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Adolescents and health services

Video of Dr Cicely Marston describe how qualitative research can identify social issues that prevent young people from accessing health services.
CICELY MARSTON: So I’m going to take the example of sexual and reproductive health services to show how qualitative research can help improve services for young people. Some programmes assume that given enough knowledge and given provision of services, young people will automatically use contraception and abortion services, for instance, but that’s been shown not be the case throughout the world. So the question is, why is it that young people are still not using condoms, for instance, when they’re available, and when they know that they protect against STIs? So one of the things that qualitative research has shown is that young people often judge their partners to be clean or unclean depending on how socially close they are.
So while they’re perfectly willing to– and do use condoms with say sex workers, or with someone they just met, they’ll be less likely to use a condom with someone that they’ve known for ages because they designate them as clean, and so not a risk for STIs or HIV. So that’s one of the things that qualitative research has helped us understand. Another thing is that young people may deliberately be keeping their intentions vague. So they may not want to make it clear to their partner, or the partner– they may not want to talk openly about the fact they may be about to have sex. And that could be for a number of reasons.
So one, might be that the one person might worry about looking foolish. Or maybe the woman would not want to seem overly forward because that would maybe affect her reputation, and so on. And so unclear communication is often a characteristic of well, many sexual relationships not just young people’s, but particularly in the case of young people, and particularly if they haven’t had sex before with each other or in general. Because it adds to the sort of– the possibility of it going wrong, or the kind of nervousness, and so on. And so when it comes to the actual moment of maybe having sex they might well not be at all prepared.
Now, that in itself wouldn’t be a problem if they then just didn’t have sex. But what sometimes can happen is that first of all, for some young men studies have shown that the experience of having sex is actually more important to them than the risk. And so they are willing to take a risk or maybe they don’t think there’s much of risk. And they’d rather have sex because the social rewards are so great for having sex that they just would prefer to go ahead and do it anyway. And that might be true of young women as well. Or either party might want to please their partner.
And obviously we’re talking about opposite sex sex now, but of course the same might be true of same sex relationships. And so basically you end up with a situation where there’s unclear communication potentially where maybe neither party really quite understands what the other intends to do. And so you end up in a position where contraception hasn’t been thought about, or condoms haven’t thought about. So qualitative research also gives us an idea about why young men and women might have sex with each other even though they don’t want a pregnancy, but still not use contraception. So an obvious reason for that, which most people say for young people is that they’re ignorant. So that’s a classic explanation.
They don’t know what they are doing. They’re kind of a bit stupid. They– and so the kind of methods of fixing that is just to tell them to use condoms, or tell them to use a contraceptive method. But that doesn’t take account of the reasons why they’re actually maybe going ahead and having sex without contraception in the first place. Often it’s not at all because they don’t know about methods. I mean, we already talked about the fact they might not think it’s necessary to use a method with- for STI prevention with a partner they consider to be clean.
But other reasons might include the fact that they’ve had difficulty getting access to services because the services simply aren’t available for young people. Many young men assume that the women will take responsibility for contraception. And so they might assume that the women is actually on the pill or is using some other methods without checking. Women might not feel able to obtain, or carry contraceptive methods, or suggest using them because of the risks of their reputation that that entails. So there’s a sort of a social desirability, or there’s a social desire to kind of be swept away in the moment.
And women who are not swept away, women who plan too carefully are seen as sort of morally suspect in many cultures and many settings.

Qualitative research can help to improve health interventions for adolescents and young people. In this video, Dr Cicely Marston uses the example of sexual and reproductive health to demonstrate why simply providing information and services is not always enough.

How can research help?

Qualitative research can give us clues about why young people might not take up contraception to protect against unwanted pregnancies and STIs, even when given enough information about contraceptive methods.

Social influences and pressures can be drawn out through qualitative research. Social expectations, particularly those around how men and women should behave, are a powerful influence on behaviour, as are young people’s ideas about stigma and risk. These pressures can make it harder to communicate clearly with a partner, making safe sex less likely.

How does this relate to health services?

Providing information and methods such as condoms without addressing some of the crucial social factors identified is clearly problematic. Involving young people in the planning and operation of programmes helps to position activities correctly and identify problems as they arise. An intervention for young people that doesn’t involve them during the design and implementation stages is likely to be unsuccessful.

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Improving the Health of Women, Children and Adolescents: from Evidence to Action

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