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Table 2 Themes, sub-themes and sample illustrative phrases or sentences of quotes showing barriers to using AFSRHs, Hossana Town, Sothern Ethiopia, March 2020

From: What do service providers in Southern Ethiopia say about barriers to using youth-friendly sexual and reproductive health services for adolescents?: Qualitative study

Themes

Subthemes

Sample codes

Sample illustrative phrases /sentences of quotes

Provider level barriers

Poor provider competency

Providers lack knowledge

[…] I was very much confused. I tried to... […]

[…]... worry about of HIV /AIDS but, for pregnancy."

[…]If I had understood his feeling, I would have helped him. […]

Providers had negative attitude

[…] I face problem when educating female servants. […]

Providers lack communication

[…]“Are you expecting me to say just I am going to eat it? [..]

[…]... providers often do not use a direct language. […]

Confidentiality breach, disrespect and discrimination of adolescents

Provider breach confidentiality

[…]... problem of keeping confidentiality of adolescents’ sexual... […]

[…] I will tell his secrete to his family. […]

Providers disrespect adolescents

[…]... perform abortions without proper counseling and without looking at other options. […]

Provider discriminate by sex

[…]... facilities to seeking help for STI problem. Unfortunately,... […]

Providers' lack of follow-up

Providers lack follow-up

[..]... the service. I referred to but I don’t know their fate […]

Adolescent level barriers

Fear to violation of confidentiality and cultural taboos

Adolescents fear confidentiality breach

[…]…are afraid of losing their privacy and confidentiality. […]

Adolescents fear providers

[…] They felt fear and shame. […]

Lack of information and attitude towards SRHs

Adolescents lack knowledge

[…]They don’t worry about the side effects of post pills. […]

Adolescents lack attitude

[..]Many adolescents developed low perceived risk of severity… […]

Preference to seeking care and peer influence

Adolescents resist advices

[…] But, they [adolescents] don’t want to do this [ sexual abstinence].”

Adolescents’ decision is influenced by peers

[…] I see that adolescents are influenced by peers. […]

Financial constraints

Adolescents lack money

[…]... dependent on family income. They lack transportation cost…[…]

Health facility level barriers

Lack of supply and unsupportive environment

Shortage of supplies

[…]… many resources and supplies required to provide services. […]

No entertainment

[…] …can’t say that youth friendly sexual and reproductive […]

Adolescents lack privacy

[…]… service itself is not youth friendly at all. […]

Inadequate staff and training

Shortage of trained providers

[…] We intentionally placed the clinic… […]

Lack training for providers

[…]Health extension workers like me should be trained on SRHs. […]

Long waiting and inconvenient working time

Long waiting time

[..] I guess waiting time is very high. […]

Community level barriers

Community ‘s bad attitude and lack information

Poor community awareness

[…]Why do employers prevent such adolescents from going to youth health centers?[…]

Community negative attitude

[…]…are considered rude, but those who enter the church are considered polite…[…]

Lack of parental and social support

Parents lack discussion

[…]Parents and teachers don’t talk about sexual and …[…]

Church lack discussion

[…] …settings especially in “Adar program”. […]

Inadequate support to schools and youth centers

Teachers lack help

[…]Reproductive health clubs in the school are not functional. […]

Youth centers were closed

[…]…youth centers which were promoting utilization of SRHs were closed

[…]

Inadequate literacy of sexual health

Lack of curriculum

"I suggest that curriculum should be designed and educated… […]

Presence of unauthorized providers

Unauthorized providers provide contraception service

[…] They don’t want to go to healthcare facilities for… […]

Health system level barriers

Poor implementation

Government lack commitment

[..] Ehh ! I noticed that unemployment is a challenge for not… […]

[…]But, when such programs phased out; activities of peer… […]

Strategy doesn't address adolescents' need

[..] I think that this strategy has to be revised…[…]

Poor multi-sectoral engagement

Lack of multi-sectoral collaboration

[…]…were providing various sexual and reproductive health services through collaboration.[…]