Understanding sexual and reproductive health communication between adolescents, parents and healthcare providers in Rwanda

Abstract

Adolescence represents a critical phase of growth and development that occurs between the ages of 10 and 19, serving as a bridge between childhood and adulthood. This stage is characterised by significant developmental milestones, an enhanced understanding of personal identity, and the pursuit of self-identity. Similar to many low and middle-income countries, adolescents in Rwanda deal with a wide range of complex sexual and reproductive health (SRH) issues. These include the stigma associated with talking about sexuality, the lack of age-appropriate and reliable information about sexual health, and cultural norms that prevent adolescents and adults from communicating openly. High rates of unwanted pregnancies, sexually transmitted Infections (STIs), and early sexual debut among Rwandan adolescents have been reported in previous studies. Furthermore, researches indicate that adolescents' interactions with their parents and healthcare providers can have a big impact on their decision-making and encourage healthy sexual practices and also delay sexual initiation. This study aims to understand SRH communication between adolescents, parents and healthcare providers in selected settings of Rwanda. The Consolidated Criteria for Reporting Qualitative Research (COREQ) criteria were strictly adhered to in this study, ensuring methodological legitimacy and transparency. The study examined the attitudes, difficulties, and solutions around reproductive health communication among healthcare providers, adolescents and parents in using a phenomenological exploratory qualitative design. Three youth-friendly facilities of Kimisagara, Rafiki, and Kamonyi were specifically selected to reflect both urban (Kigali) and rural (Kamonyi) contexts to capture a variety of contextual and cultural influences on SRH communication. Purposive sampling was employed to find participants who could offer deep and pertinent insights. One hundred thirty-two (132) adolescents (41 males, 91 females, ages 10–19) participated in the study's adolescent communication component, while 96 parents (21 males, 75 females) and four healthcare professionals (two nurses, two midwives) participated in the parent-provider partnership component. The main technique for gathering data was focus group discussions (FGDs), with eight FGDs conducted with parents and eleven with adolescents. In-depth interviews with healthcare providers were also conducted to understand their experience towards SRH communication. Adolescent focus group discussions were categorised by gender and age (10–12, 13–14, 15–17, and 18–19) to promote equal participation and guarantee a range of viewpoints. All participants and their guardians gave their consent/assent, following ethical guidelines, before participation in the study. Several themes related to adolescent SRH communication with healthcare providers and parents were detailed in this study and included: adolescents' understanding of SRH communication, source and access to reproductive health information, the attitudes of reproductive health providers towards SRH communication, perceived barriers that hinder communication between adolescents and providers about SRH, challenges of SRH communication between adolescents and healthcare providers, communication patterns, challenges that make open dialogue difficult, and various solutions to enhance discussions about SRH between parents and adolescents, the perspectives of healthcare providers regarding SRH communication