University of Health Sciences, Vientiane, Lao PDR.
Vrije Universiteit Amsterdam, De Boelelaan, the Netherlands.
PLoS One. 2019 Oct 29;14(10):e0218296. doi: 10.1371/journal.pone.0218296. eCollection 2019.
BACKGROUND: Sexual activity during youth is common in Lao PDR. However, young people seldom utilize sexual and reproductive health services and subsequently suffer from poor sexual and reproductive health. The aim of this qualitative study was to explore the barriers perceived by youth that prevent their access to sexual and reproductive health services. METHODS: Twenty-nine semi-structured interviews were conducted with 22 participants aged 15-25 years, from urban and rural areas. A vignette was used during interviews with those who had no experience with sexual and reproductive health services. Additionally, seven semi-structured interviews were conducted with health providers from youth-friendly health clinics and from public sexual and reproductive health services. Data were analyzed using a thematic approach. RESULTS: The main barriers preventing young people from accessing sexual and reproductive health services were related to cognitive accessibility and psychosocial accessibility. The cognitive accessibility barriers were a lack of sexual knowledge and a lack of awareness of services. Perceived barriers in psychosocial accessibility were the feelings of shyness and shame caused by negative cultural attitudes to premarital sex, and the fear of parents finding out about visits to public sexual and reproductive health services, due to lack of confidentiality in the services and among health providers. In addition, the barriers of geographical accessibility, mainly insufficient availability of youth-friendly health clinics. CONCLUSION: To improve access to services, a multi-component strategy is needed: promotion of youth-friendly health clinics; sexual education in schools; a formal referral system between schools and youth-friendly health clinics; and community support interventions. Prior to implementation, more research should be done on the applicability of these methods in the Laos context. Future research should try to determine the cost-effectiveness of youth-friendly health clinics integrated in a district hospital and stand-alone clinics, to provide insight into which form should be further developed.
背景：在老挝人民民主共和国，年轻人在青年时期进行性行为是很常见的。然而，年轻人很少利用性健康和生殖健康服务，因此性健康和生殖健康状况较差。本 qualitative 研究的目的是探讨阻碍年轻人获得性健康和生殖健康服务的因素。
方法：对来自城市和农村地区的 22 名年龄在 15-25 岁的参与者进行了 29 次半结构式访谈。对于没有性健康和生殖健康服务经验的参与者，访谈中使用了情景案例。此外，还对来自青年友好型健康诊所和公共性健康和生殖健康服务的 7 名卫生服务提供者进行了半结构式访谈。使用主题方法进行数据分析。
结果：阻碍年轻人获得性健康和生殖健康服务的主要障碍与认知可及性和心理社会可及性有关。认知可及性障碍包括性知识匮乏和对服务缺乏认识。心理社会可及性方面的障碍包括对婚前性行为的负面文化态度导致的害羞和羞耻感，以及由于服务和卫生服务提供者缺乏保密性，担心父母发现他们去公共性健康和生殖健康服务机构就诊。此外，地理可及性障碍主要是青年友好型健康诊所不足。
结论：为了改善服务的可及性，需要采取多方面的策略：推广青年友好型健康诊所；在学校开展性教育；在学校和青年友好型健康诊所之间建立正式的转诊制度；并采取社区支持干预措施。在实施之前，应该对这些方法在老挝背景下的适用性进行更多的研究。未来的研究应该尝试确定整合到区医院和独立诊所中的青年友好型健康诊所的成本效益，以了解哪种形式应该进一步发展。
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