Habtu Yitagesu, Kaba Mirgissa, Mekonnen Hussein
School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
School of Nursing, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Reprod Health. 2021 Feb 9;18(1):32. doi: 10.1186/s12978-021-01092-0.
In Ethiopia, the utilization coverage of adolescent-friendly health services (AFSRHs) ranged only from 9 to 55% and it was the lowest of all Sub-Saharan African countries in 2016. Little is known why adolescents were not accessing the existing services to the side of healthcare providers.
The aim of this study is to explore contextual perceived and actual barriers to accessing AFSRHs by adolescents in Southern Ethiopia.
Phenomenological study design supplemented with observation was used to explore perceived and actual barriers to accessing AFSRHs in 2020. Criterion sampling was used to select study participants. In-depth interviews with healthcare providers and non-specialist sexual and reproductive healthcare providers were conducted. Transcribed interviews and observations were imported to Open Code 4.02 for coding, categorizing, and creating themes. Finally, barriers to accessing existing services were explained using thematic analysis.
The study explores contextual barriers to accessing sexual and reproductive health services in five emergent themes. According to providers' points of view, the barriers include ranging from providers (e.g. poor providers' competency), health facilities (e.g. supply constraints and unsupportive environment), adolescents (e.g. perceived lack of information and attitude towards SRHs), community (e.g. lack of parental and social support), and broader health system (e.g. poor implementation and multi-sectorial engagement).
As to providers, adolescents face multiple barriers to accessing youth friendly sexual and reproductive health services. Healthcare facilities and all levels of the healthcare system should implement varieties of approaches to increase access to the services for adolescents. Given the lack of progress in utilization of adolescents- youth friendly sexual and reproductive services, the existing strategy should be re-evaluated and new interventions at all levels of the healthcare system are needed. Moreover, implementation research is required at system level factors.
在埃塞俄比亚，青少年友好型健康服务（AFSRHs）的利用覆盖率仅在9%至55%之间，是2016年撒哈拉以南非洲所有国家中最低的。对于青少年为何没有利用现有医疗服务，医疗服务提供者方面知之甚少。
本研究旨在探索埃塞俄比亚南部青少年获取青少年友好型健康服务时在情境中感知到的和实际存在的障碍。
2020年采用现象学研究设计并辅以观察，以探索获取青少年友好型健康服务时感知到的和实际存在的障碍。采用标准抽样来选择研究参与者。对医疗服务提供者以及非专科性与生殖健康服务提供者进行了深入访谈。将转录后的访谈内容和观察结果导入Open Code 4.02进行编码、分类和创建主题。最后，通过主题分析解释获取现有服务的障碍。
该研究在五个新出现的主题中探索了获取性与生殖健康服务的情境障碍。从提供者的角度来看，障碍包括提供者方面（如提供者能力不足）、卫生设施方面（如供应限制和不利环境）、青少年方面（如感觉缺乏信息以及对性与生殖健康的态度）、社区方面（如缺乏父母和社会支持）以及更广泛的卫生系统方面（如实施不力和多部门参与不足）。
对于提供者而言，青少年在获取青少年友好型性与生殖健康服务方面面临多重障碍。医疗设施和各级医疗系统应采取多种方法，以增加青少年获得这些服务的机会。鉴于在青少年友好型性与生殖服务利用方面缺乏进展，应重新评估现有策略，并且需要在医疗系统各级开展新的干预措施。此外，需要针对系统层面因素开展实施研究。
