Facility Preparedness, Barriers, and Facilitators to the integration and implementation of Adolescent and Youth-friendly health services in Primary Health Care centres in Southwest Nigeria - A mixed method study

Facility Preparedness, Barriers, and Facilitators to the integration and implementation of Adolescent and Youth-friendly health services in Primary Health Care centres in Southwest Nigeria - A mixed method study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Facility Preparedness, Barriers, and Facilitators to the integration and implementation of Adolescent and Youth-friendly health services in Primary Health Care centres in Southwest Nigeria - A mixed method study Temitope Ladi-Akinyemi, Mobolanle Balogun, Sarah Welch, Grace Emmanuel, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5451843/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background Adolescences/youth (A/Y) make the transition to adulthood in good health, but there are particular public health challenges within this age group, such as injuries from accidents or violence, mental health problems, problems from substance use, problems from undernutrition and overnutrition, endemic diseases (e.g. malaria), and sexual and reproductive health (SRH) problems. Adolescent and youth-friendly health services (AYFHSs) provide access to information and services on prevention, diagnosis, counselling, treatment, and care and allow all people to safely reach services without travelling long distances. This study aimed to describe the existing services provided for A/Y at PHCs, assess the knowledge, perceptions, and practices of AYFHS among the healthcare providers (HCPs), and understand the medical officers of health (MOHs) perceived facilitators and barriers to integration of AYFHS at PHCs in Ogun State. Methods The study was a descriptive cross-sectional with a mixed-method approach. A checklist, questionnaire, and interview guide were used to collect data from the PHCs, HCPs and MOHs, respectively. The quantitative data were analysed via SPSS version 27. Qualitative data were transcribed verbatim, analysed manually and presented in narrations using rapid, deductive thematic analysis. The level of significance was set at a P-value < 0.05. Results Ten model PHCs, 32 HCPs, and ten MOHs participated in the study. In the assessment of the facility readiness for AYFHSs, basic amenities, medical equipment, etc., were available or adequate, but there was a lack or absence of clearly visible signboards, comfortable waiting areas, displays of IEC materials, and confidentiality procedures and practices. More than 80% and 62.5% of the HCPs had good knowledge and positive perceptions of providing AYFHS, respectively. There were statistically significant associations between the overall perception scores of the respondents and the practices of some AYFHSs, such as A/Y having a consultation without an appointment (p=0.020). In the interviews with the MOHs, some factors were identified as facilitators (e.g. existing relationships with NGOs for support) and barriers (e.g. inadequate staffing) to the AYFHS. Conclusion Most of the PHCs in this study are inadequately prepared to provide AYFHSs and fall short of national recommendations. Most of the identified barriers to AYFHS integration were health system-related. facility preparedness adolescent and youth-friendly health services primary healthcare centres integration healthcare providers mixed methods approach BACKGROUND Risk behaviours among A/Y contribute substantially to the global burden of disease. 1 Over the past fifty years, there has been minimal improvement in A/Y health overall, and the notion that adolescence is the healthiest period of life compared with early childhood or adulthood is rapidly eroding. 1 Addressing A/Y health is an important public health and economic concern. The health of today's A/Y will not only determine the overall health situation of the country but also will impact every facet of national development. Investment in the health and well-being of A/Y increases the potential for a demographic dividend. 2 Nigeria is the most populous country in Africa, with a population of over 200 million people. It also has a very young population as the majority of the country’s population is under the age of 25 years, 22% of which are aged 10–19 years. 3 Although A/Y constitute a significant proportion of the population of Nigeria, they face particular health challenges, especially those related to sexual and reproductive care. 4 These individuals must experience a safe and pleasurable sexual life, the absence of which may expose them to sexually transmitted infections and unintended pregnancies. 5 , 6 Presently, approximately one-quarter of Nigerian adolescents are sexually active, with the age of sexual debut ranging from 10–15 years. 3 , 7 , 8 The World Health Organization (WHO) defines adolescent- and youth-friendly Health Services (AYFHSs) as an approach that combines the clinical and programmatic qualities that A/Y demands with the high standards that have to be achieved for individual and public health. 9 These services need to be equitable, accessible, acceptable, appropriate, and effective for adolescents. 9 They should also be provided in the right place, at the right time, and at the right price (free where necessary); delivered in the right style to be acceptable to young people; and be comprehensive, effective, and efficient. 4 , 10 , 11 Adolescent and youth-friendly Health Facilities can either be stand-alone or integrated facilities. 9 In standalone AYFHSs, all services are offered within the facility, but complicated cases are referred to appropriate health facilities for further management. Integration is a process whereby services are offered to A/Y in primary health care (PHC) settings as an integral component of care and part of the routine activities of public health facilities. These services are provided in such a way that they are of high technical quality and meet the expectations of young people, resulting in increased efficiency and effectiveness of services. 4 , 11 Nigeria’s Federal Ministry of Health (FMOH) launched the Nigerian National Action Plan (NNAP) in 2010 to advance the health and development of A/Y in Nigeria. The NNAP stipulates the integration of the AYFHS into the country’s PHC system. In line with this action plan, a guideline for the integration of AYFHS into PHC services in Nigeria was launched in June 2013. 12 More recently, the FMOH promulgated a monitoring and evaluation plan for adolescent and young adult health. 13 In February 2019, the Ogun State Primary Health Care Development Board, with support from Advance Family Planning’s local partner in Nigeria, Pathfinder International, and in collaboration with The Challenge Initiative, launched an Adolescent Reproductive Health Strategic Framework (2018–2022). The framework aimed to increase access to sexual and reproductive health (SRH) information and services for all A/Y in the state by 2022. 14 Studies have revealed a paucity of well-trained, adolescent-friendly health workers in areas such as Africa and Asia, where the population of A/Y makes up the largest proportion of the general population. 15 , 16 In sub-Saharan Africa, the magnitude of this deficit was exposed in a systematic review of determinants of teenage pregnancy. The lack of skilled HCPs, along with infrastructure gaps in providing quality services to adolescents, substantially contributed to unintended pregnancy. 17 A lack of AYFHS training and clinical space meant that AYFHS programs were not being implemented at the PHC facilities. 18 However, information about the knowledge and perceptions of the AYFHS among PHC workers in Nigeria is yet to be well documented despite yearly reports of high adolescent and youth morbidity and mortality. Additionally, there has been no documented assessment of the AYFHS in Ogun State, Southwest Nigeria. Thus, there is a need for an assessment of the integration of the AYFHS into health services provided in PHCs in Ogun State. METHODS Study aim This study aims to describe the existing services provided for young people at PHCs, whether AYFHSs are provided, to assess the knowledge, perceptions, and practices of AYFHSs among the PHC workers, and to understand the MOHs of health perspectives on facilitators and barriers to the integration of AYFHSs at PHCs in Ogun State. Study setting Nigeria is the sixth most populous country in the world and the most populous country in Africa, with a population of over 200 million, 33% of whom are A/Y aged 10–24 years. 19 Nigeria is in the West African subregion and has diverse climates and topographies. 20 The country is administered in subdivisions known as states. Nigeria’s PHC system is run by an MOH who supervises the centres, as well as nurse practitioners and community health officers (CHOs) who serve as the heads of the PHCs and supervise community health extension workers (CHEWs). Ogun State is one of the 36 states in the Federal Republic of Nigeria. It covers a total land area of 16,980.55 sq. km. It lies within the southwestern region of the country. The estimated population of the state in 2022 was 6,379,500, with an A/Y population of over 1.5 million. The state has 20 local government areas (LGAs), each with at least one functioning model 24-hour PHC. The state has two federal facilities, one state facility and one private tertiary health facility, 39 public secondary health facilities, 450 PHCs, and 904 private health facilities. Study design and population This was a descriptive cross-sectional study with a mixed-method approach. Ten out of the 20 LGAs were selected for the study via a simple random sampling method. All the model PHCs in the selected 10 LGAs were used for the study. All the HCPs who offer clinical care in each of the selected model PHCs were invited to participate in the study. All the HCPs at the selected PHCs who provided clinical care (i.e., the MOH, nurses, community health officers (CHOs), and community health extension workers (CHEWs)) were recruited for the study. Healthcare providers who were on leave, outside postings, or training during the data collection were excluded from the study. Data collection The data for this study were collected using a multimethod approach. First, a checklist from a previous similar study in South Africa (YFS Self-Appraisal Framework Adolescent and Youth Friendly Services assessment tool for use at healthcare facilities (DOC 2674 kb)) 21 was used for the assessment of the existing services and the provision of AYFHS in each of the PHCs. Assessment of the existing services provided for young people at each of the PHCs, including whether the AYFHS program is available and accessible. The interviewer was shown around the facility and documented what was either seen on the ground or reported by the healthcare workers. The HCP in charge of each of the PHCs was interviewed on the provision of the AYFHS at the PHC. Second, a pretested, semi-structured, self-administered questionnaire, which was adapted from previous literature, was used to assess the knowledge, perceptions, and practices of the AYFHS among the HCPs at the PHCs. The questionnaire included questions such as demographic characteristics and the professional experience of the HCPs; other questions focused on the knowledge (yes, no, & not sure), perceptions (4-point Likert scale), and the practice (yes & no) of the AYFHS. It was distributed to the healthcare workers by the research assistants when they were available during clinic hours. Third, key informant interviews were conducted among the MOHs in the 10 selected LGAs using a qualitative data collection method. These sets of interviews were conducted using a semistructured, narrative approach, with appropriate probes from an open-ended question interview guide to ensure that the study objectives were met. 22 The interviews explored the experiences and perceptions of the MOHs regarding the facilitators of and barriers to the integration of the AYFHS into the existing PHC services. The interviews were conducted via Zoom because the interviewees were unavailable for face-to-face interviews. Consent and sociodemographic characteristic data were collected from the interviewees in Zoom before the interview. The Interviews were led by TL-A., and with the permission of the respondents, the interviews were recorded. All the interviews were conducted in English. After a brief introduction, the researcher introduced the topic, the broad aims, and the areas to be covered during the interviews. The interviews were regulated with a discussion guide. The researcher ended the interviews by allowing the interviewees to ask any questions and thanking them for participating in the interviews. Each interview lasted between 30 and 45 minutes. Data management and analysis The items on the checklist were entered into a secure database, and analysis was performed using descriptive statistics, which are presented as frequencies and percentages in tables. The quantitative data were entered into an Excel spreadsheet and exported into SPSS version 27 for analysis. Categorical variables are presented as frequencies and percentages in tables and charts. Summary measures of the continuous variables are presented as the mean and standard deviations and medians and interquartile ranges for normally distributed and nonnormally distributed variables, respectively. For knowledge, a correct response was given a score of 2, and an incorrect response was given a score of 1. Perception was measured using a 4-point Likert scale: strongly agree, agree, disagree, and strongly disagree. If the statement is correct, strongly agree = 4, agree & disagree = 3, strongly disagree = 1, but if the statement is incorrect, strongly disagree = 4, agree & disagree = 3, strongly agree = 1. The composite scores for knowledge and perception were 54 and 120, respectively. Respondents who score 70% and above have good knowledge (≥ 38) and positive perceptions (≥ 84), and respondents with less than 70% have poor knowledge (< 38) and negative perceptions (< 84) of the AYFHS. Bivariate analyses were used to test for associations between independent variables (respondents' demographic characteristics and training on the AYFHS) and dependent variables (overall knowledge and perception scores and practice of the AYFHS). The level of significance was set at 0.05. Qualitative data were transcribed verbatim, analysed manually and presented in narrations. The interview data were analysed via rapid, deductive thematic analysis focused on facilitators and barriers to implementing AYFHS. 23 , 24 The analysis team consisted of five individuals: 1. S.W., a qualitative researcher at Northwestern University; 2. M.B., a public health physician at the College of Medicine, University of Lagos; 3. T.L.-A., a public health physician and statistician at the College of Medicine, University of Lagos; 4. G.E., a public health specialist; 5. F.M., a public health professional. All the data were analysed by S.W. paired with one other member of the analysis team. Initial concepts related to barriers and facilitators were identified and summarised. These summaries were reviewed by the whole analysis team and, through successive rounds of weekly discussion and excerpt review, refined into final themes. Ethical considerations Ethical approval for this study was obtained from Olabisi Onabanjo University Teaching Hospital Health Research and Ethics Committee (OOUTH/HREC/534/2022AP) and Ogun State Ministry of Health, Health Planning, Research and Statistics (HPRS/381/476). Informed consent was obtained from each respondent, and the respondents were informed of their right to withdraw from the study at any point in time without any consequences. Respondents were not given any form of incentives. RESULTS Quantitative phase of the study. Assessment of the existing services and the provision of the AYFHS in each of the PHCs. Table 1 Facility inventory checklist for provision of AYFHSs in PHCs (n = 10) S/N Variable No n (%) Yes n (%) 1. Clearly visible signboard with necessary information 7(70) 3(30) 2. Presence of comfortable waiting area 9 (90) 1 (10) 3. Availability of basic amenities (e.g., constant electricity, clean functional toilet, waste disposal, disposal of sharps and adequate hand hygiene facility) 3(30) 7(70) 4. Surrounding of the facility is clean 8 (80) 2 (20) 5. Adequate and comfortable facility furniture (quantity and state of repair) 9(90) 1(10) 6. Availability of equipment in the facility (sphygmomanometer, stethoscope, thermometer, BMI growth charts for adolescents, computer with email/internet access) 2 (20) 8 (80) 7. Presence of visual and auditory privacy features 5(50) 5(50) 8. Confidentiality procedure and application in practice 8(80) 2(20) 9. Minimum level of stock of some medicine and supplies in the facility 2(20) 8(80) 10. Presences of some registers, tools, and records 6(60) 4(40) 11. Guidelines and other decision support tools (e.g., job aids, algorithms) for information, counselling, and clinical management 6(60) 4(40) 12. Display of important information for A/Y on the walls of the facility 10(100) 0(0) 13. Availability of training records/reports for the following: Communication skills to talk to A/Y, policy on privacy and confidentiality, etc. 9(90) 1(10) 14. Availability of guidelines/standard operating procedures (SOPs) such as supportive supervision in adolescent health care, provision of services to A/Y with or without an appointment, applying policies for free, or affordable, service provision to adolescents, etc. 9(90) 1(10) 15. Availability of the following list, medicines, supplies and necessary equipment, agencies, and organizations with which the facility partners, package of information, counselling, treatment, and care services 7(70) 3(30) 16. Availability of job description of the following personnel focusing on A/Y health care. Doctors Nurse Midwife Outreach workers Counsellors Other (please specify) 8(80) 7(70) 8(80) 8(80) 9(90) 10(100) 2(20) 3(30) 2(20) 2(20) 1(10) 0(0) During the assessment of the facility readiness for the integration and implementation of the AYFHS, the facility inventory checklist was used for each of the 10 selected PHCs. The researcher reported that the following are available or adequate: Basic amenities, e.g., clean, functional toilets in 70% of the facilities; medical equipment in the facility, e.g., sphygmomanometers in 80% of the facilities; and the minimum level of stock of some medicine and supplies, e.g., antimalaria in 80% of the facilities. Note that the above are for all the patients and are not specific for A/Y (Table 1 ). The absence or lack of the following was observed during the assessment of the existing services and the provision of AYFHS in each of the selected PHCs. They include the absence of clearly visible signboards with the necessary information in 70% of the facilities; Comfortable waiting areas in 90% of the facilities; display of IEC materials addressing AYFHS on the facility walls; adequate and comfortable facility furniture in 90% of the facilities; training records/reports and guidelines/SOPs such as supportive supervision for AYFHS in 90% of the facilities; clean surroundings in 80% of the facilities; confidentiality procedures and application in practice in 80% of the facilities; job descriptions relating to AYFHS for doctors (80%), nurses (70%), midwives (80%), and outreach workers (80%) in the facilities; guidelines and other decision support tools (e.g., job aids, algorithms) for information, counselling, and clinical management in 60% of the facilities; and some registers, tools, and records on A/Y healthcare services in 60% of the facilities (Table 1 ). Table 2 Sociodemographic characteristics and AYFHS activities of the respondents (n = 32) Variables Frequency n (%) Age group 21–30 4(12.5) 31–40 7(21.9) 41–50 18(56.3) 51–60 3(9.4) Mean (SD) 42.1 (8.38) Sex Female 32(100) Religion Christianity 25(78.1) Islam 7(21.9) Highest level of education obtained Tertiary 29(90.6) Post tertiary 3(9.4) Designation Nurse 11(34.4) Junior CHEW 4(12.5) Senior CHEW 15(46.9) CHO 2(6.3) Marital status Single 4(12.5) Married 25(78.1) Divorced/widowed 3(9.4) Training on AYFHS No 21(65.6) Yes 11(34.4) Years of working experience 1–10 20(62.5) 11–20 9(28.1) > 20 3(9.4) Median (IQR) 5.0 (2.00-15.75) Availability of regular training of HCP on provision of AYFHS No 32(100.0) HCPs’ confidence to provide care to A/Y Confident 29(90.6) Not confident 3(9.4) HCPs’ ability to relate and answer A/Y questions Comfortable 29(90.6) Not comfortable 3(9.4) Availability of AYFHS in your health facility Yes 12(37.5) No 20(62.5) Thirty–two HCPs from 10 model PHCs in 10 LGAs in Ogun state participated in the quantitative phase of the study. The mean age of the respondents was 42.1 (8.38) years, and all were females. Approximately 90% of the respondents had tertiary education. The median number of years of working experience was 5.0 (2.00-15.75). Two-thirds (65.6%) of the respondents had training in the provision of adolescent health services. There was no regular training of the HCPs on the provision of adolescent health services in any of the PHCs. More than 60% of the respondents revealed that there are no AYFH services in their PHCs. Approximately 90% of the HCPs claimed that they could confidently provide care and were comfortable relating to and answering young clients' health-related questions (Table 2 ). Table 3 Knowledge of AYFHS among respondents (n = 32) Variables Frequency n (%) A/Y are about a third of Nigeria’s population (correctly identified “Yes”) 25(78.1) Failure to ensure the health and well-being of A/Y may result in wastage of investments previously made in the childhood (correctly identified “Yes”) 26(81.3) Identification of list of leading health challenges of A/Y such as SRH issues, MH, substance use, etc. (correctly identified “Yes”) 26(81.3) Identification of list of characteristics of AYFHS according to WHO’s criteria such as accessible, available, acceptable, appropriate, equitable (correctly identified “Yes”) 26(81.3) HCP must ensure the privacy of A/Y in all aspects of service delivery (correctly identified “Yes”) 27(84.3) HCP are obliged by legal requirements to report incidents such as assaults and gun wound (correctly identified “Yes”) 23(71.9) HCP are obliged by legal requirements to report incidents such as prostitution and conflict (correctly identified “No”) 5(15.6) HCP behavior that can hinder effective communication with A/Y include being judgmental and inconsiderate, etc. (correctly identified “Yes”) 24(75.0) HCP should not allow their personal beliefs and values to influence their dealing with A/Y clients (correctly identified “Yes”) 25(78.1) Without adequate skills and competencies, A/Y focused health workers are likely to lose motivation (correctly identified “Yes”) 28(87.5) HCP attends to A/Y according to their status (correctly identified “No”) 2(6.3) Adolescent/youth must book a formal appointment with their HCP before consultation (correctly identified “No”) 19(59.4) Adolescents/youth are not allowed to participate in service provision (correctly identified “No”) 21(65.6) HCP should manage A/Y health issues correctly according to evidence based treatment guidelines (correctly identified “Yes”) 28(87.5) A greater proportion (78.1%) of the respondents knew the population of A/Y in Nigeria. More than 80% of the respondents identified the leading health challenge of A/Y. They also identified the list of characteristics of AYFH services. In addition, more than 75% of the respondents agreed that the judgmental and inconsiderate behaviour of HCPs can hinder effective communication with A/Y. However, a lower percentage (15.6%) of the respondents knew that they were not under any legal obligation to report incidents of prostitution and conflict among young people. A smaller number (6%) of the respondents also agreed that A/Y should be treated equally (Table 3 ). Overall, more than 80% of the respondents had good knowledge of the AYFHS. Table 4 Perception of AYFHS among respondents (n = 32) Statements Strongly Agree n (%) Agree n (%) Disagree n (%) Strongly Disagree n (%) Adolescents/youth seeking SRH services should be told to abstain when they ask for contraceptives 5(15.6) 6(18.8) 9(28.1) 12(37.5) Discussing sexual intercourse with A/Y is shameful 1(3.1) 1(3.1) 10(31.3) 20(62.5) Unmarried A/Y should not be provided with contraceptives because culture and religion prohibit engagement in premarital sex 2(6.3) 2(6.3) 11(34.4) 17(53.1) Parents should be informed if their unmarried daughters come to a health facility to seek reproductive health services 3(9.4) 9(28.1) 14(43.8) 6(18.7) HCP should scold a young person if he or she asks for contraceptives 3(9.4) 2(6.3) 17(53.1) 10(31.2) HCP should refuse to provide contraceptives for A/Y before marriage 5(15.6) 16(50.0) 11(34.4) 11(34.4) Teaching unmarried A/Y about contraceptives is acceptable 14(43.8) 12(37.5) 5(15.6) 1(3.1) Reproductive health services are only available for married A/Y 5(15.6) 2(6.3) 11(34.4) 14(43.8) Adolescents/youth should be welcomed into the clinic for SRH services if they seek them 18(56.3) 8(25.0) 4(12.5) 2(6.3) If a girl has irregular periods, her parents should be informed 4(12.5) 12(37.5) 10(31.3) 6(18.7) HCP personal beliefs should guide the way he/she provides health services to young people 5(15.6) 6(18.8) 12(28.1) 9(28.1) Only girls should be given information about SRH because they are the ones who have the most issues related to sexual behavior 4(12.5) 1(3.1) 11(34.4) 16(50.0) If a client does not volunteer information that they have been subject to violence perpetrated by members of their family, HCP shouldn’t ask them directly about it because it is none of his/her business 2(6.3) 5(15.6) 14(43.8) 11(34.4) Boys cannot be the victims of sexual assault 4(12.5) 3(9.4) 12(37.5) 13(40.6) Asking A/Y if they are victims of any kind of violence is considered interfering with their personal or family issues 3(9.4) 4(12.5) 14(43.8) 11(34.4) Adolescents/youth should not be given information about puberty because it will encourage them to engage in sexual behaviors 1(3.1) 2(6.3) 15(46.8) 14(43.8) Educating A/Y on reproductive health topics leads to sexual immorality 1(3.1) 14(43.8) 17(53.1) 17(53.1) If an adolescent has a genital ulcer, it is because he or she is promiscuous 2(6.3) 2(6.3) 15(49.6) 13(40.6) If a young person comes into a health facility and says she has been the victim of sexual assault, she probably did something to deserve it 4(12.5) 7(21.9) 13(40.6) 8(25.0) The best way to prevent unmarried A/Y from becoming sexually active is to keep them in the dark about sexual issues 3(9.4) 2(6.3) 13(40.6) 14(43.7) Educational materials on SRH should be openly available to A/Y 17(53.1) 12(37.5) 2(6.3) 1(3.1) Adolescent/youth should be given the same level of confidentiality when receiving SRH services as adults 15(46.9) 13(40.6) 3(9.4) 1(3.1) Schools and health facilities should work together to provide SRH information and services to A/Y 13(40.6) 17(53.1) 2(6.3) 0(0.0) Health workers play an important role in reducing SRH problems among pre-marital A/Y 12(37.5) 18(56.3) 2(6.3) 0(0.0) Sexual and gender-based violence among A/Y should receive governmental attention as a significant social issue 11(34.4) 19(59.4) 2(6.3) 0(0.0) It is important to make sure that any services provided to A/Y are done so privately so no one else in the clinic can hear 9(28.1) 18(56.3) 4(12.5) 1(3.1) Involving A/Y in assessing service provision and participating in service provision can help make health services more sensitive and responsive to their needs 12(37.5) 14(43.8) 5(15.6) 1(3.1) Lack of community support and enabling environment cannot deter or discourage service providers from delivering the needed health services to A/Y 7(21.9) 11(34.4) 7(21.9) 7(21.8) The physical state of health facilities, the health care processes, as well as the types of procedures that are carried out influence on a large extent, whether A/Y will find the health care facilities attractive for them to use 8(25.0) 15(46.9) 7(21.9) 2(6.3) Health workers' friendliness and professional conduct are irrelevant to the success of AYFHS 2(6.3) 12(37.5) 10(31.3) 8(25.0) Approximately 62.5% of the respondents strongly disagreed that it is shameful to discuss sexual intercourse with A/Y. More than 50% of the respondents strongly disagreed that unmarried A/Y should not be provided with contraceptives due to cultural and religious beliefs, and educating them on reproductive health topics leads to sexual immorality (Table 4 ). Furthermore, fewer than 40% of the respondents strongly disagreed that A/Y should be asked to abstain from sex, be scolded, or should be refused contraceptives when they request them. Fewer than 20% of the respondents strongly disagreed that parents should be informed if their unmarried daughters come to a health facility to seek reproductive health services or if their daughter has irregular periods (Table 4 ). Overall, less than two-thirds (62.5%) of the respondents had positive perceptions of the provision of AYFHS. This is based on the findings from the statements on the perceptions of the HCPs towards the AYFHS. Table 5 Practice of the AYFHS among respondents (n = 32) Practice No (%) Yes (%) Use of guidelines when providing services to the A/Y 14(43.8) 18(56.2) The working hours in the facility is convenient for A/Y 8(25.0) 24(75.0) A/Y have consultation without appointment in your PHC 7(21.9) 25(78.1) Inform adult visiting the facility about services available for A/Y 9(28.1) 23(71.9) Use support materials to communicate with parents about the value of providing health services to A/Y 18(56.3) 14(43.7) Follow routine procedure for A/Y counselling and consultation 3(9.4) 29(90.6) Follow routine collection of psychosocial history during A/Y consultation 1(3.1) 31(96.9) Inform A/Y about the availability of health, social services and other services 10(31.3) 22(68.2) Deny A/Y services due to recent stock-out 19(59.4) 13(40.6) Deny A/Y services due to lack of equipment 18(56.3) 14(43.7) Good clinical operations A higher proportion (96.9%) of the HCPs in the selected PHCs routinely take a psychosocial history, such as asking the A/Y about home and relationships with adults, asking questions about school, their eating habits, sexual relationships, smoking, and alcohol consumption, use of substances, and asking questions about the mood and mental health of the A/Y during counselling or consultation. More than 90% of the respondents follow routine procedures during A/Y counselling and consultation, including introducing themselves to the A/Y and asking the A/Y what he/she likes to be called, asking the A/Y who he/she brought with him/her to the consultation, ensuring that no one sees or hears the A/Y from outside during the consultation or counselling, ensuring that there is a screen between the consultation and examination area, assuring the A/Y that no information will be disclosed to anyone without his/her permission, and finally explaining to the A/Y the conditions when the HCP might need to disclose information, such as in situations required by law. The HCPs also ensure that the adolescent’s records, laboratory results, and any other important information are kept under lock and key or password protected if on the computer. Ensuring that the facility’s working hours are convenient for A/Y (75%) and attending to the adolescent’s needs without booking an appointment (78.1%). Poor clinical operations More than 50% of the HCPs do not use IEC materials to communicate with the parents of A/Y about the importance and benefits of providing healthcare services to A/Y. Approximately 43.3% of the HCPs do not make use of guidelines when providing healthcare services to A/Y. Denying adolescent healthcare services at the PHCs was reported by 43.7%, and 40.6% of the respondents as a result of a lack of equipment and stock-out of commodities and supplies, respectively (Table 5 ). Table 6 Association between respondent characteristics and knowledge & perception scores of AYFHS Variables Knowledge of AYFHS Perception towards AYFHS Good 26(81.3) Poor 6(18.7) Total 32(100.0) Good 20(62.5) Poor 12(37.5) Total 32(100.0) Age group (yrs) ≤ 24 3(100.0) 0(0.0) 3(100.0) 2(66.7) 1(33.3) 3(100.0) 25 and above 23(79.3) 6(20.7) 29(100.0) 18(62.1) 11(37.9) 29(100.0) Chi-square & P-value 1.316 & 0.382 0.025 & 0.876 Religion Christianity 19(76.0) 6(24.0) 25(100.0) 17(68.0) 8(32.0) 25(100.0) Islam 7(100.0) 0(0.0) 7(100.0) 3(42.9) 4(57.1) 7(100.0) Chi-square & P-value 3.331 & 0.150 1.436 & 0.225 Marital status Married 20(80.0) 5(20.0) 25(100.0) 15(60.0) 10(40.0) 25(100.0) Unmarried 6(85.7) 1(14.3) 7(100.0) 5(71.4) 2(28.6) 7(100.0) Chi-square & P-value 0.123 & 0.732 0.314 & 0.581 Highest level of education obtained Tertiary 23(79.3) 6(20.7) 29(100.0) 18(62.1) 11(37.9) 29(100.0) Post-tertiary 3(100.0) 0(0.0) 3(100.0) 2(66.7) 1(33.3) 3(100.0) Chi-square & P-value 1.316 & 0.382 0.025 & 0.876 Designation Nurses 11(100.0) 0(0.0) 11(100.0) 8(72.7) 3(27.3) 11(100.0) CHEW 15(71.4) 6(28.6) 21(100.0) 12(57.1) 9(42.9) 21(100.0) Chi-square & P-value 5.758 & 0.049* 0.767 & 0.387 Training on AYFHS No 15(71.4) 6(28.6) 21(100.0) 13(61.9) 8(38.1) 21(100.0) Yes 11(100.0) 0(0.0) 11(100.0) 7(63.6) 4(36.4) 11(100.0) Chi-square & P-value 5.758 & 0.049* 0.009 & 0.923 Years of working experience (yrs) 1–10 15(75.0) 5(25.0) 20(100.0) 13(65.0) 7(35.0) 20(100.0) 11 and above 11(91.7) 1(8.3) 12(100.0) 7(58.3) 5(41.7) 12(100.0) Chi-square & P-value 1.507 & 0.242 0.142 & 0.706 *Statistically significant Table 6 reveals a statistically significant association between designation (p = 0.049) and training on AYFHS (p = 0.049) and overall knowledge scores of the AYFHS among the respondents. There were no statistically significant associations between the sociodemographic characteristics of the respondents and their overall perception scores. Table 7 Association between knowledge & perception scores of the AYFHS and the practice of the AYFHS among the respondents. Variables Knowledge of AYFHS Perception towards AYFHS Good 26(81.3) Poor 6(18.7) Total 32(100.0) Good 20(62.5) Poor 12(37.5) Total 32(100.0) Use of guidelines when providing services to the A/Y No 12(85.7) 2(14.3) 14(100.0) 12(85.7) 2(14.3) 14(100.0) Yes 14(77.8) 4()22.2 18(100.0) 8(44.4) 10()55.6 18(100.0) Chi-square & P-value 0.332 & 0.568 5.723 & 0.017* The working hours in the facility is convenient for A/Y No 5(62.5) 3(37.5) 8(100.0) 6(75.0) 2(25.0) 8(100.0) Yes 21(87.5) 3(12.5) 24(100.0) 14(58.3) 10(41.7) 24(100.0) Chi-square & P-value 2.215 & 0.117 0.741 & 0.399 Adolescent/youth have consultation without appointment in your PHC No 4(57.1) 3(42.9) 7(100.0) 7(100.0) 0(0.0) 7(100.0) Yes 22(88.0) 3(12.0) 25(100.0) 13(52.0) 12(48.0) 25(100.0) Chi-square & P-value 2.978 & 0.064 7.723 & 0.020* Inform adult visiting the facility about services available for A/Y No 6(66.7) 3(33.3) 9(100.0) 8(88.9) 1(11.1) 9(100.0) Yes 20(87.0) 3(13.0) 23(100.0) 12(52.2) 11(47.8) 23(100.0) Chi-square & P-value 1.616 & 0.186 4.220 & 0.054 Use of support materials to communicate with parents about the value of providing health services to A/Y No 13(72.2) 5(27.8) 18(100.0) 12(66.7) 6(33.3) 18(100.0) Yes 13(92.9) 1(7.1) 14(100.0) 8(57.1) 6(42.9) 14(100.0) Chi-square & P-value 2.410 & 0.138 0.305 & 0.581 Follow routine procedure for A/Y counselling and consultation No 2(66.7) 1(33.3) 3(100.0) 3(100.0) 0(0.0) 3(100.0) Yes 24(82.8) 5(17.2) 29(100.0) 17(58.6) 12(41.4) 29(100.0) Chi-square & P-value 0.404 & 0.497 3.004 & 0.159 Follow routine collection of psychosocial history during A/Y consultation No 1(100.0) 0(0.0) 1(100.0) 1(100.0) 0(0.0) 1(100.0) Yes 25(80.6) 6(19.4) 31(100.0) 19(61.3) 12(38.7) 31(100.0) Chi-square & P-value 0.423 & 0.625 0.959 & 0.431 Informing A/Y about the availability of health, social services and other services No 8(80.0) 2(20.0) 10(100.0) 9(90.0) 1(10.0) 10(100.0) Yes 18(81.8) 4(18.2) 22(100.0) 11(50.0) 11(50.0) 22(100.0) Chi-square & P-value 0.015 & 0.903 5.340 & 0.030* Denying A/Y services due to recent stock-out No 17(89.5) 2(10.5) 19(100.0) 13(68.4) 6()31.6 19(100.0) Yes 9(69.2) 4(30.8) 13(100.0) 7(53.8) 6(46.2) 13(100.0) Chi-square & P-value 2.050 & 0.150 0.696 & 0.403 Denying A/Y services due to lack of equipment No 16(88.9) 2(11.1) 18(100.0) 11(61.1) 7(38.9) 18(100.0) Yes 10(71.4) 4(28.6) 14(100.0) 9(64.3) 5(35.7) 14(100.0) Chi-square & P-value 1.575 & 0.209 0.034 & 0.854 HCP ‘s confident to provide care to A/Y Confident 23(79.3) 6(20.6) 29(100.0) 18(62.1) 11(37.9) 29(100.0) Not confident 3(100.0) 0(0.0) 3(100.0) 2(66.7) 1(33.3) 3()100.0 Chi-square & P-value 1.316 & 0.382 0.025 & 0.876 HCP’s ability to relate and answer A/Y questions Comfortable 24(82.8) 5(17.5) 29(100.0) 18(62.1) 11(37.9) 29(100.0) Not comfortable 2(66.7) 1(33.3) 3(100.0) 2(66.7) 1(33.3) 3(100.0) Chi-square & P-value 0.404 & 0.497 0.025 & 0.876 Availability of AYFHS in your health facility No 16(80.0) 4(20.0) 20(100.0) 17(85.0) 3(15.0) 20(100.0) Yes 10(83.3) 2(16.7) 12(100.0) 3(25.0) 9(75.0) 12(100.0) Chi-square & P-value 0.055 & 0.815 11.936 & <0.001* *Statistically significant There was no statistically significant association between the overall knowledge scores of the respondents and their AYFHS practices. However, there are some statistically significant associations between the overall perception scores of the respondents and the use of guidelines when providing services (p = 0.017), A/Y having consultation without appointments (p = 0.020), Informing A/Y about the availability of health and social services and other services (p = 0.030), and the availability of AYFHS in their health facility(p < 0.001) (Table 7 ). Qualitative phase of the study. Ten MOHs participated in the qualitative phase of the study. The mean age of the MOHs was 47.6 (SD: 4.14) years. The respondents included eight males and two females. They are all married medical doctors. The median number of years of working experience was 13.5 years (IQR: 6.50–18.25). The facilitators mentioned included a positive attitude toward the AYFHS, existing relationships with nongovernmental organisations (NGOs) for support, existing structures for youth and community involvement, and existing practices ensuring the confidentiality of information. Barriers included staffing issues, lack of funding, lack of demand for AYFHS, lack of political will, insufficient arrangements to ensure privacy, and lack of free or subsidised treatment for adolescents/youths. Positive attitudes toward AYFHS The Interviewed MOHs held very positive views towards establishing AYFHSs in one of the facilities in their LGA. Positive attitude toward AYFHS Sub-theme Respondents’ statements Improve the care adolescents get “It will be nice and will go a long way. If we have one facility like that, we will just direct any patient or client to the facility rather than waiting till the nurses trained on adolescents’ health care are less busy before attending to them.” (P1) “It is important and long overdue because the needs of the youth and adolescents have been left alone, and we have seen the impacts, the trends of abuse of drugs like contraceptive drugs, hard drugs, narcotics, these can have an effect on the way they perceive risk and how they can get involved in things that affect their health like unprotected sex so it will be very beneficial to them and the population of youths are very high in Ogun state and it shares boundary with Lagos state. The importance is that much more necessary.” (P3) Reach more adolescents “It will be an improvement to what is already on the ground and we will be able to reach out to the adolescent age group more, it will make their catchment wider.” (P5) Focus on prevention “It’s a welcome idea. It will go a long way to reduce problems facing adolescents’ health challenges specifically with poor health-seeking behavior, providing accessibility for health care services to the adolescents.” (P8) “It will be an avenue to help youth and adolescents in confidentiality like teenage pregnancy [and] infections. They know where to go before it becomes a serious problem so they won’t go for abortion, they will be properly guided the same thing with infections, protection, and how to prevent them, instead of going to Google, but they can find someone who can give them the right advice.” (P7) Existing relationships with NGOs for support The respondents identified existing relationships with NGOs. These relationships include education, outreach, and material provision to PHCs. Existing relationships with NGOs for support “MARIE STOPES has been the number one in the state for support of reproductive health, family planning component especially but if you now want to factor in the HIV/AIDS component you can now factor in APIN, IHVN, UNFPA are the major funders of the RH and they have programs with the state that they also train the health workers.” (P4) “UNFPA is doing so much in terms of capacity building, contact tracing/follow-up, while MARIE STOPES is doing something along the line of contraception, those are the two agencies supporting us.” (P10) Existing structures for youth and community involvement The LGAs have an existing governing structure/board that includes the members of the community, A/Y, to advise on how to plan health services and make them work. This group is an established way to obtain input from and get information from the community, including A/Y. Existing structures for youth and community involvement “It’s a bottom-top approach. Each ward has a ward health committee and members, and there's a chairman representing the community leader or traditional leader or representatives. The officer in charge of that facility serves as the secretary, 15–20-member committee, other members include youth organizations maybe two, youth representatives maybe two, representatives of Civil Service Organisation (CSO) and Community-Based Organisation (CBO) in that community, and other voluntary organizations such as Boy Scout, and girl's guide, we have representatives of Okada riders, road transport workers, market women or women society in that community.” (P10) “They serve as the link between us and the youth in the community in terms of dissemination of information to their counterparts. They help us talk to their peers when we have youth-oriented activities and have them involved. They bring back feedback from their peers. There was an instance when there was a high rate of pregnancy and STI from a particular school around the community the youths in the governing board serve as a link to reach others to address the problem.” (P2) “We have market women, Okada riders, TBAs (traditional birth attendants), teachers, and youths in the community. Usually not more than 20 members so we now pick them from different sectors of the community” (P9) “The youth representative will bring up matters and issues concerning the youth and help them seek solutions from the board. They also help mobilize the youth for the purpose of health talk or health information to be disseminated to them.” (P3) “They play the roles the others play. But sometimes we may invite them if we have any challenge with any adolescent to advice or talk to them.” (P1) Confidentiality of information. Existing practices are in place to ensure the confidentiality of adolescent data and information. Confidentiality of information “The person attending to them is well trained so the confidentiality of the information they have given is assured.” (P1) “We don’t discuss their issue outside except when they come with their parents. Even when their parents are there, we don’t attend to them in front of their parents especially in the cases of HIV except if the adolescent wants us to discuss it in front of their parents.” (P6) “We are intending to move to the way of electronic medical records. The state is already proposing that, but we don’t use general outpatient cards for them. There is special booklet for them to report interaction with them which is not kept with the general patient cards.” (P9) “Each person/client has their own record/case file it is not general which are properly kept in locked cabinets (under lock and key) and cannot be accessed by unauthorized individuals except those of us that work there.” (P2) Staffing Healthcare providers’ knowledge, perceptions, and skills are at the core of quality service provision. To achieve technical competence, the facilities should ensure that the number, qualifications, and skill mix of staff are adequate to deliver the required package of the AYFHS. The MOH discussed the shortage of staff in general and adequately trained staff in particular to provide AYFHS. Staffing Sub-theme Respondents’ statements Lack of training of the HCPs on AYFHS “There are no provisions for training for outreach workers. What we give them is stipends for logistics to go for the outreach. The outreach is not for adolescents specifically, it’s for immunization, family planning, general health provision not specific for adolescents” (P4). “I don’t know the actual number, but I know that some of the nurses, midwives, community health officers, and the senior CHEW have been trained on adolescent healthcare under reproductive health. But none of them is specifically trained on AYFHS” (P5) Inadequate number of staff “There is a shortage of manpower and high workload in most of the facilities under the LGA.” (P3) “I closed down 3 PHCs and may close down more because more people are retiring, leaving the country, dying, and no replacement so that means we cannot leave an unskilled person to man that facilities so that may warrant more closures in the near future if manpower is not addressed.” (P4) “There is a gross shortage of staff.” (P9) Lack of funding The respondents mentioned funding challenges that would be barriers to providing AYFHS, including funding for staff, staff training, built environment needs such as dedicated areas for adolescents, supplies and medications, and a lack of a specific line item in the general budget. Lack of funding Sub-theme Respondents’ statements Clinic arrangement and environment “At the primary health care level, I don’t think there are, no special arrangements for them, just consultation area that we use for everybody no special consultation room for them.” (P8) Commodities and supplies “Lack of commodities and supplies to maintain and run the unit effectively could also be a challenge.” (P2) “They [provision for commodities and supplies] come under the general logistic management commodities, but none [are] in place for the adolescent”. (P10) Continuous professional education on AYFH services “ None, whenever we have it [professional education on adolescent health care], funds are not been released.” (P10) “No, there isn’t but routine general training not specifically for adolescents.” (P8) “For now, we don’t have any budgetary allocation for that (professional education on adolescent health care). Most of the things we use here are donor-driven supplies.” (P2) Start-up cost “The funds for maintenance might be available because the federal government has provided what is called Basic Health Care Fund but it is not enough for startup. It can only be enough for sustainability. So, starting up is our major problem.” (P5) “Funds is one of the bureaucracies of the government. If that is [establishing AYFHS] going to be done by an NGO, there will be a need to write for permission then approval but funds is the major challenge.” (P9) Lack of demand The participants expressed concern that parents, guardians, adolescents, and other community members and community organisations may not currently recognise the value of providing health services to A/Y or supporting such provisions due to stigma or a lack of awareness or knowledge. Lack of demand Sub-theme Respondents’ statements Stigma concerns from parents and adolescents “ The fear of people being stigmatized for coming into the facility since in the community where everyone is familiar with one another, that is the major challenge I see.” (P7) Poor awareness “Our services are facility-based, more of a clinical base. We don't do any outreach whatsoever.” (P10) “All the nurses in charge of adolescent health work within the healthcare facility.” (P1) “The adolescent health does not have an advocate and ambassador at all levels. People are not speaking up for them. The first thing that will help us achieve this is to bring this problem to the forefront; we need a champion and advocate for our youth.” (P10) Lack of political will The inability to achieve the buy-in of government stakeholders may lead to challenges stemming from funding appropriation. Lack of political will “Once there is political will they mark some amount of the general budget into it, sustainability won’t be an issue if the community buys into it for participation.” (P10) “Providing a continuous monthly WI-FI service to be available will also require funds. I’m sure the local government may do it one or two times getting the approval to have funds for it will now be a problem.” (P9) Lack of privacy The participants mentioned concerns about the adequacy and ability of PHCs to provide services in private areas, which would impact the quality of care and potential demand. Lack of privacy “At the primary health care level, I don’t think there are, no special arrangements for them, just consultation area that we use for everybody no special consultation room for them.” (P8) “Some LGAs have a separate section/clinic where they come, and they are taken care of and relate with one another and are being managed by the HIV unit but there isn’t one in my LGA. But we understand that privacy is important for them to properly open up and be free to express themselves away from the public eye. There isn’t any clinic or separate section for them.” (P3) Lack of free or subsidised treatment for the adolescent Finally, the MOHs expressed concerns that A/Y may not be able to access the AYFHS due to funding limitations and the lack of subsidies for their treatment. Lack of free or subsidised treatment for the adolescent “No, they are treated just like any other people, they have to pay, and unfortunately our social insurance skill covers under five, elderly, and pregnant women.” (P10) “No system in place for free treatment.” (P7) “No subsidy in place for their treatment.” (P5) DISCUSSION This multimethod research reveal that the PHCs that participated in the study had deficiencies in terms of the comfort and cleanliness of the clinics, as well as the availability of guidelines, procedures, records, IEC materials, supplies, and job descriptions related to the AYFHS. Most of the PHC workers had good knowledge and positive perceptions of the AYFHS. However, there were significant gaps in their practices. The identified facilitators to providing AYFHSs were positive attitudes towards the AYFHS, existing relationships with NGOs for support, existing structures for youth and community involvement, and the confidentiality of information. The barriers identified were inadequate staffing, lack of funding, lack of demand, lack of political will, lack of privacy, and lack of free or subsidised treatment for A/Y. The starting point for any initiative aimed at improving the quality of health service provision to the people is the national health policy and strategy developed by the key stakeholders (Ministry of Health). The advocacy activities should aim to influence these key stakeholders to embrace and support the AYFHS and create a positive environment for AYFHS delivery and uptake. The stakeholders will identify key community organisations in the catchment area and engage in formal and informal partnerships with them to increase their support for the A/Y use of services. The national guidelines for integrating AYFHSs into PHCs require that facilities be physically attractive and welcoming to young people. 25 Health services should be provided in ways that meet the expectations of adolescent clients. One of these expectations is the provision of a layout designed to ensure privacy throughout an A/Y visit. 26 This includes the point of entry, the reception area, the waiting area, the examination area, and the patient-record storage area. Any deviation from this standard may result in a barrier. However, most of the PHCs in our study lacked the comfortability and cleanliness to meet this requirement. A clean health facility is not only visibly appealing but also contributes to the prevention of healthcare-associated infections. 27 The key stakeholders are to identify community resources and build partnerships with agencies and organisations for advocacy and to increase community support for the A/Y use of services. There should be policies and procedures in place that guarantee the confidentiality of A/Y clients in the health facilities. The dearth of guidelines, procedures, supplies and other tools specific to AYFHS is a major challenge to the provision of AYFHS and has negative implications for the capacity and preparedness of health providers to provide care to A/Y even when they are willing. Most of the HCPs surveyed had good knowledge and positive perceptions of the AYFHS. However, 38% displayed a negative perception; in particular, 66% of providers either agreed or strongly agreed that contraceptives should be refused by unmarried adolescents. Similarly, unfavourable attitudes are displayed towards unmarried adolescents in Ethiopia. 28 These are potential sources of barriers to AYFHSs at the PHCs and should be addressed in HCP training. The benefit of AYFHS training is evident in this study as all providers who had been trained had good knowledge of AYFHS. The gaps in provider practices were related to the gaps in facility readiness. For example, the non-use of IEC material or guidelines likely resulted from an absence of these materials at the PHCs. Providers, even when trained or willing, are hindered from providing quality services when resources are unavailable. 29 The MOHs generally had positive attitudes towards the AYFHS. Their interest would be pivotal to any future integration of AYFHS at the PHC level. The evidence shows that from the perspective of adolescents, the negative attitudes of providers are one of the key hindrances to the use of services. 30 Owing to their leadership role, MOH can influence PHC providers to provide good quality care to adolescents and advocate for funding and mobilisation of local resources to support the AYFHS. The strategic elements for integrating the AYFHS into PHC in Nigeria include youth involvement and supportive resources and interventions. 25 The existing relationships with NGOs and existing structures for youth involvement found in this study are potential elements of success in AYFHS delivery in PHCs and should be explored in future interventions. The facility should be adequately funded to allow the facility to implement actions for inspecting, testing, and maintaining medical equipment and documenting results. There should be a system in place for the procurement and stock management of the commodities and supplies necessary to deliver the required AYFHS. The allocation of funds from the national budget for capacity building should be negotiated as part of the continuous professional education activities at the AYFHS at the federal, state, and LGA levels. Health system barriers to access and utilisation of youth-friendly sexual and reproductive health services were found to be the most common in a systematic review spanning sub-Saharan Africa. 31 Similarly, in our study, all the barriers except for lack of demand were health system-related. Interestingly, a comparable study in northern Nigeria revealed a strong influence of social barriers to the utilisation of PHCs among adolescents. 16 This is possible because social norms in northern Nigeria can negatively impact adolescents’ access to and utilisation of SRH services. 32 The mentioned study also included the voices of adolescents, which we recommend for future exploratory studies in southwest Nigeria, as the views of PHC providers and managers may differ considerably from those of adolescents. In the ideal AYFHS, HCPs should deliver the same level of care and consideration to all A/Y regardless of age, sex, social status, cultural background, ethnic origin, disability, or any other reason. Health facilities should put in place systems to ensure that adolescents are knowledgeable about their health and know where and when to obtain healthcare services. The low demand for service by A/Y was perceived to result from poor awareness in the communities. Similarly, a study in northern Nigeria revealed that poor knowledge of reproductive health services at PHC was a barrier to utilisation. 16 Community outreach is critical for health promotion activities for A/Y and families, including awareness creation. These outreaches could be through school health services or interventions to reach out-of-school youth as part of an integrated health service delivery. 25 For effective and functioning AYFHSs, policies and procedures should be in place to ensure that health services are either free or affordable to A/Y. This will allow them to access the necessary healthcare services without asking their parents for money. However, according to the discussion with the MOH during the interviews, no such systems are in place in the PHCs. Strengths and limitations This is one of few studies in Africa to use multiple methods to assess facility preparedness, barriers, and facilitators to AYFHS at the PHC level. We used a representative sample of PHCs in the state, and a total population of HCPs (who offer clinical care) was included in the surveys. However, this study is not without limitations. First, our findings are only generalisable to PHCs within Ogun state. They do not reflect the differences in PHC service provision in other parts of Nigeria, which vary from one region to another. Second, the views of A/Y are not captured in this study, so the identified barriers and facilitators may not be comprehensive of the A/Y experience. CONCLUSIONS Most of the PHCs in Ogun state in southwest Nigeria are inadequately prepared to provide AYFHSs and fall short of national recommendations. The providers, though knowledgeable about AYFHS, had gaps in their perceptions and practices. Most of the identified barriers to AYFHS integration were health system-related. However, networks and structures exist that can be leveraged for the successful implementation of AYFHS at the PHCs. We recommend advocacy to relevant stakeholders to implement the national guidelines supported by adequate funding, AYFHS provider training, community engagement and supportive supervision of PHCs. Future exploratory studies among adolescents and youth in the study areas could help to identify and consider their needs in interventions to fully integrate AYFHSs into PHCs. Abbreviations A/Y Adolescent/Youth APIN Apin Public Health Initiative AYFHS Adolescent and Youth–Friendly Health Services CBO Community–based Organization CHEW Community health extension worker CHO Community Health Officer CSO Civil Society Organization FMOH Federal Ministry of Health HCP Healthcare provider HREC Health Research and Ethics Committee HPRS Health Planning Research and Statistics IEC Information, Education and Communication IHVN Institute of Human Virology Nigeria IQR Interquarter range LGA Local Government Area MOH Medical Officer of Health NGO Nongovernmental organisation NNAP Nigeria National Action Plan OOUTH Olabisi Onabanjo University Teaching Hospital PHC Primary Health Centre RH Reproductive health SD Standard deviation SOP Standard operating procedure SPSS Statistical Package for the Social Sciences SRH Sexual and Reproductive Health TBA Traditional Birth Attendant UNFPA United Nations Population Fund Wi Fi–Wireless Fidelity WHO World Health Organization Declarations Ethical approval and consent to participate Ethical approval for this study was obtained from Olabisi Onabanjo University Teaching Hospital Health Research and Ethics Committee (OOUTH/HREC/534/2022AP) and Ogun State Ministry of Health, Health Planning, Research and Statistics (HPRS/381/476). Informed consent was obtained from each respondent. Consent for publication All the respondents and participants provided consent for their data to be used in publications. Availability of data and materials All the data analysed during this study are included in this manuscript. Competing interests The authors of this manuscript declare that they have no conflicts of interest. Funding This study was funded by Northwestern University’s Robert J Havey Institute of Global Health Catalyzer Fund. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Authors contributions Conceptualisation and design of the study - TL-A, MB, and GM Proposal development - TL-A, MB, and GM Data collection (quantitative) – TL-A and GE Data collection (qualitative) – TL-A Data analysis (quantitative and qualitative) – TL-A, MB, SW, GE, and FM Writing – original draft – TL-A Writing – review and editing - TL-A, MB, SW, GE, FM and GM Approval of the manuscript for submission - TL-A, MB, SW, GE, FM and GM Acknowledgements Many thanks to the respondents and the participants, without whom this research would not have been possible. We are also grateful to the research assistants who helped with the implementation of the research. Authors’ information TL-A – Associate Professor and Consultant of Community Health and Primary Care and a statistician at the College of Medicine, University of Lagos MB - Associate Professor and Consultant of Community Health and Primary Care at the College of Medicine, University of Lagos SW - A qualitative researcher at Northwestern University GE – A public health specialist at the College of Medicine, University of Lagos FM – A public health professional at Northwestern University GM – Associate Professor of Paediatrics and attending physician of adolescent and young adult medicine at Northwestern University. References Sawyer SM, Afifi RA, Bearinger LH, et al. Adolescence: a foundation for future health. Lancet. 2012;379(9826):1630–40. 10.1016/S0140-6736(12)60072-5 . Bloom DE, Kuhn M, Prettner K. Africa’s prospects for enjoying a demographic dividend. J Demogr Econ. 2017;83(1):63–76. 10.1017/dem.2016.19 . Npc NPC. ICF. Nigeria Demographic and Health Survey 2018 - Final Report. Published online October 1, 2019. Accessed October 25, 2023. https://dhsprogram.com/publications/publication-FR359-DHS-Final-Reports.cfm Arije O, Hlungwani T, Madan J. Key informants’ perspectives on policy- and service-level challenges and opportunities for delivering adolescent and youth-friendly health services in public health facilities in a Nigerian setting. BMC Health Serv Res. 2022;22:1493. 10.1186/s12913-022-08860-z . Bankole A, Adewole IF, Hussain R, Awolude O, Singh S, Akinyemi JO. The Incidence of Abortion in Nigeria. Int Perspect Sex Reprod Health. 2015;41:170. Nigeria. Federal Ministry of Health | Health and Education Resource Centre. Accessed October 25, 2023. https://healtheducationresources.unesco.org/organizations/nigeria-federal-ministry-health Gabriel-Job N, Asuquo E, Alabere D. Determinants of the age at sexual debut among adolescents in secondary schools in Obio/Akpor local government area of Rivers State, Nigeria. P H Med J. 2018;12(2):81–81. Uthman OA. Geographical variations and contextual effects on age of initiation of sexual intercourse among women in Nigeria: a multilevel and spatial analysis. Int J Health Geogr. 2008;7:27. 10.1186/1476-072X-7-27 . Chatterjee S, Baltag V, World Health Organization, Department of Maternal N Child and Adolescent Health, World Health Organization, Joint United Nations Programme on HIV/AIDS. Global Standards for Quality Health-Care Services for Adolescents: A Guide to Implement a Standards-Driven Approach to Improve the Quality of Health-Care Services for Adolescents .; 2015. Accessed April 18, 2017. http://apps.who.int/iris/bitstream/10665/183935/1/9789241549332_vol1_eng.pdf Ambresin AE, Bennett K, Patton GC, Sanci LA, Sawyer SM. Assessment of Youth-Friendly Health Care: A Systematic Review of Indicators Drawn From Young People’s Perspectives. J Adolesc Health. 2013;52(6):670–81. 10.1016/j.jadohealth.2012.12.014 . Mazur A, Brindis CD, Decker MJ. Assessing youth-friendly sexual and reproductive health services: a systematic review. BMC Health Serv Res. 2018;18(1):216. 10.1186/s12913-018-2982-4 . National strategic framework on the health and development of adolescents and young people in Nigeria 2007–2011 | Health and Education Resource Centre. Accessed October 25. 2023. https://healtheducationresources.unesco.org/library/documents/national-strategic-framework-health-and-development-adolescents-and-young-people National Monitoring and Evaluation of Adolescent. and Young People’s Health in Nigeria: Monitoring and Evaluation Plan 2021–2025. Published online July 2021. Ogun State Primary Health Care Development Board. Adolescent Reproductive Health Strategic Framework (2018–2022). Published online August 2018. Newton-Levinson A, Leichliter JS, Chandra-Mouli V. Sexually Transmitted Infection Services for Adolescents and Youth in Low- and Middle-Income Countries: Perceived and Experienced Barriers to Accessing Care. J Adolesc Health Off Publ Soc Adolesc Med. 2016;59(1):7–16. 10.1016/j.jadohealth.2016.03.014 . Nmadu AG, Mohamed S, Usman NO. Barriers to adolescents’ access and utilisation of reproductive health services in a community in north-western Nigeria: A qualitative exploratory study in primary care. Afr J Prim Health Care Fam Med. 2020;12(1):2307. 10.4102/phcfm.v12i1.2307 . Yakubu I, Salisu WJ. Determinants of adolescent pregnancy in sub-Saharan Africa: a systematic review. Reprod Health. 2018;15(1):15. 10.1186/s12978-018-0460-4 . Geary RS, Gómez-Olivé FX, Kahn K, Tollman S, Norris SA. Barriers to and facilitators of the provision of a youth-friendly health services programme in rural South Africa. BMC Health Serv Res. 2014;14(1):259. 10.1186/1472-6963-14-259 . United Nations Department of Economic and Social Affairs PD. World Population Prospects 2022: Summary of Results. 2022. National Population Commission (NPC) [Nigeria] and ICF Macro. National Demographic and Health Survey. 2008. 2009:187–96. Department of Health/Love life. AYFS Standard Operating Procedure. (YFS Self- Appraisal Framework. Adolescent and Youth Friendly Services assessment tool for use at healthcare facilities. (DOC 2674 kb)). Republic of South Africa: Department of Health; 2013. Bowling A, Ebrahim S. Handbook of Health Research Methods:Investigation, Measurement and Analysis. McGraw-Hill Education; 2005. https://books.google.com.ng/books?id=_HznvwUxkZsC . Kiger ME, Varpio L. Thematic analysis of qualitative data: AMEE Guide 131. Med Teach. 2020;42(8):846–54. Watkins D. Rapid and Rigorous Qualitative Data Analysis: The RADaR Technique for Applied Research. Int J Qualitative Methods. 2017;16:160940691771213. Federal Ministry of Health, National guidelines for the integration of adolescent and youth-friendly services into primary health care facilities in Nigeria. 2013. https://scorecard.prb.org/wp-content/uploads/2018/05/National-Guidelines-for-the-integration-of-Adolescent-and -Youth-Friendly-Services-Into-Primary-Health-Care-Facilities-in-Nigeria-2013.pdf World Health Organization. Quality assessment guidebook: a guide to assessing health services for adolescent clients. In. Geneva: World Health Organization; 2009. Browne K, Mitchell BG. Multimodal environmental cleaning strategies to prevent healthcare-associated infections. Antimicrob Resist Infect Control. 2023;12(1):83. 10.1186/s13756-023-01274-4 . Tilahun M, Mengistie B, Egata G, Reda AA. Health workers’ attitudes toward sexual and reproductive health services for unmarried adolescents in Ethiopia. Reprod Health. 2012;9:19. 10.1186/1742-4755-9-19 . PMID: 22943476; PMCID: PMC3500724. Mosadeghrad AM, Factor Affecting Medical Services Quality. Iran J Public Health. 2014; 43(2): 210 – 20. PMID: 26060745; PMCID: PMC4450689. Onukwugha FI, Hayter M, Magadi MA. Views of Service Providers and Adolescents on Use of Sexual and Reproductive Health Services by Adolescents: A Systematic Review. Afr J Reprod Health.2019; 23(2):134–147. 10.29063/ajrh2019/v23i2.13 . PMID: 31433601. Ninsilima LR, Chiumia IK, Ndejjo R. Factors influencing access to and utilisation of youth-friendly sexual and reproductive health services in sub-Saharan Africa: a systematic review. Reprod Health 18(135),2021. https://doi.org/10.1186/s12978-021-01183-y Taiwo MO, Oyekenu O, Hussaini R. Understanding how social norms influence access to and utilization of adolescent sexual and reproductive health services in Northern Nigeria. Front Sociol. 2023;8:865499. 10.3389/fsoc.2023.865499 . PMID: 37899781; PMCID: PMC10603227. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5451843","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":379383995,"identity":"4f439f8a-f214-49f5-be74-f16f73213651","order_by":0,"name":"Temitope Ladi-Akinyemi","email":"data:image/png;base64,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","orcid":"","institution":"University of Lagos","correspondingAuthor":true,"prefix":"","firstName":"Temitope","middleName":"","lastName":"Ladi-Akinyemi","suffix":""},{"id":379383998,"identity":"351a0212-c7fc-49a0-b9d8-e9dc9602727e","order_by":1,"name":"Mobolanle Balogun","email":"","orcid":"","institution":"University of Lagos","correspondingAuthor":false,"prefix":"","firstName":"Mobolanle","middleName":"","lastName":"Balogun","suffix":""},{"id":379384000,"identity":"f956a155-1529-454f-a2ad-3dc98093f17f","order_by":2,"name":"Sarah Welch","email":"","orcid":"","institution":"Northwestern University","correspondingAuthor":false,"prefix":"","firstName":"Sarah","middleName":"","lastName":"Welch","suffix":""},{"id":379384001,"identity":"ed46de0f-6e4e-478b-8126-17b301012dad","order_by":3,"name":"Grace Emmanuel","email":"","orcid":"","institution":"University of Lagos","correspondingAuthor":false,"prefix":"","firstName":"Grace","middleName":"","lastName":"Emmanuel","suffix":""},{"id":379384002,"identity":"bd7e95fa-7933-4f07-b4fe-2a6ad436cbb4","order_by":4,"name":"Franscesca Montalto","email":"","orcid":"","institution":"Northwestern University","correspondingAuthor":false,"prefix":"","firstName":"Franscesca","middleName":"","lastName":"Montalto","suffix":""},{"id":379384003,"identity":"ce30380f-d422-4e5f-a984-3a9529f6de43","order_by":5,"name":"Gregg Montalto","email":"","orcid":"","institution":"Northwestern University","correspondingAuthor":false,"prefix":"","firstName":"Gregg","middleName":"","lastName":"Montalto","suffix":""}],"badges":[],"createdAt":"2024-11-14 07:38:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5451843/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5451843/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":70388972,"identity":"b0d3f59f-ed7b-40ce-a41f-235f19f76bd7","added_by":"auto","created_at":"2024-12-02 17:27:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1674622,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5451843/v1/03047b0d-ab68-4abb-8c6d-679647f39f96.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Facility Preparedness, Barriers, and Facilitators to the integration and implementation of Adolescent and Youth-friendly health services in Primary Health Care centres in Southwest Nigeria - A mixed method study","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eRisk behaviours among A/Y contribute substantially to the global burden of disease. \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Over the past fifty years, there has been minimal improvement in A/Y health overall, and the notion that adolescence is the healthiest period of life compared with early childhood or adulthood is rapidly eroding. \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Addressing A/Y health is an important public health and economic concern. The health of today's A/Y will not only determine the overall health situation of the country but also will impact every facet of national development. Investment in the health and well-being of A/Y increases the potential for a demographic dividend. \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eNigeria is the most populous country in Africa, with a population of over 200\u0026nbsp;million people. It also has a very young population as the majority of the country\u0026rsquo;s population is under the age of 25 years, 22% of which are aged 10\u0026ndash;19 years. \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Although A/Y constitute a significant proportion of the population of Nigeria, they face particular health challenges, especially those related to sexual and reproductive care. \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e These individuals must experience a safe and pleasurable sexual life, the absence of which may expose them to sexually transmitted infections and unintended pregnancies. \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Presently, approximately one-quarter of Nigerian adolescents are sexually active, with the age of sexual debut ranging from 10\u0026ndash;15 years. \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe World Health Organization (WHO) defines adolescent- and youth-friendly Health Services (AYFHSs) as an approach that combines the clinical and programmatic qualities that A/Y demands with the high standards that have to be achieved for individual and public health. \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e These services need to be equitable, accessible, acceptable, appropriate, and effective for adolescents. \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e They should also be provided in the right place, at the right time, and at the right price (free where necessary); delivered in the right style to be acceptable to young people; and be comprehensive, effective, and efficient.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAdolescent and youth-friendly Health Facilities can either be stand-alone or integrated facilities. \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e In standalone AYFHSs, all services are offered within the facility, but complicated cases are referred to appropriate health facilities for further management. Integration is a process whereby services are offered to A/Y in primary health care (PHC) settings as an integral component of care and part of the routine activities of public health facilities. These services are provided in such a way that they are of high technical quality and meet the expectations of young people, resulting in increased efficiency and effectiveness of services. \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eNigeria\u0026rsquo;s Federal Ministry of Health (FMOH) launched the Nigerian National Action Plan (NNAP) in 2010 to advance the health and development of A/Y in Nigeria. The NNAP stipulates the integration of the AYFHS into the country\u0026rsquo;s PHC system. In line with this action plan, a guideline for the integration of AYFHS into PHC services in Nigeria was launched in June 2013. \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e More recently, the FMOH promulgated a monitoring and evaluation plan for adolescent and young adult health. \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e In February 2019, the Ogun State Primary Health Care Development Board, with support from Advance Family Planning\u0026rsquo;s local partner in Nigeria, Pathfinder International, and in collaboration with The Challenge Initiative, launched an Adolescent Reproductive Health Strategic Framework (2018\u0026ndash;2022). The framework aimed to increase access to sexual and reproductive health (SRH) information and services for all A/Y in the state by 2022.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eStudies have revealed a paucity of well-trained, adolescent-friendly health workers in areas such as Africa and Asia, where the population of A/Y makes up the largest proportion of the general population. \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e In sub-Saharan Africa, the magnitude of this deficit was exposed in a systematic review of determinants of teenage pregnancy. The lack of skilled HCPs, along with infrastructure gaps in providing quality services to adolescents, substantially contributed to unintended pregnancy. \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e A lack of AYFHS training and clinical space meant that AYFHS programs were not being implemented at the PHC facilities. \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e However, information about the knowledge and perceptions of the AYFHS among PHC workers in Nigeria is yet to be well documented despite yearly reports of high adolescent and youth morbidity and mortality. Additionally, there has been no documented assessment of the AYFHS in Ogun State, Southwest Nigeria. Thus, there is a need for an assessment of the integration of the AYFHS into health services provided in PHCs in Ogun State.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy aim\u003c/h2\u003e \u003cp\u003eThis study aims to describe the existing services provided for young people at PHCs, whether AYFHSs are provided, to assess the knowledge, perceptions, and practices of AYFHSs among the PHC workers, and to understand the MOHs of health perspectives on facilitators and barriers to the integration of AYFHSs at PHCs in Ogun State.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy setting\u003c/h3\u003e\n\u003cp\u003eNigeria is the sixth most populous country in the world and the most populous country in Africa, with a population of over 200\u0026nbsp;million, 33% of whom are A/Y aged 10\u0026ndash;24 years. \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e Nigeria is in the West African subregion and has diverse climates and topographies. \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e The country is administered in subdivisions known as states. Nigeria\u0026rsquo;s PHC system is run by an MOH who supervises the centres, as well as nurse practitioners and community health officers (CHOs) who serve as the heads of the PHCs and supervise community health extension workers (CHEWs).\u003c/p\u003e \u003cp\u003eOgun State is one of the 36 states in the Federal Republic of Nigeria. It covers a total land area of 16,980.55 sq. km. It lies within the southwestern region of the country. The estimated population of the state in 2022 was 6,379,500, with an A/Y population of over 1.5\u0026nbsp;million. The state has 20 local government areas (LGAs), each with at least one functioning model 24-hour PHC. The state has two federal facilities, one state facility and one private tertiary health facility, 39 public secondary health facilities, 450 PHCs, and 904 private health facilities.\u003c/p\u003e\n\u003ch3\u003eStudy design and population\u003c/h3\u003e\n\u003cp\u003eThis was a descriptive cross-sectional study with a mixed-method approach. Ten out of the 20 LGAs were selected for the study via a simple random sampling method. All the model PHCs in the selected 10 LGAs were used for the study. All the HCPs who offer clinical care in each of the selected model PHCs were invited to participate in the study. All the HCPs at the selected PHCs who provided clinical care (i.e., the MOH, nurses, community health officers (CHOs), and community health extension workers (CHEWs)) were recruited for the study. Healthcare providers who were on leave, outside postings, or training during the data collection were excluded from the study.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eThe data for this study were collected using a multimethod approach. First, a checklist from a previous similar study in South Africa (YFS Self-Appraisal Framework Adolescent and Youth Friendly Services assessment tool for use at healthcare facilities (DOC 2674 kb))\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e was used for the assessment of the existing services and the provision of AYFHS in each of the PHCs. Assessment of the existing services provided for young people at each of the PHCs, including whether the AYFHS program is available and accessible. The interviewer was shown around the facility and documented what was either seen on the ground or reported by the healthcare workers. The HCP in charge of each of the PHCs was interviewed on the provision of the AYFHS at the PHC.\u003c/p\u003e \u003cp\u003eSecond, a pretested, semi-structured, self-administered questionnaire, which was adapted from previous literature, was used to assess the knowledge, perceptions, and practices of the AYFHS among the HCPs at the PHCs. The questionnaire included questions such as demographic characteristics and the professional experience of the HCPs; other questions focused on the knowledge (yes, no, \u0026amp; not sure), perceptions (4-point Likert scale), and the practice (yes \u0026amp; no) of the AYFHS. It was distributed to the healthcare workers by the research assistants when they were available during clinic hours.\u003c/p\u003e \u003cp\u003eThird, key informant interviews were conducted among the MOHs in the 10 selected LGAs using a qualitative data collection method. These sets of interviews were conducted using a semistructured, narrative approach, with appropriate probes from an open-ended question interview guide to ensure that the study objectives were met.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e The interviews explored the experiences and perceptions of the MOHs regarding the facilitators of and barriers to the integration of the AYFHS into the existing PHC services. The interviews were conducted via Zoom because the interviewees were unavailable for face-to-face interviews.\u003c/p\u003e \u003cp\u003eConsent and sociodemographic characteristic data were collected from the interviewees in Zoom before the interview. The Interviews were led by TL-A., and with the permission of the respondents, the interviews were recorded. All the interviews were conducted in English. After a brief introduction, the researcher introduced the topic, the broad aims, and the areas to be covered during the interviews. The interviews were regulated with a discussion guide. The researcher ended the interviews by allowing the interviewees to ask any questions and thanking them for participating in the interviews. Each interview lasted between 30 and 45 minutes.\u003c/p\u003e\n\u003ch3\u003eData management and analysis\u003c/h3\u003e\n\u003cp\u003eThe items on the checklist were entered into a secure database, and analysis was performed using descriptive statistics, which are presented as frequencies and percentages in tables.\u003c/p\u003e \u003cp\u003eThe quantitative data were entered into an Excel spreadsheet and exported into SPSS version 27 for analysis. Categorical variables are presented as frequencies and percentages in tables and charts. Summary measures of the continuous variables are presented as the mean and standard deviations and medians and interquartile ranges for normally distributed and nonnormally distributed variables, respectively.\u003c/p\u003e \u003cp\u003eFor knowledge, a correct response was given a score of 2, and an incorrect response was given a score of 1. Perception was measured using a 4-point Likert scale: strongly agree, agree, disagree, and strongly disagree. If the statement is correct, strongly agree\u0026thinsp;=\u0026thinsp;4, agree \u0026amp; disagree\u0026thinsp;=\u0026thinsp;3, strongly disagree\u0026thinsp;=\u0026thinsp;1, but if the statement is incorrect, strongly disagree\u0026thinsp;=\u0026thinsp;4, agree \u0026amp; disagree\u0026thinsp;=\u0026thinsp;3, strongly agree\u0026thinsp;=\u0026thinsp;1. The composite scores for knowledge and perception were 54 and 120, respectively. Respondents who score 70% and above have good knowledge (\u0026ge;\u0026thinsp;38) and positive perceptions (\u0026ge;\u0026thinsp;84), and respondents with less than 70% have poor knowledge (\u0026lt;\u0026thinsp;38) and negative perceptions (\u0026lt;\u0026thinsp;84) of the AYFHS. Bivariate analyses were used to test for associations between independent variables (respondents' demographic characteristics and training on the AYFHS) and dependent variables (overall knowledge and perception scores and practice of the AYFHS). The level of significance was set at 0.05.\u003c/p\u003e \u003cp\u003eQualitative data were transcribed verbatim, analysed manually and presented in narrations. The interview data were analysed via rapid, deductive thematic analysis focused on facilitators and barriers to implementing AYFHS. \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e The analysis team consisted of five individuals: 1. S.W., a qualitative researcher at Northwestern University; 2. M.B., a public health physician at the College of Medicine, University of Lagos; 3. T.L.-A., a public health physician and statistician at the College of Medicine, University of Lagos; 4. G.E., a public health specialist; 5. F.M., a public health professional. All the data were analysed by S.W. paired with one other member of the analysis team. Initial concepts related to barriers and facilitators were identified and summarised. These summaries were reviewed by the whole analysis team and, through successive rounds of weekly discussion and excerpt review, refined into final themes.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e for this study was obtained from Olabisi Onabanjo University Teaching Hospital Health Research and Ethics Committee (OOUTH/HREC/534/2022AP) and Ogun State Ministry of Health, Health Planning, Research and Statistics (HPRS/381/476). Informed consent was obtained from each respondent, and the respondents were informed of their right to withdraw from the study at any point in time without any consequences. Respondents were not given any form of incentives.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e \u003cb\u003eQuantitative phase of the study.\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eAssessment of the existing services and the provision of the AYFHS in each of the PHCs.\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFacility inventory checklist for provision of AYFHSs in PHCs (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS/N\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClearly visible signboard with necessary information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(30)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresence of comfortable waiting area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAvailability of basic amenities (e.g., constant electricity, clean functional toilet, waste disposal, disposal of sharps and adequate hand hygiene facility)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(70)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurrounding of the facility is clean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdequate and comfortable facility furniture (quantity and state of repair)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAvailability of equipment in the facility (sphygmomanometer, stethoscope, thermometer, BMI growth charts for adolescents, computer with email/internet access)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresence of visual and auditory privacy features\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConfidentiality procedure and application in practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMinimum level of stock of some medicine and supplies in the facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8(80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresences of some registers, tools, and records\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGuidelines and other decision support tools (e.g., job aids, algorithms) for information, counselling, and clinical management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisplay of important information for A/Y on the walls of the facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAvailability of training records/reports for the following: Communication skills to talk to A/Y, policy on privacy and confidentiality, etc.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAvailability of guidelines/standard operating procedures (SOPs) such as supportive supervision in adolescent health care, provision of services to A/Y with or without an appointment, applying policies for free, or affordable, service provision to adolescents, etc.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAvailability of the following list, medicines, supplies and necessary equipment, agencies, and organizations with which the facility partners, package of information, counselling, treatment, and care services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(30)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAvailability of job description of the following personnel focusing on A/Y health care.\u003c/p\u003e \u003cp\u003eDoctors\u003c/p\u003e \u003cp\u003eNurse\u003c/p\u003e \u003cp\u003eMidwife\u003c/p\u003e \u003cp\u003eOutreach workers\u003c/p\u003e \u003cp\u003eCounsellors\u003c/p\u003e \u003cp\u003eOther (please specify)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(80)\u003c/p\u003e \u003cp\u003e7(70)\u003c/p\u003e \u003cp\u003e8(80)\u003c/p\u003e \u003cp\u003e8(80)\u003c/p\u003e \u003cp\u003e9(90)\u003c/p\u003e \u003cp\u003e10(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(20)\u003c/p\u003e \u003cp\u003e3(30)\u003c/p\u003e \u003cp\u003e2(20)\u003c/p\u003e \u003cp\u003e2(20)\u003c/p\u003e \u003cp\u003e1(10)\u003c/p\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eDuring the assessment of the facility readiness for the integration and implementation of the AYFHS, the facility inventory checklist was used for each of the 10 selected PHCs. The researcher reported that the following are available or adequate: Basic amenities, e.g., clean, functional toilets in 70% of the facilities; medical equipment in the facility, e.g., sphygmomanometers in 80% of the facilities; and the minimum level of stock of some medicine and supplies, e.g., antimalaria in 80% of the facilities. Note that the above are for all the patients and are not specific for A/Y (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe absence or lack of the following was observed during the assessment of the existing services and the provision of AYFHS in each of the selected PHCs. They include the absence of clearly visible signboards with the necessary information in 70% of the facilities;\u003c/p\u003e \u003cp\u003eComfortable waiting areas in 90% of the facilities; display of IEC materials addressing AYFHS on the facility walls; adequate and comfortable facility furniture in 90% of the facilities; training records/reports and guidelines/SOPs such as supportive supervision for AYFHS in 90% of the facilities; clean surroundings in 80% of the facilities; confidentiality procedures and application in practice in 80% of the facilities; job descriptions relating to AYFHS for doctors (80%), nurses (70%), midwives (80%), and outreach workers (80%) in the facilities; guidelines and other decision support tools (e.g., job aids, algorithms) for information, counselling, and clinical management in 60% of the facilities; and some registers, tools, and records on A/Y healthcare services in 60% of the facilities (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics and AYFHS activities of the respondents (n\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(21.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18(56.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e51\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(9.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.1 (8.38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32(100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChristianity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25(78.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIslam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(21.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHighest level of education obtained\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29(90.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost tertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(9.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDesignation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(34.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior CHEW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSenior CHEW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15(46.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25(78.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced/widowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(9.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTraining on AYFHS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21(65.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(34.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears of working experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20(62.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(28.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(9.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.0 (2.00-15.75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAvailability of regular training of HCP on provision of AYFHS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHCPs\u0026rsquo; confidence to provide care to A/Y\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConfident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29(90.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(9.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHCPs\u0026rsquo; ability to relate and answer A/Y questions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComfortable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29(90.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot comfortable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(9.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAvailability of AYFHS in your health facility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(37.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20(62.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThirty\u0026ndash;two HCPs from 10 model PHCs in 10 LGAs in Ogun state participated in the quantitative phase of the study. The mean age of the respondents was 42.1 (8.38) years, and all were females. Approximately 90% of the respondents had tertiary education. The median number of years of working experience was 5.0 (2.00-15.75). Two-thirds (65.6%) of the respondents had training in the provision of adolescent health services. There was no regular training of the HCPs on the provision of adolescent health services in any of the PHCs. More than 60% of the respondents revealed that there are no AYFH services in their PHCs. Approximately 90% of the HCPs claimed that they could confidently provide care and were comfortable relating to and answering young clients' health-related questions (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKnowledge of AYFHS among respondents (n\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA/Y are about a third of Nigeria\u0026rsquo;s population (correctly identified \u0026ldquo;Yes\u0026rdquo;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25(78.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFailure to ensure the health and well-being of A/Y may result in wastage of investments previously made in the childhood (correctly identified \u0026ldquo;Yes\u0026rdquo;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26(81.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIdentification of list of leading health challenges of A/Y such as SRH issues, MH, substance use, etc. (correctly identified \u0026ldquo;Yes\u0026rdquo;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26(81.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIdentification of list of characteristics of AYFHS according to WHO\u0026rsquo;s criteria such as accessible, available, acceptable, appropriate, equitable (correctly identified \u0026ldquo;Yes\u0026rdquo;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26(81.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCP must ensure the privacy of A/Y in all aspects of service delivery (correctly identified \u0026ldquo;Yes\u0026rdquo;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27(84.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCP are obliged by legal requirements to report incidents such as assaults and gun wound (correctly identified \u0026ldquo;Yes\u0026rdquo;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23(71.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCP are obliged by legal requirements to report incidents such as prostitution and conflict (correctly identified \u0026ldquo;No\u0026rdquo;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5(15.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCP behavior that can hinder effective communication with A/Y include being judgmental and inconsiderate, etc. (correctly identified \u0026ldquo;Yes\u0026rdquo;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24(75.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCP should not allow their personal beliefs and values to influence their dealing with A/Y clients (correctly identified \u0026ldquo;Yes\u0026rdquo;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25(78.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWithout adequate skills and competencies, A/Y focused health workers are likely to lose motivation (correctly identified \u0026ldquo;Yes\u0026rdquo;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28(87.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCP attends to A/Y according to their status (correctly identified \u0026ldquo;No\u0026rdquo;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdolescent/youth must book a formal appointment with their HCP before consultation (correctly identified \u0026ldquo;No\u0026rdquo;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19(59.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdolescents/youth are not allowed to participate in service provision (correctly identified \u0026ldquo;No\u0026rdquo;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21(65.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCP should manage A/Y health issues correctly according to evidence based treatment guidelines (correctly identified \u0026ldquo;Yes\u0026rdquo;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28(87.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA greater proportion (78.1%) of the respondents knew the population of A/Y in Nigeria. More than 80% of the respondents identified the leading health challenge of A/Y. They also identified the list of characteristics of AYFH services. In addition, more than 75% of the respondents agreed that the judgmental and inconsiderate behaviour of HCPs can hinder effective communication with A/Y. However, a lower percentage (15.6%) of the respondents knew that they were not under any legal obligation to report incidents of prostitution and conflict among young people. A smaller number (6%) of the respondents also agreed that A/Y should be treated equally (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Overall, more than 80% of the respondents had good knowledge of the AYFHS.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePerception of AYFHS among respondents (n\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatements\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStrongly Agree\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStrongly Disagree\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdolescents/youth seeking SRH services should be told to abstain when they ask for contraceptives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5(15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(18.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9(28.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12(37.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiscussing sexual intercourse with A/Y is shameful\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10(31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20(62.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnmarried A/Y should not be provided with contraceptives because culture and religion prohibit engagement in premarital sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11(34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e17(53.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParents should be informed if their unmarried daughters come to a health facility to seek reproductive health services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9(28.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14(43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6(18.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCP should scold a young person if he or she asks for contraceptives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17(53.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10(31.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCP should refuse to provide contraceptives for A/Y before marriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5(15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11(34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11(34.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeaching unmarried A/Y about contraceptives is acceptable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14(43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5(15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1(3.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReproductive health services are only available for married A/Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5(15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11(34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14(43.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdolescents/youth should be welcomed into the clinic for SRH services if they seek them\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18(56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2(6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf a girl has irregular periods, her parents should be informed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10(31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6(18.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCP personal beliefs should guide the way he/she provides health services to young people\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5(15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(18.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12(28.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9(28.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnly girls should be given information about SRH because they are the ones who have the most issues related to sexual behavior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11(34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16(50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf a client does not volunteer information that they have been subject to violence perpetrated by members of their family, HCP shouldn\u0026rsquo;t ask them directly about it because it is none of his/her business\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5(15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14(43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11(34.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoys cannot be the victims of sexual assault\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13(40.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsking A/Y if they are victims of any kind of violence is considered interfering with their personal or family issues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14(43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11(34.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdolescents/youth should not be given information about puberty because it will encourage them to engage in sexual behaviors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15(46.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14(43.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducating A/Y on reproductive health topics leads to sexual immorality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17(53.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e17(53.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf an adolescent has a genital ulcer, it is because he or she is promiscuous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15(49.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13(40.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf a young person comes into a health facility and says she has been the victim of sexual assault, she probably did something to deserve it\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7(21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13(40.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8(25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe best way to prevent unmarried A/Y from becoming sexually active is to keep them in the dark about sexual issues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13(40.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14(43.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational materials on SRH should be openly available to A/Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17(53.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1(3.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdolescent/youth should be given the same level of confidentiality when receiving SRH services as adults\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15(46.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13(40.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3(9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1(3.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchools and health facilities should work together to provide SRH information and services to A/Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13(40.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17(53.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth workers play an important role in reducing SRH problems among pre-marital A/Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18(56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual and gender-based violence among A/Y should receive governmental attention as a significant social issue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11(34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19(59.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIt is important to make sure that any services provided to A/Y are done so privately so no one else in the clinic can hear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9(28.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18(56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1(3.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInvolving A/Y in assessing service provision and participating in service provision can help make health services more sensitive and responsive to their needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5(15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1(3.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of community support and enabling environment cannot deter or discourage service providers from delivering the needed health services to A/Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7(21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11(34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7(21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7(21.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe physical state of health facilities, the health care processes, as well as the types of procedures that are carried out influence on a large extent, whether A/Y will find the health care facilities attractive for them to use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(46.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7(21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2(6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth workers' friendliness and professional conduct are irrelevant to the success of AYFHS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10(31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8(25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eApproximately 62.5% of the respondents strongly disagreed that it is shameful to discuss sexual intercourse with A/Y. More than 50% of the respondents strongly disagreed that unmarried A/Y should not be provided with contraceptives due to cultural and religious beliefs, and educating them on reproductive health topics leads to sexual immorality (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Furthermore, fewer than 40% of the respondents strongly disagreed that A/Y should be asked to abstain from sex, be scolded, or should be refused contraceptives when they request them. Fewer than 20% of the respondents strongly disagreed that parents should be informed if their unmarried daughters come to a health facility to seek reproductive health services or if their daughter has irregular periods (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Overall, less than two-thirds (62.5%) of the respondents had positive perceptions of the provision of AYFHS. This is based on the findings from the statements on the perceptions of the HCPs towards the AYFHS.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePractice of the AYFHS among respondents (n\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of guidelines when providing services to the A/Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14(43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18(56.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe working hours in the facility is convenient for A/Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24(75.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA/Y have consultation without appointment in your PHC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7(21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25(78.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInform adult visiting the facility about services available for A/Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9(28.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23(71.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse support materials to communicate with parents about the value of providing health services to A/Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18(56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(43.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow routine procedure for A/Y counselling and consultation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29(90.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow routine collection of psychosocial history during A/Y consultation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31(96.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInform A/Y about the availability of health, social services and other services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10(31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22(68.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeny A/Y services due to recent stock-out\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19(59.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13(40.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeny A/Y services due to lack of equipment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18(56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(43.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eGood clinical operations\u003c/p\u003e \u003cp\u003eA higher proportion (96.9%) of the HCPs in the selected PHCs routinely take a psychosocial history, such as asking the A/Y about home and relationships with adults, asking questions about school, their eating habits, sexual relationships, smoking, and alcohol consumption, use of substances, and asking questions about the mood and mental health of the A/Y during counselling or consultation. More than 90% of the respondents follow routine procedures during A/Y counselling and consultation, including introducing themselves to the A/Y and asking the A/Y what he/she likes to be called, asking the A/Y who he/she brought with him/her to the consultation, ensuring that no one sees or hears the A/Y from outside during the consultation or counselling, ensuring that there is a screen between the consultation and examination area, assuring the A/Y that no information will be disclosed to anyone without his/her permission, and finally explaining to the A/Y the conditions when the HCP might need to disclose information, such as in situations required by law. The HCPs also ensure that the adolescent\u0026rsquo;s records, laboratory results, and any other important information are kept under lock and key or password protected if on the computer. Ensuring that the facility\u0026rsquo;s working hours are convenient for A/Y (75%) and attending to the adolescent\u0026rsquo;s needs without booking an appointment (78.1%).\u003c/p\u003e \u003cp\u003ePoor clinical operations\u003c/p\u003e \u003cp\u003eMore than 50% of the HCPs do not use IEC materials to communicate with the parents of A/Y about the importance and benefits of providing healthcare services to A/Y. Approximately 43.3% of the HCPs do not make use of guidelines when providing healthcare services to A/Y. Denying adolescent healthcare services at the PHCs was reported by 43.7%, and 40.6% of the respondents as a result of a lack of equipment and stock-out of commodities and supplies, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between respondent characteristics and knowledge \u0026amp; perception scores of AYFHS\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eKnowledge of AYFHS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003ePerception towards AYFHS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003cp\u003e26(81.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003cp\u003e6(18.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e32(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003cp\u003e20(62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003cp\u003e12(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e32(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge group (yrs)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le; 24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23(79.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(20.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18(62.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11(37.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eChi-square \u0026amp; P-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e1.316 \u0026amp; 0.382\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.025 \u0026amp; 0.876\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChristianity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19(76.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(24.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17(68.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8(32.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIslam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4(57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eChi-square \u0026amp; P-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e3.331 \u0026amp; 0.150\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003e1.436 \u0026amp; 0.225\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20(80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15(60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10(40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5(71.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2(28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eChi-square \u0026amp; P-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e0.123 \u0026amp; 0.732\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.314 \u0026amp; 0.581\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHighest level of education obtained\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23(79.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(20.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18(62.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11(37.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-tertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eChi-square \u0026amp; P-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e1.316 \u0026amp; 0.382\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.025 \u0026amp; 0.876\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDesignation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8(72.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3(27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHEW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15(71.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12(57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9(42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eChi-square \u0026amp; P-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e5.758 \u0026amp; 0.049*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.767 \u0026amp; 0.387\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTraining on AYFHS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15(71.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13(61.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8(38.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7(63.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4(36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eChi-square \u0026amp; P-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e5.758 \u0026amp; 0.049*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.009 \u0026amp; 0.923\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears of working experience (yrs)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15(75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13(65.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7(35.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(91.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7(58.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5(41.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eChi-square \u0026amp; P-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e1.507 \u0026amp; 0.242\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.142 \u0026amp; 0.706\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e*Statistically significant\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e reveals a statistically significant association between designation (p\u0026thinsp;=\u0026thinsp;0.049) and training on AYFHS (p\u0026thinsp;=\u0026thinsp;0.049) and overall knowledge scores of the AYFHS among the respondents. There were no statistically significant associations between the sociodemographic characteristics of the respondents and their overall perception scores.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between knowledge \u0026amp; perception scores of the AYFHS and the practice of the AYFHS among the respondents.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eKnowledge of AYFHS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003ePerception towards AYFHS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003cp\u003e26(81.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003cp\u003e6(18.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e32(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003cp\u003e20(62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003cp\u003e12(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e32(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUse of guidelines when providing services to the A/Y\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12(85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14(77.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4()22.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8(44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10()55.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eChi-square \u0026amp; P-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e0.332 \u0026amp; 0.568\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003e5.723 \u0026amp; 0.017*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe working hours in the facility is convenient for A/Y\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6(75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21(87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14(58.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10(41.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eChi-square \u0026amp; P-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e2.215 \u0026amp; 0.117\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.741 \u0026amp; 0.399\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdolescent/youth have consultation without appointment in your PHC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22(88.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(12.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13(52.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12(48.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eChi-square \u0026amp; P-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e2.978 \u0026amp; 0.064\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003e7.723 \u0026amp; 0.020*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInform adult visiting the facility about services available for A/Y\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8(88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20(87.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12(52.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11(47.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eChi-square \u0026amp; P-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e1.616 \u0026amp; 0.186\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003e4.220 \u0026amp; 0.054\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUse of support materials to communicate with parents about the value of providing health services to A/Y\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(72.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(27.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(92.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8(57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6(42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eChi-square \u0026amp; P-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e2.410 \u0026amp; 0.138\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.305 \u0026amp; 0.581\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFollow routine procedure for A/Y counselling and consultation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24(82.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17(58.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12(41.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eChi-square \u0026amp; P-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e0.404 \u0026amp; 0.497\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003e3.004 \u0026amp; 0.159\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFollow routine collection of psychosocial history during A/Y consultation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25(80.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19(61.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12(38.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e31(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eChi-square \u0026amp; P-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e0.423 \u0026amp; 0.625\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.959 \u0026amp; 0.431\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInforming A/Y about the availability of health, social services and other services\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9(90.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18(81.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eChi-square \u0026amp; P-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e0.015 \u0026amp; 0.903\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003e5.340 \u0026amp; 0.030*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDenying A/Y services due to recent stock-out\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(89.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13(68.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6()31.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(69.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7(53.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6(46.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eChi-square \u0026amp; P-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e2.050 \u0026amp; 0.150\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.696 \u0026amp; 0.403\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDenying A/Y services due to lack of equipment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11(61.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7(38.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(71.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9(64.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5(35.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eChi-square \u0026amp; P-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e1.575 \u0026amp; 0.209\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.034 \u0026amp; 0.854\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHCP \u0026lsquo;s confident to provide care to A/Y\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConfident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23(79.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(20.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18(62.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11(37.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3()100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eChi-square \u0026amp; P-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e1.316 \u0026amp; 0.382\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.025 \u0026amp; 0.876\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHCP\u0026rsquo;s ability to relate and answer A/Y questions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComfortable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24(82.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18(62.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11(37.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot comfortable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eChi-square \u0026amp; P-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e0.404 \u0026amp; 0.497\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.025 \u0026amp; 0.876\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAvailability of AYFHS in your health facility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17(85.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3(15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9(75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eChi-square \u0026amp; P-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e0.055 \u0026amp; 0.815\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003e11.936 \u0026amp; \u0026lt;0.001*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e*Statistically significant\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere was no statistically significant association between the overall knowledge scores of the respondents and their AYFHS practices. However, there are some statistically significant associations between the overall perception scores of the respondents and the use of guidelines when providing services (p\u0026thinsp;=\u0026thinsp;0.017), A/Y having consultation without appointments (p\u0026thinsp;=\u0026thinsp;0.020), Informing A/Y about the availability of health and social services and other services (p\u0026thinsp;=\u0026thinsp;0.030), and the availability of AYFHS in their health facility(p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eQualitative phase of the study.\u003c/b\u003e \u003c/p\u003e \u003cp\u003e Ten MOHs participated in the qualitative phase of the study. The mean age of the MOHs was 47.6 (SD: 4.14) years. The respondents included eight males and two females. They are all married medical doctors. The median number of years of working experience was 13.5 years (IQR: 6.50\u0026ndash;18.25). The facilitators mentioned included a positive attitude toward the AYFHS, existing relationships with nongovernmental organisations (NGOs) for support, existing structures for youth and community involvement, and existing practices ensuring the confidentiality of information. Barriers included staffing issues, lack of funding, lack of demand for AYFHS, lack of political will, insufficient arrangements to ensure privacy, and lack of free or subsidised treatment for adolescents/youths.\u003c/p\u003e\n\u003ch3\u003ePositive attitudes toward AYFHS\u003c/h3\u003e\n\u003cp\u003eThe Interviewed MOHs held very positive views towards establishing AYFHSs in one of the facilities in their LGA.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePositive attitude toward AYFHS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSub-theme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRespondents\u0026rsquo; statements\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImprove the care adolescents get\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;It will be nice and will go a long way. If we have one facility like that, we will just direct any patient or client to the facility rather than waiting till the nurses trained on adolescents\u0026rsquo; health care are less busy before attending to them.\u0026rdquo; (P1)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;It is important and long overdue because the needs of the youth and adolescents have been left alone, and we have seen the impacts, the trends of abuse of drugs like contraceptive drugs, hard drugs, narcotics, these can have an effect on the way they perceive risk and how they can get involved in things that affect their health like unprotected sex so it will be very beneficial to them and the population of youths are very high in Ogun state and it shares boundary with Lagos state. The importance is that much more necessary.\u0026rdquo; (P3)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReach more adolescents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;It will be an improvement to what is already on the ground and we will be able to reach out to the adolescent age group more, it will make their catchment wider.\u0026rdquo; (P5)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFocus on prevention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;It\u0026rsquo;s a welcome idea. It will go a long way to reduce problems facing adolescents\u0026rsquo; health challenges specifically with poor health-seeking behavior, providing accessibility for health care services to the adolescents.\u0026rdquo; (P8)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;It will be an avenue to help youth and adolescents in confidentiality like teenage pregnancy [and] infections. They know where to go before it becomes a serious problem so they won\u0026rsquo;t go for abortion, they will be properly guided the same thing with infections, protection, and how to prevent them, instead of going to Google, but they can find someone who can give them the right advice.\u0026rdquo; (P7)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eExisting relationships with NGOs for support\u003c/h2\u003e \u003cp\u003eThe respondents identified existing relationships with NGOs. These relationships include education, outreach, and material provision to PHCs.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExisting relationships with NGOs for support\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;MARIE STOPES has been the number one in the state for support of reproductive health, family planning component especially but if you now want to factor in the HIV/AIDS component you can now factor in APIN, IHVN, UNFPA are the major funders of the RH and they have programs with the state that they also train the health workers.\u0026rdquo; (P4)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;UNFPA is doing so much in terms of capacity building, contact tracing/follow-up, while MARIE STOPES is doing something along the line of contraception, those are the two agencies supporting us.\u0026rdquo; (P10)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eExisting structures for youth and community involvement\u003c/h2\u003e \u003cp\u003eThe LGAs have an existing governing structure/board that includes the members of the community, A/Y, to advise on how to plan health services and make them work. This group is an established way to obtain input from and get information from the community, including A/Y.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExisting structures for youth and community involvement\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;It\u0026rsquo;s a bottom-top approach. Each ward has a ward health committee and members, and there's a chairman representing the community leader or traditional leader or representatives. The officer in charge of that facility serves as the secretary, 15\u0026ndash;20-member committee, other members include youth organizations maybe two, youth representatives maybe two, representatives of Civil Service Organisation (CSO) and Community-Based Organisation (CBO) in that community, and other voluntary organizations such as Boy Scout, and girl's guide, we have representatives of Okada riders, road transport workers, market women or women society in that community.\u0026rdquo; (P10)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;They serve as the link between us and the youth in the community in terms of dissemination of information to their counterparts. They help us talk to their peers when we have youth-oriented activities and have them involved. They bring back feedback from their peers. There was an instance when there was a high rate of pregnancy and STI from a particular school around the community the youths in the governing board serve as a link to reach others to address the problem.\u0026rdquo; (P2)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;We have market women, Okada riders, TBAs (traditional birth attendants), teachers, and youths in the community. Usually not more than 20 members so we now pick them from different sectors of the community\u0026rdquo; (P9)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;The youth representative will bring up matters and issues concerning the youth and help them seek solutions from the board. They also help mobilize the youth for the purpose of health talk or health information to be disseminated to them.\u0026rdquo; (P3)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;They play the roles the others play. But sometimes we may invite them if we have any challenge with any adolescent to advice or talk to them.\u0026rdquo; (P1)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eConfidentiality of information.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eExisting practices are in place to ensure the confidentiality of adolescent data and information.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConfidentiality of information\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;The person attending to them is well trained so the confidentiality of the information they have given is assured.\u0026rdquo; (P1)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;We don\u0026rsquo;t discuss their issue outside except when they come with their parents. Even when their parents are there, we don\u0026rsquo;t attend to them in front of their parents especially in the cases of HIV except if the adolescent wants us to discuss it in front of their parents.\u0026rdquo; (P6)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;We are intending to move to the way of electronic medical records. The state is already proposing that, but we don\u0026rsquo;t use general outpatient cards for them. There is special booklet for them to report interaction with them which is not kept with the general patient cards.\u0026rdquo; (P9)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Each person/client has their own record/case file it is not general which are properly kept in locked cabinets (under lock and key) and cannot be accessed by unauthorized individuals except those of us that work there.\u0026rdquo; (P2)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStaffing\u003c/h2\u003e \u003cp\u003eHealthcare providers\u0026rsquo; knowledge, perceptions, and skills are at the core of quality service provision. To achieve technical competence, the facilities should ensure that the number, qualifications, and skill mix of staff are adequate to deliver the required package of the AYFHS. The MOH discussed the shortage of staff in general and adequately trained staff in particular to provide AYFHS.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabe\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eStaffing\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSub-theme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRespondents\u0026rsquo; statements\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of training of the HCPs on AYFHS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;There are no provisions for training for outreach workers. What we give them is stipends for logistics to go for the outreach. The outreach is not for adolescents specifically, it\u0026rsquo;s for immunization, family planning, general health provision not specific for adolescents\u0026rdquo; (P4).\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I don\u0026rsquo;t know the actual number, but I know that some of the nurses, midwives, community health officers, and the senior CHEW have been trained on adolescent healthcare under reproductive health. But none of them is specifically trained on AYFHS\u0026rdquo; (P5)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInadequate number of staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;There is a shortage of manpower and high workload in most of the facilities under the LGA.\u0026rdquo; (P3)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I closed down 3 PHCs and may close down more because more people are retiring, leaving the country, dying, and no replacement so that means we cannot leave an unskilled person to man that facilities so that may warrant more closures in the near future if manpower is not addressed.\u0026rdquo; (P4)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;There is a gross shortage of staff.\u0026rdquo; (P9)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eLack of funding\u003c/h2\u003e \u003cp\u003eThe respondents mentioned funding challenges that would be barriers to providing AYFHS, including funding for staff, staff training, built environment needs such as dedicated areas for adolescents, supplies and medications, and a lack of a specific line item in the general budget.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabf\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLack of funding\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSub-theme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRespondents\u0026rsquo; statements\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinic arrangement and environment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;At the primary health care level, I don\u0026rsquo;t think there are, no special arrangements for them, just consultation area that we use for everybody no special consultation room for them.\u0026rdquo; (P8)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommodities and supplies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Lack of commodities and supplies to maintain and run the unit effectively could also be a challenge.\u0026rdquo; (P2)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;They [provision for commodities and supplies] come under the general logistic management commodities, but none [are] in place for the adolescent\u0026rdquo;. (P10)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContinuous professional education on AYFH services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eNone, whenever we have it [professional education on adolescent health care], funds are not been released.\u0026rdquo; (P10)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;No, there isn\u0026rsquo;t but routine general training not specifically for adolescents.\u0026rdquo; (P8)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;For now, we don\u0026rsquo;t have any budgetary allocation for that (professional education on adolescent health care). Most of the things we use here are donor-driven supplies.\u0026rdquo; (P2)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStart-up cost\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;The funds for maintenance might be available because the federal government has provided what is called Basic Health Care Fund but it is not enough for startup. It can only be enough for sustainability. So, starting up is our major problem.\u0026rdquo; (P5)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Funds is one of the bureaucracies of the government. If that is [establishing AYFHS] going to be done by an NGO, there will be a need to write for permission then approval but funds is the major challenge.\u0026rdquo; (P9)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLack of demand\u003c/h2\u003e \u003cp\u003eThe participants expressed concern that parents, guardians, adolescents, and other community members and community organisations may not currently recognise the value of providing health services to A/Y or supporting such provisions due to stigma or a lack of awareness or knowledge.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabg\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLack of demand\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSub-theme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRespondents\u0026rsquo; statements\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStigma concerns from parents and adolescents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eThe fear of people being stigmatized for coming into the facility since in the community where everyone is familiar with one another, that is the major challenge I see.\u0026rdquo; (P7)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor awareness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Our services are facility-based, more of a clinical base. We don't do any outreach whatsoever.\u0026rdquo; (P10)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;All the nurses in charge of adolescent health work within the healthcare facility.\u0026rdquo; (P1)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;The adolescent health does not have an advocate and ambassador at all levels. People are not speaking up for them. The first thing that will help us achieve this is to bring this problem to the forefront; we need a champion and advocate for our youth.\u0026rdquo; (P10)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eLack of political will\u003c/h2\u003e \u003cp\u003eThe inability to achieve the buy-in of government stakeholders may lead to challenges stemming from funding appropriation.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabh\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of political will\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Once there is political will they mark some amount of the general budget into it, sustainability won\u0026rsquo;t be an issue if the community buys into it for participation.\u0026rdquo; (P10)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Providing a continuous monthly WI-FI service to be available will also require funds. I\u0026rsquo;m sure the local government may do it one or two times getting the approval to have funds for it will now be a problem.\u0026rdquo; (P9)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eLack of privacy\u003c/h2\u003e \u003cp\u003eThe participants mentioned concerns about the adequacy and ability of PHCs to provide services in private areas, which would impact the quality of care and potential demand.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabi\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of privacy\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;At the primary health care level, I don\u0026rsquo;t think there are, no special arrangements for them, just consultation area that we use for everybody no special consultation room for them.\u0026rdquo; (P8)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Some LGAs have a separate section/clinic where they come, and they are taken care of and relate with one another and are being managed by the HIV unit but there isn\u0026rsquo;t one in my LGA. But we understand that privacy is important for them to properly open up and be free to express themselves away from the public eye. There isn\u0026rsquo;t any clinic or separate section for them.\u0026rdquo; (P3)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLack of free or subsidised treatment for the adolescent\u003c/h2\u003e \u003cp\u003eFinally, the MOHs expressed concerns that A/Y may not be able to access the AYFHS due to funding limitations and the lack of subsidies for their treatment.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabj\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of free or subsidised treatment for the adolescent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;No, they are treated just like any other people, they have to pay, and unfortunately our social insurance skill covers under five, elderly, and pregnant women.\u0026rdquo; (P10)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;No system in place for free treatment.\u0026rdquo; (P7)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;No subsidy in place for their treatment.\u0026rdquo; (P5)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003e This multimethod research reveal that the PHCs that participated in the study had deficiencies in terms of the comfort and cleanliness of the clinics, as well as the availability of guidelines, procedures, records, IEC materials, supplies, and job descriptions related to the AYFHS. Most of the PHC workers had good knowledge and positive perceptions of the AYFHS. However, there were significant gaps in their practices. The identified facilitators to providing AYFHSs were positive attitudes towards the AYFHS, existing relationships with NGOs for support, existing structures for youth and community involvement, and the confidentiality of information. The barriers identified were inadequate staffing, lack of funding, lack of demand, lack of political will, lack of privacy, and lack of free or subsidised treatment for A/Y.\u003c/p\u003e \u003cp\u003eThe starting point for any initiative aimed at improving the quality of health service provision to the people is the national health policy and strategy developed by the key stakeholders (Ministry of Health). The advocacy activities should aim to influence these key stakeholders to embrace and support the AYFHS and create a positive environment for AYFHS delivery and uptake. The stakeholders will identify key community organisations in the catchment area and engage in formal and informal partnerships with them to increase their support for the A/Y use of services.\u003c/p\u003e \u003cp\u003eThe national guidelines for integrating AYFHSs into PHCs require that facilities be physically attractive and welcoming to young people.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e Health services should be provided in ways that meet the expectations of adolescent clients. One of these expectations is the provision of a layout designed to ensure privacy throughout an A/Y visit.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e This includes the point of entry, the reception area, the waiting area, the examination area, and the patient-record storage area. Any deviation from this standard may result in a barrier. However, most of the PHCs in our study lacked the comfortability and cleanliness to meet this requirement. A clean health facility is not only visibly appealing but also contributes to the prevention of healthcare-associated infections. \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe key stakeholders are to identify community resources and build partnerships with agencies and organisations for advocacy and to increase community support for the A/Y use of services. There should be policies and procedures in place that guarantee the confidentiality of A/Y clients in the health facilities. The dearth of guidelines, procedures, supplies and other tools specific to AYFHS is a major challenge to the provision of AYFHS and has negative implications for the capacity and preparedness of health providers to provide care to A/Y even when they are willing.\u003c/p\u003e \u003cp\u003eMost of the HCPs surveyed had good knowledge and positive perceptions of the AYFHS. However, 38% displayed a negative perception; in particular, 66% of providers either agreed or strongly agreed that contraceptives should be refused by unmarried adolescents. Similarly, unfavourable attitudes are displayed towards unmarried adolescents in Ethiopia.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e These are potential sources of barriers to AYFHSs at the PHCs and should be addressed in HCP training. The benefit of AYFHS training is evident in this study as all providers who had been trained had good knowledge of AYFHS. The gaps in provider practices were related to the gaps in facility readiness. For example, the non-use of IEC material or guidelines likely resulted from an absence of these materials at the PHCs. Providers, even when trained or willing, are hindered from providing quality services when resources are unavailable.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe MOHs generally had positive attitudes towards the AYFHS. Their interest would be pivotal to any future integration of AYFHS at the PHC level. The evidence shows that from the perspective of adolescents, the negative attitudes of providers are one of the key hindrances to the use of services.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e Owing to their leadership role, MOH can influence PHC providers to provide good quality care to adolescents and advocate for funding and mobilisation of local resources to support the AYFHS.\u003c/p\u003e \u003cp\u003eThe strategic elements for integrating the AYFHS into PHC in Nigeria include youth involvement and supportive resources and interventions.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e The existing relationships with NGOs and existing structures for youth involvement found in this study are potential elements of success in AYFHS delivery in PHCs and should be explored in future interventions.\u003c/p\u003e \u003cp\u003eThe facility should be adequately funded to allow the facility to implement actions for inspecting, testing, and maintaining medical equipment and documenting results. There should be a system in place for the procurement and stock management of the commodities and supplies necessary to deliver the required AYFHS. The allocation of funds from the national budget for capacity building should be negotiated as part of the continuous professional education activities at the AYFHS at the federal, state, and LGA levels. Health system barriers to access and utilisation of youth-friendly sexual and reproductive health services were found to be the most common in a systematic review spanning sub-Saharan Africa.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e Similarly, in our study, all the barriers except for lack of demand were health system-related. Interestingly, a comparable study in northern Nigeria revealed a strong influence of social barriers to the utilisation of PHCs among adolescents.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e This is possible because social norms in northern Nigeria can negatively impact adolescents\u0026rsquo; access to and utilisation of SRH services.\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e The mentioned study also included the voices of adolescents, which we recommend for future exploratory studies in southwest Nigeria, as the views of PHC providers and managers may differ considerably from those of adolescents.\u003c/p\u003e \u003cp\u003eIn the ideal AYFHS, HCPs should deliver the same level of care and consideration to all A/Y regardless of age, sex, social status, cultural background, ethnic origin, disability, or any other reason. Health facilities should put in place systems to ensure that adolescents are knowledgeable about their health and know where and when to obtain healthcare services. The low demand for service by A/Y was perceived to result from poor awareness in the communities. Similarly, a study in northern Nigeria revealed that poor knowledge of reproductive health services at PHC was a barrier to utilisation.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Community outreach is critical for health promotion activities for A/Y and families, including awareness creation. These outreaches could be through school health services or interventions to reach out-of-school youth as part of an integrated health service delivery.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eFor effective and functioning AYFHSs, policies and procedures should be in place to ensure that health services are either free or affordable to A/Y. This will allow them to access the necessary healthcare services without asking their parents for money. However, according to the discussion with the MOH during the interviews, no such systems are in place in the PHCs.\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eThis is one of few studies in Africa to use multiple methods to assess facility preparedness, barriers, and facilitators to AYFHS at the PHC level. We used a representative sample of PHCs in the state, and a total population of HCPs (who offer clinical care) was included in the surveys.\u003c/p\u003e \u003cp\u003eHowever, this study is not without limitations. First, our findings are only generalisable to PHCs within Ogun state. They do not reflect the differences in PHC service provision in other parts of Nigeria, which vary from one region to another. Second, the views of A/Y are not captured in this study, so the identified barriers and facilitators may not be comprehensive of the A/Y experience.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eMost of the PHCs in Ogun state in southwest Nigeria are inadequately prepared to provide AYFHSs and fall short of national recommendations. The providers, though knowledgeable about AYFHS, had gaps in their perceptions and practices. Most of the identified barriers to AYFHS integration were health system-related. However, networks and structures exist that can be leveraged for the successful implementation of AYFHS at the PHCs. We recommend advocacy to relevant stakeholders to implement the national guidelines supported by adequate funding, AYFHS provider training, community engagement and supportive supervision of PHCs. Future exploratory studies among adolescents and youth in the study areas could help to identify and consider their needs in interventions to fully integrate AYFHSs into PHCs.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eA/Y\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdolescent/Youth\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAPIN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eApin Public Health Initiative\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAYFHS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdolescent and Youth\u0026ndash;Friendly Health Services\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCBO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCommunity\u0026ndash;based Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCHEW\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCommunity health extension worker\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCommunity Health Officer\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCSO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCivil Society Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFMOH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFederal Ministry of Health\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHCP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealthcare provider\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHREC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealth Research and Ethics Committee\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHPRS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealth Planning Research and Statistics\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIEC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInformation, Education and Communication\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIHVN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInstitute of Human Virology Nigeria\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInterquarter range\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLGA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLocal Government Area\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMOH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMedical Officer of Health\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNGO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNongovernmental organisation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNNAP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNigeria National Action Plan\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOOUTH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOlabisi Onabanjo University Teaching Hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePHC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePrimary Health Centre\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eReproductive health\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSOP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard operating procedure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for the Social Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSRH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSexual and Reproductive Health\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTBA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTraditional Birth Attendant\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUNFPA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUnited Nations Population Fund\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWi\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFi\u0026ndash;Wireless Fidelity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from Olabisi Onabanjo University Teaching Hospital Health Research and Ethics Committee (OOUTH/HREC/534/2022AP) and Ogun State Ministry of Health, Health Planning, Research and Statistics (HPRS/381/476). Informed consent was obtained from each respondent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the respondents and participants provided consent for their data to be used in publications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the data analysed during this study are included in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors of this manuscript declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by Northwestern University’s Robert J Havey Institute of Global Health Catalyzer Fund. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualisation and design of the study - TL-A, MB, and GM\u003c/p\u003e\n\u003cp\u003eProposal development - TL-A, MB, and GM\u003c/p\u003e\n\u003cp\u003eData collection (quantitative) – TL-A and GE\u003c/p\u003e\n\u003cp\u003eData collection (qualitative) – TL-A\u003c/p\u003e\n\u003cp\u003eData analysis (quantitative and qualitative) – TL-A, MB, SW, GE, and FM\u003c/p\u003e\n\u003cp\u003eWriting – original draft – TL-A\u003c/p\u003e\n\u003cp\u003eWriting – review and editing - TL-A, MB, SW, GE, FM and GM\u003c/p\u003e\n\u003cp\u003eApproval of the manuscript for submission - TL-A, MB, SW, GE, FM and GM\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMany thanks to the respondents and the participants, without whom this research would not have been possible. We are also grateful to the research assistants who helped with the implementation of the research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTL-A – Associate Professor and Consultant of Community Health and Primary Care and a statistician at the College of Medicine, University of Lagos\u003c/p\u003e\n\u003cp\u003eMB - Associate Professor and Consultant of Community Health and Primary Care at the College of Medicine, University of Lagos\u003c/p\u003e\n\u003cp\u003eSW - A qualitative researcher at Northwestern University\u003c/p\u003e\n\u003cp\u003eGE – A public health specialist\u0026nbsp;at the College of Medicine, University of Lagos\u003c/p\u003e\n\u003cp\u003eFM – A public health professional at Northwestern University\u003c/p\u003e\n\u003cp\u003eGM – Associate Professor of Paediatrics and attending physician of adolescent and young adult medicine at Northwestern University.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSawyer SM, Afifi RA, Bearinger LH, et al. 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Understanding how social norms influence access to and utilization of adolescent sexual and reproductive health services in Northern Nigeria. Front Sociol. 2023;8:865499. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fsoc.2023.865499\u003c/span\u003e\u003cspan address=\"10.3389/fsoc.2023.865499\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 37899781; PMCID: PMC10603227.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"facility preparedness, adolescent and youth-friendly health services, primary healthcare centres, integration, healthcare providers, mixed methods approach","lastPublishedDoi":"10.21203/rs.3.rs-5451843/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5451843/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdolescences/youth (A/Y) make the transition to adulthood in good health, but there are particular public health challenges within this age group, such as injuries from accidents or violence, mental health problems, problems from substance use, problems from undernutrition and overnutrition, endemic diseases (e.g. malaria), and sexual and reproductive health (SRH) problems. Adolescent and youth-friendly health services (AYFHSs) provide access to information and services on prevention, diagnosis, counselling, treatment, and care and allow all people to safely reach services without travelling long distances. This study aimed to describe the existing services provided for A/Y at PHCs, assess the knowledge, perceptions, and practices of AYFHS among the healthcare providers (HCPs), and understand the medical officers of health (MOHs) perceived facilitators and barriers to integration of AYFHS at PHCs in Ogun State.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was a descriptive cross-sectional with a mixed-method approach. A checklist, questionnaire, and interview guide were used to collect data from the PHCs, HCPs and MOHs, respectively. The quantitative data were analysed via SPSS version 27. Qualitative data were transcribed verbatim, analysed manually and presented in narrations using rapid, deductive thematic analysis. The level of significance was set at a P-value \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTen model PHCs, 32 HCPs, and ten MOHs participated in the study. In the assessment of the facility readiness for AYFHSs, basic amenities, medical equipment, etc., were available or adequate, but there was a lack or absence of clearly visible signboards, comfortable waiting areas, displays of IEC materials, and confidentiality procedures and practices.\u003c/p\u003e\n\u003cp\u003eMore than 80% and 62.5% of the HCPs had good knowledge and positive perceptions of providing AYFHS, respectively. There were statistically significant associations between the overall perception scores of the respondents and the practices of some AYFHSs, such as A/Y having a consultation without an appointment (p=0.020). In the interviews with the MOHs, some factors were identified as facilitators (e.g. existing relationships with NGOs for support) and barriers (e.g. inadequate staffing) to the AYFHS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost of the PHCs in this study are inadequately prepared to provide AYFHSs and fall short of national recommendations. Most of the identified barriers to AYFHS integration were health system-related.\u003c/p\u003e","manuscriptTitle":"Facility Preparedness, Barriers, and Facilitators to the integration and implementation of Adolescent and Youth-friendly health services in Primary Health Care centres in Southwest Nigeria - A mixed method study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-02 17:04:33","doi":"10.21203/rs.3.rs-5451843/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-18T10:01:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-15T11:54:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-15T11:52:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2024-11-14T07:31:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e55a0d54-65e2-4c09-8f5f-7f3afa9cfa3f","owner":[],"postedDate":"December 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-26T20:53:14+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-02 17:04:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5451843","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5451843","identity":"rs-5451843","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}