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
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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
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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
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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
ABSTRACT Globally, adolescent population is estimated to be 1.25 billion (WHO 2012). Among these, 513 millions are between 15-19 years and 85% of the total adolescents are living in developing countries. Worldwide, adolescents continue to face challenges in accessing reproductive health services (Kamau A 2014). It has been estimated that 1.7 million adolescent girls lose their lives yearly due pregnancy related complications (WHO 2014) The research aimed at assessing the factors that hinder adolescents from seeking reproductive health services at Bassajabalaba secondary school. This research included thirty (30) respondents using cross-sectional and descriptive study designs employing both quantitative and qualitative research designs. Data collection tools were a questionnaire and a key informant interview. Data was manually analysed and presented in tables. The study findings revealed that 10(40%) of respondents feared other patients, nearly a half of respondents 11(46%) were watching pornography and sex video shows in public local clubs. Nearly three quarters of respondents reported that health facilities open for only six hours in a day and 28(93%) reported that health facilities did not provide privacy. Majority of respondents 27(90%) said that health workers did not teach them how to use reproductive health methods. The recommendations were; adolescents should avoid watching pornography, avoid taking alcohol and should access newspapers and radios for reproductive health information. Health facility management should improve reproductive health services, prohibit under table payments and organize reproductive health outreaches in schools and community settings. The government should integrate sexual and reproductive health in school and institution curriculum and should construct more health facilities.