Perceptions of Nurses at Ndola Teaching Hospital towards Sexual Health Needs of People with Mental Health Problems

Sexual and reproductive health (SRH) is among the fundamental packages of health care, which all clients seeking health care should receive. However, it is unclear how healthcare providers, in particular, nurses perceive the issue of people with mental problems having sexual health needs. The aim of this study was to explore perceptions of nurses at Ndola Teaching Hospital towards sexual health needs of people with mental health problems. A general descriptive qualitative study design was utilized and data were collected using three focus group discussions (FGDs) that were recorded and later transcribed verbatim. Purposive sampling was used to select 21 nurses who participated in the study. Nine were male, while 12 were female. Each FGD comprised seven participants. Thematic analysis was used to analyze the data, and six major themes: 1) physiological interplay among different body systems, 2) disease process and effects of psychotropic, 3) participant differences in age, gender, educational level, and cultural backgrounds, 4) staff shortages in mental health units, 5) deficient record keeping, and 6) Social stereotypes and labelling theories emerged. Despite acknowledging the existence of sexual activity among people with mental health problems;participants had both positive and negative perceptions. It is, therefore, recommended that interventions aimed at strengthening implementation of SRH guidelines among nurses caring for people with mental health problems should be put in place.

A Survey on the Sexual Health of Elderly Patients with Cardiovascular Disease and Their Spouses

Objective:To investigate the sexual relationship and sexual health of elderly patients with cardiovascular disease and their spouses,as well as to explore the relationship between sexual health and the quality of life.Methods:A total of 206 CHD patients and their spouses(N=206)as well as 238 age-and gender-matched healthy people were recruited and investigated by using a seilf-designed sexual relationship and sexual health questionnaire and the SF-36 questionnaire;data analysis and comparison were carried out by using SPSS 22.0.Results:The scores of perceived health,marital satisfaction,sexual satisfaction,sexual function,and quality of life were all significantly different among elderly CVD patients,then-spouses,and healthy people(F=3.894,p<0.05).There was a significant correlation between perceived health,marital satisfaction,sexual satisfaction,and sexual function with quality of life(p<0.05).Conclusion:Sexual behavior is an important aspect of quality of life.The sexual relationship,sexual health,and quality of life of elderly patients with cardiovascular disease and their spouses were significantly lower than those of healthy people.It is recommended that more attention should be paid on the sexual relationship and sexual health of these patients and their spouses,with counselling offered when needed.

Impact of Delivery Types on Women's Postpartum Sexual Health

Objective To investigate the impact of childbirth on the sexual health of primiparous women in China and the prevalence of women's postpartum sexual problemsMethod In this cross-sectional study, obstetric records of 460 primiparous women delivering a live-birth at the First Affiliated Hospital of Chongqing University of Medical Sciences between November 1, 2000 and July 31, 2001 were analyzed together with the data collected from questionnaire survey conducted six months after delivery.Results Totally 460 women participated in the questionnaire survey. Though 94.74% of the subjects had resumed sexual activity within six months after birth, most of them had experienced postpartum sexual problems, among which dyspareunia was the most common type. There was no significant association between delivery types and women's sexual health status in six months after birth, including their satisfactory degree of sexual intercourse, sexual desire, sex active rate, the incidence of dyspareunia and pubococcygeal muscle strength (P>0.05). Only 20.80% of women had knowledge of sexual health and 8.02% of them had consulted for sexual problems. Conclusions Women's postpartum sexual health problems were very common, they deserve more attention. There was no significant association between delivery types and women's postpartum sexual problems at the 6th month after delivery.

Co-Creation of a Working Model to Improve Sexual Health for Persons Living with Rheumatological Diseases

Background: Sexual health needs are insufficiently met for persons living with rheumatological diseases and it is necessary to create better ways to meet these needs. Objective: To co-create a working model to improve sexual health for persons living with rheumatological diseases, that can be used by rheumatological teams in regular rheumatology practice. Design: This study applied a co-creation design with three key features: 1) it took a systems perspective with emergent multiple interactive entities;2) the research process was viewed as a creative endeavour with strong links to design, while human imagination and the individual experience of patient and staff were at the core of the creative design effort;3) the process of the co-creative efforts was as important as the generated product. Results: A model defining the role of the patient, the professionals, and the team in optimizing sexual health for persons living with rheumatological diseases was co-created. The model can be seen as a practice guideline, which includes the support needed from and to each participant in the process of promoting sexual health, while being within the professional scope of the professionals’ knowledge and capacity, and in line with the needs of the persons living with rheumatological diseases. Discussion and Conclusions: The co-creative work process identified crucial factors in promoting sexual health, resulting in a useful model for patients, professionals and teams. Co-creation was experienced to be a useful research design to improve rheumatological care, through valuing and using the competence of all research members equally.

Knowledge and Perception of Sexual Health among Medical Undergraduates: A Cross-Sectional Study

Introduction: Sexual health education is paramount in curbing the rising numbers of sexual transmitted diseases in Malaysia. Medical undergraduates which are the future frontier play an utmost role in educating and quell the social barrier in discussion on this taboo topic. We aimed to determine the knowledge, perception and factors affecting sexual health education among medical students in MMMC and to advocate sexual health education at primary level. Methods: A cross-sectional study was conducted among 309 respondents comprises of Year 3, 4 and 5. Results: There was significant association between age, gender, religion and ethnicity and sexual health knowledge and perception score. Pearson correlation coefficient shows there was positive correlation (r = 0.059) between total sexual health knowledge percentage score and total perception score but was not significant. Conclusion: Medical undergraduates should improve their knowledge and perception regarding sexual health education. It is recommended to implement sexual education in high school curriculum and institution of higher learning in Malaysia as it is not implemented yet here due to political and religion sensitivity. It is also important that students develop personalities that are ready to accept exchange and contribute sensitive issues such as sexual health.

Barriers and Promoting Strategies to Sexual Health Assessment for Patients with Coronary Artery Diseases in Nursing Practice: A Literature Review

Background: Sexual health is an important and integral part of human health. Patients often voice their concerns regarding their sexual health after experiencing coronary artery diseases. Nurses face many barriers to conduct sexual health assessment. Although many sexual health instructions have been developed, nurses still pay little attention to sexual health assessment. Purpose: The purpose of this literature review was to identify the barriers and strategies that promoted sexual health assessment in clinical nursing practice. Design: A comprehensive search of the recent literature related to barriers and promoting strategies to sexual health assessment was undertaken. Methods: A review of literature published over the last 10 years on a wide variety of recent studies in nursing and related discipline in the field of sexual health was performed. Findings: Most studies indicated that sexual health was poorly addressed in clinical settings. Barriers to addressing sexual health are multifactorial;we classified them into four categories: patients related barriers, nurses related barriers, organizational related barriers and value related barriers. Many strategies to enhance sexual health assessment and counseling in clinical setting are summarized. Conclusion: Overall, it is evident that nurses encounter many barriers to sexual health assessment. Therefore, investigating these barriers and developing appropriate interventions are recommended.

Current Situations and Challenges Concerning Sexual Health among Unmarried Couples Composed of a Mix of Japanese, South Korean Nationals, and Ethnic Koreans Born in Japan (<i>Zainichi</i>): A Qualitative Study

South Korean nationals are heavily represented in Japan’s foreign population, making up around 20% of all foreign residents in the country. Koreans in Japan can be viewed in two groups: Korean nationals who work or study in Japan, and those of Korean ancestry who were born in Japan or otherwise have historical reasons for residency (commonly called zainichi). There are certain differences seen in gender roles and Confucianism-based traditional culture among Japanese, South Korean nationals, and zainichi. This qualitative study examined consciousness and attitudes about marriage, family planning, and work-life balance in unmarried couples among these three groups. Semi- structured interviews were conducted with five unmarried couples comprising two members from the above three groups (age range: 20 - 35 years), residing in the Kinki region of western Japan. Twelve categories, 25 subcategories, and 79 codes were extracted from 636 contexts. Values regarding sexual health were analyzed from four viewpoints: marriage, family planning, work-life ba- lance, and sexual concerns. The results showed that the couples thought positively about marriage and family planning, while they had several sources of anxiety related to Confucian values and problems stemming from their different nationalities/roots. It is possible that gender roles and Confucian beliefs affect their sexual health. The study underscores that health professionals should provide pertinent knowledge and skills about family planning and child rearing, as well as premarital sexual health counselling, for unmarried couples composed of Japanese, South Korean nationals, and zainichi.

Detecting decreased sexual health with MDHAQ-S

There are instruments that measure sexual function or sexual health for persons with RA, but since sexual health is a sensitive issue, the hypothesis is that it would be easier to have a standard questionnaire that could indicate the need for communication about sexual health issues instead of an extra questionnaire with more detailed questions on sexual health. The aim of the study is to find out whether sexual health difficulties can be screened by factors included in the MDHAQ-S for persons with RA. This study explores the relation between factors included in the MDHAQ-S and the Sexual Health Questionnaire (QSH) using a mixed methods design combining quantitative and qualitative data. The MDHAQ-S covers sexual health issues, not only by using the question on sexual health, but also on other factors included in the questionnaire such as increased pain, fatigue, depression, anxiety, physical capacity, level of physiccal activity and body weight. To explore decreased sexual arousal, decreased sexual satisfaction and decreased sexual well-being, in-depth interviews must be held with persons with RA, either using a sexual health questionnaire or in a clinical interview.

Effects of Peer Health Education on Sexual Health Knowledge and Attitudes of Tertiary Institution Students in Imo State, Nigeria

This study was designed to determine effects of peer-health-education on sexual health knowledge and attitudes of tertiary institution students in Imo State Nigeria by determining the mean gain scores of sexual health knowledge and attitudes after peer health education. Quasi-experimental (pre-test-post-test) research design was employed. Two hundred students drawn from the University, Polytechnic and College of Education, using a multi-stage sampling technique participated in the peer sessions which were facilitated by trained peer educators. Data were analyzed using ANCOVA and Z-test. Findings revealed improved knowledge and attitudes on sexual health, as depicted by positive mean gain scores. Age group 16 - 20 years had the highest mean gain score (<img src="Edit_8e8f0539-e2c6-47bc-80f1-ccaee4c06df5.png" alt="" /> = 22.31) of sexual health knowledge than the rest, while age group 26 - 30 years had the highest mean gain score (<img src="Edit_dec53aa0-f549-425f-baf4-08f39aaf05fd.png" alt="" /> = 10.59) of sexual health attitudes. Males had higher mean gain score (<img src="Edit_e767bc6a-c1f3-4f0a-8b31-814581d9dd64.png" alt="" /> = 26.05) of sexual health knowledge, while females had higher mean gain score (<img src="Edit_79f87968-38f8-4873-8516-f5370ba691df.png" alt="" /> = 9.77) of sexual health attitudes. The first years (100 level students) had the highest mean gain score (<img src="Edit_3f417e44-7627-4d69-860e-94c94ae7db0e.png" alt="" /> = 25.71) of sexual health knowledge and also had the highest mean gain score (<img src="Edit_2a60fbc7-0a2c-49fe-b9a2-1cea354966a3.png" alt="" /> = 14.12) of sexual health attitudes. Level of study was significant both for knowledge and attitudes (P < 0.01). It is recommended that peer-health-education be explored further as a method of communicating sexual health issues to tertiary institution students and youths generally.

Smart Approaches to Efficient Text Mining for Categorizing Sexual Reproductive Health Short Messages into Key Themes

To promote behavioral change among adolescents in Zambia, the National HIV/AIDS/STI/TB Council, in collaboration with UNICEF, developed the Zambia U-Report platform. This platform provides young people with improved access to information on various Sexual Reproductive Health topics through Short Messaging Service (SMS) messages. Over the years, the platform has accumulated millions of incoming and outgoing messages, which need to be categorized into key thematic areas for better tracking of sexual reproductive health knowledge gaps among young people. The current manual categorization process of these text messages is inefficient and time-consuming and this study aims to automate the process for improved analysis using text-mining techniques. Firstly, the study investigates the current text message categorization process and identifies a list of categories adopted by counselors over time which are then used to build and train a categorization model. Secondly, the study presents a proof of concept tool that automates the categorization of U-report messages into key thematic areas using the developed categorization model. Finally, it compares the performance and effectiveness of the developed proof of concept tool against the manual system. The study used a dataset comprising 206,625 text messages. The current process would take roughly 2.82 years to categorise this dataset whereas the trained SVM model would require only 6.4 minutes while achieving an accuracy of 70.4% demonstrating that the automated method is significantly faster, more scalable, and consistent when compared to the current manual categorization. These advantages make the SVM model a more efficient and effective tool for categorizing large unstructured text datasets. These results and the proof-of-concept tool developed demonstrate the potential for enhancing the efficiency and accuracy of message categorization on the Zambia U-report platform and other similar text messages-based platforms.

Quality Provision of Comprehensive Sexuality Education and Sexual and Reproductive Health in Resource Constrained Higher Education Institutions: A Case of Mukuba University

In an effort to ensure that Institutions of Higher Learning provide quality Comprehensive Sexuality Education (CSE) and Sexual and Reproductive Health (SRH) at the level of Universities and Colleges, indeveloping countries such as Zambia, some universities have engaged in offering programmes and services in CSE and SRH. However, the provision of such programmes has had some limitations in terms of resources to ensure quality delivery. As a result, there was a need to examine the provision of CSE and SRH in a resource constrained Mukuba University. The study has three research objectives: 1) to examine the CSE and SRH programmes and services that are available at Mukuba University;2) to determine the actual resources available for the University to ensure quality provision of CSE and SRH to students;3) to use views and opinions of students and academics to examine the extent to which the CSE and SRH are reflected as standards by UNESCO and universities and colleges. The study took a pragmatic philosophy stance and convergent parallel research design of mixed methods;the primary approach is qualitative which will be analysed using thematic analysis, while the quantitative approach was secondary and the data was analysed using descriptive statistics. The study envisaged some implications that include the rise in communicable diseases such as Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS), gender based violence, general lack of information on matters relating to CSE and SRH among students at Mukuba University. The policy implication is that policy makers will be able to formulate policies that address the needs and challenges of students in providing quality CSE and SRH programmes and services for a university that is constrained with resources. The study found that there was a need to contextualize the quality provision of CSE and SRH at an institutional level, for instance, Mukuba University has created an enabling environment for quality provision of CSE and SRH activities and programmes through training of the stakeholders. Further, it was found that in any successful programme, it is expected to meet certain challenges that might in some cases make it difficult to implement the programme as envisaged. In other words, this study has revealed that there are some drawbacks as well as lessons that Mukuba University could learn from other universities that offer CSE and SRH. The study provides a synergistic conceptual model that could be used in the implementation of CSE and SRH in colleges and universities for sustainability. It is hoped that this study has proved that even with limited resources a university can provide CSE and SHR programmes and services without depending on support from other external funders and cooperating partners.

The Social Determinants of Health in Relation to Sexually Transmitted Infections in Maricopa County Arizona

Based on the information that was collected on the County Health Rankings website [1], one of the top health concerns for Maricopa County was sexually transmitted infections or STIs. A big concern with STIs is this is not a common subject explored in educational settings or addressed socially. There are many organizations, including the CDC, that have access to materials, there is limited distribution of the educational content. Therefore, the public is not well informed and lacks the information to make educated decisions. The areas with insufficiencies are knowledge of the disease processes, prevention, and treatment.

Kaempferia parviflora ethanol extract improves self-assessed sexual health in men:a pilot study

Background： Sexual health positively correlates with overall wellbeing. Existing therapeutics to enhance male sexual health are limited by factors that include responsiveness, adherence and adverse effects. As the population ages, safe and effective interventions that preserve male sexual function are needed. Published research suggests that various preparations of Kaempferia parviflora, a plant in the Zingiberaceae （ginger） family, support cardiovascular health and may ameliorate erectile function. Objective： The aim of this study was to examine the effects of KaempMaxTM, an ethanol extract of the K. parvi]lora rhizome, on erectile function in healthy middle-aged and older men. Design, setting, participants and interventions： We conducted an open-label, one-arm study on 14 generally healthy males aged 50-68 years with self-reported mild erectile dysfunction, who were not using pre- scription treatments. Participants took 100 mg KaempMaxTM daily for 30 days. Main outcome measures： Evaluations were conducted at baseline and on the final study assessment. Primary efficacy analyses included the International Index of Erectile Function （IIEF）; secondary efficacy analyses included the Global Assessment Question about erectile function. Results： Thirteen participants completed the 30-day study. Supplementation with KaempMaxTM resulted in statistically significant improvements in erectile function, intercourse satisfaction and total scores on the IIEF questionnaire. KaempMaxTM was well tolerated and exhibited an excellent safety profile. Conclusion： Our results suggest that KaempMaxTM may improve erectile function in healthy middle-aged and older men. While the effects were not as pronounced as what might be seen with prescription med- ication, most participants found them satisfactory. Additional, longer and placebo-controlled clinical tri- als will be needed. Trial registration： Clinicaltrials.gov identifier Ncr03389867.

What Affects Male Sexual Activity: A Comprehensive Review

The fundamental importance of sex lies in the need for reproduction and species continuity. For humans, sexual expression is an important source of physical pleasure and emotional intimacy. Healthy sexual expression is closely related to well-being, health and overall quality of life in both men and women. Sexual activity is also considered an important determinant of quality of life. At present, questions about sex are still largely ignored in routine consultations in almost all medical specialties. The factors affecting sexual activity are complex and can be divided into the influence of bio-psycho-sociological factors. Biological influences include anthropometric parameters, sexual function, lifestyle, neuroendocrine system, and diseases;psychological influences include psychological status, mental illness, and sexual attitudes;sociological influences include factors such as marriage, occupation, and economic status. With the epidemic and outbreak of Coronavirus disease 2019 (COVID-19), people’s way of life and work has changed, which also has a great impact on sexual activities. This article will provide a systematic review of factors related to male sexual activity.

KAP Survey of Turkish University Students on Sexuality,reproductive Health,Drug Addiction and Violence

Objective To investigate the attitudes, behaviours and reflections of the university students, on sexuality, reproductive health, violence, smoking, alcohol and drug use, and to find out their expectations from a youth health service. Methods A total of 5 300 students （1 880 girls, 3 420 boys）from various Jaculties of Kyrykkale University were enrolled into this cross-sectional study. Students completed the self-administered questionnaire as one of the researchers was present at the classroom. Research monitors five categories of priority health-risk behaviours among youth and young adults. Results Mean age of 3 420 male （64.5%） and 1 880female （35.5%） students were 20.3 years. Among all 4 380 （82,9%） students [1 350 girls （71.8%）, 3 030 boys （88.5%）] had some kinds of information about sexuality, however this dropped to 2 730 students （51.5%） within the context of adequacy. Friends were the major source （34%） for the first information on sexuality. Using a condom was the mostly heard method of contraception （46.9%） and interestingly 1.1% of the students had no knowledge on any of the protection methods. Among all 25.3% of the students （33.0% boys, 11.4% girls） had some kind of sexual intercourse, and within this group 58.8% experienced his/her first sexual relationship at 18 years of age and over; 53.9% were protected in all intercourses. Using a condom was the main way of protection for boys （63.7%） and pills were for the girls （73.9%）. None of the female students mentioned having an abortion but 8% had friends who had undergone abortion. Tobacco use was 35.1% among the group, and 8. 7% of the male and 3.6% of the female students were using drugs. Although 67. 4% students claimed they never witnessed violence between their parents, 43.2% witnessed violence among their siblings, 67.0% beween friends, 72.6% in the streets and 64.2% in the school. About 30.0% of the students reported having weight problems, and 14.7% admitted visiting a doctor for that problem. If there would be a service providedfor the adolescents in the university, 67% of the students would attend in case of a problem. Past experiences were important for us and we saw that among all 8% of the participants had some kind of sexual problem, within this group 50.7% felt uncomfortable during the visit and only 60.4% were satisfied with the care of the physician. Conclusion Our study results show the current situation of adolescents in Kyrykkale University and will be used to improve policies and programs to reduce priority healthrisk behaviours among youth of our and surrounding provinces and establish a youth friendly service in Kyrykkale University within this purposes.

Effectiveness of Peer-Led Intervention on KAP Related to Sexual Reproductive and Mental Health Issues among Adolescents in Low Resource Settings India: A Comparative Study among Participants and Non-Participants

Background: India being the country with largest adolescent population in the world, needs a special focus on the health services as the status of an adolescent determines the health status in his/her adulthood. Some of the major issues faced by the adolescents include: mental health problems, early pregnancy and childbirth, (HIV/STI) and other infectious diseases, violence, injuries and malnutrition. The present study aims to understand the effectiveness of peer-led intervention on knowledge, attitude and practices related to sexual reproductive and mental health issues in adolescents among participants and non-participants. The study was carried out to improve the health-seeking behaviour of adolescents on sexual reproductive and mental health issues in low resource setting across four states in India. Methods: The study adopted a cross-sectional survey which was conducted on 400 adolescents from each of the four districts namely Bangalore, Khagaria-Bihar, Khed-Pune and Sahinganj-Jharkhand. A comparative analysis was conducted between the participants and the non-participants of the intervention to understand the effectiveness of the intervention on the KAP related to sexual reproductive and mental health of adolescents. Results: The study shows that the participants from Karnataka and Maharashtra had better knowledge in emergency contraception, HIV awareness, use of contraceptives and consumption of IFA’s than the non-participants;both the participants and the non-participants showed a positive behaviour in help-seeking in case of psychological challenges. Conclusion: The peer-led approach was found to be an effective strategy for learning, sharing and monitoring adolescent sexual reproductive and mental health.

EVALUATION ON THE EFFECT OF A SHORT-TERM INTERVENTION OF SEXUAL/REPRODUCTIVE HEALTH EDUCATION AMONG RURAL MIDDLE SCHOOL STUDENTS

Objective To analyze and evaluate the impact of adolescents’ sexual and reproductive health education on students’ sexual knowledge,attitude and behavior.Methods A short term intervention was conducted among high school students in two schools in Xixiang county,Shaanxi Province.The intervention was carried out in the forms of manual,video,discussion,consultation,and so on .The contents of intervention consisted of the knowledge about adolescent physiology,care,conception,STD/HIV, and so on. Results The results showed that students’ knowledge increased significantly(11.92±4.61 before intervention vs 19.81±4.8 after intervention, P =0.000).The sexual attitude and behavior changed insignificantly,especially the change of behavior.Conclusion The intervention is significantly effective in increasing knowledge,but less effective in the change of attitude and almost ineffective in the behavior change.

Availability, Range and Utilization of Sexual and Reproductive Health (SRH) Services for Adolescents at Kinondoni Municipality, Dar es Salaam—Tanzania

Background: It is estimated 1.2 billion of world’s population are adolescents aged 10 - 19 years;80% live in developing countries. Adolescents in developing countries especially Sub-Saharan Africa (SSA) face high burden of sexual and reproductive health problems. Sixteen million girls aged 15 to 19 years give birth every year of which 95% occur in low- and middle-income countries. Twenty five percent of unsafe abortions are in 15 - 19 years in Sub-Saharan Africa. Contraceptive use is low as approximately 10% of adolescents are current users. These problems can be averted if different ranges of Sexual and Reproductive Health Services for adolescent (SRHSA) are available and utilized by adolescents. In Tanzania, there is limited information addressing the availability, types and utilization pattern of sexual and reproductive health services by adolescents. This study investigates the availability, range and utilization of sexual and reproductive health services for adolescents (ASRHS) at Kinondoni Municipality, Tanzania. Method: A cross-sectional study was carried out in April to May 2013. A checklist was used to collect information on the availability and range of services offered at selected health facilities. In depth interviews conducted with in-charges of Reproductive and Child Health (RCH) clinics to explore barriers for provision of Sexual and Reproductive Health Services (SRHS) for adolescents. Adolescents were questioned using a questionnaire on utilization of SRHS and perceived barriers. Descriptive statistics were used to summarize quantitative data and content analysis for qualitative data. Results: On availability and range of adolescents’ sexual and reproductive health services, a total of 25 health facilities were surveyed. Forty four percent of the surveyed facilities did not have the adolescent sexual and reproductive health services (ASRHS). The Adolescents Sexual and Reproductive Health (ASRH) services offered differed greatly between facilities. On utilization of adolescents’ sexual and reproductive health services in total, 204 adolescents from the community were involved in this study. A third of adolescents reported to have ever used ASRH. The adolescents perceived barriers for underutilization of the services were fear of being seen at the clinics (23.3%), lack of money (18.3%), lack of privacy & confidentiality (14.2%) and unfriendly health care providers. Three barriers were perceived by health care providers in the provision of ASRHS: integration of SRHS, lack of training in relation to adolescents SRHS and attitudes of health care providers towards young people. Conclusion: About half of the health facilities did not have the SRH-services to adolescent (44%) and different ranges of services were not offered at the facilities as it was shown in the records. The results from this study show services were underutilized by adolescents. Training, attitudes of health care providers towards young people, & cost influenced ASRHS provision and utilization. Strategies to increase training in ASRHS for health providers including communication skills and scaling ASRH services to all primary care facilities may help to improve availability and access of services to adolescents.