Heunis, ChristoKigozi-Male, GladysMaeko, Naum Mahlatse2025-01-032025-01-032024http://hdl.handle.net/11660/12903Dissertation (M.Soc.Sc.(Health Systems Studies))--University of the Free State, 2024𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱: 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 𝘪𝘯𝘥𝘪𝘷𝘪𝘥𝘶𝘢𝘭, 𝘪𝘯𝘵𝘦𝘳𝘱𝘦𝘳𝘴𝘰𝘯𝘢𝘭, 𝘤𝘰𝘮𝘮𝘶𝘯𝘪𝘵𝘺, 𝘪𝘯𝘴𝘵𝘪𝘵𝘶𝘵𝘪𝘰𝘯𝘢𝘭 𝘢𝘯𝘥 𝘱𝘰𝘭𝘪𝘤𝘺-𝘭𝘦𝘷𝘦𝘭 𝘧𝘢𝘤𝘵𝘰𝘳𝘴. 𝗠𝗮𝗶𝗻 𝗿𝗲𝘀𝗲𝗮𝗿𝗰𝗵 𝗾𝘂𝗲𝘀𝘁𝗶𝗼𝗻: How do socio-ecological factors influence young adults and SRH providers’ experiences and views regarding SRH services in Soshanguve, South Africa? 𝗔𝗶𝗺: 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. 𝗠𝗲𝘁𝗵𝗼𝗱𝗼𝗹𝗼𝗴𝘆: 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 Thompson’s (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. 𝗙𝗶𝗻𝗱𝗶𝗻𝗴𝘀: 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 𝘪𝘯𝘥𝘪𝘷𝘪𝘥𝘶𝘢𝘭 𝘭𝘦𝘷𝘦𝘭, knowledge, attitudes and beliefs about SRH were crucial determinants. At the 𝘪𝘯𝘵𝘦𝘳𝘱𝘦𝘳𝘴𝘰𝘯𝘢𝘭 𝘭𝘦𝘷𝘦𝘭, both groups perceived parent-child and peer communication as the critical factors influencing young adults' knowledge, attitudes, and behaviours towards SRH. 𝘊𝘰𝘮𝘮𝘶𝘯𝘪𝘵𝘺-𝘳𝘦𝘭𝘢𝘵𝘦𝘥 factors hindering and facilitating young adults’ 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 𝘪𝘯𝘴𝘵𝘪𝘵𝘶𝘵𝘪𝘰𝘯𝘢𝘭-𝘳𝘦𝘭𝘢𝘵𝘦𝘥 barriers and facilitators such as limited clinic operating hours, overcrowding, and lack of confidentiality. However, young adults expressed greater concerns about SRH providers’ judgemental and gender-bias attitudes, while SRH providers were concerned with the impact of the clinic booking system, especially for the abortions. At the 𝘱𝘰𝘭𝘪𝘤𝘺 𝘭𝘦𝘷𝘦𝘭, 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. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻: The findings revealed the views and experiences of both young adults and SRH providers regarding young adults’ 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.enSexual and reproductive health servicesRisky sexual behaviourSocio-ecological modelYoung adultsSRH providersDissertationUniversity of the Free State