Where and how do young people like to get their sexual and reproductive health (SRH) information? Experiences from students in higher learning institutions in Mbeya, Tanzania: a cross-sectional study

Perspectives on barriers to traditional sources of sexual and reproductive health information and services: Are mHealth technologies the answer?

Background

In Ghana, several qualitative studies have explored users' perspectives on conventional sources of sexual and reproductive health (SRH) information and factors which influence provision of and access in rural settings. However, there is a dearth of qualitative studies on healthcare provider (HCP) perspectives on factors that deter access to conventional sources of SRH information among young people in rural Ghana and innovative ways for addressing barriers. This study explored perspectives on barriers to traditional sources of SRH information and services and innovative ways of using mHealth technologies for addressing provision and access challenges among young people in rural Ghana.

Methods

This study used a qualitative approach using in-depth interviews. Semi-structured in-depth interviews were conducted with HCPs in rural areas in three regions of Ghana between May and August 2021. Participants were selected from rural communities using the convenience snowball sampling and were interviewed via Zoom. The interviews explored the experiences and perceptions of HCPs on conventional SRH information and services and young people's access to this information and services. The interviews were audio recorded and transcribed verbatim. Data were analysed thematically using NVivo software version 12, following the approach outlined by Braun and Clarke.

Results

Twenty HCPs were interviewed for this study. The participants identified different sources of SRH information and services used by rural young people. Peers or friends, health facilities, health providers, and community settings were reported as the main services and sources of SRH information. Participants reported several barriers and challenges to the provision of and access to SRH information to young people, including socio-cultural norms, religious beliefs, unfriendly health facility environments, negative health providers' attitudes, lack of privacy and confidentiality resulting in unfriendly youth SRH services, distance, and financial challenges due to costs of transportation which limits rural young people's access to, and use of, SRH services. All the participants indicated that in addressing provision and access barriers, the use of mobile phones could be beneficial.

Conclusion

This study highlights several barriers and challenges that deter provision of, and access to, SRH information and services for young people in rural Ghana. The findings indicate the use of innovative mobile health (mHealth) technologies may be one solution to some of the barriers and challenges.

Inequities between rural and urban realities: young Hispanic women's pregnancy intentions and birth outcomes

The present study sought to determine if inequities exist in Hispanic women's pregnancy intentions and birth outcomes by metropolitan status. In the U.S. pregnancy intentions and birth outcomes of young Hispanic women are a significant public health problem as they are often overlooked on health issues such as pregnancy and childbirth. Data were from the 2015 to 2019 National Survey of Family Growth and focused on the first pregnancies of Hispanic women aged 18 to 24 years old who were not pregnant at the time of the interview and answered the nativity question. Multivariable multinomial regression was used to evaluate how metropolitan status affects pregnancy intentions and birth outcomes. Additionally, multivariable multinomial regression was used to evaluate how metropolitan status affects each pregnancy intention-birth outcome combination. There was no significant association solely between metropolitan status and pregnancy intention (i.e. unintended pregnancy). Metropolitan Hispanic women reported more miscarriages than live births. Hispanic women in the suburbs were more likely to miscarry during an intended pregnancy than those in urban. These findings can improve family planning services for rural women by identifying the specific factors that affect pregnancy intentions and developing targeted interventions to reduce unintended pregnancies.

HIV knowledge, sexual attitudes, and PrEP-Eligible behaviors among college students in Southwest China: a cross-sectional study

BACKGROUND

There is an increasing number of human immunodeficiency virus (HIV) reported cases among students in Southwest China. However, the data on HIV/sex-related knowledge, attitude toward sex, sexual behaviors, and correlates of pre-exposure prophylaxis (PrEP)-eligible behaviors among college students in this area is still limited. This study aimed to assess the prevalence of HIV/sex-related knowledge, sexual attitudes, sexual behaviors, and factors associated with PrEP-eligible behaviors among college students.

METHOD

An online survey from 2020 to 2021 based on a multistage stratified and cluster sampling method was conducted among college students in Southwest China, and a well-designed questionnaire collected data. Propensity score matching (PSM), logistic, and log-binomial regression were used to identify the determinants of PrEP-eligible behaviors.

RESULT

A total of 108,987 students participated in the survey, and 92,946 provided valid responses. 91.6% (85,145/92,946) had good HIV-related knowledge, while only 26.0% (24,137/92,946) reported awareness of sex-related knowledge. Furthermore, more than half of the participants (64.5%) held negative stances towards engaging in "one-night stand", and 58.9% (617/1,047) reported PrEP-eligible behaviors. Log-binomial regression analysis indicated that unaware of HIV-related knowledge (aPR = 1.66, 95% CI:1.22-2.26, P = 0.001), not discussing about sex with their parent(s) (aPR = 1.16, 95% CI:1.01-1.33, P = 0.021), not receiving sex-related education in school(aPR = 1.24, 95% CI: 1.07-1.45, P = 0.005), not participating in HIV/AIDS prevention activities in the past year (aPR = 1.32, 95%CI:1.09-1.60, P = 0.004), experiencing forced sex (aPR = 2.08, 95% CI: 1.19-3.63, P = 0.010), and having the drug abuse (aPR = 22.21, 95% CI:5.59-88.31, P < 0.001) were significantly associated with increased odds of PrEP-eligible behaviors.

CONCLUSION

College students in Southwest China exhibited suboptimal HIV/sex-related knowledge, received limited sex education, reported conservative attitudes towards casual sex, and significant PrEP-eligible behaviors. These findings suggest that sexually experienced college students who were unaware of HIV-related knowledge, lacked sex education, experienced forced sex, and reported drug abuse were the key individuals for evaluating eligibility for PrEP initiation, and interventions aimed at increasing awareness of HIV/sex-related knowledge, promoting participation in sex education, addressing issues related to forced sex and tackling drug abuse could contribute to reducing the incidence of PrEP-eligible behaviors among college students.

Understanding the contents and gaps in sexual and reproductive health toolkits designed for adolescence and young adults: a scoping review

INTRODUCTION

Adolescence is a crucial stage of physical and sexual maturation and development and a period in which understanding sexual and reproductive health (SRH) is important. SRH interventions and toolkits provide a range of valuable resources and information to young people, educators, and members of the community on numerous topics, including contraception and puberty.

OBJECTIVES

The usefulness and reliability of these available toolkits have not been previously studied, thus limiting our understanding of their appropriateness and contents. Hence, this scoping review aimed to synthesize the available toolkits aimed at the SRH of adolescents and young adults to understand the contents, design, and information gaps.

METHODS

A systematic search was conducted of 6 medical databases and 12 gray literature sites. Sixteen toolkits published globally before May 2023 were included in our review.

RESULTS

The majority of toolkits (n = 12) contained information related to general SRH knowledge and contraception, whereas only 3 contained information on teenage pregnancy. We found that aiming the toolkits toward educators and health care workers was a favorable design over targeting adolescents and young adults directly and that vulnerable youth-including LGBTQI+ (lesbian, gay, bisexual, transgender, queer or questioning, asexual or allied, intersex, and additional identities) and youth from humanitarian settings-were not well represented.

CONCLUSION

We identified key gaps in the inclusion of information in a range of SRH topics, such as LGBTQI+ sexuality, teenage pregnancy, and safe abortion, in the currently available SRH toolkits and their lack of applicability in a global context. Furthermore, we provide recommendations for areas of improvement to encourage adolescents' agency in their SRH education.

Exploring Indonesian Primary Schoolgirls' Experiences of School-based HPV Vaccination, Knowledge of HPV Risks and Prevention, and Preferences for Cervical Cancer Education

OBJECTIVE

In 2016, Indonesia introduced its Human Papillomavirus (HPV) vaccination demonstration program for girls in grades 5 and 6 of primary school, to reduce cervical cancer (CC) burden in selected provinces and test the viability of nationwide vaccination. This study explored schoolgirls' experience of school-based HPV vaccination, their knowledge of HPV and HPV vaccination, and their preferences for cervical cancer (CC) education.

METHODS

An online survey was conducted with schoolgirls who experienced HPV vaccination between 2019 and 2021 through the demonstration program. Using purposive sampling, respondents were recruited through partnerships with primary public health centres and primary schools in Jakarta and Yogyakarta. Data analysis was conducted using Chi-square test, Independent-samples t-test, and one-way ANOVA.

RESULTS

One hundred and forty primary schoolgirls with a mean age of 12.2 years (SD = 0.70) completed the survey. Schools and mothers were identified as key actors in socialising children about important health information and as girls' preferred sources of information. The average summed score for girls' knowledge of HPV, the HPV vaccine, and CC after being vaccinated was 5.07 out of 10 (SD 0.23). Significant differences in the mean knowledge scores among participants with different preferences regarding CC education in school were observed.

CONCLUSION

While schoolgirls' experiences of HPV vaccination were largely positive, their knowledge of critical health information regarding HPV vaccination and CC prevention needs improving. Thus, it is necessary to provide parents, and school-based educators with culturally appropriate strategies and comprehensive evidence-based information about HPV vaccination and CC prevention more effectively to children.

Sexually transmitted infection (STI) knowledge and perceptions among people in HIV-sero-different partnerships in rural southwestern Uganda

Globally, over one million people acquire curable sexually transmitted infections (STI) each day. Understanding how people think about STIs is key to building culturally appropriate STI prevention and treatment programs. We explored STI knowledge and perceptions in rural, southwestern Uganda to inform future interventions. From August 2020 to December 2020, we conducted individual in-depth interviews among adult men and women (≥18 years) with recent or current personal or partner pregnancy, a history of an STI diagnosis and treatment, and membership in an HIV-sero-different relationship. Interviews explored STI knowledge, perceptions, and barriers and facilitators to engaging in STI care. We used inductive and deductive approaches to generate a codebook guided by the healthcare literacy skills framework in a thematic analysis. Ten men with STI, five of their female partners, eighteen women with STI, and four of their male partners participated in individual in-depth interviews. The median age was 41 (range 27-50) for men and 29 (range 22-40) for women. Sixteen (43%) participants were with HIV. Significant themes include: 1) Participants obtained STI knowledge and information from the community (friends, family members, acquaintances) and medical professionals; 2) While participants knew STIs were transmitted sexually, they also believed transmission occurred via non-sexual mechanisms. 3) Participants associated different connotations and amounts of stigma with each STI, for example, participants reported that syphilis was passed down "genetically" from parent to child. 4) Participants reported uncertainty about whether STIs affected pregnancy outcomes and whether antenatal STI treatment was safe. The complicated nature of STIs has led to understandable confusion in settings without formal sexual healthcare education. Robust counseling and education prior to sexual debut will help allow men and women to understand the signs, symptoms, and treatments necessary for STI cure and to navigate often complicated and overburdened healthcare systems.

Sexual and reproductive health literacy among young people in Sub-Saharan Africa: evidence synthesis and implications

BACKGROUND

Sexual and reproductive health literacy is a key to attaining and maintaining sexual and reproductive health, especially among young people in low-income countries, such as sub-Saharan Africa. While the importance of sexual and reproductive health literacy is gaining wider recognition, studies on the topic have been mainly concentrated in high-income (developed) countries.

OBJECTIVE

The aim of this study was to provide a coherent summary and synthesis of the available evidence on sexual and reproductive health literacy among young people in sub-Saharan Africa, with implications for policy, interventions, and research.

METHODS

The review was conducted using the Joanna Briggs Institute's methodology for reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline to enhance the clarity and transparency of the reporting process. PubMed, CINAHL, AJOL, AIM, and Google Scholar were searched for evidence from 18 March to 20 May 2022.

RESULTS

The search provided 2,682 articles in total, of which only 24 met the eligibility criteria and were included in this review. The findings revealed persistent sexual and reproductive health information/knowledge gaps, poor sexual and reproductive health-related knowledge and practices, lack of exercising sexual and reproductive health knowledge, and multiple determinants of sexual and reproductive health literacy among young people, ranging from personal to larger structural conditions.

CONCLUSION

The review found that sexual and reproductive health literacy among young people in sub-Saharan Africa is concerning and has not been fully researched. A deeper understanding of the issue is essential for designing and implementing effective interventions to improve sexual and reproductive health literacy and health outcomes among young people.

An Assessment of Community Pharmacists' Competence and Involvement in Adolescent Sexuality Education and Reproductive Health Services

Background: Provision of sexuality education and reproductive health (SERH) services for the adolescent population has been inadequate. Increasing access to adolescent SERH through the community pharmacy is a viable option in bridging this gap. Objective: The study objectives were to assess community pharmacists' involvement, self -reported competence, confidence and comfort level regarding provision of adolescent SERH services and explore barriers to service delivery. Method: A pre-tested questionnaire was distributed to 200 community pharmacists by simple random sampling. Self-reported competency and confidence were measured on a Likert scale ranging from 1-5, midpoint 3. Continuous data was expressed as mean and standard deviation while categorical data was expressed as frequencies and percentages. Results: Community pharmacist' self-reported competence, confidence and comfort levels were high, 4.09 ± 0.14; 3.2±0.75; 4.17± 0.18 respectively on a Scale of 1-5. Majority of the pharmacists, 130 (81.3%) claimed to have had formal training in sexuality education and nearly three quarters, 105 (65.6%) had recently updated their knowledge. Although product availability was adequate, 118 (73.6%), availability of educational materials was low, 37 (23%). Schools were the most frequent place where pharmacists had distributed sexuality education materials 96 (60%). Lack of time and religious objection were the major barriers to service delivery 99(61.9%); 63(39.4%) respectively. Conclusion: Pharmacist' self-reported comfort, competency and confidence levels in delivering adolescent SERH services were high. The major barriers to service delivery were lack of time and religious objection. These findings suggest that community pharmacists have a potentially major impact on improving access to adolescent SERH service. Therefore, the option of delivering SERH services through pharmacies is worth exploring in order to improve access and service delivery to the adolescent population.

"If your mother does not teach you, the world will…": a qualitative study of parent-adolescent communication on sexual and reproductive health issues in Border districts of eastern Uganda

BACKGROUND

Adolescents experience a host of sexual and reproductive health (SRH) challenges, with detrimental SRH and socio-economic consequences. These include early sexual debut, sexually transmitted infections including HIV/AIDS, teenage pregnancy, and early childbearing. Parent-adolescent communication about SRH has significant potential to reduce adolescents' risky sexual behaviors. However, communication between parents and adolescents is limited. This study explored the facilitators and barriers to parent-adolescent communication about sexual and reproductive health.

METHODS

We conducted a qualitative study in the border districts of Busia and Tororo in Eastern Uganda. Data collection entailed 8 Focus Group Discussions comprising of parents, adolescents (10-17 years), and 25 key informants. Interviews were audio-recorded, transcribed, and translated into English. Thematic analysis was conducted with the aid of NVIVO 12 software.

RESULTS

Participants acknowledged the key role parents play in communicating SRH matters; however, only a few parents engage in such discussions. Facilitators of parent-adolescent communication were: having a good parent-child relationship which makes parents approachable and motivates children to discuss issues openly, a closer bond between mothers and children which is partly attributed to gender roles and expectations eases communication, and having parents with high education making them more knowledgeable and confident when discussing SRH issues with children. However, the discussions are limited by cultural norms that treat parent-child conversations on SRH as a taboo, parents' lack of knowledge, and parents busy work schedules made them unavailable to address pertinent SRH issues.

CONCLUSION

Parents' ability to communicate with their children is hindered by cultural barriers, busy work schedules, and a lack of knowledge. Engaging all stakeholders including parents to deconstruct sociocultural norms around adolescent SRH, developing the capacity of parents to confidently initiate and convey accurate SRH information, initiation of SRH discussions at early ages, and integrating parent-adolescent communication into parenting interventions, are potential strategies to improve SRH communication between parents and adolescents in high-risk settings such as borders.

Factors related to self-rated health of older adults in rural China: A study based on decision tree and logistic regression model

Objective

This study aimed to explore the related factors of self-rated health (SRH) by using decision tree and logistic regression models among older adults in rural China.

Methods

Convenience sampling was employed with 1,223 enrolled respondents who met the inclusion criteria from 10 randomly selected villages in M County in China. The content of the questionnaire covered demographic characteristics, physical and mental health, sleep status, and risk of falling. The Pittsburgh Sleep Quality Index (PSQI) and the Morse Falls Risk Scale (MFS) were used to evaluate sleep status and risk of falling, respectively. The decision tree and logistic regression models were employed to analyze the related factors of SRH.

Results

Notably, 817 (68.7%) subjects had good SRH. The logistic regression model showed that living standard, alcohol consumption, sleep quality, labor, hospitalization, discomfort, the number of chronic diseases, and mental health were associated with SRH (P-value < 0.05), while the decision tree model showed that the number of chronic diseases, sleep quality, mental health, hospitalization, gender, and drinking were associated with SRH. The sensitivity and specificity of the logistic regression model were 67.7 and 75.5%, respectively, and the area under the ROC curve was 0.789 (0.763, 0.816); the sensitivity and specificity of the decision tree model were 71.5, and 61.4% respectively, and the area under the ROC curve was 0.733 (0.703, 0.763).

Conclusion

Decision tree and logistic regression models complement each other and can describe the factors related to the SRH of the elderly in rural China from different aspects. Our findings indicated that mental health, hospitalization, drinking, and sleep quality were the important associated factors.