Evaluating the Accessibility, Availability, and Utilization of Services in Adolescent Friendly Health Clinics: Insights from a Rural, Backward Caste-Dominated District in Eastern India

Sribas Ray, Rajib Saha, Aditya Prasad Sarkar

Abstract

Objective: In India, despite the presence of Adolescent Friendly Health Clinics (Anwesha Clinics), barriers to accessing these services remain prevalent. This study explores the accessibility, availability, and utilization of services at Anwesha Clinics in Bankura Health District, a rural, backward caste-dominated district in eastern India.
Material and Methods: This study employed an analytical design with an explanatory sequential mixed-methods approach, combining quantitative and qualitative data. The research was conducted across three randomly selected Anwesha Clinics in Bankura, covering a total sample size of 212 adolescents. Data collection spanned 18 months (April 2021–September 2022) and included a pre-designed semi-structured questionnaire for quantitative data, focus group discussions (FGDs) with adolescents who never visited the clinic, and in-depth interviews with counselors for qualitative insights. Clinic infrastructure and IEC materials were assessed using a UNFPA (United Nations Population Fund) reportbased checklist. Quantitative data were analyzed using SPSS for descriptive statistics, chi-square tests, and logistic regression to identify predictors of service utilization. Qualitative data were thematically analyzed, with coding to identify themes related to service access and barriers.
Results: The study found 66.51% service utilization, predominantly for counseling, menstrual issues, and anemia. Barriers included lack of awareness, distance, privacy concerns, and inadequate clinic infrastructure. Logistic regression identified significant predictors of service utilization, with females, adolescents from lower socio-economic classes, and those within 3 km of a clinic being more likely to utilize services.
Conclusion: Enhancing clinic infrastructure, increasing awareness, and ensuring privacy are crucial for improving adolescent engagement with Adolescent Friendly Health Clinics.

 Keywords

Adolescent Friendly Health Clinics; explanatory sequential mixed-methods approach; focus group discussions; service utilization

 Full Text:

PDF

References

World Health Organization. Adolescents: health risks and solutions. Geneva: WHO; 2020.

United Nations Population Fund. State of world population 2019. New York: United Nations Population Fund; 2019.

Jain A, Singh A. Reproductive health issues among adolescents in India: a review. Int J Community Med Public Health 2018;5: 1883-90.

World Health Organization. Adolescent-friendly health services: An agenda for change. Geneva: WHO; 2018.

Kessler RC, Berglund P, Demler O. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2012;62:593-602.

Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry 2010;49:980-89.

Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.

Suicide in the world: global health estimates. Geneva: WHO; 2019.

Bej P. A review of adolescent health in India: issues and concerns. Asian J Psychiatr 2016;23:22-31.

Goyal N. Morbidity pattern and its correlates among adolescent girls residing in rural and urban areas of Haldwani, India. Int J Community Med Public Health 2018;5:4889.

SPSS Inc. Released 2007, SPSS for Windows, Version 16.0. Chicago: SPSS Inc; 2007.

Mahalakshmy T, Premarajan KC, Soundappan K, Rajarethinam K, Krishnamoorthy Y, Rajalatchumi A, et al. Awareness of adolescent-friendly health services in India. J Adolesc Health 2015;56:367-73.

Tiwari VK, Sinha S, Sharma V, Yadav R, Singh A, Kumar P, et al. Barriers to accessing adolescent health services in rural areas. Indian J Public Health 2015;59:111–6.

Dixit GT, Jain S, Mansuri F, Jakasania A. Factors influencing access to adolescent health services in India. Int J Health Serv 2016;46:274-82.

Gupta M, Bhatnagar N, Bahugana P. Misconceptions and barriers to accessing AFHC in adolescents. BMC Health Serv Res 2017;17:234.

Sinha S. Barriers to accessing healthcare in rural adolescents. Indian J Rural Health 2017;15:123-9.

Ramesh S. Parent and peer involvement in adolescent health awareness programs. J Adolesc Health 2015;57:182-8.

Patel S. Impact of outreach activities on adolescent health service utilization in Gujarat. Indian J Pediatr 2018;85:385-90.

Chauhan SL, Joshi BN, Raina N, Kulkarni RN. Quality assessment of adolescent friendly health clinics: a study from India. J Adolesc Health 2020;67:132-8.

Bali S. Barriers to utilization of adolescent health services: findings from Madhya Pradesh. J Adolesc Health 2019;64:253- 58.

Bhat AA. A review of adolescent friendly health centres in North India: gaps and recommendations. Indian J Public Health 2019;63:376-80.

Assessment of adolescent reproductive and sexual health centres in Gujarat. Gujarat: Government of Gujarat, Department of Health and Family Welfare; 2018.

Mahalakshmy T, Premarajan KC, Soundappan K, Rajarethinam K, Krishnamoorthy Y, Rajalatchumi A, et al. Utilization of adolescent health services in puducherry: a community-based study. Indian J Public Health 2019;63:53-8.

Dixit GT, Jain S, Mansuri F, Jakasania A. Utilization of adolescent friendly health services in India: a study in urban and rural settings. J Adolesc Health 2015;56:430-38.

Hoopes AJ, Agarwal P, Bull S, Chandra-Mouli V. Measuring adolescent friendly health services in India: a scoping review. BMC Health Serv Res 2019;19:524-36.

Giri N, Shrestha S, Uprety S, Sangroula RK. Utilization of adolescent friendly health services in nepal: a cross-sectional study. J Adolesc Health 2021;68:487-93.

Khera AP. Barriers to Accessing Adolescent Friendly Health Services in Gaya, India. Int J Health Serv 2019;49:239-48.

Prasad RR. Factors associated with utilization of adolescent friendly health centers in Jaipur, India. Indian J Med Sci 2020; 72:129-35.

Kotecha, PV, Patel MB. Factors influencing utilization of adolescent friendly health services in rural India. Indian J Public Health 2008;52:13-6.

Kotecha PV, Soni P, Patel M. Barriers to the utilization of adolescent-friendly health services: a study from Gujarat, India. Int J Adolesc Med Health 2012;24:221-5.

Mahalakshmy T, Kumar P, Ravi M. An assessment of factors influencing utilization of adolescent health services in Puducherry, India. Indian J Community Health 2019;31:134-9.

Prasad RR, Kumar M. Factors associated with underutilization of adolescent-friendly health services in Jaipur, India. J Adolesc 2020;39:101-7.

DOI: http://dx.doi.org/10.31584/jhsmr.20261324

Refbacks

  • There are currently no refbacks.
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.