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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.
