Perspectives from the frontline: Nurses’ experiences of adolescent engagement in sexual and reproductive health services

Background: Nurses have a critical role to play in the delivery of sexual and reproductive health (SRH) services to adolescents and young people. Nurses’ interactions with adolescents and young people can shape sexual and reproductive behaviours and outcomes, including willingness to access and engage with healthcare services. However, little research from low- and middle-income contexts has explored nurses’ firsthand perspectives regarding their relationships with adolescents and young people in the context of SRH service provision, especially since the COVID-19 pandemic. Aim: This study explored nurses’ perceptions of working with adolescents and young people as well as how these impressions manifest in one-on-one exchanges between nurses and young patients. Method: Semi-structured interviews were conducted with 20 nurses providing SRH services to adolescents and young people and based at public health facilities in urban, peri-urban and rural areas within a health sub-district of the Eastern Cape province of South Africa. Data were analysed using an inductive thematic approach. Results: While many nurses described the challenges facing adolescents and young people in an empathic way and expressed a desire and willingness to engage with and educate them, some found it ‘difficult to break through’. Nurses linked this difficulty to the shame adolescents and young people feel when discussing SRH concerns, but also to them having ‘attitude’ and ‘not listening’. Findings highlight how while nurses may genuinely care about providing services to their young patients, internal and social biases may impact their motivation and willingness to effectively support adolescents and young people within the context of SRH service provision. To improve patient–provider relations, we suggest a focus on practical and participatory interventions to improve interpersonal dynamics.