Margret B
Margret B
Margret B
BY
BIIRA MARGRET
JUNE, 2024
DECLARATION
I Biira Margret hereby declare that this Research proposal is my own original work and has
never been presented by any person to any institution for any Academic award.
The literature that was used was however got from other cases indicated in the references.
Sign………… Date…………………….
i
APPROVAL
This Research proposal was under my supervision as the institutions Research supervisor
Date……………………………..
ii
TABLE OF CONTENTS
DECLARATION..............................................................................................................................i
APPROVAL....................................................................................................................................ii
TABLE OF CONTENTS...............................................................................................................iii
ABBREVIATIONS.........................................................................................................................v
OPERATIONAL TERMS..............................................................................................................vi
1.0 Introduction...........................................................................................................................1
Chapter three..................................................................................................................................11
3.0 Introduction..........................................................................................................................11
iii
N = (0.02 (1-0.02) X1.962)/0.12..................................................................................................12
iv
ABBREVIATIONS
FP Family Planning
v
OPERATIONAL TERMS
Knowledge: This term refers to the level of understanding, awareness, and information possessed
by the youth attending Bwera General Hospitalabout the youth-friendly services available at the
health center.
Access: In this study, "access" relates to the ease with which youth attending Bwera General
Hospitalcan physically reach the health center and gain entry to avail themselves of youth-
friendly services.
Utilization: "Utilization" refers to the actual use of youth-friendly services by the youth attending
Bwera General Hospital. This term involves assessing the extent to which these services are
employed by the target population.
vi
CHAPTER ONE; INTRODUCTION
1.0 Introduction
This chapter describes the background of the study, statement of the problem, broad objective
and specific objectives
Globally, about 33% of new HIV infections occur among youth. In Sub-Saharan Africa (SSA),
women aged 15–24 years account for almost half of women acquiring HIV. YFS comprises a
major component of the global burden of sexual ill-health. Nearly a quarter of girls aged 15–
19 years are married with an estimated 16 million adolescents giving birth each year globally,
95% of whom are from low- and middle-income countries (LMICs) (Negash et al., 2016),
Trends in delayed marriages do not indicate a decrease in the age of onset of sexual activity
among the young people but rather highlights the need to improve access to YFHS information,
skills and improve services to learn more about sexuality and prevent unwanted pregnancies and
Globally, Numerous surveys in LMICs indicated that only 33% of young men and 20% of young
women have comprehensive knowledge of HIV but still less than half of young men and women
surveyed reported using condoms at their last time of sexual activity.(MOH, 2016)
sexually transmitted infections (Campbell et al., 2016) In 2016, the prevalence of teenage
pregnancy was 19.3% and 21.5% in SSA and east Africa, respectively. Nearly half of
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pregnancies among youth aged 15–19 in SSA were unintended. Pregnancy-related deaths are the
second leading cause of death among female youth.
In many African countries, sexual and reproductive health (SRH) needs of young people / youth
are often underserved and underestimated despite their demonstrated need and the urgency of
these services (WHO, 2017). Continental population remain high at approximately 1.2 billion
with the highest number being youth aged 15–24 years, 226 million—19% of the global youth p
In sub-Saharan Africa, adolescents face many significant SRH challenges such as limited access
to youth-friendly services (YFS) including information on growth, unsafe abortion, gender-based
violence, sexuality, and family planning (FP). This has led youth into risky sexual behavior
resulting in high STI and HIV prevalence among young people, early pregnancy, and
vulnerability to delivery complications resulting in high rates of death and disability (Nambile et
al., 2022). opulation of whom live in sub-Saharan Africa (Binu et al., 2016).
In Uganda, youth-friendly services remain scarce, with only 10% of the health facilities in the
country offering such services (Bukenya et al., 2019). In Uganda, the 2020 Uganda Demographic
and Health Survey (Amongin et al., 2020) reported that 24.8% of girls aged 15–19 had begun
bearing children. Over 30.4% of 15–19-year-old girls who require contraceptives are unable to
access such services, while 17.2% of adolescent girls die because of childbirth-related
complications (Amongin et al, 2020). In addition, only 41.1% of pregnant adolescent girls
attended the eight antenatal visits that are recommended by the WHO (Nabisere et al., 2019) To
my knowledge, no earlier study has been done to explore the availability, access, and utilization
of youths about youth friendly services among youths in Kasese district. This therefore tempts
the researcher to seek the previously mentioned aspects of YFS but specifically youth friendly
health services at Bwera Hospital.
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these services, and their willingness to utilize them is a complex issue that demands
comprehensive investigation.
Understanding the factors influencing youth knowledge, access, and utilization of health services
is essential for tailoring healthcare programs and policies to meet the unique needs of this
demographic. Prior research suggests that factors such as socioeconomic status, cultural beliefs,
and healthcare provider attitudes can significantly affect youth engagement with health services
(Blum et al., 2018; Mmari et al., 2014). Furthermore, the lack of adequate knowledge and access
to youth-friendly services can contribute to delayed or inadequate healthcare-seeking behavior
among young people, potentially leading to adverse health outcomes (UNFPA, 2019).
To address this knowledge gap and enhance the effectiveness of healthcare interventions
targeting youth, a comprehensive study is needed to assess the level of knowledge about youth-
friendly services, the accessibility of these services, and the extent to which they are utilized
among youth in the Bwera hospital catchment area. By identifying barriers and facilitators to
access and utilization, this research will inform evidence-based interventions aimed at improving
youth healthcare outcomes and ensuring that youth-friendly services are responsive to the unique
needs of this population.
To find out the level of utilization of youth-friendly services among youths attending services at
Bwera Hospital, Kasese district.
To recognize the accessibility of youths to friendly services among youths attending services at
Bwera Hospital, Kasese district
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1.5 Research questions
What is the knowledge of the youths on youth friendly services at Bwera Hospital, Kasese
district?
To find out the level of utilization of youth friendly services among youths attending services at
Bwera hospital, Kasese district?
To recognize the accessibility of youths to friendly services among youths attending services at
Bwera hospital, Kasese district?
The extent to which the youths attending services at Bwera hospital are aware of the available
youth friendly services, their ability to access these services, and their willingness to utilize them
isn’t yet known and is what is to be assessed in this study
The study provides critical insights into the gaps and challenges in providing youth-friendly
health services at a local health facility.
It can help identify areas for improvement in service delivery, resource allocation, and training of
healthcare personnel to better cater to the needs of adolescent and young adult populations.
The research findings can inform policy development and revisions related to adolescent
healthcare services in Uganda, contributing to the alignment of healthcare policies with the
specific needs of young people.
4
NGOs and donor agencies working in the field of youth health can use the study's results to tailor
their programs and allocate resources more effectively to address the identified challenges.
Youth advocacy groups can leverage the study's findings to advocate for improved access to
youth-friendly services in Bwera hospital District and other underserved areas, promoting the
rights and well-being of young people.
International organizations like the World Health Organization can use the study's findings to
support their global initiatives for adolescent health and provide recommendations for improving
youth-friendly healthcare services in similar contexts worldwide.
The study's results can raise awareness among community members and parents about the
importance of accessible and youth-friendly healthcare services for their adolescent children,
leading to increased support and demand for such services.
Adolescents and young adults can benefit directly from the study by gaining better access to
healthcare services that are tailored to their unique needs, promoting their physical and mental
well-being.
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CHAPTER TWO; LITERATURE REVIEW
Several studies have identified barriers that hinder young people from obtaining information
about youth-friendly services. In a study conducted by Jones et al. (2020) in the United States,
stigma surrounding sensitive topics such as sexual health was identified as a significant deterrent
to knowledge acquisition. Similarly, a lack of comprehensive sexuality education in schools was
noted as a limiting factor in youths' awareness of available services (Smith & Brown, 2018).
The level of knowledge about youth-friendly services directly correlates with their utilization.
Young people who are well-informed about the availability of these services are more likely to
access them. In a study by Garcia and Rodriguez (2017) in Spain, it was observed that
adolescents with higher levels of knowledge about youth-friendly services were more likely to
seek sexual health advice and use contraceptive methods. This underscores the importance of
knowledge as a catalyst for service utilization.
The level of knowledge about youth-friendly services among youths attending services has
significant implications for policy and practice. It underscores the need for comprehensive
sexuality education in schools, as well as the importance of healthcare providers actively
6
promoting these services to their adolescent patients. Furthermore, reducing the stigma
surrounding sensitive topics is essential for improving youths' knowledge and access to youth-
friendly services.
This literature review has highlighted the importance of assessing the level of knowledge about
youth-friendly services among youths attending services. Research indicates that knowledge is a
key determinant of service utilization, and efforts should be made to improve awareness among
young people. Comprehensive sexuality education, reduced stigma, and the active involvement
of healthcare providers are essential components of increasing knowledge and improving the
utilization of youth-friendly services.
Youth awareness of the existence and benefits of youth-friendly services is essential. Studies by
Viner et al. (2015) suggest that young people often lack awareness of such services, leading to
underutilization. Comprehensive sex education and targeted health promotion campaigns have
been recommended to improve knowledge.
The fear of stigmatization and breaches of confidentiality can deter youths from seeking services.
Dixon-Mueller and Germain (2014) highlight that healthcare providers' attitudes and behaviors
significantly influence the willingness of adolescents to access services. Ensuring non-
judgmental, confidential, and respectful care is paramount in promoting utilization.
7
Peer and parental support or opposition can sway youths' decisions to access services. Lammers
et al. (2015) found that positive parental involvement and peer encouragement were associated
with increased utilization. Conversely, negative reactions from parents or peers could discourage
service uptake.
Cultural and societal norms also play a role in utilization. In some societies, discussions related
to sexual health may be considered taboo, hindering youths' access to information and services
(UNICEF, 2020). Efforts to challenge and change these norms are essential in promoting
utilization.
Gender disparities in utilization have been documented. Ganchimeg et al. (2016) suggest that
females are more likely to access youth-friendly services than males. Understanding these
gender-based differences can inform targeted interventions.
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youth-friendly services. Studies by Anderson et al. (2018) found that financial constraints can
deter youths from seeking services, especially when these services are not covered by insurance
or require out-of-pocket expenses.
Improved accessibility to youth-friendly services has been linked to positive health outcomes
among young people. For instance, access to sexual and reproductive health services is
associated with reduced rates of unintended pregnancies and sexually transmitted infections
(Bearinger et al., 2007). Mental health services accessibility, on the other hand, has been
correlated with reduced rates of depression and substance abuse (Patton et al., 2016). ngaging
youths in the planning and development of services can enhance accessibility. McMillan et al.
(2016) discussed the importance of involving young people in the design and evaluation of
youth-friendly services to ensure their unique needs and preferences are met.
Understanding the perspectives of youths attending these services is crucial. Studies have
shown that involving young people in the design and evaluation of youth-friendly services can
enhance their accessibility and acceptability (Agampodi et al., 2018). Listening to the voices of
young service users can provide valuable insights into improving service provision. Policy and
legal frameworks also influence the accessibility of youth-friendly services. Studies by
Anderson and Johnson (2021) emphasized the importance of having supportive policies and
laws that facilitate the provision of these services and protect the rights of young individuals.
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Chapter three
Research Methodology
3.0 Introduction
This chapter presents the methods and processes of the study which include the study design,
study setting, study population, inclusion and exclusion criteria, sample size determination,
sampling technique, data management, ethical considerations, study limitations, and
dissemination of results.
The study population will include all the youths attaining health care services at Bwera General
Hospital,
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3.4 Sample size determination
Sample size was calculated based on the Kish Leslie formula for sample size determination of
cross-sectional studies.
e sample size was based on Kish Leslie’s formula for cross-sectional studies
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3.8 Data collection tools
Data will primarily be collected using an interviewer-administered questionnaire with four
sections.
Utilization of youth friendly services This refers to the actual use of the services offered at
Bwera Hospital by the young people attending health services there.
Independent Variables:
Knowledge about youth-friendly services: This refers to the exhibition of information about
the different YFS the youth could access, the why, when, and where to access these services.
Accessibility of youth-friendly services: This captures the ease with which young people can
reach and utilize the services. Factors like clinic hours, location within the hospital, wait times,
transportation costs, and stigma associated with seeking youth-friendly care can all influence
accessibility.
To ensure the validity and reliability of the data collection questionnaire and the authenticity of
the data to be collected, a structured questionnaire will be pre-tested by the researcher in a
different target population, and the necessary amendments made. 13 youths at Kagando Hospital
which is approximately 5% of the number of participants, will be selected to participate in the
pretest survey. The same questionnaire Will be administered to the study population after one
week to assess the reliability of the questionnaire. The results obtained from the first stage will
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be compared to the responses obtained in the second phase. Results obtained from the pre-test
will be used to inform amendments necessary to collect reliable and accurate data. These
questionnaires used in the pretest will not be used as part of the study population questionnaire.
The research assistant will be trained to avoid errors as he helps the researcher collect accurate
data and save time
Demographic characteristics were analyzed descriptively, the association between dependent and
independent variables will be determined using inferential statistics, and bivariate analysis will
be done to determine if there is a statistical relationship between variables and factors will be
cross-tabulated with the dependent variable where statistical significance will be determined at
p<0.05.
Pearson Chi squares will be used to establish relationships between the independent and
dependent variables. The analyzed data will be presented in charts and tables which will form the
basis for discussion and conclusion among others.
Participants will be given written consent regarding the research to seek consent. Each
participant’s choice to participate or not, will be respected and data collected from participants
will be kept confidential.
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3.4. study limitations
Because the study is cross-sectional in nature, causality cannot be established.
The study will rely on self-reported data, which is susceptible to recall bias and social
desirability bias.
A printed copy will be presented to the hospital administration at Bwera General Hospital
A soft copy of the results will be submitted to online journals for review as the results can be
significant to future researchers of the same causality.
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Appendix I: Consent Form
I am Biira Margret a student of Mountains of the Moon University, Fort Portal. I am researching
the topic of knowledge, access, and utilization of youth towards youth-friendly services
among youths attending services at Bwera Hospital.
You are requested to participate in this study by responding to the questionnaire and providing
the required. The results of the study will ensure anonymity and confidentiality of the results.
Your participation will not be rewarded financially the information provided will be beneficial
both academically and to the community.
You may choose not to participate or withdraw from the study when you feel you cannot
participate anymore.
I have been told about the study and I have understood the main aim of the study and also that
it's voluntary and confidentiality will be observed.
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Appendix II: Research Questionnaire
This study is being carried out by Biira Margrett a student pursuing a bachelor’s degree in
nursing and community health at Mountains of the Moon University. The study is entitled
“Knowledge, access and Utilization of youths towards youth friendly services among youths
attending services at Bwera General Hospital The information obtained will be used for
academic purposes and will be kept Thank you very much for your cooperation.
1. Age category
20-25 years
2. Gender:
Male Female
3. Educational Level:
Primary Secondary
4. Marital Status:
Single Married
Divorced/Separated
5. occupation
employed student
6. Have you heard about Youth-Friendly Services at Bwera General Hospital before this
study?
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Yes No
7. How did you first learn about Youth-Friendly Services? (Select all that apply)
Family School
Social media
8. On a scale of 1 to 5, how well do you understand the services offered under Youth-
Friendly Services at Bwera General Hospital?
1 2 3
4 5
2 How often have you come across information about sexual and reproductive health in the
past year?
Rarely Weekly
Monthly daily
Never
3 Are you aware of the specific location of the Youth-Friendly Services within Bwera General
Hospital?
4 Please select the sources where you have obtained information about sexual and reproductive
health:
Television Radio
Others
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Access to Youth-Friendly Services:
5 Have you ever visited Bwera General Hospital for Youth-Friendly Services?
Yes No
6 If you have visited, how would you rate the ease of accessing these services? (1 = Very
Difficult, 5 = Very Easy)
1 2 3
i. 5
7 What barriers, if any, have you encountered when trying to access Youth-Friendly Services?
(Select all that apply)
Lack of transportation
Stigma or judgment
Lack of information
Financial constraints
8 Have you ever attended a sexual and reproductive health awareness program or workshop
organized by Bwera General Hospital?
Yes No
9 On a scale of 1 to 5, how accessible do you find sexual and reproductive health information
in your community? (1 = Not accessible, 5 = Highly accessible)
1 2 3
i. 5
10 Are you comfortable discussing sexual and reproductive health issues with healthcare
providers or counselors at Bwera General Hospital?
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Yes No
11 Please indicate which of the following Youth-Friendly Services you have utilized at Bwera
General Hospital:
Contraceptive services
None
12 How satisfied are you with the quality of services provided at Bwera General Hospital's
Youth-Friendly Services? (1 = Very Dissatisfied, 5 = Very Satisfied)
1 2 3
i. 5
13 Would you recommend Youth-Friendly Services at Bwera General Hospital to your friends
or peers?
14 How many times have you utilized the Youth-Friendly Services at Bwera General Hospital in
the past year?
0 times
1-2 times
3-5 times
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15 What factors influenced your decision to utilize Youth-Friendly Services? (Select all that
apply)
Availability of services
Convenience of location
16 Please rate your overall satisfaction with the cleanliness and ambiance of the Youth-Friendly
Services facility at Bwera General Hospital. (1 = Very Dissatisfied, 5 = Very Satisfied)
1 2 3
4 5
19, How satisfied are you with the waiting times at Bwera General Hospital when accessing
Youth-Friendly Services? (1 = Very Dissatisfied, 5 = Very Satisfied)
1 2 3
4 5
Thank you
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Appendix III: Study Work Plan
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Appendix Four; Study Budget
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