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      Sexual reproductive health service provision to young people in Kenya; health service providers’ experiences

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          Abstract

          Background

          Addressing the sexual and reproductive health (SRH) needs of young people remains a challenge for most developing countries. This study explored the perceptions and experiences of Health Service Providers (HSP) in providing SRH services to young people in Kenya.

          Methods

          Qualitative study conducted in eight health facilities; five from Nairobi and three rural district hospitals in Laikipia, Meru Central, and Kirinyaga. Nineteen in-depth interviews (IDI) and two focus group discussions (FGD) were conducted with HSPs. Interviews were tape recorded and transcribed. Data was coded and analysed using the thematic framework approach.

          Results

          The majority of HSPs were aware of the youth friendly service (YFS) concept but not of the supporting national policies and guidelines. HSP felt they lacked competency in providing SRH services to young people especially regarding counselling and interpersonal communication. HSPs were conservative with regards to providing SRH services to young people particularly contraception. HSP reported being torn between personal feelings, cultural and religious values and beliefs and their wish to respect young people’s rights to accessing and obtaining SRH services.

          Conclusion

          Supporting youth friendly policies and competency based training of HSP are two common approaches used to improve SRH services for adolescents. However, these may not be sufficient to change HSPs’ attitude to adolescents seeking help. There is need to address the cultural, religious and traditional value systems that prevent HSPs from providing good quality and comprehensive SRH services to young people. Training updates should include sessions that enable HSPs to evaluate how their personal and cultural values and beliefs influence practice.

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          Most cited references14

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          Study design in qualitative research--2: Sampling and data collection strategies.

          In two prior papers in our series on qualitative research [Frankel & Devers (2000a, 2000b) Qualitative research: a consumer's guide, Education for Health, 13, 113-123; Frankel & Devers (2000) Study design in qualitative research-1: developing research questions and assessing research needs, Education for Health, 13, 251-261], we examine two critical issues in qualitative research design: sampling, including identifying and negotiating access to research sites and subjects, and data collection and management. We describe these two key steps in the qualitative research design process, discuss challenges that often emerge when pursuing these steps, and provide guidelines for addressing them. Qualitative research most often uses "purposive," rather than random, sampling strategies. A good understanding of these sampling strategies and why they are used is central to designing a credible qualitative study. In addition, given the real-world context in which most qualitative research is carried out, identifying and negotiating access to research sites and subjects are critical parts of the process. We also provide suggestions for developing and maintaining productive and mutually satisfying research relationships with sites and subjects. Finally, data collection and management are often neglected subjects in qualitative research. We offer practical advice on how to collect and manage qualitative data, including factors to consider when deciding how structured the data collection process should be, the pros and cons of audio- and/or videotaping compared with note-taking, and tips for writing up field notes and document management. A forthcoming, final paper in the series will focus on qualitative data analysis and the publication of qualitative research results.
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            Does making clinic-based reproductive health services more youth-friendly increase service use by adolescents? Evidence from Lusaka, Zambia.

            To report the findings of a study that evaluated the impact of three youth-friendly service (YFS) projects in Lusaka, Zambia. In 1994, the Lusaka District Health Management Team (LDHMT) identified adolescents as a priority underserved population with regard to reproductive health information and services. As part of its long-term goal to improve the health and well-being of Lusaka youth, the LDHMT, in collaboration with CARE, UNICEF/Zambia Family Life Movement, and John Snow International, implemented three separate YFS projects to increase service use among adolescents. Service statistics from 10 clinics (8 "treatment clinics" and 2 "non-YFS clinics") were used to measure adolescent service use. Qualitative and quantitative data were collected to measure the degree of "youth-friendliness" at the clinics and the level of community acceptance of providing reproductive health services to youth. Specific indicators of youth-friendliness were developed that measured the attitudes of the clinic staff toward giving services to youth, whether clinic staff honored privacy and confidentiality, whether boys and young men were welcomed, whether the clinic policies supported providing services for youth, whether clinic staff promoted its services to youth in surrounding community, and whether youth, themselves, perceived that they would be welcomed and have their needs met at the clinics. Similarly, indicators of community acceptance were developed that measured whether parents and other adults supported the provision of reproductive health services to youth. Although the projects appear to have improved the clinic experience for adolescent clients and to have increased service use levels at some clinics, the findings suggest that community acceptance of reproductive health services for youth may have a larger impact on the health-seeking behaviors of adolescents.
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              The effectiveness of adolescent reproductive health interventions in developing countries: a review of the evidence.

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                Author and article information

                Contributors
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central
                1472-6963
                2013
                14 November 2013
                : 13
                : 476
                Affiliations
                [1 ]Division of Reproductive Health, Ministry of Public Health and Sanitation, P. O. Box 30016, Nairobi, Kenya
                [2 ]School of Public Health, University of Nairobi, P. O. Box 19676, Nairobi, Kenya
                [3 ]World Health Organization-Kenya Country Office, P. O. Box 45335–00100, Nairobi, Kenya
                [4 ]Research Methods, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
                [5 ]Sexual and Reproductive Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
                [6 ]Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
                Article
                1472-6963-13-476
                10.1186/1472-6963-13-476
                4225671
                24229365
                9a97878a-2574-4331-b1f3-5be0157d23cb
                Copyright © 2013 Godia et al.; licensee BioMed Central Ltd.

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 November 2012
                : 8 November 2013
                Categories
                Research Article

                Health & Social care
                Health & Social care

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