CATEGORY 4 Enabling Factors
5.2. DISCUSSION OF QUALITATIVE FINDINGS
5.2.6 Conclusion
Several factors are at play that hinders adolescents' utilization of the sexual reproductive health services. These barriers are not insurmountable as they can be solved with simple measures like
change of attitude for both adolescents and the provider. Flexibility when dealing with adolescents in tenns of time and approach can go a long way in facilitating effective utilization of the services.
5.3 Overall Conclusion of Study Findings
This study showed that in general, adolescents had adequate knowledge regarding sexual reproduction and sexual health services. The major source of knowledge for adolescents was primarily from the teacher as 74% had learnt about puberty from the teacher and 94% had also learnt about sexual reproduction from the teacher. On the hand, findings from the focus group discussions revealed underutilization of the services which was related to various limitations such as, perceptions of the services and the youth's own perceptions of HIV/ AIDS.
In as much as adolescent are at greater reproductive health risk, (Senderowitz et aI., (2003) they are usually reluctant to access sexual reproductive health services. This is related to their of lack of awareness, inadequate infonnation and significant barriers posed by the existing health services, this findings are similar to the study conducted in Uganda by Neema, Mussin and Kibombo, (2004) which showed high knowledge of HIV, contraception and STI, but the high knowledge was not consistent with the behavior as the those sexually active adolescents continued to indulge in risky behaviors. Lou and Chen, (2009) found that sexual knowledge does not directly influence safe sex behaviors, this is consistent with the findings of the FGD where adolescents agreed that they do not attend the sexual reproductive health services despite that they were able to show knowledge of how to protect themselves.
The major theme of "under utilization" which was consistently noted in the FGDs due to their perceived susceptibility, and cultural norms that played a role in their under-utlisation is consistent with a study in Ghana by Oware-Gyekye, (2005) that found that some of the reasons why adolescent are reluctant to use SRH services was that society frowns at those adolescents who are found using sexual health services. This is related to subjective cultural norms of the society.
Adolescents who participated in the survey showed high knowledge of sexual reproduction, contraception they were also able to show similar knowledge when they were asked to state the services that were being offered at the clinic as (70.3%) could correctly mention some of the services that were being offered at the local clinic. However a worrying percentage (21%) said they did not know the services at the clinic. Those adolescents who took part on the focus group discussion felt that the clinic was not going out to "sell" their services which meant that they did not really know what was happening at the clinic. Biddlecom et aI., (2006) highlighted some of the barriers that are faced by adolescents for example, some of the barriers are related to social context and these are some of them: feelings of shyness, fear, and embarrassment. This notion was supported by the views of the participants who took part in the focus group discussions.
They stated that felt that they were too young to go and seek such kind of services; this was also projected to the service provider who adolescents thought resembled their parents and would think them too young to indulge in sexual activities. However when adolescents age was related to knowledge no relationships were obtained. They all scored high marks on the level of knowledge.
Adolescents also related the age of the provider to those of their parents and this was perceived as a barrier to effective utilization of the services. Adolescents felt that they would be better
served by a provider who is closer to their age like someone in their twenties who had just existed adolescence. They felt that they could not talk freely to adults as they reminded them of their parents. The participants in this study also referred to some of the barriers as related to cultural taboos where parents refused to talk to adolescents about sexual matters and adolescents were not allowed to talk to their parents about matters relating to sexuality. Dejong et aI., (2007) in their study conducted in the Middle East and North Africa observed that cultural taboos are major obstacles to inform discussion about reproductive health issues particularly with young people. This has also been supported by Mohammadi et aI., (2006) who observed that adolescents are reluctant to seek information from their parents for fear that their parents will assume that they are engaging in sexual activity and then they will be viewed negatively.
5.3.1 Conclusion
This chapter has summarized the overall impressions from both the qualitative and quantitative findings. The health belief model was used to guide the study and it proposes that when one has understanding of the risks involved they are likely to take action to prevent the problems.
However, the findings of this study have revealed that despite the apparent high level of knowledge displayed by both groups, there is still underutilization of SRH services by adolescents in Tutume. Further more problems that hinder adolescents from accessing SRH services exist. In this era of HIV It is necessary for different stake holders to come together in trying to reduce these problems such as opening up communication channels for adolescents are able to discuss without fear issues pertaining sexual matters. This will go a long way n reducing the negative perceptions harbored by both adolescents and service providers.