Masters Degrees (Centre for Health Systems Research & Development)
Permanent URI for this collection
Browse
Recent Submissions
Item Open Access Sexual and Reproductive Health Services: experiences and views of young adults and providers in Soshanguve(University of the Free State, 2024) Maeko, Naum Mahlatse; Heunis, Christo; Kigozi-Male, Gladys๐๐ฎ๐ฐ๐ธ๐ด๐ฟ๐ผ๐๐ป๐ฑ: Despite efforts to educate young people about healthy sexual behaviours and the availability of sexual and reproductive health (SRH) services, risky sexual behaviour (RSB) outcomes such as unplanned pregnancies, unsafe abortions, and sexually transmitted infections (STIs) among youth in South Africa persist. Efforts have been made to implement SRH interventions aimed at addressing RSB outcomes through targeted clinic SRH services tailored for young people. However, implementation discrepancies continue, necessitating improvements in service delivery strategies and policy guidelines. These discrepancies stem from various barriers such as insufficient knowledge, education gaps, myths, misconceptions, family dynamics, socio-cultural elements, and systemic health issues. To comprehensively analyse these challenges, this study adopted the Socio-Ecological Model (SEM) proposed by McLeroy et al. (1988). The SEM framework acknowledges the multi-layered influences on human behaviour; that is, the ๐ช๐ฏ๐ฅ๐ช๐ท๐ช๐ฅ๐ถ๐ข๐ญ, ๐ช๐ฏ๐ต๐ฆ๐ณ๐ฑ๐ฆ๐ณ๐ด๐ฐ๐ฏ๐ข๐ญ, ๐ค๐ฐ๐ฎ๐ฎ๐ถ๐ฏ๐ช๐ต๐บ, ๐ช๐ฏ๐ด๐ต๐ช๐ต๐ถ๐ต๐ช๐ฐ๐ฏ๐ข๐ญ ๐ข๐ฏ๐ฅ ๐ฑ๐ฐ๐ญ๐ช๐ค๐บ-๐ญ๐ฆ๐ท๐ฆ๐ญ ๐ง๐ข๐ค๐ต๐ฐ๐ณ๐ด. ๐ ๐ฎ๐ถ๐ป ๐ฟ๐ฒ๐๐ฒ๐ฎ๐ฟ๐ฐ๐ต ๐พ๐๐ฒ๐๐๐ถ๐ผ๐ป: How do socio-ecological factors influence young adults and SRH providersโ experiences and views regarding SRH services in Soshanguve, South Africa? ๐๐ถ๐บ: The aim of the study was to explore how socio-ecological factors influence the experiences and views of young adults and SRH providers regarding SRH services in Soshanguve. ๐ ๐ฒ๐๐ต๐ผ๐ฑ๐ผ๐น๐ผ๐ด๐: The research project utilised an interpretive paradigm. A qualitative approach was employed by using an exploratory research design to explore the personal views and experiences of young adults and SRH providers regarding SRH services at clinics. The study was conducted in three purposively selected local clinics in Soshanguve. The sample consisted of fifteen young adults, comprising of seven females and eight males, selected through convenience sampling. Five SRH providers were selected through purposive sampling. They were collected through in-depth interviews (IDIs) with young adult participants, in addition to key informant interviews (KIIs) with SRH provider-participants. All interviews were audio-recorded and transcribed for analysis by applying Thompsonโs (2022) eight-step abductive analysis, which allowed the blending of inductive and deductive reasoning. Data from young adults and SRH providers was triangulated. Ethical considerations focused on informed consent, confidentiality, privacy, and respect throughout the research. ๐๐ถ๐ป๐ฑ๐ถ๐ป๐ด๐: Both young adults and SRH providers identified key challenges across the SEM that affected their views and experiences of clinic SRH service in Soshanguve. At the ๐ช๐ฏ๐ฅ๐ช๐ท๐ช๐ฅ๐ถ๐ข๐ญ ๐ญ๐ฆ๐ท๐ฆ๐ญ, knowledge, attitudes and beliefs about SRH were crucial determinants. At the ๐ช๐ฏ๐ต๐ฆ๐ณ๐ฑ๐ฆ๐ณ๐ด๐ฐ๐ฏ๐ข๐ญ ๐ญ๐ฆ๐ท๐ฆ๐ญ, both groups perceived parent-child and peer communication as the critical factors influencing young adults' knowledge, attitudes, and behaviours towards SRH. ๐๐ฐ๐ฎ๐ฎ๐ถ๐ฏ๐ช๐ต๐บ-๐ณ๐ฆ๐ญ๐ข๐ต๐ฆ๐ฅ factors hindering and facilitating young adultsโ access to and utilisation of clinic SRH services such as societal attitudes, religious beliefs, and cultural norms emerged as significant barriers contributing to stigma and discrimination for both groups. Both groups perceived similar ๐ช๐ฏ๐ด๐ต๐ช๐ต๐ถ๐ต๐ช๐ฐ๐ฏ๐ข๐ญ-๐ณ๐ฆ๐ญ๐ข๐ต๐ฆ๐ฅ barriers and facilitators such as limited clinic operating hours, overcrowding, and lack of confidentiality. However, young adults expressed greater concerns about SRH providersโ judgemental and gender-bias attitudes, while SRH providers were concerned with the impact of the clinic booking system, especially for the abortions. At the ๐ฑ๐ฐ๐ญ๐ช๐ค๐บ ๐ญ๐ฆ๐ท๐ฆ๐ญ, both groups emphasised the need for guidelines that could support comprehensive education, youth-friendly services, and mobile SRH services to address systemic issues and enhance access for young adults. ๐๐ผ๐ป๐ฐ๐น๐๐๐ถ๐ผ๐ป: The findings revealed the views and experiences of both young adults and SRH providers regarding young adultsโ access to and utilisation of clinic SRH services in Soshanguve, thus underscoring the necessity for a multi-layered SEM approach. Addressing the identified SEM factors through targeted interventions and policies can assist in bridging the gaps in service delivery and the utilisation of resources to promote better SRH outcomes among young adults.Item Open Access Barriers to and facilitators of male uptake of HIV testing services in Orange Farm Township, Gauteng Province: user and provider perspectives(University of the Free State, 2024) Chauke, Nyeleti P.; Kigozi-Male, N. G.; Heunis, J. C.๐๐ฎ๐ฐ๐ธ๐ด๐ฟ๐ผ๐๐ป๐ฑ ๐ฎ๐ป๐ฑ ๐ข๐ฏ๐ท๐ฒ๐ฐ๐๐ถ๐๐ฒ๐: South Africa remains heavily burdened by the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic, with devastating effects among men. Unlike women, men are increasingly unlikely to access HIV testing services (HTS) at primary health care (PHC) facilities. Male uptake of HTS is very low with high rates of HIV-related deaths among men. The 2016 South Africa Demographic and Health Survey found that although 94% of men aged 15 to 49 were aware of HIV testing locations, only 29% had undergone an HIV test. The study draws on the Socio-Ecological Model (SEM) to explore, from the perspective of both users and providers, barriers to and facilitators of menโs uptake of HTS at three PHC facilities in the Orange Farm township. The SEM illustrates how multiple factors influence an individualโs health behaviour. The SEM comprises five levels which include the individual, interpersonal, organisational, community, and policy levels. ๐ ๐ฒ๐๐ต๐ผ๐ฑ: The researcher adopted a constructivist paradigm for this study as it is believed that individuals give meaning to their experiences through interactions with their environments. A case study design was employed, and qualitative semi-structured interviews were used as a data collection tool. The semi-structured interviews were conducted among a total of 23 conveniently selected participants including, 12 male patients, six lay counsellors and five Nurse-initiated Management of Antiretroviral Therapy (NIMART) trained professional nurses. The purpose of these sample sizes was to reach saturation as opposed to the generalisability of findings. Data were analysed thematically using the SEM constructs as a priori themes with subsequent development of subthemes. The process involved the grouping of key barriers to and facilitators of HTS perceived by male patients, lay counsellors, and professional nurses according to the SEM constructs. ๐๐ถ๐ป๐ฑ๐ถ๐ป๐ด๐:. Both users and healthcare providers perceived similar barriers to male uptake of HTS. These included, at the (1) individual level โ lack of knowledge; (2) interpersonal level โ negative peer and family influence; (3) organisational level โ discomfort when attended by female healthcare providers; (4) community level โ lack of education and awareness within the community; and (5) policy level โ non-adherence to policy and privacy concerns. Again, perceived similarly by both patients and healthcare providers, facilitators of HTS included at the (1) individual-level โ overcoming fear; (2) interpersonal level โ fostering supportive family and friend networks; (3) organisational level โ initiation of โmale-friendly servicesโ in PHC facilities; (4) community level โ initiating community health education and awareness tailored for men; and (5) policy level โ reinforcement of policy adherence. ๐๐ผ๐ป๐ฐ๐น๐๐๐ถ๐ผ๐ป๐: The findings indicate that barriers to and facilitators of male HTS uptake vary across the SEM levels. Both users and providersโ views highlighted a multifactorial influence on male uptake of HTS at PHC facilities, necessitating a multifaceted intervention strategy, encompassing all five SEM levels. Such efforts can result in more men accessing HIV testing at PHC facilities, enrolling in treatment, and most importantly, adopting preventative measures to curb the spread of HIV/AIDS.