Knowledge, Barriers and Utilization of Adolescents Sexual Reproductive Health Services among Malaysian Youth – A mixed methods study

Abstract

Despite the availability of SRH (sexual reproductive health) services, it is uncertain whether youths are aware of and utilise SRH services. This study aims to identify factors and barriers that affect the utilisation of SRH services among youths in Malaysia. A sequential mixed-method study design comprising two different phases were used in this study. Phase one was the quantitative phase, followed by phase two qualitative phase. A web-based cross-sectional study was conducted from March 2022 to June 2022 using a self-administered pre-tested questionnaire. Variables used in the questionnaire were identified by applying the Andersen Behavioral Model of Health Service Utilisation. Logistic regression was used to identify factors associated with SRH utilisation. Complementary to the quantitative analyses, the qualitative phase was conducted via in-depth interviews among 18 youths. Methodological triangulation was applied to analyse the evidence from quantitative findings to support the themes that emerge in the qualitative study. A total of 617 youths aged 18-24 participated in the quantitative phase. Of these, 65% (n = 403) of participants were unaware of the availability of the services, and only 20.4% (n =126) of youths had ever visited SRH services in their entire life. Findings from the logistic regression analyses indicated that predisposing factors such as age, marital status, high-risk behavior such as vaping, and exposure to information from friends, family, and LPPKN (Lembaga Penduduk Dan Pembangunan Keluarga Negara) are significantly associated with SRH utilisation. (p<0.05). Older age group (20-24 years old) utilises SRH services more than the younger age group ( 18-19 years old)(AOR=0.605,95%CI=0.38,0.96), married youths (AOR=0.218,95% CI=0.09,0.50) and vaping (AOR = 2.05,95% CI=1.14,3.66) was associated with SRH utilisation. Exposure of SRH information from LPPKN is associated with SRH utilisation (AOR = 0.48,95%CI =0.29,0.78), exposure of SRH information from friends is associated with SRH utilisation ( AOR =0.611,95% CI 0.38,0.98), exposure of SRH information from family is associated with SRH utilisation (AOR=2.086,95% CI=1.28,3.38) .Enabling factor associated with SRH utilisation is the availability of services, described as self-buy medicine in pharmacy and the comfortability of services. (p<0.05) (AOR=1.57,95%CI = 0.36,0.90) Youths more comfortable with SRH services are twice as likely to utilise SRH services. (AOR=1.92,95%CI =1.23,2.99). Need factor that is associated with SRH utilisation are youths who are diagnosed with SRH diseases who are 5 times likely to utilise SRH services. (AOR 5.16,95%CI=2.17,12.2). The qualitative findings further confirmed the results by exploring the barriers preventing youths from accessing SRH services. This includes cognitive accessibility, defined as lack of sexual knowledge and awareness of SRH services; psychosocial accessibility, defined as feelings of shyness and shame caused by cultural attitudes; geographical accessibility, referring to the availability of SRH services; affordability, referring to cost and quality of SRH services in health care settings. These findings were further confirmed by methodological triangulation. Awareness of utilisation of (SRH) services among youths in Malaysia is still generally poor. Recommendations to improve access by young people include a multi-component strategy involving multiple stakeholders in providing these SRH services.

Links

BibTeX (Download)

@phdthesis{drph-Rowena-John-2024,
title = {Knowledge, Barriers and Utilization of Adolescents Sexual Reproductive Health Services among Malaysian Youth - A mixed methods study},
author = {Rowena John},
year  = {2024},
date = {2024-01-18},
urldate = {2024-01-18},
school = {Universiti Malaya},
abstract = {Despite the availability of SRH (sexual reproductive health) services, it is uncertain whether youths are aware of and utilise SRH services. This study aims to identify factors and barriers that affect the utilisation of SRH services among youths in Malaysia. A sequential mixed-method study design comprising two different phases were used in this study. Phase one was the quantitative phase, followed by phase two qualitative phase. A web-based cross-sectional study was conducted from March 2022 to June 2022 using a self-administered pre-tested questionnaire. Variables used in the questionnaire were identified by applying the Andersen Behavioral Model of Health Service Utilisation. Logistic regression was used to identify factors associated with SRH utilisation. Complementary to the quantitative analyses, the qualitative phase was conducted via in-depth interviews among 18 youths. Methodological triangulation was applied to analyse the evidence from quantitative findings to support the themes that emerge in the qualitative study. A total of 617 youths aged 18-24 participated in the quantitative phase. Of these, 65% (n = 403) of participants were unaware of the availability of the services, and only 20.4% (n =126) of youths had ever visited SRH services in their entire life. Findings from the logistic regression analyses indicated that predisposing factors such as age, marital status, high-risk behavior such as vaping, and exposure to information from friends, family, and LPPKN (Lembaga Penduduk Dan Pembangunan Keluarga Negara) are significantly associated with SRH utilisation. (p\<0.05). Older age group (20-24 years old) utilises SRH services more than the younger age group ( 18-19 years old)(AOR=0.605,95%CI=0.38,0.96), married youths (AOR=0.218,95% CI=0.09,0.50) and vaping (AOR = 2.05,95% CI=1.14,3.66) was associated with SRH utilisation. Exposure of SRH information from LPPKN is associated with SRH utilisation (AOR = 0.48,95%CI =0.29,0.78), exposure of SRH information from friends is associated with SRH utilisation ( AOR =0.611,95% CI 0.38,0.98), exposure of SRH information from family is associated with SRH utilisation (AOR=2.086,95% CI=1.28,3.38) .Enabling factor associated with SRH utilisation is the availability of services, described as self-buy medicine in pharmacy and the comfortability of services. (p\<0.05) (AOR=1.57,95%CI = 0.36,0.90) Youths more comfortable with SRH services are twice as likely to utilise SRH services. (AOR=1.92,95%CI =1.23,2.99). Need factor that is associated with SRH utilisation are youths who are diagnosed with SRH diseases who are 5 times likely to utilise SRH services. (AOR 5.16,95%CI=2.17,12.2). The qualitative findings further confirmed the results by exploring the barriers preventing youths from accessing SRH services. This includes cognitive accessibility, defined as lack of sexual knowledge and awareness of SRH services; psychosocial accessibility, defined as feelings of shyness and shame caused by cultural attitudes; geographical accessibility, referring to the availability of SRH services; affordability, referring to cost and quality of SRH services in health care settings. These findings were further confirmed by methodological triangulation. Awareness of utilisation of (SRH) services among youths in Malaysia is still generally poor. Recommendations to improve access by young people include a multi-component strategy involving multiple stakeholders in providing these SRH services.},
note = {Doctor of Public Health Thesis},
keywords = {},
pubstate = {published},
tppubtype = {phdthesis}
}