Department of Community Medicine, College of Health Sciences, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
Health Policy Research Group, University of Nigeria, Enugu Campus, Enugu, Nigeria.
BMC Health Serv Res. 2023 May 17;23(1):505. doi: 10.1186/s12913-023-09470-z.
BACKGROUND: Adolescents are vulnerable to sexual and reproductive health (SRH) risks yet, have poor utilisation of SRH services due to personal, social, and demographic influences. This study aimed to compare the experiences of adolescents that had received targeted adolescent SRH interventions and those that did not and evaluated the determinants of awareness, value perception, and societal support for SRH service utilisation among secondary school adolescents in eastern Nigeria. METHODS: We undertook a cross-sectional study of 515 adolescents in twelve randomly selected public secondary schools, grouped into schools that had received targeted adolescent SRH interventions and those that did not, across six local government areas in Ebonyi State, Nigeria. The intervention comprised training of schools' teachers/counsellors and peer educators and community sensitisation and engagement of community gatekeepers for demand generation. A pre-tested structured questionnaire was administered to the students to assess their experiences with SRH services. Categorical variables were compared using the Chi-square test, and predictors were determined through multivariate logistic regression. The level of statistical significance was determined at p < 0.05 and a 95% confidence limit. RESULTS: A higher proportion of adolescents in the intervention group, 126(48%), than in the non-intervention group, 35(16.1%), were aware of SRH services available at the health facility (p-value < 0.001). More adolescents in the intervention than the non-intervention group perceived SRH services as valuable- 257(94.7%) Vs 217(87.5%), p-value = 0.004. Parental/community support for SRH service utilisation was reported by more adolescents in the intervention group than in the non-intervention group- 212 (79.7%) Vs 173 (69.7%), p-value = 0.009. The predictors are (i) awareness-intervention group (β = 0.384, CI = 0.290-0.478), urban residence (β=-0.141, CI=-0.240-0.041), older age (β-0.040, CI = 0.003-0.077) (ii) value perception - intervention group (β = 0.197, 0.141-0.253), senior educational class (β = 0.089, CI = 0.019-0.160), work-for-pay (β=-0.079, CI=-0.156-0.002), awareness (β = 0.192, CI = 0.425-0.721) (iii) parental/community support - work-for-pay (β = 0.095, CI = 0.003-0.185). CONCLUSIONS: Adolescents' awareness, value perception, and societal support for sexual and reproductive health services were influenced by the availability of SRH interventions and socio-economic factors. Relevant authorities should ensure the institutionalisation of sex education in schools and communities, targeting various categories of adolescents, to reduce disparity in the utilisation of sexual and reproductive health services and promote adolescents' health.
背景:青少年易受到性与生殖健康(SRH)风险的影响,但由于个人、社会和人口因素的影响,他们对 SRH 服务的利用程度较差。本研究旨在比较接受过有针对性的青少年 SRH 干预的青少年和未接受过干预的青少年的经历,并评估在尼日利亚埃邦伊州六个地方政府区的 515 名中学生中,青少年对 SRH 服务利用的意识、价值感知和社会支持的决定因素。
方法:我们进行了一项横断面研究,在尼日利亚埃邦伊州的 12 所随机选择的公立中学中,将 515 名青少年分为接受过有针对性的青少年 SRH 干预的学校和未接受过干预的学校,共有 6 个地方政府区。干预措施包括对学校教师/辅导员和同伴教育者进行培训,以及对社区进行宣传和参与社区把关人以产生需求。对学生进行了一项预测试的结构化问卷调查,以评估他们对 SRH 服务的体验。使用卡方检验比较分类变量,通过多变量逻辑回归确定预测因素。统计显著性水平确定为 p < 0.05 和 95%置信限。
结果:干预组中有更多的青少年(126 名,48%)比非干预组(35 名,16.1%)更了解可在医疗机构获得的 SRH 服务(p 值 < 0.001)。与非干预组相比,更多的干预组青少年认为 SRH 服务有价值- 257 名(94.7%)与 217 名(87.5%),p 值=0.004。更多的干预组青少年报告父母/社区支持 SRH 服务的利用- 212 名(79.7%)与 173 名(69.7%),p 值=0.009。预测因素是(i)意识-干预组(β=0.384,CI=0.290-0.478),城市居住(β=-0.141,CI=-0.240-0.041),年龄较大(β-0.040,CI=0.003-0.077)(ii)价值感知-干预组(β=0.197,0.141-0.253),高级教育类(β=0.089,CI=0.019-0.160),有薪工作(β=-0.079,CI=-0.156-0.002),意识(β=0.192,CI=0.425-0.721)(iii)父母/社区支持-有薪工作(β=0.095,CI=0.003-0.185)。
结论:青少年对性与生殖健康服务的意识、价值感知和社会支持受到 SRH 干预措施和社会经济因素的影响。相关当局应确保在学校和社区中制度化性教育,针对各类青少年,以减少性与生殖健康服务利用方面的差距,促进青少年的健康。
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