Study design, Period and Setting
School based comparative cross-sectional study design was used to assess the extent of Sexual and reproductive health services utilization among youth friendly service implemented and non-implemented schools and the associated factors among adolescent from 1-30, March 2019 in south Ari district, South Omo, Southern Ethiopia. South Ari is located at a distance of 735 Km away from Addis Ababa, the capital city of Ethiopia. There is a total of six secondary schools in the district, from which two of them are implemented youth friendly services.
Source Population: All adolescents of age between 15-19 years who attended public high school in the year 2019.
Study Population: All adolescents of age between 15 - 19 years in selected public schools during data collection period.
Sample size determination
The sample size for this study was determined using a formula for estimation of two population proportion using Epi info software version 7 with the assumptions of; 41.1% ever users RH services taken from previous study on utilization of RH in urban area for magnitude of utilization of sexual and reproductive health services of Youth-friendly service-implemented site(14), 21.5% ever users of RH services taken from previous study on reproductive health services utilization among rural adolescents in east Gojjam zone for magnitude utilization of sexual and reproductive health services of non-implemented sites(5), 95% confidence level, 5% margin of error, 80% power, 1:1 YFS implemented to YFS non-implemented ratio, 10% estimated non–response rate and considering a design effect of 2. The total sample size for the first objective was 428 (214 for YFS implemented and 214 for YFS non-implemented areas).
Sampling procedure
Multi-stage sampling technique was employed in order to select a representative sample of students. Four secondary schools (two from YFS sites and two non-YFS sites) were selected randomly out of seven secondary schools in the woreda. Samples were selected from the selected schools proportional to their size of the student population. The total sample was allocated to each grade from grade 9 to 12 proportionate to their student population size. From each grade, sections were selected randomly. Finally, the study participants were recruited by a simple random method based on their attendance list in their respective schools. On the day of data collection, the randomly selected students were told to remain in their classes. Finally, the study participants were recruited by a simple random method based on their attendance list. On the day of data collection, the randomly selected students were told to remain in their classes.
Dependent Variable was sexual and reproductive health services utilization.
Independent variables were predisposing, enabling and need factors. The predisposing factors are sex, age, income status, and place of living and marital status (or relationship condition), knowledge and attitude. The enabling factors are; access to services, cost of the SRH services and perceived parental income status. The need factors include perceived need for SRHS, perceived personal health status, worries (concern) about health.
Operational definition
Adolescent
In this study adolescent stands for boys and girls between the ages of 15–19.
High school- Grade 9-12
Reproductive health services- services provided for adolescents such as advice and counseling on sexual and reproductive issues, Voluntary Counseling and Testing, Condom provision, family planning, abortion & post abortion care, and sexual transmitted infection treatment in Health centers and/or public Hospitals.
Utilization of sexual and reproductive health services-this was measured through the dichotomous response (yes or no) by asking whether a participant had utilized one or more of SRH service components within the last 12 months. The positive response was further validated with questions on the type of SRH services utilized. A positive (“yes”) response to any one of these services was regarded as service utilization(15).
Knowledge of SRH services- Adolescents who score above the mean of reproductive health service related questions were labeled as having high knowledge and those score below the mean were considered as having low knowledge.
Attitude-To measure adolescent’s attitude on YFHS, other questions were used to construct composite score: “Positive Attitude” those who scored above a mean on attitude measuring YFS questions and “Negative Attitude” those who scored a mean or below the mean in the attitude measuring YFS questions.
Data collection tools and procedures
The data collection instrument was self-administered questionnaire; a number of questions that can address the objective of the study. The questionnaires were developed by after reviewing previous similar literatures. The questionnaire was prepared in English and translated to Amharic and back to English for consistency of meaning. Pre-test of the questionnaire was done on 5% of the sample size in people who were not included in the study two weeks before beginning of the actual data collection and modification were made based on feedback from the pretest. Data was collected by four Diploma health workers. Two supervisors with BSc degree in heath and fluent in Amharic were assigned.
Data quality assurance
To assure the quality of data, properly designed data collection instruments were prepared. Appropriate training for facilitators and supervisors that include a briefing on the general objective of the study, discussing the contents of the questionnaire was given. The overall activity of data collection was supervised and coordinated by the principal investigator. The collected data was reviewed and checked for completeness and relevance before data entry by the supervisors and principal investigator. The variables were defined or coded, then the data editing was carried out during entry of data.
Data analysis procedure
Data were entered in to Epi Data version 4.4.1 software and then exported to SPSS version 20 statistical package for analysis. Descriptive statistics were computed and summarized by tables, frequencies, graphs, mean, and proportion. Odds ratios and confidence interval were also calculated to determine the strength of association of the selected variable. The association between utilization and its independent variable were examined by binary logistic regression. Variables which showed significant association and having p-value ≤ 0.25 in bivariate logistic regressions were a potential candidate for multivariable logistic regression analysis to control confounders in regression models. The association between reproductive health utilization and associated factors were reported by odds ratio at 95% CI and variables having p-value less than 0.05 in the multivariable logistic regression model was considered as statistically significant.