Socio-cultural and programmatic contextual influences on adolescents' sexual and reproductive health help-seeking behaviour in Grenada

The response to ASRH has been ad-hoc in the Caribbean island of Grenada, with the exception of sexuality education offered by schools and a few non-governmental organizations. No SRH policy or services specifically for adolescents exist, and pertinent legislations have age and gender gaps. Additionally, adolescent sexuality is taboo and adolescents experience various negative SRH outcomes. Therefore, it is critical to understand adolescents� help-seeking behaviours to cope with their SRH concerns, to inform the design and implementation of adolescent-friendly services and policies.

The aim of this thesis is to understand how adolescents aged 16-19 in Grenada perceive the socio-cultural and programmatic contexts as it relates to facilitating and hindering their help-seeking behaviour for sexual and reproductive health concerns. The research was guided by an ecological help-seeking framework and used an exploratory, qualitative constructionist approach. During 2009 and 2010, focus groups and semi-structured interviews were conducted among male and female adolescents in a rural and an urban community, and in two institutions for: 1) boys who are out-of-school, and 2) pregnant or adolescent mothers. Key informant interviews were conducted with organizational stakeholders, focus groups with key community members, and pertinent legislative, policy, and program documents were reviewed. Data were analyzed using framework analysis, managed in NVivo 8 software.

The study found that adolescents pathways to help-seeking involves the complex processes of a) identifying the SRH concern, b) identifying a need for help, c) seeking and accessing help and, d) assessing the help received. Mothers and other female relatives play an important role in all stages of the help-seeking. The socio-cultural and programmatic contexts interacted to primarily hinder adolescents� SRH behaviours at all stages of their help-seeking pathways. Desirable characteristic of sources of help are identified, and recommendations are suggested to improve ASRH help-seeking and help-giving in Grenada. It is hoped that by providing coordinated, comprehensive, and effective interventions, local stakeholders can address the key contextual factors to help adolescents cope successfully with their SRH concerns.