Strengthening uptake of adolescent-friendly health services in Blantyre, Malawi

Background: Adolescent-friendly health services (AFHSs) remain underutilised across the sub-Saharan African region. Identifying strategies is crucial to enhancing uptake and mitigating impact. Aim: To explore factors influencing the uptake of AFHSs, identify key barriers and develop strategies to enhance their utilisation. Setting: The research was conducted at four selected health facilities within Blantyre District, Malawi. Methods: An explanatory sequential mixed-methods design was employed. In the first phase, a quantitative survey was administered to a randomly selected sample of 293 adolescents using a multistage sampling approach. Data were analysed using Statistical Package for Social Sciences (SPSS) version 26, employing Chi-square tests (p 0.05) to assess associations between variables and regression analysis to determine the influence of independent variables on service uptake. In the second phase, qualitative data were collected through individual interviews with six healthcare providers and three focus group discussions involving 24 adolescents. Thematic analysis was used to analyse qualitative data. Results: Findings revealed a low uptake of AFHSs at 43%. Factors influencing the low uptake included limited awareness of AFHSs, absence of designated adolescent spaces, negative provider attitudes, lack of recreational activities, frequent stock-outs of medical supplies and service preference patterns amongst adolescents. Based on these findings, nine context-specific strategies were developed to enhance access and uptake of AFHSs. Conclusion: The proposed strategies have the potential to improve the uptake of AFHSs and, consequently, increase contraceptive use amongst adolescents. Contribution: This study highlights critical barriers to the uptake of AFHSs and provides targeted strategies to address them.