Mukeshimana Madeleine, Nkurunziza Aimable, Nyiringango Gerard, Karamage Eliphaz, Asingizwe Domina, Nshutiyukuri Claudine, Musabwasoni Sandra, Bagweneza Vedaste, Habtu Michael, Uzayisenga Josephine, Adejumo Oluyinka, Tamrat Endale
University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda.
University of Toronto, Lawrence Bloomberg Faculty of Nursing, Toronto, Ontario, Canada.
PLoS One. 2025 Jun 24;20(6):e0325184. doi: 10.1371/journal.pone.0325184. eCollection 2025.
Youth Friendly Health Services Centers (YFHS) in Rwanda have been established to address the lack of information and services related to reproductive health. However, there is a paucity of studies investigating the hurdles faced by illiterate adolescents when seeking sexual and reproductive health services. This study assessed adolescents' sexual and reproductive health (ASRH) accessibility and utilization in YFHS among illiterate adolescents in Rwanda.
This study used a mixed-method participatory study design. One hundred fifty illiterate adolescents were recruited using a convenience sampling. A checklist was used to observe the 16 YFHS. In the quantitative phase, data were organized using Statistical Package for the Social Sciences (SPSS) version 26, and analyzed through descriptive and inferential statistics. Two focus group discussions moderated by trained illiterate adolescents were conducted. Data were organized using Dedoose software and analyzed thematically.
The proportion of YFHS utilization was 25.3%. In the multivariate regression analysis, five outcomes remained significant to utilize YFHS: ever heard about YFHS (Adjusted Odds Ratio [AOR] = 6.32; 95% Confidence Interval [CI] = 2.07-19.27, having ASRH information (AOR = 8.99; 95 CI = 1.43-56.77), having information about any family planning (AOR = 19.00; 95 CI = 1.52-236.84), use of any type of contraceptives (AOR = 4.45; 95%CI = 1.34-14.85), and having information on prevention and management (AOR = 24.99; 95 CI = 2.76-226.53). Observers rated the quality of SRHs in YFHS at 24.36%. Facilitators to access YFHS include having information about ASRH, free-of-charge services, and peer educators. The reported barriers included providers' negative attitudes, internalized stigma, and lack of materials tailored to illiterate adolescents. The study participants suggested ways to improve the YFHS, such as community awareness, staff training, entertainment, and increasing the number of YFHS.
The utilization of YFHS among illiterate adolescents remains low, highlighting the need for targeted interventions to improve access and quality. Key facilitators, such as access to information, peer education, and free services, should be strengthened, while addressing barriers like provider attitudes, stigma, and resource limitations. These findings underscore the necessity of enhancing both the accessibility and quality of YFHS to ensure comprehensive reproductive health care for illiterate adolescents.
卢旺达已设立青年友好型健康服务中心（YFHS），以解决生殖健康相关信息和服务匮乏的问题。然而，鲜有研究调查文盲青少年在寻求性健康和生殖健康服务时所面临的障碍。本研究评估了卢旺达文盲青少年在青年友好型健康服务中心获得性健康和生殖健康（ASRH）服务的可及性及利用情况。
本研究采用混合方法参与式研究设计。通过便利抽样招募了150名文盲青少年。使用一份清单对16个青年友好型健康服务中心进行观察。在定量阶段，数据使用社会科学统计软件包（SPSS）26版进行整理，并通过描述性和推断性统计进行分析。开展了两场由受过培训的文盲青少年主持的焦点小组讨论。数据使用Dedoose软件进行整理并进行主题分析。
青年友好型健康服务中心的利用率为25.3%。在多变量回归分析中，有五个因素对利用青年友好型健康服务中心仍然具有显著意义：曾听说过青年友好型健康服务中心（调整后的优势比[AOR]=6.32；95%置信区间[CI]=2.07 - 19.27）、拥有性健康和生殖健康信息（AOR = 8.99；95%CI = 1.43 - 56.77）、拥有任何计划生育信息（AOR = 19.00；95%CI = 1.52 - 236.84）、使用过任何类型的避孕药具（AOR = 4.45；95%CI = 1.34 - 14.85）以及拥有预防和管理方面的信息（AOR = 24.99；95%CI = 2.76 - 226.53）。观察者对青年友好型健康服务中心性健康和生殖健康服务质量的评分是24.36%。获得青年友好型健康服务中心服务的促进因素包括拥有性健康和生殖健康信息、免费服务以及同伴教育者。报告指出的障碍包括提供者的负面态度、内化的耻辱感以及缺乏针对文盲青少年的材料。研究参与者提出了改善青年友好型健康服务中心的方法，如社区宣传、工作人员培训、娱乐活动以及增加青年友好型健康服务中心的数量。
文盲青少年对青年友好型健康服务中心的利用率仍然较低，这凸显了针对性干预措施以改善可及性和服务质量的必要性。应加强关键促进因素，如信息获取、同伴教育和免费服务，同时解决提供者态度、耻辱感和资源限制等障碍。这些研究结果强调了提高青年友好型健康服务中心的可及性和质量以确保为文盲青少年提供全面生殖健康护理的必要性。
