Introduction: Due to the limited access to sexual and reproductive health service, out-of-school-adolescents become at a higher risk for early marriage, early pregnancy early parenthood, and poor health outcomes over their life course. Hence, the aim of this study was to explore the challenges faced by female out-of-school adolescents in accessing sexual and reproductive health service in Bench-Sheko zone. Methods: A community-based qualitative exploratory study was carried out from November 01/2020 to December 01/2020 among selected out-of-school adolescents residing in rural and urban districts of Bench-Sheko Zone, and healthcare professionals working in the local health centers. FGD participants and healthcare providers were purposely selected for this study. Eight focus group discussions and 8 in-depth interviews were conducted among female out-of-school adolescents, and health care professionals, respectively. Result: The study revealed that out-of-school adolescents encounter several challenges in accessing sexual reproductive health service which includes socio-cultural barriers, health system barriers, perceived legal barrier, inadequate information regarding sexual reproductive health service, and low parent-adolescent communication. Conclusion: The finding suggests the need to engage community influencers (religious leaders, community leaders, and elders) in overcoming the socio-cultural barriers. Program planners and policy makers have better make an effort to create adolescent friendly environments in SRH service areas. Furthermore, implementing community-based awareness raising programs, parental involvement in sexual reproductive health programs, and encouraging parent-adolescent communication on sexual reproductive health issues could improve sexual reproductive health service utilization by out-of-school adolescents in the study area.
The study was undertaken from November 01/2020 to December 01/2020 in selected districts of Bench-Sheko zone. The Zone is found 561 km away from Addis Ababa, the capital city of Ethiopia, in Southwest direction with an estimated population of 829 493, of them 418 213 are women, 207 276 are adolescents, 129 500 are children under 5, and 26 462 are below 1 year.20 The expected number of households in the zone is around 169 284 and the primary health service coverage of the zone is 92.6% accounting a total catchment area of 19 965.8 km2 with majority 86% (1 061 120) of the inhabit in the rural areas. The zone comprises 1 city administration (Mizan-Aman), 6 Woredas (districts), 246 kebeles (smallest administrative units) (229 rural and 17 urban). Regarding health institution, the zone has 2 Hospitals, 26 health centers, and 182 health posts. There are 50 physicians’ and 511 of health professionals of different ranks and 476 health extension workers.21 In this study, a qualitative approach, exploratory-descriptive design was employed. This design enables the investigator to explore the phenomena from the perspective of the participant being studied.22 This study was conducted among out-of-school adolescents residing in the districts of Sheko, Debub Bench, Guraferda, and Debrework and selected healthcare providers working in the specified districts. Two focus group discussions (FGD) per district, a total 8 FGDs were conducted among out-of-school adolescents; again, 2 in-depth interviews per district, a total of 8 in-depth interviews were made among healthcare providers (MCH coordinator and district health officer). From each district 2 kebeles (1 urban Kebele and 1 rural Kebele) were randomly selected. At Kebele level, eligible adolescents for FGD discussion were identified with the help of Keble administrator, Health Extension Workers, and Ketena (Kebele sub-administration) representative of each Keble. Then, they were screened against the inclusion criterion which includes: being female, age group 15 to 19, and residing in the area at least for 6 months. Adolescents who had active community participation such as being member youth association, engaging in HIV prevention and control program, and involving in different sexual reproductive health (SRH) activities were given priority. Upon securing consent (parental consent for adolescents age < 18), participants were informed both the time and the place where the FGD discussion was going to be held. For the in-depth interviews, district health officers and maternal and child health (MCH) coordinators were purposely selected as they were assumed to be more informative on the SRH service challenges that out-of-school adolescents are encountering. A self-developed FGD guide was used to conduct the FGD discussion. Before the actual data collection, the developed FGD guide was pretested in the districts that were not included in the study. Based on the pretest finding, some modifications were made accordingly. A total of 8 FGDs were conducted among out-of-school adolescents; each FGD discussion was modulated by the principal investigator and 1 public health professional who had experience in qualitative data collection technique was hired as rapporteur. Majority of the FGD discussion topic were focused on SRH service utilization experience, perceived and actual barriers to access SRH service, and SRH service preference. For instance the following question was raised: “what do you think about the challenges that out-of-school adolescents encounter when deciding to use sexual and reproductive health service?” Taking the current COVID-19 pandemic into account, the size of FGD discussants was fixed at most 8 and preventive measures such as use of personal protective materials and physical distancing were applied during the discussions. Since subject matter is sensitive for adolescents, before opening of each FGD discussions, attempts were made to build rapport among the discussants and they were insured that the information they would provide will not be disclosed. Each discussion lasted on average 80 minutes. All the discussions were tape-recorded and notes were taken to guarantee the accuracy of the data. At the end of each session, participants were briefed on the importance of SRH service utilization for adolescents. The 8 in-depth interviews were conducted among health professional working in the local health centers. A self-developed interview guide was used to conduct the interviews. The interview sessions lasted on average 35 minutes and all interview sessions were tape-recorded. The audio recorded FGD discussions and in-depth interviews were transcribed verbatim. Thematic analysis was used. Two investigators (WA & MD) transcribed the audio-recorded in-depth interview data and FGD discussions independently. Then the transcribed data were translated to English by the investigators. The translated data were checked by an independent research assistant to check the quality of the translation. Inductive coding was applied where themes were derived from the empirical evidences related with this study. Multiple consensus codding where 2 of the investigators (WA & MD) developed codes for each in-depth interview and FGD discussions. Any discrepancies between the coders were discussed until consensus meet. Those codes that could not be resolved by discussion were referred to the third member of the research team (SH) to resolve the discrepancies. Data that could not be agreed up on the consensus meeting were omitted from the analysis. Related codes were combined to form themes. Finally, in presenting the finding, participants’ quotes were used to elaborate the umbrella theme being discussed. Trustworthiness of a qualitative study defines as: the extent to which the claimed meanings represent the views of the study participants correctly. The 4 criteria for warranting trustworthiness that comprises credibility, transferability, dependability, and confirmability were insured in this study. To assurance credibility, a member check was made by engaging some of the study participants to assert the correctness of transcribed data and emerging themes as accurately representing their views. A clear description of the technique for participants’ selection and thorough report of the research setting was done in order to improve transferability. Method applied for data collection, analysis and interpretation is also taken within the report for dependability. An audit trail comprising of field notes, audio recordings, analysis notes, and coding details were also kept for confirmability.
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