Access and utilization of youth friendly sexual and reproductive health services among illiterate adolescents in Rwanda: A mixed-methods participatory study
Bibliographic record
Abstract
BACKGROUND: Youth Friendly Health Services Centers (YFHS) in Rwanda have been established to address the lack of information and services related to reproductive health. However, there is a paucity of studies investigating the hurdles faced by illiterate adolescents when seeking sexual and reproductive health services. This study assessed adolescents' sexual and reproductive health (ASRH) accessibility and utilization in YFHS among illiterate adolescents in Rwanda. METHODS: This study used a mixed-method participatory study design. One hundred fifty illiterate adolescents were recruited using a convenience sampling. A checklist was used to observe the 16 YFHS. In the quantitative phase, data were organized using Statistical Package for the Social Sciences (SPSS) version 26, and analyzed through descriptive and inferential statistics. Two focus group discussions moderated by trained illiterate adolescents were conducted. Data were organized using Dedoose software and analyzed thematically. RESULTS: The proportion of YFHS utilization was 25.3%. In the multivariate regression analysis, five outcomes remained significant to utilize YFHS: ever heard about YFHS (Adjusted Odds Ratio [AOR] = 6.32; 95% Confidence Interval [CI] = 2.07-19.27, having ASRH information (AOR = 8.99; 95 CI = 1.43-56.77), having information about any family planning (AOR = 19.00; 95 CI = 1.52-236.84), use of any type of contraceptives (AOR = 4.45; 95%CI = 1.34-14.85), and having information on prevention and management (AOR = 24.99; 95 CI = 2.76-226.53). Observers rated the quality of SRHs in YFHS at 24.36%. Facilitators to access YFHS include having information about ASRH, free-of-charge services, and peer educators. The reported barriers included providers' negative attitudes, internalized stigma, and lack of materials tailored to illiterate adolescents. The study participants suggested ways to improve the YFHS, such as community awareness, staff training, entertainment, and increasing the number of YFHS. CONCLUSIONS: The utilization of YFHS among illiterate adolescents remains low, highlighting the need for targeted interventions to improve access and quality. Key facilitators, such as access to information, peer education, and free services, should be strengthened, while addressing barriers like provider attitudes, stigma, and resource limitations. These findings underscore the necessity of enhancing both the accessibility and quality of YFHS to ensure comprehensive reproductive health care for illiterate adolescents.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".