Stakeholders’ perceptions of adolescents’ sexual and reproductive health needs in Southeast Nigeria: a qualitative study

BMJ Open, Volume 12, No. 6, Year 2022

Interprétation

Objectives This study explored the perceptions of adult stakeholders on adolescents sexual and reproductive health (SRH) needs, variations of perceived needs by different social stratifiers and adolescent’s perceived interventions to address these needs. This will provide evidence that could be useful for policy and programme reviews for improving access and use of services in to meet the SRH needs of adolescents. Design A qualitative cross-sectional study was conducted in Ebonyi state, Southeast, Nigeria. Data were analysed using thematic framework and content analysis approaches. Setting and participants This qualitative study was conducted in six selected local government areas in Ebonyi state, Nigeria. The study participants comprised of adult stakeholders including community leaders, adolescent boys and girls aged 13-18 years. Adolescents were purposively selected from schools, skill acquisition centres and workplaces. A total of 77 in-depth interviews, 6 (with community leaders) and 12 (with adolescents) focus group discussions were conducted using pretested question guides. Results Adolescent SRH needs were perceived to be unique and special due to their vulnerability, fragility and predisposition to explore new experiences. Recurring adolescent SRH needs were: SRH education and counselling; access to contraceptive services and information. These needs were perceived to vary based on sex, schooling and marital status. Adolescent girls were perceived to have more psychological needs, and more prone to negative health outcomes. Out-of-school adolescents were described as more vulnerable, less controlled, less supervised and more prone to sexual abuse. Unmarried adolescents were perceived more vulnerable to sexual exploitation and risks, while married were perceived to have more maternal health service needs. Conclusions Perceptions of adolescents’ SRH needs converge among stakeholders (including adolescents) and are thought to vary by gender, schooling and marital status. This calls for well-designed gender-responsive interventions that also take into consideration other social stratifiers and adolescent’s perceived SRH intervention strategies. The study was conducted in six local government areas (LGA) of Ebonyi State in the southeast geopolitical zone of Nigeria. The state had a population estimate of 6 268 003 inhabitants in 2017 with an estimated area of 5935 km2. Its annual population growth rate is estimated to be 2.7% and over 40% of the State’s total population are less than 15 years.22 It was reported that 8.2% of girls aged 15–19 years in Ebonyi State have already begun childbearing and 39.7% maternal mortality rate occurring among the same age bracket.13 Further description of study area can be found in previously published manuscripts.23 24 A qualitative research method using exploratory approach was employed to interview policy-makers, SRH programme managers, health workers, community and religious leaders, and parents. The study explored information on (1) the SRH needs of adolescents and (2) variation in SRH needs with regards to gender, marital status and schooling status. The respondents were state level participants that comprised programme managers, policy-makers and implementing partners in adolescent health. They were recruited from several governmental and non-governmental organisations in the state which includes: State Ministry of Health, State Ministry of Women Affairs and Social Development, State Ministry of Youth and Sports Development, State House of Assembly, State Ministry of Education, State Universal Basic Education Board, State Primary Health Care Development Agency and civil society organisations working in adolescent health. Participants from the community level included formal and informal health service providers, village heads, youth leaders, religious leaders, school principals and parents of adolescents. In and out of school adolescent boys and girls were also selected from each community. The initial list of interviewees was drawn following recommendations from a stakeholders’ engagement meeting, and additional people were added following participants’ referrals. The study adopted both purposive and random sampling techniques to recruit participants. In order to ensure equal representation of geopolitical and geographical zones, six LGAs (two from each senatorial zone) were selected. In each senatorial zone, one urban/semiurban and one rural LGA were selected to ensure geographical representation; and from each LGA, one community was selected. The LGAs and communities were selected based on recommendations by key stakeholders in the Ministry of Health as areas that have been prioritised by the State government for implementation of adolescent SRH interventions due to high rates of unwanted teenage pregnancy and abortion. Study participants were purposively selected based on their knowledge, work experience and current involvement in adolescent health in the State. Community leaders (village heads, youth leaders) were purposively selected based on their potential influence on adolescents’ SRH. Participants from the community were selected to represent variations in gender as well as to reflect values and beliefs. The school teachers and principals were selected because of the strategic role they play in socialisation and value formation for young people. A relationship was established with some of the target study population who attended the stakeholder engagement meeting before commencement of data collection. Out-of-school adolescents aged 15–18 years were purposively selected and invited for the interview. These adolescents were selected due to their willingness and participation during the project community survey. The in-school adolescents were randomly selected from the each community government secondary schools. Detailed description of sampling procedure and selection criteria have been provided in previously published manuscripts.23 24 Face-to-face in-depth interviews (IDIs) and focus group discussions (FGDs) were employed for data collection. IDI and FGD guides were developed specifically for the study by the research team, and were pretested in a proximate State among population groups similar to the study population. A total of 77 IDIs and 18 FGDs were conducted. The 6 FGDs were used to collect information from village heads, 12 sex disaggregated FGDs were used to collect information from adolescents basically, on perceived intervention to address their SRH needs, while IDIs were used for the rest of the participants. Each FGD session was facilitated by a moderator (a qualitative researcher), a note-taker (who doubled as the observer) and an interpreter (who doubled as the local guide). The IDIs were facilitated by an interviewer (qualitative researcher) and a note-taker. Interviews and discussions were conducted in English or the local language (depending on participants’ preferences). The FGD were held in convenient locations for participants. Number of participants in each FGD ranged from 8 to 13 and the data collection lasted for 1 month. All interviews were audiorecorded and each session took an average of 60 min. A detailed description of data collection process can be found in previously published manuscript.24 Parts of the method and process of data analysis has been described in detail elsewhere at Mbachu et al.23 Audio files were transcribed and translated to English language where necessary. Microsoft word was used to process and edit the transcripts. Field notes were incorporated into the edited transcripts and anonymised using unique codes. Thematic framework approach was used and the key themes and subthemes relating to SRH needs of adolescents include: (1) perception of uniqueness of adolescents’ SRH needs; (2) perception of SRH needs of adolescents; (3) variations in SRH needs of adolescents—gender variations; schooling variations; marital status variations. Additionally, content analysis was performed on all the coded texts under perception of SRH needs of adolescents and perceived intervention to address the needs. This was performed to estimate the frequency of occurrence of each need as a proxy for measuring level of importance. Patients and public were not involved in designing and planning of the research study. However, experts and study communities were involved before field entry through stakeholders’ engagement workshop, where they codesigned the study tools with the research team and through community mobilisation. During data collection, the study involved target population as they were invited to participate in the interview. Succeeding data collection and analysis, a workshop was organised for validation of findings by key stakeholders and community influencers. However, the public and target population were not involved in data analysis and writing of this manuscript.

Résumé de l’IA

Study Justification:

The study aimed to explore the perceptions of adult stakeholders on adolescents’ sexual and reproductive health (SRH) needs in Southeast Nigeria. The justification for this study is to provide evidence that can be used for policy and program reviews to improve access and use of services to meet the SRH needs of adolescents. By understanding the unique and special needs of adolescents, variations in these needs based on different social stratifiers, and the interventions perceived by adolescents themselves, policymakers and program managers can design gender-responsive interventions that address the specific needs of adolescents in Southeast Nigeria.

Study Highlights:

– The study was conducted in six selected local government areas in Ebonyi state, Southeast Nigeria.
– A total of 77 in-depth interviews and 18 focus group discussions were conducted with adult stakeholders, including community leaders and adolescent boys and girls aged 13-18 years.
– The study found that adolescent SRH needs were perceived to be unique and special due to their vulnerability, fragility, and predisposition to explore new experiences.
– Recurring adolescent SRH needs identified were SRH education and counseling, and access to contraceptive services and information.
– These needs were perceived to vary based on sex, schooling, and marital status. Adolescent girls were perceived to have more psychological needs and be more prone to negative health outcomes. Out-of-school adolescents were described as more vulnerable and less supervised, while unmarried adolescents were perceived to be more vulnerable to sexual exploitation and risks.
– The study highlights the importance of well-designed gender-responsive interventions that consider other social stratifiers and the intervention strategies perceived by adolescents themselves.

Recommendations:

Based on the study findings, the following recommendations can be made:

1. Develop and implement comprehensive SRH education and counseling programs for adolescents, taking into consideration their unique needs and vulnerabilities.
2. Improve access to contraceptive services and information for adolescents, ensuring that they are age-appropriate, confidential, and easily accessible.
3. Design targeted interventions for adolescent girls, addressing their psychological needs and promoting positive health outcomes.
4. Provide support and interventions for out-of-school adolescents, focusing on their vulnerability and the need for supervision and protection.
5. Address the specific SRH needs of unmarried adolescents, including prevention of sexual exploitation and risks.
6. Involve key stakeholders, including policymakers, SRH program managers, health workers, community and religious leaders, and parents, in the design and implementation of interventions to ensure their effectiveness and sustainability.

Key Role Players:

1. State Ministry of Health
2. State Ministry of Women Affairs and Social Development
3. State Ministry of Youth and Sports Development
4. State House of Assembly
5. State Ministry of Education
6. State Universal Basic Education Board
7. State Primary Health Care Development Agency
8. Civil society organizations working in adolescent health
9. Community leaders (village heads, youth leaders)
10. Formal and informal health service providers
11. School principals and teachers
12. Parents of adolescents

Cost Items for Planning Recommendations:

1. Development and implementation of comprehensive SRH education and counseling programs
2. Training and capacity building for health workers and program managers
3. Provision of age-appropriate contraceptive services and information
4. Awareness campaigns and community mobilization efforts
5. Monitoring and evaluation of interventions
6. Research and data collection to inform evidence-based interventions
7. Collaboration and coordination among key stakeholders
8. Infrastructure and equipment for SRH service delivery
9. Advocacy and policy development for adolescent SRH
10. Support services for vulnerable adolescents
11. Communication and dissemination of information to target populations
Please note that the above cost items are for planning purposes and may vary depending on the specific context and resources available.

Force de la preuve

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is strong, as it provides a clear description of the study design, data collection methods, and key findings. However, to improve the evidence, the abstract could include more specific information about the sample size, demographics of the participants, and the thematic framework used for data analysis.

Abstrait

The study was conducted in six local government areas (LGA) of Ebonyi State in the southeast geopolitical zone of Nigeria. The state had a population estimate of 6 268 003 inhabitants in 2017 with an estimated area of 5935 km2. Its annual population growth rate is estimated to be 2.7% and over 40% of the State’s total population are less than 15 years.22 It was reported that 8.2% of girls aged 15–19 years in Ebonyi State have already begun childbearing and 39.7% maternal mortality rate occurring among the same age bracket.13 Further description of study area can be found in previously published manuscripts.23 24 A qualitative research method using exploratory approach was employed to interview policy-makers, SRH programme managers, health workers, community and religious leaders, and parents. The study explored information on (1) the SRH needs of adolescents and (2) variation in SRH needs with regards to gender, marital status and schooling status. The respondents were state level participants that comprised programme managers, policy-makers and implementing partners in adolescent health. They were recruited from several governmental and non-governmental organisations in the state which includes: State Ministry of Health, State Ministry of Women Affairs and Social Development, State Ministry of Youth and Sports Development, State House of Assembly, State Ministry of Education, State Universal Basic Education Board, State Primary Health Care Development Agency and civil society organisations working in adolescent health. Participants from the community level included formal and informal health service providers, village heads, youth leaders, religious leaders, school principals and parents of adolescents. In and out of school adolescent boys and girls were also selected from each community. The initial list of interviewees was drawn following recommendations from a stakeholders’ engagement meeting, and additional people were added following participants’ referrals. The study adopted both purposive and random sampling techniques to recruit participants. In order to ensure equal representation of geopolitical and geographical zones, six LGAs (two from each senatorial zone) were selected. In each senatorial zone, one urban/semiurban and one rural LGA were selected to ensure geographical representation; and from each LGA, one community was selected. The LGAs and communities were selected based on recommendations by key stakeholders in the Ministry of Health as areas that have been prioritised by the State government for implementation of adolescent SRH interventions due to high rates of unwanted teenage pregnancy and abortion. Study participants were purposively selected based on their knowledge, work experience and current involvement in adolescent health in the State. Community leaders (village heads, youth leaders) were purposively selected based on their potential influence on adolescents’ SRH. Participants from the community were selected to represent variations in gender as well as to reflect values and beliefs. The school teachers and principals were selected because of the strategic role they play in socialisation and value formation for young people. A relationship was established with some of the target study population who attended the stakeholder engagement meeting before commencement of data collection. Out-of-school adolescents aged 15–18 years were purposively selected and invited for the interview. These adolescents were selected due to their willingness and participation during the project community survey. The in-school adolescents were randomly selected from the each community government secondary schools. Detailed description of sampling procedure and selection criteria have been provided in previously published manuscripts.23 24 Face-to-face in-depth interviews (IDIs) and focus group discussions (FGDs) were employed for data collection. IDI and FGD guides were developed specifically for the study by the research team, and were pretested in a proximate State among population groups similar to the study population. A total of 77 IDIs and 18 FGDs were conducted. The 6 FGDs were used to collect information from village heads, 12 sex disaggregated FGDs were used to collect information from adolescents basically, on perceived intervention to address their SRH needs, while IDIs were used for the rest of the participants. Each FGD session was facilitated by a moderator (a qualitative researcher), a note-taker (who doubled as the observer) and an interpreter (who doubled as the local guide). The IDIs were facilitated by an interviewer (qualitative researcher) and a note-taker. Interviews and discussions were conducted in English or the local language (depending on participants’ preferences). The FGD were held in convenient locations for participants. Number of participants in each FGD ranged from 8 to 13 and the data collection lasted for 1 month. All interviews were audiorecorded and each session took an average of 60 min. A detailed description of data collection process can be found in previously published manuscript.24 Parts of the method and process of data analysis has been described in detail elsewhere at Mbachu et al.23 Audio files were transcribed and translated to English language where necessary. Microsoft word was used to process and edit the transcripts. Field notes were incorporated into the edited transcripts and anonymised using unique codes. Thematic framework approach was used and the key themes and subthemes relating to SRH needs of adolescents include: (1) perception of uniqueness of adolescents’ SRH needs; (2) perception of SRH needs of adolescents; (3) variations in SRH needs of adolescents—gender variations; schooling variations; marital status variations. Additionally, content analysis was performed on all the coded texts under perception of SRH needs of adolescents and perceived intervention to address the needs. This was performed to estimate the frequency of occurrence of each need as a proxy for measuring level of importance. Patients and public were not involved in designing and planning of the research study. However, experts and study communities were involved before field entry through stakeholders’ engagement workshop, where they codesigned the study tools with the research team and through community mobilisation. During data collection, the study involved target population as they were invited to participate in the interview. Succeeding data collection and analysis, a workshop was organised for validation of findings by key stakeholders and community influencers. However, the public and target population were not involved in data analysis and writing of this manuscript.

Matériaux

Innovations

Based on the information provided, here are some potential innovations that could be used to improve access to maternal health:

1. Mobile health (mHealth) interventions: Develop mobile applications or text messaging services to provide adolescents with sexual and reproductive health (SRH) education, counseling, and information on contraceptive services. This can help overcome barriers such as lack of awareness and stigma associated with seeking SRH services.

2. Community-based interventions: Implement community-based programs that involve community leaders, parents, and religious leaders in promoting SRH education and services for adolescents. This can help address cultural and social barriers to accessing maternal health services.

3. School-based interventions: Integrate comprehensive SRH education into the school curriculum and provide access to contraceptive services in schools. This can ensure that adolescents receive accurate information and have access to necessary services in a supportive and non-judgmental environment.

4. Peer education programs: Train and empower peer educators who can provide accurate SRH information and support to their peers. Peer education programs have been shown to be effective in improving knowledge, attitudes, and behaviors related to SRH.

5. Strengthening healthcare systems: Improve the availability and quality of maternal health services in healthcare facilities, particularly in rural areas. This can include training healthcare providers on adolescent-friendly services and ensuring the availability of contraceptives and other necessary supplies.

It is important to note that these recommendations are based on the information provided and may need to be tailored to the specific context and needs of the target population.

AI Innovations Description

The study titled “Stakeholders’ perceptions of adolescents’ sexual and reproductive health needs in Southeast Nigeria: a qualitative study” aimed to explore the perceptions of adult stakeholders on adolescents’ sexual and reproductive health (SRH) needs in order to provide evidence for policy and program reviews to improve access and use of services for adolescents.

The study was conducted in six selected local government areas in Ebonyi state, Southeast Nigeria. The participants included adult stakeholders such as community leaders, adolescent boys, and girls aged 13-18 years. The data collection methods included in-depth interviews and focus group discussions using pretested question guides.

The study found that adolescent SRH needs were perceived to be unique and special due to their vulnerability, fragility, and predisposition to explore new experiences. The recurring needs identified were SRH education and counseling, as well as access to contraceptive services and information. These needs were perceived to vary based on sex, schooling, and marital status. Adolescent girls were perceived to have more psychological needs and be more prone to negative health outcomes. Out-of-school adolescents were described as more vulnerable, less controlled, less supervised, and more prone to sexual abuse. Unmarried adolescents were perceived to be more vulnerable to sexual exploitation and risks, while married adolescents were perceived to have more maternal health service needs.

The study concluded that stakeholders’ perceptions of adolescents’ SRH needs were consistent and varied based on gender, schooling, and marital status. This highlights the need for well-designed gender-responsive interventions that consider other social stratifiers and incorporate adolescents’ perceived SRH intervention strategies.

The study employed a qualitative research method using exploratory approaches and involved various stakeholders, including policy-makers, SRH program managers, health workers, community and religious leaders, and parents. The participants were selected through purposive and random sampling techniques to ensure equal representation of geopolitical and geographical zones. In-depth interviews and focus group discussions were conducted, and the data were analyzed using thematic framework and content analysis approaches.

It is important to note that patients and the public were not directly involved in the design and planning of the study, but experts and study communities were involved through stakeholder engagement workshops and community mobilization. The findings were validated through a workshop with key stakeholders and community influencers.

Overall, the study provides valuable insights into the perceptions of stakeholders regarding adolescents’ SRH needs in Southeast Nigeria and highlights the importance of developing targeted interventions to improve access to maternal health services for adolescents.

AI Innovations Methodology

Based on the information provided, here are some potential recommendations for improving access to maternal health:

1. Strengthen SRH education and counseling: Develop comprehensive and age-appropriate sexual and reproductive health education programs that provide adolescents with accurate information about their bodies, relationships, contraception, and pregnancy. This can be done through schools, community centers, and online platforms.

2. Increase access to contraceptive services and information: Ensure that adolescents have easy access to a wide range of contraceptive methods, including condoms, birth control pills, and long-acting reversible contraceptives. This can be achieved by improving the availability and affordability of contraceptives, training healthcare providers to offer non-judgmental and confidential services, and implementing community-based distribution programs.

3. Address gender disparities in SRH needs: Recognize and address the unique SRH needs and challenges faced by adolescent girls, such as psychological needs and increased vulnerability to negative health outcomes. This can be done by promoting gender equality, empowering girls through education and skills development, and providing targeted support and services.

4. Support out-of-school adolescents: Develop targeted interventions to reach out-of-school adolescents who may be more vulnerable to sexual abuse and exploitation. This can include community outreach programs, peer education initiatives, and mobile health clinics to provide essential SRH services and information.

5. Improve maternal health services for married adolescents: Recognize the specific maternal health needs of married adolescents and ensure they have access to quality antenatal care, skilled birth attendants, and postnatal care services. This can be achieved by strengthening the healthcare system, training healthcare providers in adolescent-friendly care, and promoting early and regular prenatal care.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Baseline data collection: Gather data on the current status of access to maternal health services, including indicators such as maternal mortality rates, contraceptive prevalence rates, and utilization of antenatal care services. This can be done through surveys, interviews, and analysis of existing data sources.

2. Define simulation parameters: Determine the specific variables and assumptions that will be used in the simulation model. This can include factors such as population size, geographical distribution, healthcare infrastructure, and resource availability.

3. Develop a simulation model: Use a modeling software or statistical tool to create a simulation model that incorporates the recommended interventions and their potential impact on access to maternal health services. This model should consider factors such as population dynamics, healthcare utilization patterns, and the effectiveness of the interventions.

4. Run the simulation: Input the baseline data and simulation parameters into the model and run the simulation to generate projections of the potential impact of the recommendations on improving access to maternal health services. This can include estimates of changes in maternal mortality rates, contraceptive use, and utilization of antenatal care services.

5. Analyze the results: Interpret the simulation results and analyze the potential impact of the recommendations on improving access to maternal health services. Identify key findings, trends, and areas of improvement.

6. Validate the simulation: Validate the simulation results by comparing them with real-world data and expert opinions. This can be done through peer review, expert consultations, and stakeholder feedback.

7. Refine and iterate: Based on the validation and feedback, refine the simulation model and repeat the simulation process to further improve the accuracy and reliability of the results.

By following this methodology, policymakers and program managers can gain insights into the potential impact of different recommendations on improving access to maternal health services and make informed decisions on resource allocation and program implementation.

Auteur

Dima Health

Statistics:

Citations: 2

Identifiers:

DOI: 10.1136/bmjopen-2021-051389

Research Areas:

Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Violence and Injury

Study Countries:

Nigeria

Study Design:

Cross Sectional Study, Exploratory Study, Grounded Theory, randomised-control-trial

Study Approach:

Mixed-methods, Qualitative, Quantitative

Participants Gender:

Male & Female

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