Adolescent-friendly services : experiences of adolescents living with HIV attending healthcare services in Botha-Bothe District in Lesotho

Mabandla, Mamoferefere Tatapa Zim (2020-03)

Thesis (MNur)--Stellenbosch University, 2020.

Thesis

ENGLISH SUMMARY : There is an increased focus on the promotion of health and wellbeing amongst adolescents. Adolescents living with HIV (ALHIV) need to access high-quality and comprehensive health services. Adolescent-friendly services are services which are easy to reach, are appealing, and are delivered in acceptable ways to adolescents, to meet their health needs. Considering the health of adolescents, the need for adolescent-friendly services was identified, to lessen the load of diseases and to decrease the number of deaths that occur amongst adolescents. The adolescent HIV burden is still a concern and countries are struggling to establish interventions that are effective for positively influencing HIV related outcomes in this group. There are few studies on the experiences of ALHIV about accessing health services in different countries and various health facilities. Little is known about adolescent-friendly services for ALHIV in the context of Lesotho. Aim: The study aimed to explore and to describe the experiences of ALHIV regarding attending healthcare services in Botha-Bothe District Lesotho, in order to make recommendations towards improving adolescent-friendly services. Method: A qualitative exploratory-descriptive research design was applied. The Health Research Ethics Committee (HREC) from Stellenbosch University and the Research Coordinating Unit (RCU) from the Lesotho Ministry of Health approved the study. Twelve ALHIV between the ages of fourteen (14) and nineteen (19), who were attending healthcare services at Baylor or Ngoajane health facilities and were aware of their HIV status, were purposively selected to participate in the study. For adolescents under eighteen (18) years old, written informed adolescent assent and parental consent was obtained. Written informed consent was obtained from adolescents aged between eighteen and nineteen (18 and 19). Individual interviews were conducted by the researcher. The six steps of data analysis described by Creswell were applied when analysing the data. The researcher ensured trustworthiness by adhering to the principles of confirmability, transferability, credibility and dependability. Results: Five themes were identified: the social environment of the health facility, the physical environment of the health facility, services, support and expectations regarding healthcare services. Communication between the participants and the healthcare workers was challenging. It seemed that it was difficult to communicate effectively because of the generation gap and the adolescent stage of development. Healthcare workers were more likely to communicate in a consistent respectful manner if adolescents were adherent to treatment and care. Health facilities do not have a dedicated space to allow adolescents to interact with peers and share their experiences. Services that adolescents use in the facilities are counseling and HIV care and treatment. Family members seemed to be involved minimally in the care and in the treatment of adolescents. Adolescents prefer services to be provided on a Friday after school, or on a Saturday when they are not attending school. Conclusion: ALHIV need to access comprehensive adolescent-friendly services, as this may improve their health outcomes. The elements of adolescent-friendly services that could be improved include providing a dedicated space, the provision of ageappropriate educational materials, encouraging care partnerships and the training of healthcare workers to ensure technical and attitudinal competences, in providing healthcare services to adolescents.

AFRIKAANSE OPSOMMING : Agtergrond: Daar is 'n verhoogde fokus op die bevordering van gesondheid en welstand onder adolessente. Adolessente wat met MIV leef (ALMIV) moet toegang hê tot hoë gehalte en omvattende gesondheidsdienste. Adolessent-vriendelike dienste is dienste wat maklik is om te bereik, is aanloklik, en word gelewer in aanvaarbare maniere om in adolessente se gesondheidsbehoeftes te voorsien. Met inagneming van die gesondheid van adolessente, is die behoefte aan adolessent-vriendelike dienste geïdentifiseer, om die lading van siektes te verminder en om die aantal sterftes wat onder adolessente voorkom te verminder. Die adolessent MIV-las is steeds 'n bekommernis en lande sukkel om intervensies te vestig wat effektief is om die MIV-verwante uitkomste in hierdie groep positief te beïnvloed. Daar is min studies oor die ervaringe van ALMIV oor die toegang tot gesondheidsdienste in verskillende lande en verskeie gesondheidsfasiliteite. Min is bekend oor adolessentvriendelike dienste vir ALMIV in die konteks van Lesotho. Doel: Die studie het ten doel gehad om die ervaringe van ALMIV oor die bywoning van gesondheidsdienste in Botha-Bothe distrik Lesotho te verken en te beskryf, ten einde aanbevelings te maak om adolessent-vriendelike dienste te verbeter. Metode: 'n Kwalitatiewe verkennende-beskrywende navorsingsontwerp is toegepas. Die gesondheidsnavorsings etiekkomitee (GNEK) van die Universiteit Stellenbosch en die navorsing koördinerende eenheid (NKE) van die Lesotho ministerie van gesondheid het die studie goedgekeur. Twaalf ALMIV tussen die ouderdom van veertien (14) en negentien (19), wat gesondheidsdienste by Baylor of Ngoajane gesondheidsfasiliteite bygewoon het en van hul MIV-status bewus was, was doelbewus gekies om aan die studie deel te neem. Vir adolessente onder agtien (18) jaar oud, is skriftelike ingeligte adolessente bekragtiging en ouer toestemming verkry. Skriftelike ingeligte toestemming is verkry van adolessente tussen agtien en negentien (18 en 19). Individuele onderhoude is deur die navorser gedoen. Die ses stappe van data-analise wat deur Creswel beskryf is, is toegepas wanneer die data ontleed was. Die navorser het betroubaarheid verseker deur aan die beginsels geloofwaardigheid, bevestigbaarheid, oordraagbaarheid en bestendigheid, te voldoen. Resultate: Vyf temas is geïdentifiseer: die sosiale omgewing van die gesondheidfasiliteit, die fisiese omgewing van die gesondheidfasiliteit, dienste, ondersteuning en verwagtinge met betrekking tot gesondheidsdienste. Kommunikasie tussen die deelnemers en die gesondheidsorgwerkers was uitdagend. Dit was moeilik om effektief te kommunikeer as gevolg van die generasie gaping en die adolessente se stadium van ontwikkeling. Gesondheidswerkers was meer geneig om in 'n konsekwente respekvolle wyse te kommunikeer as adolessente toegewy was aan behandeling en sorg. Gesondheidsfasiliteite het nie 'n toegewyde ruimte om adolessente toe te laat om met eweknieë te kommunikeer en hul ervarings te deel nie. Dienste wat adolessente in die fasiliteite gebruik, is berading en MIV sorg en behandeling. Gesinslede was minimaal betrokke in die sorg en in die behandeling van adolessente. Adolessente verkies dat dienste op 'n Vrydag na skool, of op 'n Saterdag wanneer hulle nie skool bywoon nie, aangebied word. Slotsom: Omvattende adolessent-vriendelike dienste moet aan adolessente gelewer word, aangesien dit hul gesondheidsuitkomste kan verbeter. Die elemente van adolessentvriendelike dienste wat verbeter kan word, sluit in die verskaffing van 'n toegewyde ruimte, die voorsiening van ouderdoms toepaslike opvoedkundige materiale, aanmoediging van sorgvennootskappe en die opleiding van gesondheidsorgwerkers in tegniese- en houdings-vaardighede, in die verskaffing van gesondheidsorg dienste aan adolessente.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/108137
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