Africa Health Research Institute, KwaZulu-Natal, South Africa.
London School of Hygiene and Tropical Medicine, London, United Kingdom.
PLoS One. 2020 Apr 14;15(4):e0231080. doi: 10.1371/journal.pone.0231080. eCollection 2020.
Young people's health service utilisation (the number accessing a facility) has been the focus of guidelines and health systems strengthening policies. This is due to young people being at an increased health risk because of inequitable access and utilisation of health services, which is more pronounced in rural settings with limited service availability. This is a major concern as globally, youth constitute a considerable and increasing part of the population in Sub-Saharan Africa.
The objective of this paper is to present a comprehensive approach for the exploration of health service utilisation by young people in rural KwaZulu-Natal, South Africa. We examined barriers and facilitators conceptualised by the constructs of the Theory of Planned Behaviour, framed within a socio-ecological model.
Data were collected in January to June 2017 from two sites using in-depth interviews, spiral transect walks and community mapping with young people (aged 10 to 24 years), primary care health providers, school health professionals, community stakeholders and young people's parents.
Socio-ecological and behavioural factors influenced young people's intention to use services. Barriers included perceived negative attitudes of health providers and perceived poor staff competencies. Facilitators included an appreciation of receiving health education and assumed improved health. At social and community levels, normative beliefs hindered young people from utilising services as they feared stigmatisation and gossip. At a public policy level, structural elements had a disempowering effect as the physical layout of the clinics hindered utilisation, limited resources influenced staffing, and facility opening times were not convenient for school goers.
We suggest that to fully appreciate the complexity of health service utilisation, it is necessary to not only consider factors and processes relevant to the individual, but also acknowledge and act upon, the disjuncture between community level cultural values, norms and national policies.
年轻人的卫生服务利用（即使用设施的人数）一直是指南和卫生系统强化政策的重点。这是因为年轻人由于获得和利用卫生服务的不平等而面临更高的健康风险，而在农村地区，由于服务可用性有限，这种情况更为明显。这是一个主要问题，因为在全球范围内，青年在撒哈拉以南非洲的人口中占相当大且不断增加的比例。
本文旨在提出一种综合方法，探讨南非夸祖鲁-纳塔尔省农村地区年轻人的卫生服务利用情况。我们检查了计划行为理论的结构概念化的障碍和促进因素，并将其框定在社会生态模型内。
2017 年 1 月至 6 月，我们在两个地点使用深入访谈、螺旋横切步行和社区绘图，收集了年龄在 10 至 24 岁之间的年轻人、初级保健卫生提供者、学校卫生专业人员、社区利益相关者和年轻人父母的数据。
社会生态和行为因素影响了年轻人使用服务的意愿。障碍包括卫生提供者的负面态度和员工能力差的看法。促进因素包括对接受健康教育的重视和假设健康状况的改善。在社会和社区层面，规范性信念阻碍了年轻人利用服务，因为他们担心受到污名化和八卦。在公共政策层面，结构要素具有削弱作用，因为诊所的物理布局阻碍了利用，资源有限影响了人员配备，并且设施的开放时间对学生不方便。
我们建议，要充分了解卫生服务利用的复杂性，不仅需要考虑与个人相关的因素和过程，还需要承认和采取行动，解决社区层面的文化价值观、规范和国家政策之间的脱节。
