Previous studies on YHCs focused on client satisfaction, process of service delivery, and clinic setting. However, limited research investigated the youth perspectives in developing countries [2, 7, 11, 12]. The present study focused on identifying the youth perceived health needs and attitude towards use of the YHCs as an approach of service delivery among Assiut University students.
In this research, the majority (80%) of participants reported that youth have special health needs. Mental health was mentioned most often followed by health education and nutritional services. The participants in Oraby’s study in Egypt (2013) reported the need for SRH services such as information on masturbation and its supposed side effects for young men and hymen and virginity for young women [11]. Khalaf et al. in Jordan found that both male and female youth expressed the need for an awareness related to reproductive health, especially issues related sexual health, maternal issues, and psychological issues [8].
In our study, most of respondents agreed that health services did not meet youth health needs mostly attributing it to low quality while nearly one quarter said that no services for youth were available. Oraby stated that limited space and regulation in some YHCs negatively affect confidentiality and privacy of young people [11]. Similarly, Jordanian youth mentioned low quality of services, inaccessibility, lack of resources, and unqualified health care provider were the problems encountered by them when using reproductive health services [8]. Also, Ghafari et al. in Malaysia found that low professional skills of health care providers mitigated proper use of youth services [3]. DeJong and El-Khoury indicated that government health services generally do not recognize the special needs of young people or foster the environment that supports them [13]. The WHO reported that lacking of adolescent responsive health systems is a problem in much of the world and need to expand coverage and adopt standards in delivering youth services [14]. Also, the UNFPA declared that adolescents’ services in Arabic countries are overlooked by maternal and child services and by services for adults [15].
Regarding participants’ opinions about the specific services that they would like to see offered in a youth-focused clinic, the majority expressed an interest in counseling and laboratory tests and nearly half expressed an interest in premarital examinations. This is consistent with Motuma et al. in their study in Ethiopia who mentioned that reproductive health counseling was utilized by nearly 60% of the study youth participants [7]. Atuyambe et al. in their qualitative study in Uganda indicated that adolescents had multiple needs for reproductive health to be addressed through adolescent-friendly services and in particular young counseling services [16].
Similarly, other studies reported the lack of reproductive knowledge and emphasized the importance of reproductive counseling for young adults. Mohammadi et al. in Tehran, Iran, showed that half of the male adolescents had poor knowledge about reproductive health [17]. Moodi et al. found that premarital couples had poor knowledge on reproductive health [18]. Furthermore, Mosavi et al. in Iran, revealed that the most important problems related to adolescents’ SRH were the lack of accurate information [19]. Khalaf et al. in their qualitative study in Jordan indicated that both male and female youth had a limited reproductive health information [8]. Similarly, Gausman et al. in Jordan reported that Jordanian youth need reproductive health-related information [20].
The study by the FHI-UNFPA reported that young people desire services that respect confidentiality, privacy, and build bridges of trust between them and service providers [12]. Khalaf et al. in Jordan found that youth would like to use youth reproductive health services that are available, attractive, accessible, with proper resources including skilled personnel, and preferably only for youth [8].
Regarding preferences of participants for the characteristics of youth-friendly services, in the current study, students preferred the YHC to be offered on campus. Easy accessibility, delivered with a high level of competence, and serving larger number of youths were the most cited reasons. They preferred the services to be exclusive for youth and explained this preference as youth are a vulnerable group with special problems. FHI-UNFPA reported that YFCs in Egypt should be in places which young people tend to be frequent such as youth centers, sporting clubs, mosques, and churches and provision of the services within an environment that suit their preferences. Furthermore, the need of technically competent and empathetic providers was noted [12].
Most students preferred services to be offered at non-traditional times, while Atuyambe et al. in Uganda showed that adolescents preferred RH services to be available all the time (opening and closing hours) [16].
In the present study, nearly two thirds of respondents preferred the provider to be of the same sex. This agreed with the findings that emphasized preference of youth for providers of the same gender [16, 21]. Lack of health providers of same gender affects negatively the utilization of service in Egypt. Oraby mentioned that absence of a male doctor in some YFCs limited the uptake of services by male clients [11]. The FHI-UNFPA reported that in Egypt doctors of the same sex as their clients would help imparting a feeling of ease between client and physician and contributing to making services youth friendly [22].
The UNFPA reported that a basic right for females and males is to provide them with the tools to understand their sexual responsibilities and enrich their sexual knowledge and awareness [23]. In the present study, the overwhelming majority of respondents agreed that university students need SRH information and realized the importance of availability of SRH educational materials on campus as well as establishing a clinic providing SRH services in campus. In consistence with our results, Motuma et al. in Ethiopia reported that about 70% of the youth respondents reported that the youth should get important information, education, and communication (IEC) on RH at the age of 15 years or older [7].
In the current study, the vast majority indicated that they did not believe that SRH information leads to high-risk sexual behaviors. Similarly, Simbar et al. in Iran found that more than two thirds of Iranian university students did not believe that educating young people about SRH would lead to sexual immorality [24]. A study conducted among male adolescents in Tehran, Iran, concluded that limited adolescents’ knowledge regarding STIs poses a significant threat to their sexual and reproductive health [17].
In the present study, participated students had positive attitude towards SRH either providing information or establishing a clinic in spite of the conservative culture known about the population in Upper Egypt. In the same line, only 10% of participants in this study agreed that visiting a YHC would indicate that someone was sexually active. In contrast, negative attitude was reported in the middle east and north Africa by DeJong et al., where youth reluctance in seeking sexual information was due to fear to be misunderstood as being engaged in sexual relation [25].
Only 15% of students in this study were aware that a YHC existed. In agreement with Senderowitz et al., the lack of awareness and little knowledge of the available SRH services were significant barriers to young clients [26]. Also, Oraby in Egypt revealed that non-beneficiaries of YHCs tended to report that they had simply “never heard about YHCs” [11].
Among the small group who had used the YHC, just over half had heard about it from an advertisement, followed by friends, and health education sessions. In the study conducted in Egypt by Oraby, she found that beneficiaries of YHCs had heard about the clinics through the sessions conducted by peer educators or while accompanying a friend or a relative where governmental YHCs are located [11].
In the present study, students who were aware of the YHC but had never used it reported reasons like they did not have a health problem, did not have enough information about the YHC, and felt shamed about using it. In consistency, Hoggart and Phillips in the UK [27] and Bankole and Malarcher in four countries of Africa (Burkina Faso, Ghana, Malawi, and Uganda) recognized that fear of discrimination and disrespect hurdles young people who need to use SRH services [28]. Oraby’s study in Egypt and Mohammadi et al.’s in Iran revealed that all YHCs have under-utilized capacity. They stated that the possible causes of under-utilization of YHCs included, negative attitude of the surrounding community towards youth especially to unmarried youth who culturally are not expected to need SRH services and are stigmatized if they sought care from these services [11, 29].
Study limitations
Results are not representative to the whole youth in Upper Egypt. They are limited to university students as there are groups of youth who did not join university education. Another limitation is non-use of a standardized questionnaire, studying a limited number of relationships, and the possibility of a desirable response when we use interviews.
