Abstract,
Background: The World Health Organization (WHO) defines adolescents as those between the ages of 10 and 19. Parent-adolescent communication is a fundamental process through which parents convey ideas, values, beliefs, expectations, information, and knowledge to their children. Parents are one of the primary stakeholders who plays important roles in protecting adolescents from risky sexual behaviors such as unsafe sex, unwanted pregnancy, substance use, and violence.
Methodology: A quantitative, descriptive cross-sectional study using self- administered questionnaire was carried out in sundarharaincha municipality of koshi province among 265 adolescent participants. Simple random sampling was used for selecting schools while purposive sampling was used for participant selection. Excel and SPSS were being used for data coding, decoding, and statistical analysis.
Findings: According to the survey, a minority of respondents (31.3%) had inadequate understanding of SRH issues, while the majority (68.7%) had appropriate knowledge of these issues. Additionally, the majority of respondents (70.2%) reported having a sufficient amount of communication with their parents regarding SRH difficulties, whereas the minority (29.8%) reported having a low degree of communication.
Conclusion: The survey indicates that adolescents have a good understanding of sexual and reproductive health and effectively communicate with their parents about health-related issues. To improve parents’ adolescent communication, the study suggests conducting community awareness programs and creating a friendly environment between adolescents and parents.
Keywords: Parent-adolescent; Communication; Sexual; Reproductive health; Nepal
Introduction,
Adolescence is a transitional phase of growth and development between childhood and adulthood. The terms adolescent, youth and young people are used interchangeably to represent people of young age. According to World Health Organization (WHO), adolescent refers to the age group 10 to 19 where as young people represent the people of age group 10 to 24. Population who falls in the age group 15-24 is considered as a youth. Adolescence is a transitional developmental period between childhood and adulthood characterized by biological, psychological, and social role changes [1]. Moreover, this stage of development is a critical period for the establishment of lifelong positive and risky health-related behaviors [2]. Adolescent Sexual and Reproductive Health (ASRH) has been overlooked historically despite the high risks it has been neglected in our society. Some of the challenges faced by adolescents include early pregnancy and parenthood, difficulties accessing contraception and safe abortion, and high rates of HIV and sexually transmitted infections. Various political, economic, and sociocultural factors restrict the delivery of information and services; healthcare workers often act as a barrier to care by failing to provide young people with supportive, nonjudgmental, youth-appropriate services [3].
Parent-adolescent communication is a fundamental process through which parents convey ideas, values, beliefs, expectations, information, and knowledge to their children [4]. Parents are one of the primary stakeholders who plays important roles in protecting adolescents from risky sexual behaviors such as unsafe sex, unwanted pregnancy, substance use, and violence. Parents who are open enough for their child with regards to sexuality have better communication which is important to reduce risky sexual behaviors such as early sexual initiation, unwanted pregnancy, and other reproductive health problems. Different factors like cultural taboo feel embraced to discuss on sexual issues, lack of communication skill, belief on sexuality, and knowledge on sexuality affect adolescent parent communication on SRH issues [5]. Effective parent-adolescent communication is important to reduce adolescents’ engagement in risky sexual behaviors [6]. Parent–adolescent communication about SRH prevents adolescents from adopting unhealthy SRH practices [7]. Sexual activities begin at early age and rates of sexual initiation during young adulthood are rising or remaining unchanged in many developing countries, high HIV prevalence adds to the risks associated with early sexual activity, thus Parent-adolescent communication plays important role to reduce those risky behaviors [8].
Adolescents often lack basic reproductive health RH information, knowledge, and access to health services for RH [9]. Adolescents’ knowledge and access to reproductive health services is important for their physical and psychosocial wellbeing [10]. Inadequate knowledge of health services and negative effects on sexual and reproductive health, such as unintended pregnancies, unsafe abortions, and HIV/AIDS, cause a significant number of deaths among adolescents and young people worldwide between the ages of 10-24 years [11]. The aim of this study is to assess adolescent students' understanding of sexual and reproductive health issues as well as parent-adolescent communication.
Methods,
This was a quantitative, descriptive cross-sectional study conducted in sundarharaincha municipality of Koshi province of Nepal among 265 secondary level science and management students. The sample size was determined using single population proportion formula considering the following assumptions: P=21.3% (proportion of students communicating on SRH issues with parents which was taken from previously done study, (Sexual and reproductive health communication between parents and high school adolescent Global health action 2020) [12]:
Sample size (n) = [z2pq/d2]
Here, z = 1.96 for 95% confidence interval
P = prevalence =21.3%=21.3/100=0.213
q= (1-p)=1-0.213=0.787
d= allowable error (5%)
According to the formula,
Sample size (n) = [z2pq/d2]
= 1.962*0.213*0.787/0.052
=258
Adding 10% non-respondent rate,
=258+258*10/100=258+25.8=282.8=283
The estimated sample size was 283, but 18 respondents deny for the participation thus the actual sample size was 265. (265 data were taken)
Two schools Sukuna Multiple Campus and Sukuna Secondary School of Sundarharaincha Municipality were randomly selected for the study and participants from these two schools were purposively selected. Self-Administered questionnaire was used as a technique of data collection. Self-Administered Questionnaire consists of question related to demographic information and Question related to SRH knowledge and parent-adolescent communication on SRH issues. After collection of data, all responses were check for their completeness, correctness and internal consistency to exclude missing or inconsistent data. Corrected data was entered into the epi data. The data was analyzed by using statistical software namely SPSS (statistical Package for Social Science) version 25. Statistical significance was set at a 95% confidence level and p<0.05. The purposed study was conducted after the ethical approval from IRC. Administrative approval was obtained from the respective college of Sundarharaincha Municipality. Written informed consent was taken from the participants before starting the research. Privacy and confidentiality were ensured.
Result,
Table 1 showed that majority of respondents (84.2%) were late adolescents followed by (15.8%) early adolescents. Majority of respondents (54%) were female and remaining (46%) were male. Majority of respondent (61.9%) were Brahmin/chhetri followed by (30.9%) Janajati, (4.9%) Dalit and (2.3%) Others. The majority of respondent father’s education (63%) were Secondary level followed by (30.2%) Basic level and (6.8%) University level. Likewise, majority of respondent’s mother’s education (51.7%) were Secondary level followed by (46%) Basic level and (2.3%) University level.
Characteristics n=265
Frequency
Percentage (%)
Age of respondent
Early adolescent (15-16)
42
15.8
Late adolescent (17-19)
Mean age ±S.D=17.46±0.925223
84.2
Sex of respondent
Male
122
46.0
Female
143
54.0
Ethnicity
Brahmin/ chhatri
164
61.9
Janajati
82
30.9
Dalit
13
4.9
Others
6
2.3
Father’s education level
Basic level
80
30.2
Secondary level
167
63.0
University level
18
6.8
Mother’s Education level
Basic level
122
46.0
Secondary level
137
51.7
University
6
2.3
Table 1: Demographic information of respondent.
Table 2 showed that Majority (95.5%) of respondents heard about Sexual and reproductive health issues and Minority (4.5%) didn’t hear about sexual and reproductive health issues. The source of information for most of the respondents was (67.6 %) teacher followed by (56.9%) Radio, TV and internet, (53%) books and newspaper, (37.5%) friends and (26.5%) parents. Out of total respondents most (89.1%) of the respondents heard about pubertal changes and (10.9%) did not heard about pubertal changes.
Characteristics (n=265)
Frequency
Percentage (%)
Heard about SRH issues
Yes
253
95.5
No
12
4.5
Source of information about ASRH issues (n= 253) *
Radio, TV and internet
144
56.9
Books and newspaper
134
53.0
Teacher
171
67.6
Parents
67
26.5
Friends
95
37.5
Knowledge on ASRH issues*
Early pregnancy
130
51.4
Unsafe abortion
90
35.6
Difficulties accessing contraception
55
21.7
STDS and HIV
67
26.5
Sexual violence
120
47.4
Stigma and norms related to menstruation
115
45.5
Heard about pubertal changes (n=265)
Yes
236
89.1
No
29
10.9
Multiple response*
Table 2: Knowledge on Sexual and Reproductive Health Issues.
Table 3 showed that most (75.8%) of the respondents had knowledge on safe abortion where (24.2%) did not have knowledge on safe abortion. Majority (74.7%) of respondents had knowledge on safe abortion service site and (25.3%) did not have knowledge on safe abortion service site. Out of the total respondents Majority (58.6%) of the respondents said that they can obtain safe abortion services from all private hospitals followed by (47.5%) FPAN, (35.4%) all government hospital (31.8) listed hospitals/clinics by government, (24.2%) health post, (20.2%) PHCC and (7.6%) Marie stopes. Most of the respondents (54%) had knowledge on legalization of abortion in Nepal and (46%) had no knowledge on it. All of the respondent (100%) said that knowledge on SRH issues was important in their life. Majority of respondent thinks knowledge on SRH issues (77.4%) was most important followed by (20.8%) more important and (1.9%) important. Table 4 showed that majority (68.7%) of respondents had adequate level of knowledge on SRH issues and Minority (31.3%) of respondents had low level of Knowledge on SRH issues.
Characteristics (n=265)
Frequency
Percentage (%)
Knowledge on safe abortion
Yes
201
75.8
No
64
24.2
Knowledge on safe abortion service site
Yes
198
74.7
No
67
25.3
Knowledge on places to obtain safe abortion services (n=198)*
Marie stops
15
7.6
FPAN
94
47.5
All private hospitals
116
58.6
All government hospitals
70
35.4
Listed hospitals/clinics by government
63
31.8
PHCC
40
20.2
Health post
48
24.2
Knowledge on legalization of abortion in Nepal (n=265)
Yes
143
54.0
No
122
46.0
Importance of Knowledge on SRH issues (n=265)
Yes
265
100.0
If yes, how much
Important
5
1.9
More important
55
20.8
Most important
205
77.4
Multiple response*
Table 3: Knowledge on safe abortion.
Table 5 showed that among the total respondents, Most of the respondents (59.2%) had communication practice about SRH issues with parents and (40.8%) have never communicated about SRH issues with parents. Out of the respondents who have communicated with parents about SRH issues, Majority of respondents discussed on (66.9%) mensural hygiene and sanitation management followed by (37.6%) stigma of mensuration, (33.8%) pubertal changes, (32.5%) early pregnancy, (31.2%) sexual violence, (24.2%) contraception and family planning, (22.9%) unsafe abortion, (16.6%) STI and HIV, (10.8%) safer sexual practice and (5.1%) Pre-marital sex. Majority (70.1%) of the respondent feels comfortable to discuss about SRH issues with parents and Minority (29.9%) of them feel uncomfortable. The frequency of times respondent discuss SRH issues with parents were (61.1%) sometimes, (35%) rarely and (3.8%) Frequently.
Level of Knowledge
Frequency
Percentage (%)
Adequate knowledge
175
68.7
Inadequate knowledge
90
31.3
Knowledge mean ± S.D=21.7±6.7
Table 4: Level of Adolescent knowledge on SRH issues.
Characteristics (n=265)
Frequency
Percentage (%)
Communication practice about SRH issues with parents
Yes
157
59.2
No
108
40.8
Topic discussed with parents (n=157) *
Early pregnancy
51
32.5
Unsafe abortion
36
22.9
Contraception and family planning
38
24.2
STI and HIV
26
16.6
Sexual violence
49
31.2
Stigma of mensuration
59
37.6
Mensural hygiene and sanitation management
105
66.9
Pre-marital sex
8
5.1
Safer sexual practice
17
10.8
Pubertal changes
53
33.8
Comfortable to discuss SRH issues with parents
Yes
110
70.1
No
47
29.9
Discuss SRH issues with parents
Rarely
55
35.0
Sometimes
96
61.1
Frequently
6
3.8
Multiple response*
Table 5: Communication practice on Sexual and Reproductive Health Issues.
Table 6 showed that Majority of parents (98.1%) responded positively and (1.9%) responded negatively when the respondents communicated about SRH issues with their Parents. Most of the respondents (95.5%) had fruitful communication with their parents about SRH issues and (4.5%) did not have fruitful communication. The benefit gained by the respondents from discussing about SRH issues with parents was highest (79.7%) gained more knowledge on SRH followed by (59.5%) clear doubts of SRH, (58.1%) increase bounding with parents, (54.1%) makes aware about SRH issues, (52.7%) helps to identify SRH issues and (51.1%) makes aware about SRH.
Characteristics (n=157)
Frequency
Percentage (%)
Parents response
Positive
154
98.1
Negative
3
1.9
Fruitful communication
Yes
150
95.5
No
7
4.5
Benefits gained from discussing SRH issues*
Gained more knowledge on SRH
118
79.7
Help to identify SRH issue
78
52.7
Clear my doubts of SRH
88
59.5
Increase bonding with parents
86
58.1
Makes aware about SRH issues
80
54.1
Makes aware about SRH
76
51.4
Multiple response*
Table 6: parent’s response on Sexual and Reproductive Health Issues.
Table 7 showed that majority (70.2%) of respondent had adequate level of communication with their parents about SRH issues and minority (29.8%) of respondents had low level of communication with their parents about SRH issues.
Level of Communication
Frequency
Percentage (%)
Adequate communication
186
70.2
Low communication
79
29.8
Communication mean ± S.D=10.44±3.38
Table 7: Level of communication.
Table 8 showed that Most of the respondents (54.8%) discuss SRH issues with mother followed by (36.3%) with both parents and (8.95%) with father. Among the total respondents communicated SRH issues other than parents were highest (76.2%) with friends followed by (38.1%) with sister, (15.5%) with brother and (4.9%) with relatives. Majority of respondent (86%) felt need of parent adolescent communication on SRH issues where (14%) didn’t feel the need of parent adolescent communication on SRH issues.
Characteristics
Frequency
Percentage (%)
Discuss SRH issues with (n=157)
With both parents
57
36.3
With father
14
8.9
With mother
86
54.8
Communicate SRH issues other than parents (n=265)*
Brother
41
15.5
Sister
101
38.1
Friends
202
76.2
Relatives
13
4.9
Need of parent-adolescent communication
Yes
228
86.0
No
37
14.0
Multiple response*
Table 8: Need of Parent-Adolescent communication on SRH Issues.
Table 9 showed that Majority of respondent (75.2%) faced challenges and minority (24.8%) did not face any challenges during parent adolescent communication on SRH issues. The majority of respondent faced challenge was (66.1%) hard to start the communication with parents followed by (49.2%) Shyness to discuss about SRH, (26.3%) fear of parents, (19.5%) no proper response from parents, (16.1%) lack of awareness regarding SRH issues to parents and (11.9%) Stigma related to SRH. The major reason for not communicating with parent was (62.6%) shyness followed by (57.4%) hesitation, (45.3%) fear to talk with parents, (28.3%) poor knowledge regarding SRH issues on parents, (23.8%) low parent’s education level, and (8.3%) no respond from parents.
Characteristics (n =157)
Frequency
Percentage (%)
Challenges faced
Yes
118
75.2
No
39
24.8
Challenges face on discussing SRH issues (n=118)*
No proper response from parents
23
19.5
Lack of awareness regarding SRH issues to parents
19
16.1
Shyness to discuss about SRH
58
49.2
Stigma related to SRH
14
11.9
Hard to start the communication with parents
78
66.1
Fear of parents
31
26.3
Reason for not communicating with parents (n=265)*
Fear to talk with parents
120
45.3
Hesitation
152
57.4
Shyness
166
62.6
No respond from parents
22
8.3
Poor knowledge regarding SRH issues on parents
75
28.3
Low parent’s education level
63
23.8
Multiple response*
Table 9: Challenges of Parent-Adolescent Communication.
Table 10 showed that ways of improving parents adolescent communication on SRH issues among majority of respondent was (41.9%) by conducting various awareness program in community followed by (29.1%) creating friendly environment between parents and children, (21.1%) had no idea about it, (4.9%) positive and proper response from parents (1.5%) conducting training on SRH and (1.5%) by changing the thoughts and unnecessary norms of society.
Characteristics (n=265)
Frequency
Percentage (%)
Improve parent-adolescent communication
By conducting various awareness program in our community
111
41.9
By conducting training on SRH
4
1.5
Positive and proper response from parents
13
4.9
By creating friendly environment between parents and children
77
29.1
By changing the thoughts and unnecessary norms of society
4
1.5
No idea
56
21.1
Table 10: Ways of Improving Parent-Adolescent communication.
Table 11, as determined by chi-square analysis, it was found that No respond from parents (p<0.002) and Poor Knowledge regarding SRH issues on parents (0.036) had significant association with communication practice about SRH issues with parents. The above table also showed that fear to talk with the parents, hesitation, shyness and low parents education level did not have any significant association in communication practice with parents about SRH issues.
Table 11: Association of reason for not communicating with communication practice on SRH issues with parents.
Discussion,
This study showed that (59.2%) had communication practice about ASRH issues with parents. 53.62% of the respondents discussed at least two topics about SRH issues at least with the father, mother, sister, peer, teacher, and other individuals which was prevalence of adolescent communication on sexual and reproductive health matters with their parents as per study done by Tesfaye Shibiru Bikila [13]. Whereas the prevalence of communication practice in this study is quite good (59.2%) when compared with the previous study of Bharat raj Bhatta (43%) conducted in 2021 have communicated about SRH issues with parents. Also in this study the topic discussed was (66.9%) mensural hygiene and sanitation management followed by (37.6%) stigma of mensuration, (33.8%) pubertal changes, (32.5%) early pregnancy, (31.2%) sexual violence, (24.2%) contraception and family planning, (22.9%) unsafe abortion, (16.6%) STI and HIV, (10.8%) safer sexual practice and (5.1%) Pre-marital sex. which is quite good As compared to the previous study (17.8%), (16.2%), and (14.8%) reported that they discussed about menstruation, pubertal changes, and STI/HIV with their parents, respectively [7]. The topics on menstruation and unintended pregnancy were discussed more often by female students than male students showed by the both research.
DG Yesus conducted a cross-sectional survey in west north Ethiopia in 2010 which shows the most common source of information for sexual and reproductive health issues followed by friends. Three hundred sixty two (88%) respondents believed that it is important to discuss sexual and reproductive health issues/matters with parents [14]. whereas in this study most common source of information for sexual and reproductive health issues followed by (67.6 %) teacher. 86% respondents felt need / important to discuss sexual and reproductive health issues with parents.
In this study, the student ASRH mean knowledge score was 21.7± 6.7 as compared to the previous study conducted in 2015, students ASRH mean knowledge score was 55.3±24 which was quite less in this study [15]. Previous study shows that cultural norms and fear of discussion are the major challenges that affect parent adolescent communication [16] where as hard to start the communication, no proper response from parent and shyness are the major challenges. Reason for not open parent-adolescent SRH communication include feelings of shyness, discomfort and shame, associated socio-cultural taboos, and lack of SRH knowledge [17] which is also shown by this survey. This study cannot be generalized for all setting as it uses non probability sampling in selection of study participants.
Conclusion,
The study reveals that adolescents have adequate knowledge on sexual and reproductive health, with nearly all aware of these issues. 3/4 of respondents have knowledge about safe abortion and service sites, and over half were aware of Nepal's legalization of abortion. All respondents agree that understanding these topics is crucial for their lives. The study found that most respondents had adequate communication on Sexual and Reproductive Health (SRH) issues with their parents. Over half discussed topics like early pregnancy, unsafe abortion, STIs, HIV, sexual violence, and menstrual hygiene. Most felt comfortable discussing these issues, and a high proportion of respondents reported productive conversations and benefits from them.
The study found that over half of respondents discuss Sexual and Reproductive Health (SRH) issues with their mother, while 3/4 discuss it with friends. Most respondents felt the need for communication with parents but found it difficult. Sophistication was the main reason for not communicating. To improve parents' adolescent communication, the study suggests conducting community awareness programs and creating a friendly environment between adolescents and parents.
Author Statements,
Conflicting Interest,
There are no competing interests exist.
Acknowledgements,
We would like to thank all participants involved in this study for their availability and contribution.
References
- Blum RW, Bastos FIPM, Kabiru CW, Le LC. Adolescent health in the 21st century. Lancet. 2012; 379: 1567-8.
- Holmbeck GN. A developmental perspective on adolescent health and illness: an introduction to the special issues. J Pediatr Psychol. 2002; 27: 409-16.
- Morris JL, Rushwan HJI. JoG, obstetrics. Adolescent sexual and reproductive health. Global Chall. 2015; 131: S40-S2.
- Sexual A. Reproductive Health toolkit for Humanitarian Settings. A companion to the interagency field manual on reproductive health in humanitarian settings. united nations population fund and Save the Children USA. 2009.
- Pathak RS, Pokharel TJNPJ. Sexual and reproductive health status of adolescents and youth in Nepal. 2012; 17: 131-3.
- Mekie M, Addisu D, Melkie A, Taklual WJI. JoP. Parent-adolescent communication on sexual and reproductive health issues and its associated factors in Ethiopia: a systematic review and meta-analysis. 2020; 46: 1-13.
- Bhatta BR, Kiriya J, Shibanuma A. Jimba MJPo. Parent–adolescent communication on sexual and reproductive health and the utilization of adolescent-friendly health services in Kailali. Nepal. 2021; 16: e0246917.
- Ayalew M, Mengistie B. Semahegn AJRh. Adolescent-parent communication on sexual and reproductive health issues among high school students in Dire Dawa, Eastern Ethiopia: a cross sectional study. 2014; 11: 1-8.
- Tegegn A, Yazachew M, Gelaw YJTE. JoHD. Reproductive health knowledge and attitude among adolescents: a community based study in Jimma Town, Southwest Ethiopia. 2008; 22.
- Kyilleh JM, Tabong PT-N, Konlaan BBJ. Bih, rights h. Adolescents’ reproductive health knowledge, choices and factors affecting reproductive health choices: a qualitative study in the west Gonja District in northern region, Ghana. 2018; 18: 1-12.
- Dagnachew Adam N, Demissie GD, Gelagay AAJ. JoE, health P. Parent-Adolescent Communication on Sexual and Reproductive Health Issues and Associated Factors among Preparatory and Secondary School Students of Dabat. Town, Northwest, Ethiopia. 2020; 2020: 4708091.
- Vongsavanh V, Lan VTH, Sychareun V. Sexual and reproductive health communication between parents and high school adolescents in Vientiane Prefecture, Lao PDR. Glob Health Action. 2020; 13: 1785145.
- Bikila TS, Dida N, Bulto GA, Debelo BT, Temesgen K. Adolescents’ communication on sexual and reproductive health matters with their parents and associated factors among secondary and preparatory school students in Ambo Town, Oromia, Ethiopia. Int J Reprod Med. 2021; 2021: 6697837.
- Yesus DG, Fantahun MJE. JoHD. Assessing communication on sexual and reproductive health issues among high school students with their parents, Bullen Woreda, Benishangul Gumuz Region, North West Ethiopia. 2010; 24.
- Bam K, Haseen F, Bc R, Newman MS, Chaudhary AH, Thapa R, et al. Perceived sexual and reproductive health needs and service utilization among higher secondary school students in urban Nepal. 2015; 3: 36-45.
- Wasike HN. Parent-adolescent communication on sexual and reproductive health among secondary school students in Sirisia sub-county. Kenya: Masinde Muliro University of Science and Technology. 2017.
- Al Zaabi O, Heffernan ME, Holroyd E, Jackson M. Parent-adolescent communication about sexual and reproductive health including HIV and STIs in Oman. Sex Educ. 2021: 1-17.
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