown. Our study sought to understand the perspectives and experiences of adolescent girls and service providers in relation to availability, accessibility, and quality of SRH services available in Edmonton. The study objectives were to explore SRH services adolescents seek, uncover barriers in accessing SRH services and identify areas to improve accessibility. Qualitative description design was employed to conduct this study. Five service providers specializing in SRH, and eight females (ages 17–20 years) that access SRH services were recruited from the Alberta Health Services Birth Control Centre (BCC). Semi-structured interviews took place via Zoom. Thematic analysis was conducted using NVIVO software. Findings consisted of four primary themes: (1) views and current SRH practices; (2) barriers to accessibility; (3) the effects of COVID-19 on accessibility; (4) identified gaps in SRH care. The findings from our study support the development of knowledge translation strategies and make recommendations to improve the present quality of SRH services in Edmonton.

Task Shifting With Pharmacists to Increase Access and Uptake of Medical Abortion and Contraceptive Services among Adolescents in Kenya

The World Health Organization (WHO) recommends and recognize the importance of involvement of community providers in self-care including medical abortion (MA) among patients. In Kenya, young people between the ages of 15 to 24 constituting one-fifth of the total population are disadvantaged in accessing affordable and quality drugs at the pharmacies or chemists. Although, Misoprostol and mifepristone, used all over the world for MA are sold in many pharmacies in Kenya, adolescent women encounter barriers, including long queues, vigorous screenings and questioning to ascertain whether they are ‘genuine’ or mystery clients when accessing these drugs. The Kenyan, Family Planning guidelines also authorize pharmacies to dispense various forms of contraception, including pills and condoms. These contraceptives can be accessed for free in Kenyan public facilities but are available for sale from private pharmacies. KMET implements an Adolescents health program dubbed Safire, that supports adolescents integrated Sexual and Reproductive Health through a task shifting. The goal is to Improve access of quality adolescent sexual reproductive health (ASRH) services to women ages 10-19 years through task-shifting to minimize missed opportunities. The objective is to evaluate the acceptability, efficiency, and effectiveness of Safire delivery model in providing quality ASRH services for girls. The program received support from Kenya pharmacy Association and Ministry of health to map, recruit, and train 108 pharmacists and 56 health providers in Kiambu, Uasin Gishu, and Bungoma Counties. The pharmacists and providers were trained on quality provision of Sexual and Reproductive Health information and Services to patients. The pharmacies were then linked with trained community volunteers from likeminded civil society organizations (CSOs) to conduct community education and make referrals for sexual reproductive health information and services including abortion. After receiving the services, the volunteers follow up such clients to assess their satisfaction and feedback on services received from the pharmacies. The project has served 7,900 girls (aged 10-19 years) with MA services with 84% (6,636) receiving post-abortion family planning (PAFP) from March 2020 to February 2022 and no reported complication. Among the girls served, successful referrals by community volunteers to the pharmacies constituted 60% (4,740) during the period. Most of the clients served reported high satisfaction level after following up by the volunteers. The strengthened relationship among community health volunteers and the pharmacists created a synergy enabling cross referrals of clients for various services. This improved successful referrals and linkages. Routine quality of care assessments, support supervision and mentorship empowered the pharmacists for improved quality service provision. The engagement of local commodity distributors at negotiated price ensured reduced stock outs among the pharmacist and prices standardization for quality MA products to clients. The ministry of health should invest in training pharmacists as a task shifting approach in offering quality adolescent sexual reproductive information and services in Kenya.

Access to information and use of adolescent sexual reproductive health services: Qualitative exploration of barriers and facilitators in Kisumu and Kakamega, Kenya.

BackgroundKenya has a high prevalence of adolescent pregnancy and low access to and use of adolescent sexual reproductive health services. Despite the enactment of evidence-based policies to address this problem, adolescents continue to face health problems and barriers to adolescent sexual reproductive health information and services.Main objectiveThis study describes barriers to and facilitators of access to adolescent sexual and reproductive health services in Kisumu and Kakamega counties, Kenya.MethodologyWe used a qualitative design. Through 61 data collection sessions, 113 participants were engaged in key informant interviews, in-depth interviews, and/or focus group discussions. Trained Research Assistants (RAs) engaged adolescents, health care workers, teachers, county leaders, and community representatives. Data were captured using audio recorders and field notes. Socio-demographic data were analyzed for descriptive statistics, while audio recordings were transcribed, translated, and coded. Thematic analysis was done with NVivo.ResultsFindings show that the barriers of access to sexual reproductive health services and information were negative health workers’ attitudes, distance to the health facility, unaffordable cost of services, negative social cultural influences, lack of privacy and confidentiality. Facilitators to adolescent sexual reproductive health services were few and included getting priority for school going adolescents and enabling environment for partnerships on adolescent health issues.ConclusionsAdolescents in Kakamega and Kisumu face a myriad of barriers when seeking sexual reproductive health information and/or health services. We recommend that counties sensitize all stakeholders on adolescent sexual reproductive health problems, and support development of multi-sectoral, sustainable solutions to adolescent health needs.

Linkage of voluntary medical male circumcision clients to adolescent sexual and reproductive health (ASRH) services through Smart-LyncAges project in Zimbabwe: a cohort study

ObjectivesWHO recommended strengthening the linkages between various HIV prevention programmes and adolescent sexual reproductive health (ASRH) services. The Smart-LyncAges project piloted in Bulawayo city and Mt Darwin district of Zimbabwe...

Evaluating the effectiveness of a combined approach to improve utilization of adolescent sexual reproductive health services in Kenya: a quasi-experimental design study protocol

BackgroundAccess to and utilization of adolescent sexual and reproductive health (ASRH) services remains poor. ASRH services in Kenya are primarily offered in health facilities and include counselling, information, and services on family planning, sexually transmitted infections, and HIV and basic life skills. The Ministry of Education also provides age-appropriate sexual and reproductive health information in schools. This paper presents a study protocol that will evaluate the effectiveness of a combined approach toward improving utilization of ASRH services.MethodsThis will be a quasi-experimental study utilizing qualitative and quantitative methods. During the formative phase, data will be collected through focus group discussions, in-depth interviews, and key informant interviews to explore the barriers and facilitators of provision and utilization of ASRH services. A quantitative design will be used to obtain baseline and endline data through household surveys and client exit interviews. Following the formative and baseline household and client exit assessments, an intervention focusing on provision of ASRH service package targeting boys and girls will be implemented for 18 months. The package will include contextualized ASRH services, including counselling and age-appropriate, comprehensive sexual education for behavior change with an aim to increase utilization of ASRH services. An analysis of the primary outcome (utilization of ASRH services) will be undertaken to establish the difference in difference between the control and intervention arm, before the intervention (using the baseline survey data) and after the intervention (using the endline survey data).DiscussionAdolescents have now been included in the World Health Organization’s Global strategy for women’s, children’s and adolescents’ health (2016–2030), acknowledging the unique health challenges facing young people and their pivotal role as drivers of change in the post-2015 era. This study will generate evidence on whether a combined school, facility, and community approach works toward improving utilization of ASRH services. The information generated from the study will be beneficial for programming as it will identify underlying reasons for low utilization of ASRH services. Results will help to shape ASRH programs and reduce teenage pregnancy within Kenya and other similar low middle-income countries.Trial registrationThe study is registered at http://www.pactr.org/, registration number PACTR201906738029948.

Adolescent Sexual Reproductive Health Services in Bindura Urban of Zimbabwe

This study seeks to understand the capacity of adolescent-friendly reproductive health services (AFRHS) in promoting sexual reproductive health (SRP) among adolescents in Bindura Urban of Zimbabwe. The data collection methods used allowed the researcher to get insight on adolescents' experience and the factors associated with their accessing SRH services from AFRHS, the meaning of AFRHS for adolescents, healthcare providers' attitudes towards adolescents seeking SRH services, and community perceptions and readiness to accept AFRHS. The findings showed that both socio-cultural and health facility factors influence utilisation of SRH services. Many of these factors stem from the moral framework encapsulated in socio-cultural norms and values related to the sexual health of adolescents and healthcare providers' poor value clarification. This study provides an empirical understanding of the reasons and factors associated with SRH service utilisation, which goes much deeper than program provision of AFRHS in Zimbabwe.

Are Adolescents and Youth Programs Missing The Real Targets? Analysis of Socio-Cultural Factors Influencing Use of Sexual Reproductive Health Services by Young People in Swaziland

Background: Access to reproductive health services by youth has received minimal attention given that Sexual Reproductive Health (SRH) service provision for many years has been tailored to meet the needs of the adult population. The youth have therefore been neglected partly due to cultural sensitivity that dictates what, when and how SRH information and services should be transmitted to them. The current study therefore sought to unveil and explore sociocultural factors influencing youth utilization of SRH services provided in health facilities. Methods: A mixed method approach was used to gain a comprehensive view of factors influencing utilization of adolescent sexual reproductive health (ASRH) services. Data were collected quantitatively by using semi-structured questionnaires and qualitatively through individual in-depth interviews and Focus Group Discussions (FDGs) among a total of 927 youth aged 15-24 years (222 out of school youth and 705 in-school youth). The study sample also comprised of 68 gate keepers who included: teachers, religious authorities, parents/guardians, traditional authorities and health professionals. Results: The study exposed factors underlying utilization of SRH services among Swazi youth. Such factors included the family, peers, religious and community values and norms. Youth who perceived their families, communities and peers to be liberating towards uptake of SRH services were more likely to utilize those services compared to youth who perceived the opposite. Conclusion: The results persuade optimistic youth programs determined to increase uptake of SRH services among youth to incorporate parental and community programs instead of exclusively focusing on youth in all interventions designed to propel protective sexual behaviour among youth at all service delivery levels. Recommendations: Parental, community, traditional and religious leadership involvement in the development and execution of youth program interventions should be prioritized.

A Study Protocol to Assess Accessibility, Utilization, and Compliance on Adolescent Sexual Reproductive Health Services in South Sudan Context

A Study Protocol to Assess Accessibility, Utilization, and Compliance on Adolescent Sexual Reproductive Health Services in South Sudan Context

Impacts of health care providers’ characteristics on their assessment regarding the adequacy of adolescent sexual and reproductive health services in Swaziland

Background: At the present time, there are more than a billion of adolescents living in the developing countries. As they grow up, their circumstances and situations are quite different from that of their parents and their health care providers as well, with greater access to formal education, increasing need of technological skills such as computer, the more advanced cellular phones and internet literacy, and more exposure to new ideas through media, telecommunications and other avenues. These lead to change of environment and other factors that might influence adolescents towards taking decisions in regard to their sexual and reproductive health. On the other hand, it also raises curiosity to the health care providers as they expect them to go through their path of experiences hence that does not happen in most cases. Objective: This study sought to assess the adequacy of adolescent sexual and reproductive health services from the health care providers’ perspective, to determine health care providers’ characteristics associated with their assessment regarding the adequacy of adolescent sexual and reproductive health services as well as to determine factors and perceived barriers to the provision of adolescent sexual and reproductive health services. Methods: A cross-sectional survey was conducted among 196 health care providers in 5 purposively selected healthcare facilities using self-administered, pre-tested structured questionnaires. Descriptive statistics, bivariate statistics; independent-samples t-test and one-way ANOVA, Pearson correlation and multiple regression analysis were conducted to drive impacts and associations of health care providers’ assessment regarding adequacy of adolescent sexual and reproductive health services. Results: The majority of respondents were nurses (87%), followed by physicians and nurse assistants (7% and 6%, respectively). Bivariate results showed that level of education on health care providers’ assessment regarding the adequacy of adolescent sexual and reproductive health services was statistically significant (p = 0.03). The results were also found statistically significant (p = 0.01) on health care providers’ specialty on their assessment regarding adequacy of adolescent sexual and reproductive health services. There was a statistically significant weak positive correlation (r = 0.141, p = 0.039) between health care providers’ perceptions on their assessment regarding adequacy of adolescent sexual and reproductive health services in Swaziland. When a multiple regression analysis was conducted, nurse practitioners and obstetrician among the other groups were statistically significant at (p = 0.012 and p = 0.036, respectively). Another significant predictor of the outcome variable was religion, the Roman Catholic group was statistically significant (p = 0.019) when compared to the other religious groups. Multiple regression analysis results showed 6% of the variances in healthcare providers’ assessment regarding adequacy of adolescent sexual and reproductive health services were explained by specialty and religion. Conclusion: There is a need to improve the curriculum of health care providers in Swaziland in order to address issues of adolescent sexual and reproductive health services. There is also a need to further health care providers training so that they can be able to specialize in different field.