Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
PLoS One. 2022 Feb 10;17(2):e0263733. doi: 10.1371/journal.pone.0263733. eCollection 2022.
The evaluation of all potential determinants of implementation fidelity of Youth-Friendly Services (YFS) is crucial for Ethiopia. Previous studies overlooked investigating the determinants at different levels. Therefore, this study aimed to assess the determinants of implementation fidelity of YFS considering individual and contextual levels.
This study was conducted among 1,029 youths, from 11 health centers that are implementing the YFS in Central Gondar Zone. Data were collected by face to face interview and facility observation using a semi-structured questionnaire. A Bivariable multi-level mixed effect modelling was employed to assess the main determinants. Four separate models were fitted to reach the full model. The fitness of the model was assessed using Akaike Information Criterion (AIC) and level of significance was declared at p-values < 0.05. The results of fixed effects were presented as adjusted odds ratio (AOR) at their 95% CI.
Four hundred one (39.0%) of the respondents got the YFS with high level of fidelity. Had high level of involvement in the YFS provision (AOR = 1.35, 95% CI: 1.15, 1.57), knew any peer educator trained in YFS (AOR = 1.60, 95% CI: 1.36, 1.86), and involved as a peer educator (AOR = 1.46, 95% CI: 1.24, 1.71), were the individual level determinants. Whereas, got capacity building training; (AOR = 1.93, 95% CI (1.12, 3.48), got supportive supervision, (AOR 2.85, 95% CI (1.99, 6.37), had a separate waiting room (AOR = 9.84, 95%CI: 2.14, 17.79), and system in place to provide continuous support to staff (AOR = 2.81, 95%CI: 1.25, 6.34) were the contextual level determinants.
The level of implementation fidelity remains low. Both individual and contextual level determinants affect the implementation fidelity of YFS. Therefore, policy makers, planners, managers and YFS providers could consider both individual and contextual factors to improve the implementation fidelity.
评估青年友好服务（YFS）实施保真度的所有潜在决定因素对埃塞俄比亚至关重要。以前的研究忽略了在不同层面上调查决定因素。因此，本研究旨在评估考虑个人和环境层面的 YFS 实施保真度的决定因素。
本研究在中央贡德尔地区的 11 个卫生中心开展，共有 1029 名青年参与。数据通过面对面访谈和使用半结构化问卷进行设施观察收集。采用双变量多水平混合效应模型评估主要决定因素。拟合了四个单独的模型以达到完全模型。使用赤池信息量准则（AIC）评估模型的拟合度，并宣布显著性水平为 p 值<0.05。固定效应的结果以 95%CI 的调整优势比（AOR）表示。
401 名（39.0%）受访者获得了具有高水平保真度的 YFS。在 YFS 提供方面有较高的参与度（AOR=1.35，95%CI：1.15，1.57）、知道任何受过 YFS 培训的同伴教育者（AOR=1.60，95%CI：1.36，1.86）、并作为同伴教育者参与（AOR=1.46，95%CI：1.24，1.71）是个人层面的决定因素。而接受能力建设培训（AOR=1.93，95%CI（1.12，3.48）、接受支持性监督（AOR=2.85，95%CI（1.99，6.37）、有单独的等候室（AOR=9.84，95%CI：2.14，17.79）和建立系统为员工提供持续支持（AOR=2.81，95%CI：1.25，6.34）是环境层面的决定因素。
实施保真度水平仍然较低。个人和环境层面的决定因素都会影响 YFS 的实施保真度。因此，决策者、规划者、管理者和 YFS 提供者可以考虑个人和环境因素，以提高实施保真度。
