Exploring factors affecting the decision-making process among adolescents and youth in KwaZulu-Natal in accessing and utilising sexual reproductive health services

Abstract

Despite improved access to sexual and reproductive health services, uptake among adolescents and young people remains low. Supporting their decision-making and addressing barriers to service use is critical to improving HIV prevention, reducing sexually transmitted infections, improving treatment outcomes, and preventing early pregnancies. This analysis explored factors influencing participants sexual and reproductive health service use decisions in a study conducted between June and August 2023 in KwaZulu-Natal, South Africa. Thematic analysis revealed four key themes: (1) cues to seeking sexual and reproductive health services; (2) social influences; (3) clinic experiences; and (4) perceived effort of accessing services. Most participants sought services reactively—after sex—due to concerns about potential negative outcomes, rather than proactively. Social influences and clinic experiences shaped how the effort versus the benefit of using services was evaluated. When the perceived effort outweighed the anticipated benefits, participants often avoided services. Understanding the decision process is essential for designing more responsive, user-centred programmes interventions to improve SRH service uptake among peoples.