Demographic Characteristics of Adolescents
The characteristics of the teenagers interviewed revealed that slightly, over half (62.3%) were females while 37.7% were males. Regarding age the majority (46.6%) fell between the ages of 15 and 19 followed by 45.9% in the age range of 20 to 24 and a smaller portion (7.5%) aged between 10 and 14 years old. In terms of education enrolled students accounted for 41.5% while those not attending school constituted the remaining 58.5%. Additionally, just under half (48.6%) of the adolescents had completed education with another portion (33.6%) at the secondary level. It is worth noting that less than half (42.5%) found reading while a similar percentage (43.2%) found writing to be findings consistent with previous studies by Cutler & Lleras-Muney (2006) Wycliff (2016) and Nursanti et al (2022). The causes of pregnancy in South Sudan can be attributed to factors such as social dynamics, cultural practices, political issues and gaps within the healthcare systems approach towards youth reproductive health needs. Factors contributing to pregnancy, in South Sudan include dowry expectations, forced or arranged marriages and gender related challenges.
It's crucial to take into account the perspectives and experiences of girls and acknowledge that when they choose to become mothers, they are making decisions despite being limited by uncertain and unjust social circumstances (Gawar, 2021; Kane et al., 2019). A research study examining the prevalence and factors contributing to tobacco use, among school adolescents in Sudan and South Sudan revealed that there are differences between genders in terms of both the occurrence of tobacco use and the influencing factors. This emphasizes the significance of considering gender aspects when addressing health concerns (Atari, 2014).
In South Sudan there exists an opportunity to implement policies that advance gender equality and safeguard women. This is particularly important in tackling attitudes towards gender norms regarding relationships and reproductive health. It is crucial to take into account variables such, as sex, age and education when analyzing these attitudes (Scott et al., 2013; Scott et al., 2013).
Information Communication and Health Provider Treatment
The study found that less, than half of the teenagers (41.7%) mentioned having access to materials on health and services. Additionally, a majority of the teenagers (60.9%) reported a lack of reading material related to Information, Education and Communication (IEC) at healthcare facilities. However, it is worth noting that all young people (89.0%) reported receiving considerate treatment from healthcare providers. The availability of materials and IEC resources plays a role in empowering adolescents by providing them with necessary knowledge and information to make informed decisions about their sexual and reproductive health. The absence of materials may impede adolescents access to information potentially affecting their ability to make well informed choices regarding their health and wellbeing. Studies have emphasized the significance of strategies in delivering sexual and reproductive health services for adolescents well as increasing demand for these services and garnering community support. This includes education, psychological interventions and community support aimed at addressing gaps in adolescent health services (Denno et al., 2015). The utilization of health services by women in Bangladesh has been examined with an emphasis on understanding the factors influencing access, to and acceptance of sexual and reproductive health services provided by adolescent friendly healthcare facilities.
Thematic analysis has been used to gain insights, into the factors that affect access and acceptance providing lessons for improving how adolescents use services (Pandey et al., 2019).
Furthermore, a study has examined the use of printed information, materials and communication tools among healthcare providers in Ethiopia. It focuses on the factors associated with their utilization. Understanding what enables or hinders the use of these materials is important for making them more effective in spreading health information (Geleta et al., 2022; Geleta & Deriba 2022).
The findings from these studies collectively emphasize the importance of information communication and the availability of materials in influencing health outcomes. The lack of health education materials and IEC resources at healthcare facilities may create obstacles, for adolescents when accessing information. Therefore, it is essential to make efforts to increase the availability and usage of these materials to promote decision making and improve sexual and reproductive health outcomes among adolescents.
Access to Reproductive Health Services
29.5% of individuals mentioned that it takes them, around 1 2 hours to reach a healthcare provider suggesting potential difficulties in accessing health facilities due to geographical constraints. While the majority of people (66.2%) found the waiting time around 33.8% considered it unacceptable. This indicates the need for efforts to reduce waiting times and improve experiences. On a note most young individuals (70.8%) stated that they were able to obtain all prescribed medications and items at the healthcare facility indicating availability of essential medicines (Mugo et al., 2015).
Accessing reproductive health services in South Sudan presents challenges influenced by cultural and health system factors. Studies have highlighted how conflicts affect the delivery of child healthcare services in conflict affected areas like Upper Nile and Unity states (Sami et al., 2020). Additionally, research has explored women and men perspectives on barriers, to accessing and utilizing maternal healthcare services shedding light on challenges and safety concerns contributing to home deliveries (Mugo et al., 2018).
The availability of public health services, in areas has been thoroughly examined, with a focus on understanding the distribution and proximity of health facilities to the population (Macharia et al., 2017). In South Sudan concerns about dignity violations and cultural factors have been identified as reasons why some individuals choose not to utilize health services. This highlights the importance of providing care and establishing safe and respectful healthcare environments (Kane et al., 2018). Furthermore, when it comes to implementing community health worker programs it is crucial to understand the characteristics and challenges associated with delivering healthcare at the community level (Lutwama et al., 2021).
Collectively these studies emphasize how various geographical, cultural and systemic factors interact to impact access to reproductive health services in South Sudan. To address these challenges effectively a comprehensive approach is necessary. This approach should consider not accessibility but also cultural perceptions and the quality of care provided. It is also essential to seize opportunities for health programs to initiate change and create sustainable interventions that can improve reproductive health services, in South Sudan (Kane et al., 2016).
Confidentiality and Adolescents' Involvement in Decision-Making
According to a research study titled "Addressing the Gap; Enhancing Adolescent and Youth Friendly Sexual Reproductive Health Services in South Sudan " the findings shed light on confidentiality and adolescents’ participation, in decision making when it comes to accessing healthcare services. The study revealed that less than half of the participants (27.1%) reported that apart from the healthcare team someone else overheard their discussions with healthcare providers about their problems. Moreover, a small percentage of respondents (30.6%) believed that besides the healthcare team others witnessed their conversations regarding their issues with healthcare providers. However, the majority of respondents (62.4%) trusted that the information they shared remained confidential. Additionally, it was highlighted in the study that most participants (72.6%) were not involved in delivering services to adolescents or young people and a significant number of them (62.3%) were unaware of any involvement by adolescents in decision making processes related to how health services should be provided for clients. The issue of confidentiality plays a role in healthcare as it helps build trust and ensures that young individuals feel comfortable when seeking and receiving medical assistance. The study findings underscore the significance of maintaining confidentiality, within healthcare settings to protect adolescents’ privacy and foster trust.
Research has indicated that maintaining confidentiality is a factor, in enhancing the availability, continuity and quality of reproductive health services for minors (Jaruševičienė et al. 2011). Furthermore, it is of importance to protect the confidentiality of adolescents and young adults seeking services like STI testing, contraception, pregnancy care, substance use/abuse support and mental health assistance ("Confidentiality Protections for Adolescents and Young Adults in the Health Care Billing and Insurance Claims Process" 2016).
Ensuring that adolescents are involved in decision making processes and service provision is an area that requires attention. Efforts should be made to engage adolescents in decision making and service delivery to ensure healthcare services cater to their needs. Customizing sexual and reproductive health services according to the requirements of adolescents has been emphasized as a way to prevent stigma, pregnancies, abortions and transmitted infections (Boamah Kaali et al., 2018). Moreover, understanding the factors that influence adolescents’ utilization of reproductive health services is vital, for addressing barriers and enhancing service utilization (Agbenu et al., 2022).
The study findings also emphasize the need for healthcare providers to be aware of the needs and challenges faced by adolescents when accessing and utilizing healthcare services.
The attitudes of healthcare professionals play a role, in customizing reproductive health services for adolescents ensuring there are no stigmas or barriers to care (Boamah Kaali et al., 2018). Additionally improving the knowledge and skills of pharmacists when it comes to matters confidentiality can reduce obstacles to care and enhance the health outcomes of young people (Conard et al., 2003).
Signposts and Involvement of Parents and the Community
Based on the research titled "Addressing the Gap; Improving Sexual and Reproductive Health Services for Adolescents, in South Sudan " the findings shed light on the challenges faced in ensuring access to sexual and reproductive health services for people in the region. The study discovered that only a small percentage (23.3%) of respondents noticed signposts containing information about services specifically targeted towards adolescents and young individuals. Moreover, a significant majority (77.2%) reported not seeing any signposts that displayed working days and hours. Additionally, less than half of the participants actively engaged parents and community members to ensure adolescents access to sexual and reproductive health services. The absence of signposts regarding services and operating hours may impede adolescents’ awareness and utilization of essential healthcare resources. This highlights the importance of communication through signage to inform adolescents about accessible sexual and reproductive health services. Previous studies have emphasized creating youth healthcare environments by providing information and appropriate signage, which contributes to improved access, to services and overall, wellbeing (Abajobir & Seme 2014).
It is crucial, for parents and the community to be involved in ensuring that adolescents have access to sexual and reproductive health services. Research has shown that when parents communicate and provide support it can greatly influence the reproductive health behaviors and outcomes of adolescents. By communicating with parents and involving the community we can promote sexual health behaviors among adolescents and reduce risky practices (Mbachu et al., 2020; Jonas et al., 2019).
Additionally, the study emphasizes the importance of addressing barriers that prevent parents and the community from supporting reproductive health. To develop strategies for improving access to these services it is essential to understand what factors hinder adolescents from utilizing health services as well as gather perspectives from healthcare providers and service users (Habtu et al., 2021; Agbenu et al., 2022).
Performance of Health Facilities
According to the study findings more, than half of the respondents (52.1%) considered the services provided by health facilities for adolescents as good. On the hand less than half (39.6%) rated them as average and a small percentage (8.3%) perceived them as bad. This suggests that most adolescents are satisfied with the services offered by health facilities with a minority expressing dissatisfaction. The positive evaluation of these services aligns with the importance of ensuring quality and youth friendly healthcare for adolescents. Previous research has highlighted that accessible acceptable, appropriate and effective sexual and reproductive health services are crucial for people in Nigeria (Odo et al., 2018). Similarly, a study in Nepal emphasized the need to tailor these services to meet the needs and preferences of adolescents (Pandey et al., 2019). These findings also emphasize the significance of efforts in improving healthcare quality, within health facilities.
Recognizing the importance of enhancing service quality and utilization by adolescents there have been efforts to standardize, assess and improve health service provision for them (Chandra Mouli et al., 2015). It is crucial to ensure that public health facilities offer reproductive health care services to guarantee their access, to high quality care (Envuladu et al., 2020).
The positive perception of health services among adolescents emphasizes the need for support and investment in providing them with healthcare. Recognizing the importance of acceptable and effective services for adolescents’ efforts have been made to standardize and expand quality friendly healthcare services (Chandra Mouli et al., 2013). Moreover, exploring the influence of socio characteristics on adolescents’ perceptions of health facility factors highlights the significance of understanding what shapes their opinions, about healthcare services (Odhiambo et al., 2022).
Utilization of Services
A significant majority of the adolescents (72.8%) received HIV/STI testing and pregnancy services indicating that these essential services are being utilized at a rate. Furthermore, more than half of the respondents (68.0%) received care (ANC) services while two thirds (61.1%) accessed psychosocial support services. Additionally, over half of them (56.0%) received management for STI, HIV, PMTCT services, deliveries and referrals indicating a utilization of these services by adolescents. It is crucial to promote the reproductive health of adolescents by ensuring their access to and utilization of HIV/STI testing and pregnancy services ANC services, psychosocial support services well as management for STI, HIV, PMTCT services through deliveries and referrals. Numerous studies have emphasized the significance of improving access to these sexual and reproductive health services for adolescents in order to address their health needs and challenges Mustapha et al., 2018; Miller et al., 2010; Mutabazi et al., 2017). Recognizing that enhancing the utilization of reproductive health services among adolescents is vital, in promoting sexual behaviors while reducing risky practices.
Numerous research studies have emphasized the importance of targeted efforts to address attitudes, towards reproductive health services tailored for adolescents. It is crucial to reinforce attitudes and enhance the utilization of these services (Tilahun et al., 2012; Ndayishimiye et al., 2020; Nicol et al., 2017).
The significant utilization of services such as HIV/STI and pregnancy testing ANC services, psychosocial support, STI and HIV management PMTCT services, deliveries and referrals by adolescents highlights the significance of ensuring the availability, accessibility and quality of these healthcare provisions. Recognizing that improved availability and delivery of sexual and reproductive healthcare are pivotal in meeting their unique needs and promoting their sexual and reproductive wellbeing (Barnabas et al., 2017; Swenson et al., 2009; Jonas et al., 2019).
Moreover, it is crucial for adolescents to utilize sexual and reproductive health services to address the prevalence of sexually transmitted infections as well as minimize the risk of HIV transmission, within this population. Efforts to make testing more accessible and remove barriers, for adolescents who're less likely to get tested have been acknowledged as crucial in promoting the health of young people (Medina Marino et al., 2022; Akunzirwe et al., 2022; Habtu et al., 2021).
Factors Influencing Adolescents in the Utilization of Youth-Friendly Health Services
The insights gathered from the, in depth conversation about the factors that affect teenagers use of youth healthcare services in South Sudan shed light on challenges and suggestions for improving adolescent health outcomes. The lack of support from both the government and NGOs restricted access to education and insufficient awareness and education on reproductive health emerged as themes. Moreover, limited availability of healthcare services and the difficulties faced by teenagers were identified as obstacles to accessing medical care. The discussion also yielded recommendations to enhance youth healthcare services for adolescents, such as establishing youth clubs organizing health education programs and incorporating adolescent healthcare services into the school curriculum. The absence of support from the government and NGOs for people access to education and inadequate awareness and education regarding sexual and reproductive health align with findings, from previous research studies.
Several studies have emphasized the influence of socio educational factors, on the utilization of healthcare services highlighting the importance of support systems and educational opportunities to enhance health outcomes among adolescents (Mugo et al., 2015; Mugo et al., 2018; Atari, 2014; Mugo et al., 2018; Shiekh & Kwaak 2015; Ali, 2022; Wilunda et al., 2016; Ng et al., 2021; Belaid et al., 2020; Rutandaro et al., 2022; Tongun et al., 2019; Gawar, 2021; Kane et al., 2019; Kier, 2022; Haider, 2021; Nyiel et al., 2021; Berenger & Verdier-Chouchane 2016). The recommendations put forth in the focused discussion align with the call, for strategies aimed at enhancing healthcare services for adolescents.Recent research has highlighted the significance of prioritizing healthcare services for people enhancing health education and awareness and addressing socio economic obstacles to enhance healthcare utilization, among adolescents (Mugo et al., 2015; Mugo et al., 2018; Atari, 2014; Mugo et al., 2018; Shiekh & Kwaak 2015; Ali, 2022; Wilunda et al., 2016; Ng et al., 2021; Belaid et al., 2020; Rutandaro et al., 2022; Tongun et al., 2019; Gawar, 2021; Kane et al., 2019; Kier, 2022; Haider, 2021; Nyiel et al., 2021; Berenger & Verdier‐Chouchane 2016).
However, it is important to acknowledge limitations in this study. Firstly, the research was conducted in a number of healthcare facilities. May not accurately represent all the healthcare facilities, in South Sudan. Secondly the data relied on self-reported information which can potentially introduce bias. Furthermore, it is worth noting that the study did not incorporate a control group, which poses challenges in determining the connections, between the variables.
Moving forward it would be beneficial for research to prioritize assessing the effectiveness of interventions aimed at enhancing healthcare services catering to adolescents and young individuals. This could involve creating and implementing training programs for professionals establishing platforms for youth engagement and participation well as advocating for policies related to girls’ education and early marriage. Furthermore, conducting research is necessary to gain insight into the barriers preventing access to healthcare services, for adolescents and young individuals. It is crucial to develop strategies that can effectively address these barriers.