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| ORIGINAL ARTICLE |
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| Year : 2023 | Volume
: 28
| Issue : 2 | Page : 134-144 |
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Assessing current and preferred sources of information on adolescents’ sexual and reproductive health in Southeast Nigeria: A mixed-methods study
Chibuike I Agu1, Chinyere O Mbachu2, Ifunanya C Agu3, Chinyere Okeke2, Mildred N Ndubuisi3, Nkoli Ezumah3, Obinna E Onwujekwe4
1 Department of Community Medicine, Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria
2 Department of Community Medicine, College of Medicine, University of Nigeria Enugu-Campus, Enugu, Nigeria
3 Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria Enugu-Campus, Enugu, Nigeria
4 Department of Health Administration and Management, Faculty of Health Sciences and Technology, University of Nigeria Enugu-Campus, Enugu, Nigeria
| Date of Submission | 30-Jun-2022 |
| Date of Decision | 23-Sep-2022 |
| Date of Acceptance | 05-Dec-2022 |
| Date of Web Publication | 21-Mar-2023 |
Correspondence Address:
Ifunanya C Agu
Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria Enugu-Campus, Enugu
Nigeria
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijmh.IJMH_55_22
Background: Although there are numerous information on sexual and reproductive health (SRH), these vary in content and quality. Objectives: This study examined the sources of SRH information, its value, and their significance for adolescent health programming. Materials and Methods: This was a mixed methods, community-based study conducted in six local government areas. Quantitative data were collected from 1057 unmarried adolescents aged 13–18 years. The qualitative data were collected through in-depth interviews (IDIs), and focus group discussions (FGDs). Descriptive and inferential analyses were performed for quantitative data using Stata software, while thematic framework approach was used to analyze qualitative data. Results: Adolescents reported school teachers (60.5%) and mothers (39.8%) as their major sources of information on signs of puberty. While, teachers (36.3%) and friends/peers (29.8%) were reported as their major source of information on relationship with opposite sex. Bivariate analysis shows that gender had statistically significant associations with parents/guardians (P < 0.001), other family members (P < 0.001), and friends (P = 0.01) as adolescents’ sources of information about relationship with opposite sex. Age category was found to be statistically significant associated with other family members (P < 0.001), teachers (P < 0.01), and friends (P < 0.001) as adolescents’ sources of information about puberty. Other common sources of SRH information elicited through adolescents’ interviews were internet, social media and mass media. Most adolescents valued information from teachers and parents, but preferred receiving SRH information from their friends/peers, social media and mass media because these sources are easy to access with a guarantee of some level of confidentiality. In the opinion of parents and other stakeholders, sources of appropriate SRH information for adolescents were health workers, teachers, parents and adult family members; whereas peers/friends and social media were considered as inappropriate sources of SRH information for adolescents. Conclusion: Efforts at addressing adolescents’ needs for SRH information should be targeted at their valued and preferred sources, whilst maintaining a delicate balance with the expectations of parents and other adults. Keywords: Adolescent, information, nigeria, reproductive health, sexual health
How to cite this article:
Agu CI, Mbachu CO, Agu IC, Okeke C, Ndubuisi MN, Ezumah N, Onwujekwe OE. Assessing current and preferred sources of information on adolescents’ sexual and reproductive health in Southeast Nigeria: A mixed-methods study. Int J Med Health Dev 2023;28:134-44 |
How to cite this URL:
Agu CI, Mbachu CO, Agu IC, Okeke C, Ndubuisi MN, Ezumah N, Onwujekwe OE. Assessing current and preferred sources of information on adolescents’ sexual and reproductive health in Southeast Nigeria: A mixed-methods study. Int J Med Health Dev [serial online] 2023 [cited 2023 May 28];28:134-44. Available from: https://www.ijmhdev.com/text.asp?2023/28/2/134/372151 |
| Introduction | |  |
Adolescence is a period of development characterized by increased sexual ideation and urge, development of sexual values, and initiation of sexual activity.[1],[2] It is a time of sexual risk-taking and experimentation with often, dire consequences, such as unwanted pregnancy, unsafe abortion, and sexually transmitted Infections [STIs] due to dearth of sexual and reproductive health (SRH) information and services.[3] Indeed, many adolescents lack adequate and appropriate information about sexual health and relationships, making them vulnerable to sexual exploitation.[4],[5]
Access to information, education and services has been highlighted as a key to promotion of SRH and rights for young people including adolescents.[6] This led to the recommendation at the International Conference on Population and Development [ICPD] held in Cairo in 1994, that to improve adolescents’ SRH, they should be provided with appropriate information and services needed.[7] Nigeria adopted the regional reproductive health strategy and endorsed all the components of SRH as entrenched in the ICPD platform for action except “the provision of safe abortion services”.[8]
In spite of this, access to appropriate SRH information remains low among adolescents leading to unhealthy SRH choices among them.[3],[9] First sexual exposures mostly occur against the backgrounds of misconceptions and inaccurate knowledge of SRH.[10],[11] There are also, wrong perceptions and poor knowledge about contraceptives among adolescents in Nigeria, which results to a high rate of unprotected sexual practices among the age group.[12],[13]
Parents and other adults are often preferred as the main source of SRH information for adolescents, but they often do not feel comfortable discussing sex-related matters with young people.[11],[14] Also, it has been reported that schools should be a cost-effective source of SRH information to adolescents since, a good number of adolescents pass through school, but, many teachers often have reservations about giving such information to adolescents.[15] Besides this, comprehensive SRH education is poorly implemented in most schools in the region as a result of social and cultural barriers that inhibit open discussions about sexual matters between young people and adults.[14],[16]
A key concern is how adolescents in the state currently receive SRH information and their preferred means of communication in future. Identifying these will help provide useful guide for the design of future adolescent SRH interventions.
Unfortunately, there has been paucity of studies on this aspect of adolescent sexual and reproductive health (ASRH) especially in the study area where there is high rate of teenage pregnancy due to lack of appropriate SRH information.[12] This paper, therefore, contributes knowledge of the preferred sources of SRH information by adolescents and the value adolescents place on these sources of information. It explored perceptions of adolescents and other stakeholders on adequacy and appropriateness of the various sources. Knowledge of these will be useful for selecting strategies for delivering accurate and appropriate SRH information to adolescents.
| Materials and Methods | | |
Ethics approval and consent to participate
The project protocol was submitted to the Health Research Ethics Committee of University of Nigeria Teaching Hospital Enugu and the Research (UNTH/CSA/329/OL.5:NHREC/05/01/2008BFWA00002458-1RB00002323) and Ethics Committee of Ebonyi State Ministry of Health. Ethical approval was secured from both committees before entry into the study site. Informed written consent was obtained from study participants prior to each interview. A written consent was also obtained from FGD discussants (adolescents, village heads). Prior to survey data collection, written informed consent was obtained from parents/guardians of adolescents aged 13 to 17 years. In addition to the consent obtained from the parents/guardians of adolescents aged 13 to 17, documented assent was obtained from adolescent whereas adolescents aged 18 years gave consent for themselves.
Study design and study area
This was a cross-sectional study that used both quantitative and qualitative method to collect quantitative and qualitative data. This study was undertaken in Ebonyi State, southeast, Nigeria. The state has three senatorial zones with thirteen local government areas (LGAs). Ebonyi state has 5,533 km2 estimated land area. Ebonyi state has an estimated population of 6,268,003 and more than 40% of its total population are below 15 years of age.[17] The NDHS report shows that Ebonyi state has the highest fertility rate of 5.4% compared to other south-eastern states in Nigeria.[18] The report also shows that maternal mortality rate among girls aged 15–19 years is 39.7%; and 8.2% of girls in the same age group have already begun childbearing in Ebonyi state.[18] Details of the study area can be found a published article.[14]
Study population
The study population for quantitative survey were male and female in-school and out-of-school unmarried adolescents aged 13 to 18 years living in the selected households with a parent/caregiver. Adolescents who were household guests or mentally challenged were excluded from the survey. The decision to target unmarried adolescent boys and girls between the ages 13–18 years was made following recommendations by key stakeholders in adolescent SRH during an engagement meeting in the study State. The engagement meeting was held prior to the survey and suggestions were made that the study should target adolescents in secondary school age range of 13–18 years because majority of adolescents in Ebonyi state achieve sexual debut at 13–15 years.
The participants who were recruited for the in-depth interviews (IDI) consisted of policy makers, program managers and implementing partners in adolescent health at the State level. Participants were recruited from various government and non-governmental organizations such as; State ministries such as health, youth and sports development, education, women affairs and social development; State house of assembly; State universal basic education board; State primary health care development agency; and civil society organisations. Other participants were adolescents aged 13 to 18 years, community and religious leaders/influencers as well as, parents/caregivers of adolescents aged 13 to 18 years.
Sampling technique
A modified cluster sampling technique was used to select households from which eligible adolescents were recruited and interviewed. Following the recommendations by key stakeholders, six LGAs listed as having the highest unwanted adolescent pregnancies and abortion rates in the State were purposively selected for the study. These LGAs have also been prioritized by the state government for interventions in ASRH. Two LGAs were purposively selected from each senatorial zone so as to ensure representation of geopolitical and geographical locations in terms of place of residence. Selected LGAs were; Abakiliki, Ikwo, Ezza south, Izzi, Ohaozara and Afikpo south. A community with a facility that provides youth-friendly SRH services was purposively selected from each of the selected LGAs. The interview participants were purposively selected considering their current participation in ASRH programs and to represent a wide range of values/ culture.
For the quantitative study, the sample size was determined from Glenn’s table of sample sizes that would be necessary for given combinations of precision, confidence level and variability for different population sizes.[19] To achieve a 5% precision at 95% confidence interval for population >100,000 a minimum sample size of 400 was determined. However, this sample size was doubled and further increased to 1,100. This was increased to enable sub-group data analysis and also to account for incomplete responses.
Data collection
The quantitative data was collected using a structured questionnaire was adapted from the World Health Organization’s (WHO) illustrative questionnaire for interview-surveys with young people.[20] The questionnaire was used to collect data on adolescents’ source of information on puberty and relationship with the opposite sex, among other SRH variables. The data was collected by fifty-four research assistants who were trained for ten days.
The qualitative data were collected using a pre-tested focus group discussion (FGD) and in-depth interview guides. The interviews were conducted over one month. Interviews were conducted by trained and experienced qualitative researchers. All interviews lasted between 50 to 70 minutes and were audio recorded. The various community interviews consisted of three facilitators: one moderator, one note taker and a local translator/guide. The discussions were held in venues that were convenient for participants while ensuring confidentiality.
The survey and interview guides were pretested in a contiguous site among target population group. Seventy-seven (77) IDI, 6 FGDs with village heads and 12 FGDs with adolescents were conducted using pretested semi structured interview guides. Based on the operational level, 52 respondents from community/LGA level were interviewed whereas, 25 state level respondents were interviewed, having reached the data saturation point. In each of the study community, one FGD was held with the village heads, one FGD with adolescent boys and another with girls. Information was collected on sources of information on pubertal changes, relationships, sex, pregnancy and its prevention, and preferred sources. In addition, the perceptions of the other stakeholders on the adequacy and appropriateness of information provided by the different sources as well as the most important source to adolescents were elicited. Details of the data collection can be found a published article.[14]
Data management and analysis
For the quantitative data, 1045 questionnaires were found to be completely filled after cleaning of data, giving a 95% response rate. The independent variables include age, place of residency, gender and schooling status, while the dependent variables are the sources of SRH information on signs of puberty and on relationship with opposite sex. A descriptive analysis was performed using Stata statistical software. Proportions were reported for categorical variables. Sources of SRH information were disaggregated by socio-demographic characteristics such as age, place of residence (urban or rural), gender, and schooling to highlight distribution and as well, test for associations. Chi square test of statistical significance was used to test for associations, while the level of statistical significance was determined by a p value of <0.05.
The qualitative data were analyzed using a thematic framework approach.[21] The key themes relating to sources of SRH information among adolescents were generated. They include sources of SRH information, perceived value, adequacy and appropriateness of sources of SRH information. This formed the initial coding framework which was tested on two other new transcripts (one of FGD and IDI). Details of the data analysis procedure can be found a published article.[14]
| Results | | |
[Table 1] shows the demographic characteristics of survey respondents. Approximately 51% of adolescents in the survey were residing in urban areas, whereas 49% of them lived in rural areas. There were 598 (57.2%) girls and 447 (42.8%) boys in the survey.
Socio-demographic distribution of IDI and FGD respondents
There were 38 males and 39 females who were interviewed. Forty-nine of these respondents resides in urban areas while 28 respondents resides in rural areas.
Findings from the quantitative survey of adolescents
[Table 2] shows the current sources of SRH information to adolescents. Out of 1045 adolescents that were surveyed, 635 (60.5%) mentioned teachers as the commonest source of information on signs of puberty, followed by mothers, 418 (39.8%).
[Table 3] shows the socio-demographic correlates of sources of information about puberty. Age category was found to be statistically significant associated with other family members (P < 0.001), teachers (P = 0.003), and friends (P < 0.001) as adolescents’ sources of information about puberty. Place of residence also had statistically significant association with parents/guardians (P < 0.001) and friends (P = 0.03) as adolescents’ sources of information about puberty. | Table 3: Socio-demographic correlates of sources of information about puberty
Click here to view |
[Table 4] shows the socio-demographic correlates of sources of information about relationships with opposite sex. Gender had statistically significant associations with parents/guardians (P < 0.001), other family members (P < 0.001), and friends (P = 0.01) as adolescents’ sources of information about relationship with opposite sex. | Table 4: Socio-demographic correlates of sources of information about relationships with opposite sex
Click here to view |
Qualitative findings
Findings show that adolescents received SRH information from various sources namely, teachers, peers/friends, family members and trusted adults, health workers, mainstream and social media, internet, and the church.
Teachers
Teachers were frequently mentioned as a source of SRH information for adolescents, particularly for in schools. Teachers were said to provide information on topics such as puberty, STIs and relationship with the opposite sex. Some of the participants expressed their opinions thus,
“Well, I know those in school get their sexual information from those teachers I talked about,” (Male, Policy maker).
“Some schools have added sex education in their curriculum as part of the studies in the schools” (Health worker, Female)
Friends/Peers
Friends and peers were also mentioned as a source of SRH information, particularly for out-of-school adolescents and, also for adolescents in school. Adolescents were believed to rely on one another and on their friends for SRH information.
“Majority of them get information from their peer groups, including their boyfriends or girlfriends” (Policy maker, Male)
“We get SRH information through our boy- or girl-friends. That is the case in my school, and if, as a girl, you don’t have boyfriend, they will tell you that you have not started” (Adolescent, Female)
“In my opinion, most adolescents receive information from their friends; in-school adolescents receive SRH information from their classmates” (Policy maker, Female)
Parents and family members
Diverse views were expressed by the participants about parents and family members being a source of SRH information for adolescents. Many participants noted that parents were a source of SRH information for adolescents who confided in them. Trusted adults were also identified as a source of SRH information for adolescents
“Some adolescents confide SRH issues in their parents, and for such individuals, it is easy for them to get information from their parents.” (Policy maker, Male)
“Adolescents, especially the out-of-school ones get much of the SRH information from their trusted adult friends” (Policy maker, Male)
One participant opined that the family is the main source of SRH information for a child, particularly information related to puberty and development of the reproductive system.
“... Family is the number one, please. A child born into a family will definitely pass through the tutelage of the parents and other family members who will give such a child information expected of them, especially the one relating to their growth into adolescence.” (School Principal, Male)
However, contrary opinions were expressed by few participants who complained that some parents never provided SRH information to their children due to lack of awareness or knowledge of its importance. Such participants expressed their thoughts in the following quotes:
“Although most of the parents teach adolescents some basic things, they do not educate their children on sex-related things perhaps because they do not appreciate the importance of doing so.” (School Principal, Female)
“Some parents are not even aware of the implication of their children’s stage of development, and thus will not be in a good position to discuss SRH matters with them.” (School Principal, Male)
Health workers
Although reported as an unpopular source by most of the participants, health workers were identified as a source of SRH information to adolescents by few participants. It was pointed out that some adolescents preferred to visit informal health service providers, such as patent medicine vendors (PMVs) for SRH information, rather than formal health service providers in the primary health centers. Typical responses were:
“What adolescents do when they have problems that are related to that (SRH), is to go to patent medicine dealers rather than going to the health centers” (Policy maker, Male)
Internet, mainstream and social media
Internet and social media recurred among participants as sources of SRH information for adolescents. Whatsapp and Facebook were described as providing information on sexual relationships. Other mass media such as television and radio were also mentioned as sources of SRH information for adolescents
“In this era of explosive social media, most adolescents get information from social media; others get from television or radio” (Policy maker, Male)
“… So many discussions in Whatsapp and Facebook give people insight on what adolescents can do and their sexual relationship, so some adolescents access such media for SRH information” (Health worker, Female)
“...internet determines the fate of our younger ones these days. They always browse and do so many things there, including getting information on sexual matters.” (Health worker, Male)
“We also get (SRH) information through listening to SRH-related programs on television and radio …” (Adolescent, Female)
Church
Church was also cited as a source of SRH information by few participants, however, it was noted that the main focus of the church is abstinence from pre-marital sex.
“In addition to other sources, they also get information from the church” (Parent, Male)
“…they can get from the church especially when the church has a program. Two weeks ago, we had a program here and we had to explain certain things about sex and reproductive health to them (Male, religious Leader)
A participant observed that some churches consider discussing SRH issues with adolescents as a taboo.
“…it depends on the church; for some churches, during youth week, they invite health workers to come and talk to them on SRH, but for some others, it’s a no go area”. (Policy maker, Male)
Preferred sources of SRH information and value placed on them by adolescents
Most adolescents described friends/ peers as their most preferred sources of SRH information, while few reported parents and social media as theirs. Reasons given for preferring friends were that they felt more comfortable and at ease expressing their opinions to their friends and that friends can be trusted with sensitive information regarding SRH. Such adolescents considered it more interesting to converse with friends on SRH issues because there were no restrictions to topics they could discuss together. However, few adolescents preferred the social media, because there are numerous platforms from which they can make or connect with friends all over the world. Internet was also, considered easy to access with no limits to information that can be sourced from there. Some adolescents mentioned parents and school teachers as a preferred source of SRH information because they are most likely to provide the right information to adolescents. In the words of adolescents:
“I prefer my friend because we will open up to ourselves without any restriction. When you discuss with your friend and they tell about sex related matters, you also tell them what you know about it” (Adolescent, Female)
“...friends are preferable, because speaking with friends is very interesting” (Adolescent, Male)
“Internet is preferred because it is a network that contains all information and can be easily accessed. On Facebook you can use it to connect and chat with your friends all over the world” (Adolescent, Male)
Perceived adequacy and appropriateness of sources of SRH information
Health workers, parents and trained counselors are adequate
Most of the participants considered information from health workers as adequate because they believed that the workers were trained on SRH, and as such they delivered information sufficiently.
“I believe that information from health centers is adequate, tailored to the needs of the adolescents because the workers in such facilities are well trained on such matters” (Policy maker, Female)
In addition, some participants compared the adequacy of SRH information from different sources. Below are some of the quotes:
“Schools and parents maybe appropriate and adequate sources of sexual and reproductive information to adolescents, but schools will do more in terms of adequacy of information, if such topics are introduced in school curriculum (School teacher, female)
“...What I am sure of is that the health facilities have trained workers and are well organized for the provision of SRH information, but in schools, trainings are done once in a while, and so, will not be as adequate as health facilities in the provision of SRH information to adolescents” (Community leader, Male)
One participant noted the need to combine various sources of information to achieve adequacy of SRH information. In his words,
“Schools, churches parents are good sources of information but independently the information they pass are inadequate, no source is enough in itself. A combination of sources may be adequate” (Policymaker, Male)
Friends/peer group, social media, teachers and church are inadequate
Most of the participants were of the view that SRH information from friends/peer group, social media and the church were inadequate. A state level policymaker described information from boy/girlfriend, peers, chemists and social media to be deficient. Similarly, information gotten from school (teachers) and churches were considered inadequate because these sources mince words in providing SRH information, hence don’t give adequate and balanced information. Also, teachers and priests were regarded as giving inadequate information. For instance, SRH education may not be part of the school curriculum. Some of the quotes:
“Really what they get from their friends is not adequate…, you cannot give what you do not have. If their peers have the information they will give, but unfortunately they don’t have it. (Policy maker, Female)
“The ones I assume not to be adequate are sexual and reproductive information they crave for on the internet and the videos, face book and so on and so forth”. (Parent, Male)
Appropriateness of sources of information
Health facilities/youth friendly centers, parents and teachers are appropriate
Most of the participants, especially the parents, state level policymakers and health workers regarded parents, health workers, and teachers as appropriate sources of SRH information. They believed that parents are in a good position to give correct information, while teachers and staff of youth friendly centers are well informed to guide the adolescents sexually. According to some participants:
“Schools and parents maybe appropriate and adequate sources of information unlike social media and friends.”(Health worker, Male)
“The health workers and school teachers give appropriate information because they are trained.” (Policy maker, female)
Friends/Peer groups and social/mass media are inappropriate
All adult participants agreed that friends/peers and social media are inappropriate as sources of SRH information to adolescents. Given as reason is that these sources can provide information that are based on misconception and could be misleading. Some of them expressed their views in the following quotes are:
“A girl with painful menstruation got information from her peers that if she sleeps with a boy the menstrual pain will reduce. This is misleading!” (School principal, Female)
“What they will get from the internet might be misleading because internet is a very broad place where you can get any information positive and negative and if the person is not guided, they may not be able to know the right or the wrong.”(Religious leader, Male)
“In terms of appropriateness, friends and peers are not because all they do is to share their personal experiences which can either be negative or positive in nature” (Village head, Male).
| Discussion | | |
The findings from this study show that teachers were the commonest source of information on pubertal changes and relationship with the opposite sex, especially, to in-school adolescents. This is consistent with previous studies in Nigeria[9] and other places.[22],[23] Particularly, adolescents in school are most likely to learn about reproductive health first from school environment. On the contrary, a study reported that friends were the most common source of SRH information.[24] This disparity in findings may be due to different study methods as the study in Malaysia involved only adolescents. Nevertheless, this affirms the finding that underscores the need for comprehensive SRH education in schools and capacity building of teachers.[22] That friends/peers were also identified as a common source of information to adolescents in this study is similar to results from researches in Pakistan[24] and Bangladesh.[25] However, concerns have been expressed regarding the quality of information from these sources.[24] Other common sources of information to adolescents include mothers, and siblings, and these are not any different from results of some other studies.[26],[27],[28] Therefore, efforts to improve mothers’ knowledge and confidence in discussing SRH may be beneficial to improving adolescents’ SRH in view of the significant influence mothers have on their children’s health-related attitudes and behaviors.[23]
Our finding that social media is a source of SRH information to adolescents can be linked to the increasing availability and access to cell phones and other mobile technologies which has made it possible to reach adolescents with SRH messages through the platform. Also, books, health education campaign in schools, markets, and other community gatherings were mentioned as sources of SRH information to adolescents. Similarly, a study in another part of the country observed that such sources were effective in transmitting information on STIs to adolescents.[29]
The significant associations between sources of information about puberty (parents/guardians and other family members) and gender from our study is comparable to the result from a study in Indonesia, where girls were more likely to discuss female pubertal changes with their mothers.[30] Also, age category had significant associations with sources of information about relationships, such as, parents/guardians, other family members and friends, hence the need for age-appropriate interventions in addressing adolescent SRH challenges.
As reported from earlier studies,[31],[32],[33] the current study found that adolescents would prefer, in decreasing order of importance, friends, social and mass media, and parents as their sources of SRH information. They feel free to discuss and share SRH information with their friends, believing that in the process, they would learn how to avoid negative consequences associated with sexual activities.[34] Given the popularity of friends/peers as a source of SRH information, there is a need to explore peer education as a strong alternative to pass complete and accurate sexuality education to adolescents.[35] Also, social media was observed to have great value to adolescents, although, information from it is often viewed as detrimental to adolescents’ SRH. Therefore, intervention programs targeting the media as a platform to disseminate SRH information to adolescents should incorporate measures to prevent media misuse by adolescents. In contrast to earlier studies, ours show that parents were not the preferred sources of SRH, even though, the information from them were considered appropriate.[15],[36] This may be a reflection of the declining relevance of the African family culture.[37]
From our study, all the stakeholders believed that parents/families provided adequate information on SRH to adolescents. Likewise, a previous study showed that mothers sufficiently provided SRH information to their adolescents.[38] However, the finding differs from the results from a study in El Salvador which observed that adolescents were not getting enough information from parents.[22] That health workers were regarded in this study as providing adequate and appropriate SRH information to adolescents is at variance with the result from a study in South Africa, where nurses complained that the time allocated to them during clinics was not enough to provide sufficient SRH information to adolescents.[39] The difference in findings may be because of different study methodologies.
On the other hand, friends/peers and social media were noted as inadequate and inappropriate in the provision of SRH information, and this may explain the finding from an earlier study that adolescents lacked sufficient knowledge of SRH because they relied on their peers and social media for information.[40] From our findings, churches and schools were also, considered inadequate in adolescent SRH information delivery. Evidently, churches are known to focus on chastity, thereby neglecting other important aspects of adolescent SRH. That not-withstanding, church-based adolescent sexual health programs can be explored to support other efforts to reduce sexual health disparities among adolescents.[41] Furthermore, our findings show that schools/teachers were believed to give SRH information that are insufficient, although considered appropriate.[15] This is unfortunate considering the importance and the widespread nature of schools SRH information provision to adolescents
A major limitation of this study is that our people treat sexual issues as sensitive, and hence, may not be inclined to freely discuss them or divulge information accurately. This may have affected the responses given by some of the participants, and possibly leading to information bias. However, gender-sensitive interview guides which, ensured confidentiality were used, while, interviews and discussions were had in safe environments where participants could express themselves freely. Also, mixed methods of data collection were used and information were elicited from other stakeholders apart from adolescents, thereby obtaining a more comprehensive representation on adolescents’ sources of SRH information.
| Conclusion | | |
Adolescents receive SRH information from a variety of sources, but they value sources that guarantee confidentiality, trust and ease of access, even if these sources are considered inappropriate by their parents and other stakeholders. This may inform their preference for certain sources of SRH, which may not always be the best in terms of content, quality and accuracy. Thus, interventions for addressing the need of adolescents for SRH information should be targeted at their valued and preferred sources, whilst maintaining a delicate balance with the choices and expectations of their parents and adult family members.
Previous publication
The research leading to results included in this manuscript is part of a needs assessment data of a project which aims to address the unmet need of contraceptives among adolescents using a community-embedded intervention in Ebonyi state, Nigeria. Several manuscripts from this baseline survey has been published - BMC Public health, https://doi.org/10.1186/s12889-019-8058-5; Int J Med Health Development, doi: 10.4103/ijmh.IJMH_14_21. The datasets of the result presented in our manuscript has be deposited in UK Data Service and a detailed description of the datasets is found in a published article “Survey data of adolescents’ sexual and reproductive health in selected local governments in southeast Nigeria”. Scientific Data (2020). doi: 10.1038/s41597-020-00783.
Acknowledgement
The authors show appreciation to all the study respondents for active participation and their willingness to share their views during the interviews.
Author contributions
CM, NE, and OO conceptualized and designed the study and data collection instruments. CA, CM, IA, and CO carried out data collection. All authors took part in data analysis. CA wrote the first draft of the manuscript, while all the authors read, revised and approved the final version for submission.
Financial support and sponsorship
The research project which led to the results included in this manuscript received funding from IDRC MENA+WA implementation research project on maternal and child health (IDRC grant number: 108677). The funders did not participate in designing the study, collecting and analyzing data, or writing and reviewing the manuscript. The views expressed in this manuscript belong exclusively to the authors and do not necessarily represent the funders’ opinions.
Conflicts of interest
There are no conflicts of interest.
Data availability statement
The qualitative dataset will be made available by the corresponding author upon reasonable request. The dataset and instrument used in collection of quantitative data are deposited in a repository; Colchester, Essex: UK Data Service. 10.5255/UKDA-SN-854374.
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[Table 1], [Table 2], [Table 3], [Table 4]
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