Adolescent satisfaction with public health services and contraceptive use in Nepal - A sequential explanatory mixed methods study

BackgroundLimited access to and use of contraceptive services among adolescents remain a major public health concern in Nepal, influenced by their experiences and satisfaction with health services. Understanding the factors that influence adolescents satisfaction with health services is essential for improving access to and utilization of contraceptive services. This study explores determinants of adolescents satisfaction with health services and how these factors influence contraceptive service use in Nepal. MethodAn explanatory sequential mixed-methods design was employed in 154 health facilities across randomly selected 28 local levels in six districts (Surkhet, Banke, Pyuthan, Nuwakot, Parsa, and Siraha) of Nepal. Quantitative data were collected through client-exit interviews with154 adolescents on their health facility visit day, followed by qualitative interviews. Total 12 focus group discussions were conducted with adolescent girls and boys. Quantitative data were analyzed using SPSS version 26, while qualitative data were transcribed, systematically coded, and analyzed using deductive thematic approach. FindingIn quantitative results, it is found that overall, 82.5% of adolescents reported satisfaction with health services on the day of visit. The key health system factors were significantly associated with satisfaction, including confidentiality (AOR: 3.50; 95% CI: 1.19-10.37) and ease of obtaining appointments (AOR: 6.28; 95% CI: 2.18-18.08). No significant association were observed between satisfaction and adolescents socio-demographic characteristics. Despite the high-level satisfaction reported in quantitative interviews, qualitative findings revealed contrasting experiences. Adolescents reported issues such as providers judgmental attitude, inadequate confidentiality and privacy, discriminatory behavior, and limited participation in decision-making processes, influencing their service seeking behavior from public health facilities. ConclusionThis study highlights the central role of health system factors in shaping adolescents satisfaction with and use of contraceptive services. Strengthening these dimensions is essential to improve contraceptive uptake among adolescents in Nepal.