Factors That Hinder Adolescents from Seeking Reproductive Health Services. A Study of Basajjabalaba Secondary School bushenyi District

TABLE OF CONTENTS

ABSTRACT.................................................................................................................................... i

COPYRIGHT................................................................................................................................ ii

AUTHORIZATION.....................................................................................................................iii

DECLARATION.......................................................................................................................... iv

DEDICATION............................................................................................................................... v

ACKNOWLEDGEMENT........................................................................................................... vi

TABLE OF CONTENTS ........................................................................................................... vii

LIST OF TABLES ...................................................................................................................... xii

LIST OF ABBREVIATIONS ...................................................................................................xiii

DEFINITION OF TERMS........................................................................................................ xiv

CHAPTER ONE: INTRODUCTION......................................................................................... 1

1.1 Background of the study ........................................................................................................... 1

1.2 Statement of the problem.......................................................................................................... 4

1.3 Purpose of the study.................................................................................................................. 5

1.4 Specific objectives.................................................................................................................... 5

1.5 Research questions.................................................................................................................... 6

1.6 Justification of the study ........................................................................................................... 6

CHAPTER TWO: LITERATURE REVIEW............................................................................ 7

2.1 Introduction............................................................................................................................... 7

2.2 Adolescent related factors that hinder seeking of reproductive health services....................... 7

2.2.1 Traditional practices............................................................................................................... 7

2.2.2 Sexual abuse........................................................................................................................... 7

viii

2.2.3 Commercial sex ..................................................................................................................... 8

2.2.4 Video watch at local clubs..................................................................................................... 8

2.2.5 Social stigma.......................................................................................................................... 8

2.2.6 Influence of drugs and peers.................................................................................................. 9

2.2.7 Fear of pain and HIV testing................................................................................................ 10

2.2.8 Lack of parental involvement .............................................................................................. 10

2.2.9 Cost of reproductive health services.................................................................................... 10

2.2.10 Lack of information about the availability of reproductive health services ...................... 11

2.2.11 Distance.............................................................................................................................. 12

2.3 Health facility related factors that hinder adolescents from seeking reproductive health services

....................................................................................................................................................... 12

2.3.1 Poor youth friendly services................................................................................................ 12

2.3.2 Limited operating hours....................................................................................................... 13

2.3.3 Physical privacy constraints................................................................................................. 13

2.3.4 Accessibility......................................................................................................................... 14

2.3.5 Lack of infrastructure providing exclusive teenage SRHS.................................................. 14

2.3.6 Under-table payments in health delivery ............................................................................. 15

2.3.7 Long distances ..................................................................................................................... 15

2.3.8 Long queues......................................................................................................................... 15

2.3.9 Few health facilities............................................................................................................. 16

2.4 Health worker related factors that hinder adolescents from seeking reproductive health services

....................................................................................................................................................... 16

2.4.1 Disregard for privacy ........................................................................................................... 16

ix

2.4.2 Improper provision of sex education ................................................................................... 16

2.4.3 Health provider’s bias.......................................................................................................... 17

2.4.4 Lack of confidentiality by health workers........................................................................... 17

CHAPTER THREE: METHODOLOGY ................................................................................ 18

3.1Introduction.............................................................................................................................. 18

3.2 Study area................................................................................................................................ 18

3.3 Study design............................................................................................................................ 19

3.4 Study population ..................................................................................................................... 19

3.4.1 Sample size determination ................................................................................................... 19

3.4.2 Sampling procedure ............................................................................................................. 19

3.4.3 Inclusion criteria .................................................................................................................. 20

3.5 Definition of variables ............................................................................................................ 20

3.5.1 The variable adolescent related factors................................................................................ 20

3.5.2 The variable health facility related factors........................................................................... 20

3.5.3 The variable health worker related factors........................................................................... 20

3.7 Research instruments.............................................................................................................. 21

3.7.1 Quantitative data .................................................................................................................. 21

3.7.2 Qualitative data .................................................................................................................... 21

3.8 Data collection tools ............................................................................................................... 21

3.8.1Questionnaire ........................................................................................................................ 21

3.8.2 Key informant interview guide ............................................................................................ 22

3.9 Pretesting................................................................................................................................. 22

3.9.1 Training of research assistants............................................................................................. 22

x

3.10 Data management.................................................................................................................. 22

3.10.1Coding................................................................................................................................. 22

3.10.2 Editing................................................................................................................................ 22

3.10.3 Data storage ....................................................................................................................... 23

3.11 Data analysis......................................................................................................................... 23

3.11.1 Quantitative data ................................................................................................................ 23

3.11.2 Qualitative data .................................................................................................................. 23

3.12 Ethical consideration............................................................................................................. 23

3.13 Study limitations................................................................................................................... 24

3.14 Dissemination of results........................................................................................................ 24

CHAPTER FOUR: DATA PRESENTATION, ANALYSIS AND INTERPRETATION ... 25

4.1 Introduction............................................................................................................................. 25

4.2 Socio-demographic data.......................................................................................................... 25

4.3 Adolescent related factors....................................................................................................... 26

4.4 Health facility related factors.................................................................................................. 29

4.5 Health worker related factors.................................................................................................. 30

CHAPTER FIVE: DISCUSSION, CONCLUSION, NURSING IMPLICATIONS AND

RECOMMENDATIONS............................................................................................................ 32

5.1 Discussion............................................................................................................................... 32

5.1.1 Adolescent related factors that hinder adolescents from seeking reproductive health services

....................................................................................................................................................... 32

5.1.2 Health facility related factors that hinder adolescents from seeking reproductive health

services.......................................................................................................................................... 35

xi

5.1.3 Health worker related factors that hinder adolescents from seeking reproductive health

services.......................................................................................................................................... 37

5.2 Conclusion .............................................................................................................................. 38

5.3 Recommendations................................................................................................................... 39

5.3.1 To-adolescents..................................................................................................................... 40

5.3.2 To-health facility management ............................................................................................ 40

5.3.3 To-the government............................................................................................................... 41

5.4 Nursing implications............................................................................................................... 42

REFERENCES............................................................................................................................ 43

APPENDICES…………………….……………………………………………………………..48

APPENDIX I: Consent form ........................................................................................................ 48

APPENDIX II: A questionnaire for respondents on factors hindering adolescents from seeking

reproductive health services, a cases study at Bassajabalaba secondary school........................... 49

APPENDIX III: An interview guide for the key informant on factors hindering adolescents from

seeking reproductive health services, a case study at Bassajabalaba secondary school............... 54

APPENDIX IV: Introductory letter .............................................................................................. 56

APPENDIX V: Acknowledgement letter ..................................................................................... 57

APPENDIX VI: A map of Uganda showing the location of Bushenyi District ........................... 58

APPENDIX VII: A map of Bushenyi district showing the location of Basajjabalaba secondary

school ............................................................................................................................................ 59