FACTORS CONTRIBUTING TO ADOLESCENTS HEALTH SEEKING BEHAVIOUR A CASE OF ABITING PARISH APALA SUB-COUNTY ALEBTONG DISTRICT. BY ONGOM HORRISH REGISTRATION NUMBER: 16/U/0155/LCP/PS A RESEARCH REPORT SUBMITED TO THE FACULTY OF HEALTH SCIENCE IN PARTIAL FULFILMENT OF AWARD FOR BACHELOR OF SCIENCE IN COMMUNITY PSYCHOLOGY AND PSYCHOTHERAPY OF LIRA UNIVERSITY JUNE 2019 i DECLARATION I Ongom Horrish do declare that this research proposal titled “examining the factors contributing to poor adolescents health care seeking behaviors; experiences of adolescents in Abitting Parish, Apala Sub-County, Alebtong District” is my original work and to the best of my knowledge and understanding, it has never been submitted to any University or any other institution of higher learning for the award of degree or a diploma. All sources I have consulted are duly acknowledged. Signature…………………………………………Date………………………………… Ongom Horrish 16/U/0155/LCP/PS i APPROVAL This is to certify that this research proposal titled, “Examining the factors contributing to poor adolescent health seeking behaviors; experiences of adolescents in Abitting Parish, Apala SubCounty, Alebtong District” has been done under my supervision and is now ready for submission to the head of department of mental health for examination. Signature……………………………………….Date…………………………………………. Prof. J.C.ENON ii DEDICATION This special research proposal is dedicated to my beloved parents Mr. Onyilo David and Mrs Teddy Onyilo, my brother Ocen Joshua, my wife Mrs Joyce Ongom, my sisters Elizabeth Ruth and Alali Immaculate and also my friends for the assistance and advice they availed to me and lastly to my academic supervisor Prof. J. C. Enon. iii ACKNOWLEDGEMENT I wish to extend my sincere appreciation to my supervisor Prof. J.C ENON for the contribution, assistance and guidance he rendered to me toward this study. I am also very grateful to the entire staff at the department of mental health of Lira University for the advice and support they have rendered to me during gathering of information, knowledge and the discussion. I am also thankful to my friends Jenifer, Nelson, Caleb, Holger Zena, Brenda, Lawrence, and others for their moral support they gave to me. iv LIST OF TABLES Table 4. 1: Showing gender distributions of respondents ............................................................. 16 Table 4:2 showing the ages of the respondents ............................................................................ 17 Table 4:3 showing marital status of respondents ................ Ошибка! Закладка не определена. Table 4: 4 showing education level of the respondents ................................................................ 17 Table 4: 5 showing responses on favorable factors contributing to health care seeking behaviors among adolescence. ...................................................................................................................... 18 Table 4: 6 showing responses on the limitation factors contributing to health care seeking behaviors among adolescence. ...................................................................................................... 19 Table 4: 7 showing responses on the measures that can be undertaken to improve health seeking behavior of adolescence. ............................................................................................................... 21 Table 8 showing the work plan of the study ................................................................................. 32 Table 9 showing the work plan of the study ................................................................................. 32 v LIST OF FIGURES Figure 1 showing the conceptual framework .................................................................................. 7 Figure 4:1 showing the gender of the respondents ....................................................................... 17 Figure 4:2 Bar graph showing the marital status of the respondentsОшибка! Закладка не определена. vi TABLES OF CONTENTS DECLARATION ............................................................................................................................. i APPROVAL ................................................................................................................................... ii DEDICATION ............................................................................................................................... iii ACKNOWLEDGEMENT ............................................................................................................. iv LIST OF TABLES .......................................................................................................................... v LIST OF FIGURES ....................................................................................................................... vi ACRONYMS .................................................................................................................................. x ABSTRACT………………………………………………………………..……………….…xi CHAPTER ONE: ........................................................................................................................................ 1 INTRODUCTION....................................................................................................................................... 1 1.0 Introduction ............................................................................................................................... 1 1.1 Background of the study ........................................................................................................... 1 1.2 Problem statement ..................................................................................................................... 3 1.3 Objectives of the study.............................................................................................................. 4 1.3.1 General objective ................................................................................................................... 4 1.3.2 Specific Objectives of the study ............................................................................................ 4 1.4 Research Questions .............................................................................................................. 4 1.5 The scope of the study .............................................................................................................. 4 1.5 .1 Geographical scopes: ............................................................................................................ 4 1.5.2 Time scope ............................................................................................................................. 5 1.5.3 1.6 Content scope ................................................................................................................... 5 Significance of the study...................................................................................................... 5 1.7 Conceptual framework. ............................................................................................................. 6 CHAPTER TWO: ....................................................................................................................................... 8 LITERATURE REVIEW .......................................................................................................................... 8 2.0 Introduction .......................................................................................................................... 8 2.1 Health seeking behavior: Theoretical approaches. ................................................................... 8 vii 2.1 Health seeking behavior of Adolescents: Global situation. ...................................................... 9 2.6 Health seeking behavior. ......................................................................................................... 11 2.7 Summary of the literature review. .......................................................................................... 12 CHAPTER THREE:................................................................................................................................. 13 RESEARCH METHODOLOGY ............................................................................................................ 13 3.0 Introduction. ............................................................................................................................ 13 3.1 Research design. ..................................................................................................................... 13 3.2 Study area................................................................................................................................ 13 3.3 Study population ..................................................................................................................... 13 3.6 Instruments/measures to be used in data collection. ............................................................... 14 3.6.1 Questionnaires...................................................................................................................... 14 3.6.2 In-depth interviews .............................................................................................................. 14 3.6.4 Sampling procedure ............................................................................................................. 15 3.7 Procedure ................................................................................................................................ 15 3.9 Limitations and Delimitations of the study. ............................................................................ 15 CHAPTER FOUR..................................................................................................................................... 16 DATA ANALYSIS, FINDINGS AND INTERPRETATION................................................................ 16 4.1 Introduction ............................................................................................................................. 16 4.1 Background information of the respondents ........................................................................... 16 4.1.1 Gender of the respondent ..................................................................................................... 16 4.1.2 Age of the respondents......................................................................................................... 17 4.1.3 Marital status of respondent ....................................... 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Закладка не определена. 4.1.2.4 Education level of respondents ....................................................................................................... 17 4.2 Findings on the favorable factors contributing to health care seeking behaviors among adolescence. .................................................................................................................................. 18 4.3 Findings on the limitation factors influencing health seeking behavior of adolescence. ....... 19 4.4 Findings on the measures that can be undertaken to improve health seeking behavior of adolescence. .................................................................................................................................. 21 viii CHAPTER FIVE ...................................................................................................................................... 22 SUMMARY OF STUDY, CONCLUSIONS AND RECOMMENDATIONS...................................... 22 5.1 Introduction ............................................................................................................................. 22 5.2 Summary of the findings ......................................................................................................... 22 5.2.1 Summary on the favorable factors contributing to health care seeking behaviors among adolescence. .................................................................................................................................. 22 5.2.2 Summary on the limitation factors influencing health seeking behavior of adolescence. ... 23 5.2.3 Summary on the measures that can be undertaken to improve health seeking behavior of adolescence. .................................................................................................................................. 23 5.3 Conclusion .............................................................................................................................. 23 5.3.1 Conclusion on the favorable factors contributing to health care seeking behaviors among adolescence. .................................................................................................................................. 24 5.3.2 Conclusion on the limitation factors influencing health seeking behavior of adolescence.Ошибка! Закл 5.3.3 Conclusion on the measures that can be undertaken to improve health seeking behavior of adolescence. ........................................................................ Ошибка! Закладка не определена. 5.4 Recommendations ................................................................................................................... 25 5.5 Suggestions for Further Research ........................................................................................... 25 APPENDICES .............................................................................................................................. 28 APPENDIX I: QUESTIONAIRES ............................................................................................... 28 Appendix II: INTERVIEW GUIDE FOR PARENTS AND PUPILS. ......................................... 31 APPENDIX III: WORK PLAN OF THE STUDY ....................................................................... 32 APPENDIX IV: BUDGET OF THE STUDY .............................................................................. 33 ix ACRONYMS AIDS : Acquired Immune Deficiency Syndrome ASRH : Adolescent Sexual and Reproductive Health BDHS : Bangladesh Demographic and Health Survey BRAC : Bangladesh Rural Advancement Committee FHI : Family Health International FLE : Family Life Education HIV : human immunodeficiency virus IEC : Information, Education, Communication NESDP : National Economic and Social Development Plan NGO : Non-Government Organization PAHO : Pan American Health Organization PHC : Primary Health Care RTI : Reproductive Tract Infection SRH : Sexual and Reproductive Health STI : Sexually Transmitted Infection TARSHI : Talking About Reproductive and Sexual Health Issues UNICEF : United Nations Children’s Fund VCT : Voluntary Counseling and Testing WHO : World Health Organization HIV : Human Immune deficiency Virus. HND : Higher National Diploma. HSB : Health Seeking Behaviour. IBM : International Business Machines. x ABSTRACT The study was to examine the factors contributing to adolescent health seeking behaviors; experiences of adolescence in a rural community in Abiting Parish, Apala Sub County Alebtong District and the study was inline the specific objectives like determining the favorable factors contributing to health care seeking behaviors among adolescence, identifying the limitation factors influencing health seeking behavior of adolescence and investigating measures that can be undertaken to improve health seeking behavior of adolescence in Abiting Parish Apala Sub County Alebtong District. This study used a cross sectional study design of both qualitative and quantitative data. Crosssectional study design is that research design used for measuring differences between varieties of several data. It was majorly used for getting different views from different groups. The research was conducted in Abitting parish, Apala Sub-County, Alebtong District, the study group of about 50 participants was randomly selected and interviewed and they were comprising of key stake holders such as parents, adolescence, NGOs dealing with children and youths, Clinical officer. The study concluded that relocating services to reach adolescents contributes to health care seeking behaviors among adolescence and that availability of adolescent health seeking services favors the adolescents to seek the health care services as they won’t be experiencing many costs in transport and low cost of health services regarding adolescence as favorable factor towards adolescent health seeking behavior and it also concluded that use of peer promoters can be undertaken to improve health seeking behavior of adolescence and that relocating service to reach adolescents can be undertaken to improve health seeking behavior of adolescence and also that outreach workers or community health promoters plays a very important role in promoting adolescent health seeking behaviors.. Finally the study recommends that tight policies should be put in place to address the issues adolescent seeking behaviors among adolescents and there is much work needed to form a consensus about what “help-seeking” is, how to measure and evaluate it, how to promote it and how to promote positive use of both informal and formal sources of support. xi CHAPTER ONE: INTRODUCTION 1.0 Introduction This study investigated the factors contributing to adolescent health in Abiting village Apala Sub County Alebtong District. It was carried out in the partial fulfillment for the award of bachelor degree in community psychology and psychotherapy of Lira University. The study covered a period of 10 months beginning from September 2019 to July 2019. This Chapter looked at the information on the background of the study, statement of problem, significance of the study, research objective, research questions and the scope of the study. 1.1 Background of the study Adolescence is widely defined as the time in life when the developing individual attains the skills and attributes necessarily to become a productive and reproductive adult. Nearly all cultures recognize a phase in life when society acknowledges these emerging capacities of young people. What varies considerably by culture and context is whether the passage from childhood to adulthood is a direct and short passage, or whether there is a prolonged adolescence marked by a choice of identities and roles. While most of the world’s adolescents make it through the period with no major problems, even those adolescents who have no significant personal problems or acute health-care needs have normative stresses and needs for help, support and orientation associated with making the transition from childhood to adulthood. In some parts of the world, research suggests that the normative tasks of adolescence are becoming more difficult in light of reduced social control by families, more varied opportunities(leading to greater confusion), increased individualism and declining importance of traditional cultural norms (Frydenberg, 1997). Programmers in South-East Asia consulted for this document reported that changes in the social structure and the economy including increases in educational attainment, increasing urbanization and increased modern-sector employment opportunities for young women– have led to a weakening of traditional familial support. These changes are often cited as the causes of increasing rates of psychological problems such as family crises, emotional/identity crises and substance use. In addition, some adolescent health staff consulted for this document 1 argue that increasing job insecurity in a globalizing economy means that adolescents have expanding normative needs for assistance in continuing with their education, newer and more diversified job training, and enhanced services related to sexuality and reproductive health – particularly given later ages at marriage and earlier sexual activity. Fatimi Z, Avan ( 2002) Around the world, adolescence is a time of opportunities as well as vulnerabilities to risk associated behaviors that can have lifelong consequences for health and well-being. Numerous World Health Organization (WHO) consultations and studies have confirmed the importance of caring and meaningful relationships, as well as pro-social connections with individuals and social institutions, reducing risks and promoting healthy and positive developmental outcomes. Many researchers, and various WHO documents, have also called for more attention to and more research on where, why and how adolescents seek health (i.e. their health-seeking behavior) and the sources of and nature of health services available to them in their specific contexts (i.e. social supports). Before proceeding, it is important to define the terms that frame this document, particularly “health-seeking behavior” Kiguli J, (2009). There are few specific, agreed upon definitions of “health-seeking behavior” in the adolescent health and development literature. Healthseeking behavior has been defined as a “sequence of remedial actions that individuals undertake to rectify perceived ill-health.” In particular, health-seeking behavior can be described with data collected from information such as the time difference between the onset of an illness and getting in contact with a healthcare professional, type of healthcare provider patients sought help from, how compliant patient is with the recommended treatment, reasons for choice of healthcare professional and reasons for not seeking help from healthcare professionals. In only a few cases in the literature is the term “health-seeking” used in a more comprehensive way to refer to the use of both formal supports and informal supports, which we argue includes family, kinship networks, friends, traditional healers and/or religious leaders? The health seeking behavior of a community determines how health services are used and in turn the health outcomes of populations. Factors that determine health behavior may be physical, socio-economic, cultural or political. Indeed, the utilization of health care services may depend on educational levels, economic factors, cultural beliefs and practices. Other factors include environmental conditions, socio-demographic factors, and knowledge about the facilities, gender issues, political environment, and the health care system itself. 2 A key determinant for health seeking behavior is the organization of the health care system in many health systems, particularly in developing countries such as Uganda, illiteracy, shows that poverty has led to underfunding of the health sectors, inadequate water and poor sanitation facilities have a big impact on health indicators. In addition, cost of services, limited knowledge on illness and wellbeing, and cultural prescriptions are a barrier to the provision of health services. These challenges, which are significant in Uganda's health system, affect the health seeking practices of communities. Alti-Muazu M, (2009). Most adolescent health problems are related to behavioral and lifestyle issues, which the literature consistently confirms are more influenced by the social setting than by health providers or other professional service providers. Furthermore, research from around the world suggests that 90–90% of childhood diseases are treated at home or outside the formal health care system, a pattern that likely continues into adolescence. This highlights even more the need to examine health-seeking more broadly than within the formal health care system. 1.2 Problem statement WHO (2011), there is a significant difference in access to various health care providers between the elderly and the adolescence. Although self-care and use of traditional healers is categorized under health care, these are often discouraged by health practitioners, with the emphasis on encouraging people to opt for conventional channels with medically trained personnel. The adolescence that are mainly concentrated in rural areas in Uganda, are the most affected by health system challenges. The Government of Uganda under the Ministry of Health has increased the number of health facilities throughout the country in recent years. However, there are still disparities between urban and rural areas, as well as by geographic location therefore certain adolescence have more access to health services than others. The lack of public facilities in some communities, which are predominantly used by the adolescence, is likely to affect the health seeking practices of the adolescents (UNICEF data 2016). Most studies on health seeking behavior in Uganda have been discussed specifically adolescent health seeking behaviors; experiences of adolescence have been neglected. Therefore, limited knowledge is available on adolescent health seeking behaviors including problems faced in pursuit of health services. The purpose of the study was to examine the factors contributing to adolescent health seeking behaviors; experiences of adolescence in a rural community in Abiting Parish Apala Sub County Alebtong District. 3 1.3 Objectives of the study 1.3.1 General objective The purpose of the study was to examine the factors contributing to adolescent health seeking behaviors in Abiting Parish, Apala Sub County Alebtong District. 1.3.2 Specific Objectives of the study i. To determine the favorable factors contributing to health care seeking behaviors among adolescence in Abiting Parish Apala Sub County Alebtong District. ii. To identify the limitation factors influencing health seeking behavior of adolescence in Abiting Parish Apala Sub County Alebtong District. iii. To investigate measures that can be undertaken to improve health seeking behavior of adolescence in Abiting Parish Apala Sub County Alebtong District. 1.4 Research Questions i. What are the favorable factors contributing to health care seeking behaviors of adolescence in Abiting Parish Apala Sub County Alebtong District? ii. What are the limitation factors that influence health care seeking behaviors of adolescence in Abiting Parish Apala Sub County Alebtong District? iii. What are measures that can be undertaken to improve health seeking behaviors of adolescence in Abiting Parish Apala Sub County Alebtong District? 1.5 The scope of the study The scope of the study was presented in three distinct sub themes as provided below. 1.5 .1 Geographical scopes: The study was conducted in Abiting Parish, one of the parishes in Apala sub-county, Abiting Parish is bordered by Olaoilongo Parish in the south, Okwangole Parish in the west, Atinkok Parish in the north and Akura Sub-county in the east. The parish is found in Apala Subcounty, Alebtong District northern Uganda. Abiting Parish covers an area of about 9.7 square kilometer with six villages which include: apanyapany, Erii, akuki, Abungenga, Okeda and abiting with population of around 3994 as per national population census of 2014 (men1767 4 and women 2127). The area was chosen for the study because it was highly affected by the LRA war in northern Uganda making the social life status in the area very diverse. 1.5.2 Time scope This study made a review of five years period and this covered the period from 2012 to 2017 and this was on the limitation factors, measures and mechanisms of improving health care seeking behaviors of adolescents in Alebtong district. The study took a period of six months that is, from November 2019 to June 2019 and the researcher believe that this period was convenience for generation of proposal, data collection and analysis as well as writing the research report. 1.5.3 Content scope The study focused on the limitations, measures to improve health care seeking behaviors of adolescents in Alebtong district and the research participants were Community members, teachers, Adolescents, parents, NGO staff and Clinical officers within apala Sub-County. The researcher focused on examining the factors contributing to adolescent health seeking behaviors; experiences of adolescence in a rural community in Abiting Parish Apala Sub County Alebtong District. The study focused on the predisposing factors influencing health seeking behavior of adolescence, enabling factors of health care seeking behavior of adolescence in Abiting Parish Apala Sub County Alebtong District and investigating the measures that can be undertaken to improve health care seeking behavior of adolescence in Abiting Parish Apala Sub County Alebtong District. 1.6 Significance of the study Adolescence, which broadly means the teenage years, has many manifestations. It refers to the development period between childhood and adulthood during which a number of dramatic physical changes and important emotional and social developments take place. This period can be difficult and confusing, and can therefore create a lot of fear and anxiety to the adolescent, parent and the community. These circumstances make adolescents vulnerable with regard to making reasonable decisions about their life, values and sexuality. The ability to make rational decisions and act on them is critical to healthy adolescent development. The goal of this strategy is to improve the quality of life and well-being of young people in Uganda. 5 This will be achieved by creating an enabling policy environment and legal framework that will facilitate adolescent health and development programmes. The attainment of the goal will also be achieved by increasing young people’s‟ access, participation and utilization of innovative, integrated, high-quality services and programmes. Promotion of positive attitudes and behavior change in communities and among parents and young people will be encouraged. It is my sincere hope that this document will serve as a reference tool to guide the Government, NGOs, the private sector, young people themselves, parents and development partners and other stake holders in the implementation of programmes that concerns adolescents. 1.7 Conceptual framework. Health seeking behavior can occur for both actual and potential problems. When it occurs for actual problems, it is called illness behavior and when it occurs for potential problems, it is called health behavior (Babitsch et al., 2012). This study will utilize the Andersen behavioral model, figure 1 to explore health seeking behavior of Adolescence in Abiting Parish Apala Sub County, Alebtong District. This conceptual framework best helps understand human behavior in relation to health care utilization. The framework is comprised of one dependent variable, health seeking behavior and three interrelated groups of independent variables: predisposing factors, enabling factors and need factors. The dependent variable; health seeking behavior is the utilization of health services to avert negative health, thus called health behavior or the utilization of health services to restore optimal health, thus called illness behavior for the purpose of achieving constructive and purposeful engagement in life events of the adolescents. The three independent variables interact in a complex way to create a triadic space within which health care utilization exists. This trust- psychosocial- geographic space is the continuum within which health is pursued, enjoyed and maintained through health seeking behavior. 6 Figure 1 showing the conceptual framework Independent variables. Dependent variable Limitation factors: age, gender, religion, occupation, education, social networks and support, qualification. Health seeking Behavior. Health behavior. Favorable factors: Income, health insurance, availability and access to services, confidentiality, satisfied with self care, workload. Illness behavior Need factors: general health status, worries about health, future health perception, illness severity. Figure 1 Conceptual framework; Source: Adapted from Andersen and Newman, (1995) 7 CHAPTER TWO: LITERATURE REVIEW 2.0 Introduction This chapter reviewed the related literature on the subject under study. This includes identifying the predisposing factors influencing health seeking behavior of adolescence, determining the enabling factors influencing health seeking behavior of adolescence and investigating the need factors that shape health seeking behavior of adolescence in Abiting Parish Apala Sub County Alebtong District. 2.1 Health seeking behavior: Theoretical approaches. Health seeking behavior has been studied extensively. Several theories have been utilized in health seeking behavior studies (Ricketts & Goldsmith, 2005; Hausmann et al., 2012). An overview of the theories is presented here. The health belief model, developed by G.M. Hochbaum in 1959, has four constructs; perceived seriousness of the disease, perceived susceptibility, perceived benefits, and perceived barriers (Taylor, D et al., 2006), which in combination can be used to explain health seeking behavior. The greater the seriousness of the disease, the more the person will change behavior or will seek treatment (Cockerham et al., 2014). Theory of reasoned action developed in 1975 by Fishbein and Ajzen proposes that a person’s health behavior is determined by his intention to perform the health behavior. This intention is itself determined by the person’s beliefs, attitudes, norms, intentions and his perception of how significant others approve of or otherwise of the behavior. The theory of “four A’s” addresses the availability, acceptability, affordability and accessibility of health services (Glanz et al., 2009). Abraham Maslow hierarchy of needs theory intimates that individuals always aim to attain a higher level of satisfaction other than their currency. In the continuum of health, people are always seeking to attain a higher level of well being by engaging in behavior that does not threaten the comfort of good health. The motivation Hygiene theory by Frederick Herzberg identifies two factors that influence satisfaction. He observes that humans have needs that emphasize on avoidance of loss of life, hunger, pain and other fears and those that compel the individual to realize his potential. It is in this quest to avoid life fears that people look for motivators for good health (Miner, 2005). 8 McClelland’s theory of needs asserts that an individual’s specific needs are a function of time and experience. He views needs as a function of achievement, affiliation and power. Individuals tend to avoid low and high risk situations that may destabilize them. McClelland did not look at hierarchy as a concept but saw the needs as occurring simultaneously. He placed emphasis on achieving needs positing that individuals with high need of achievement have five distinguishable characteristics; responsibility for finding solutions to difficulties, a preference for immediate feedback on performance, avoidance of easy attainable and highly difficult goals, enjoyment of challenging yet achievable tasks and preference for intangible e.g. knowledge or health as opposed to tangible e.g. money rewards (Friend, 2010). The purpose of presenting the above theory review is to highlight the amount of research that has gone into theorizing health seeking behaviour. The Andersen’s Health Care Utilization model suggests that predisposing factors, enabling or impeding to use factors and their need for care determine health care use. 2.1 Health seeking behavior of Adolescents: Global situation. Accordingly, we propose the following definition for adolescent help-seeking behavior. This definition is based in part on the literature on adolescents and coping behavior (frydenberg, 1997) and to a limited extent on literature on health-seeking behavior (ward et al., 1997). For the purpose of this document, we propose defining help-seeking as: any action or activity carried out by an adolescent who perceives herself/himself as needing personal, psychological, affective assistance or health or social services, with the purpose of meeting this need in a positive way. This includes seeking help from formal services for example, clinic services, counselors, psychologists, medical staff, traditional healers, religious leaders or youth programmers’ as well as informal sources, which includes peer groups and friends, family members or kinship groups and/or other adults in the community. The “help” provided might consist of a service (e.g. a medical consultation, clinical care, medical treatment or a counseling session), a referral for a service provided elsewhere or for follow-up care or talking to another person informally about the need in question. We emphasize addressing the need in a positive way to distinguish help-seeking behavior from behaviors such as association with anti-social peers, or substance use in a group setting, which a young person might define as help-seeking or coping, but which would not be considered positive from a health and well-being perspective. 9 We propose three categories of adolescent help-seeking behaviors: 1. help-seeking for specific health needs, including health services (in the formal health care system or from traditional healers and pharmacists), as well as seeking health-related information. This is generally called health-seeking behavior. 2. help-seeking for normative developmental needs, including help in completing school, or help related to vocational orientation/training, or employment-seeking; relationship formation and concerns; understanding the changes associated with sexuality or puberty; and/or other concerns that are frequently associated with adolescence. 3. help-seeking behavior related to personal stress or problems, as in the case of family crises; family violence or victimization by abuse; relationship stresses; acute financial needs; homelessness; and/or needs or problems related to chronic or acute ill-health. These are specific, problem-related to psychosocial needs that go beyond the normative needs of young people. It is important to highlight from the start that help-seeking and having access to and using social supports are generally protective factors for many adolescent health and developmental outcomes. Having and using social supports is associated, among other things, with lower rates of suicide, safer sexual behaviors, lower rates of substance use, later sexual debut and lower rates of delinquency or perpetration of violence (Frydenberg, 1997; WHO & UNICEF, 2000). Some researchers interviewing adolescents across cultures find that youth who report positive connections with parents (one form of social support) are more socially competent and less depressed (Barber, in WHO & UNICEF, 2000). Being able to seek and find help from formal or informal sources is a protective factor for adolescent health and development and overall satisfaction with life (Baumeister & Leary, 1995, cited in Costello, Pickents & Fenton, 2001). Studies from various cultures have found that beliefs beyond the self and opportunities for expression and connection are associated with positive developmental outcomes. Research from Western Europe and North America on developmental assets and developmental supports using those terms to refer to sources of help and support via the family, community or social institutions (schools, clinics, youth programmes, recreational activities, etc.) that assist adolescents with their health and development needs has also largely confirmed that having more meaningful supports and connections is better than not having them. Research also suggests that objective measures of social support are generally less important (and perhaps less valid) than the subjective meaning that an adolescent attributes to these social supports. AsCostello, Pickens & Fenton (2001) state: “The perception that social 10 support is available seems to lessen – to buffer – the negative impacts of a stressful event and to hasten recovery even if it is not actually verified, or used.” In short, believing that he/she is supported or has a range of individuals who support them, even when or if the adolescent does not use this support, is the central concern. However, it is important to point out that not all social supports peer, parents or other adults or institutions are in fact supportive. In some cases, young people may turn for help to peers who encourage anti-social behavior. Similarly, while parents and other family members can be sources of support, providing help and facilitating access to other sources of help, they may act in negative ways or restrict adolescent access to services or positive sources of support because of their own values about the given need for help (for example if the need is sexual in nature). When family members or other adults in the community ignore family violence or sexual exploitation, close social supports become complicit with the abuse. In some settings, families or the state may make decisions for and force help on adolescents, in the case of counseling for substance abuse, for example. Likewise, when adolescents turn to their peers for information on sexual health, they may find important affinitive support, but the information provided by their peers may be inaccurate. Similarly when a young person seeks health services from an untrained abortionprovider, for example, the outcome from the help-seeking and instrumental support may be negative. Ascertaining what is a positive or negative social support, or help-seeking behavior, is sometimes unclear. 2.6 Health seeking behavior. Health seeking behavior refers to actions that people resort to undertake for the purpose of finding an appropriate remedy that can occur for both actual and potential problems. When it occurs for actual problems, it is called illness behavior and when it occurs for potential problems, it is called health behavior. Illness behavior defines any act of going in search of a relief to fulfill a health need. While health behavior refer to observable actions of individuals aimed at detecting or preventing disease and improving of well being (Babitsch et al., 2012). Though nurses, and other health professionals are limited by a utilitarian society to seek treatment from another health professional because this is what they expect of their patients (Helfand, 2013), study findings are contrary. A polish study found self prescription was rampant among nurses (Binkowska-Bury et al., 2013). 11 In Nigeria, it was found that 99.6% of the respondents had ever self prescribed, with 69.3% of these having had self prescribed within the last three months (Agaba et al., 2011). In a survey to determine doctors’ personal choices in Hong Kong, China; 64% of the respondents did not seek help from another physician (Chen et al., 2009), findings that are consistent with a Nigerian study that found that only 46.9% of the respondents consulted another physician when last ill (Agaba et al, 2011). An Israeli study found that though doctors had strong belief in screening tests, only 27.5% of the respondents had undergone the tests with 55.6% blaming it on lack of time (Peleg et al., 2013). Further, a Baltimore study found more than half of the participants as not having a regular meal schedule leading to poor eating habits and obesity (Nahm et al., 2012). 2.7 Summary of the literature review. Health seeking behavior has been extensively studied and factors that influence health seeking behavior are numerous. The literature recognizes the importance of the interconnectedness of the factors which determine the utilization of health services and contextualizes a person’s health in its economic, cultural and psychosocial dimensions as a product of complex interaction between predisposing factors, enabling factors and need factors. 12 CHAPTER THREE: RESEARCH METHODOLOGY 3.0 Introduction. This chapter entailed the different methods that were used under this study in order to collect the necessary data. These included research design, study population, sampling technique, sampling size, source of data, data collection method, data processing, analysis and presentation, ethical procedures, limitation and delimitation of the study. 3.1 Research design. This study used a cross sectional study design of both qualitative and quantitative data. Cross-sectional study design is that research design used for measuring differences between varieties of several data. It was majorly used for getting different views from different groups. It was used because of the following advantages under it; the general survey research design was selected because it availed information on very many variables including the stakeholders’ knowledge on the adolescence health seeking behaviours. 3.2 Study area The study was conducted in Abiting Parish Apala Sub County, Alebtong district and it covered three (3) villages in Abiting parish and they include Apanyapany, Erii and Abitting village respectively. 3.3 Study population The research was conducted in Abiting parish, Apala Sub-County, Alebtong District, the study group of about 50 participants was randomly selected and interviewed and they were comprising of key stake holders such as parents, adolescence, NGOs dealing with children and youths, Clinical officer. This study group was purposely selected because they have knowledge, experiences and information regarding Adolescence health care seeking behavior and are expected to give relevant information pertaining the study. The sample size conforms to Sekaran’s (2002) postulate who contended that sample size larger than 50 but less than 500 is appropriate for most studies. 13 3.6 Instruments/measures to be used in data collection. The research data was collected using the Questionnaires, key informants interviews, and indepth interviews that involve the use of interview guides and Questionnaires developed by the researcher so as to obtain relevant data from participants of the study. 3.6.1 Questionnaires. Questionnaire is a preformatted written set of questions to which respondents record their responses, usually within rather closely defined alternatives. The questionnaire in this case was desired on the basis that the variables under study cannot be observed, for instance, the views, options, perceptions and feelings of the respondents in relation to the study variables. The questionnaire is equally important in this case because the required data for this study was collected from a large sample in a short period of data from respondents. The questionnaires consisted of both open and closed ended questions to be administered to the target respondents in the study area. 3.6.2 In-depth interviews In this method of data collection the researcher engaged the participants (Teachers and parents) in face to face consented interactive conversations that generate the required data suitable for the providing answers to the research questions. For those participants who do not understand English, the researcher translated the questions into the local language for the purpose of clarity and better understanding so that the participants answers the questions in appropriate sequence and elaborately as possible according to the researcher’s interest. The researcher used this method of data collection as provide opportunity and ability to explore the in depth information relating to the study variables. 3.6.3 Key informants’ interview This method of data collection was used for collecting the primary data from the participants with relevant experience and knowledge on the research topic under investigation. This is for the purpose of providing relevant and required information about the research questions. The key informant interview was purposely for the NGOs staff, clinical officers and this was conducted through face to face interviews based upon the consent of the research participants. 14 3.6.4 Sampling procedure To get the relevant number of the respondents, stratified Random Sampling was applied. After stratification, purposive sampling was used as the respondents was divided from each location and contacted. The category covered Adolescence, parents, NGOs, health assistant and clinical officer. 3.7 Procedure After informed consent from the Local leaders/heads of the area and participants has been gotten, a simple random sampling technique was used for the group participants. This is a probability sampling technique where written numbers was provided and each member from the study population was randomly selected a number. 3.9 Data management 3.9.1 Data collection method and instrument The study used Questionnaires, In-depth interviews and Key informants’ interviews to collect data using the structured questionnaires as an interview guide. 3.9.2 Data Analysis The data collected was processed by editing, coding, analyzing and summarizing into research themes based on research questions/objectives. The data was entered into Statistical Package for Social Science (SPSS) version 23 software for analysis. Univariate and Bivariate data analysis was done. Bivariate analysis involving pearson Chi-square and odd ratio with 95% confident interval was used to determine the relationship between (need factors, Limited factors, favorable factors) and health seeking behaviors. 3.9 Limitations and Delimitations of the study. The researcher anticipated the following limitations during the study. Some respondents were too busy to give the necessary information when required however the researcher gave the respondents enough time to answer the questionnaires given to them Data collection during rainy season where the researcher bought a paper bag to protect the documents and an umbrella during data collection Time limitation for data collection. This was because of the urgent need to finish report writing beating the date line set by the University. To mitigate that, the researcher used the skills of prioritization and multi-tusking. This enabled the researcher to programmed and plan for data collection period which may be on weekends and evening. 15 CHAPTER FOUR DATA ANALYSIS, FINDINGS AND INTERPRETATION 4.1 Introduction This chapter presents data analysis, findings, presentation and interpretation of findings. The purpose of study was to examine the factors contributing to adolescent health seeking behaviors in Abiting Parish, Apala Sub County Alebtong District. The chapter is organized into sections based on the research objectives which include the following: To determine the favorable factors contributing to health care seeking behaviors among adolescence, to identify the limitation factors influencing health seeking behavior of adolescence and to investigate measures that can be undertaken to improve health seeking behavior of adolescence in Abiting Parish Apala Sub County Alebtong District. 4.1 Background information of the respondents Background information of the respondents was considered by the study. Under the respondent’s background, different variables were considered which included gender, age, marital status and education level of the respondents as well. 4.1.1 Gender of the respondent The study had both male and female respondents and female persons were more than male ones as shown below. Table 4. 1: Showing gender distributions of respondents Gender Male Frequency 20 Percentage 40% Female 30 60% Total 50 100 Source: Primary Data (2019) According to the findings as in Table 4:1 above, 30(60%) of respondents were female persons while only 20 (40%) were male respondents. 16 Figure 4:1 showing the gender of the respondents 70 60 50 40 frequency 30 percentage 20 10 0 male female Source: Primary Data (2019) 4.1.2 Age of the respondents Table 4:2 showing the ages of the respondents Ages Frequency Percentage Between 13-16 years 31 62% Between 16-19 years 19 38% Total 50 100 Source: Primary Data (2019) The studies found out that (62%) of respondents were the adolescents in the age between 1316years meanwhile 38% of the respondents were between 16-19 years. The age brackets of 13-19 years of age were very crucial in this study as they are perpetrators of adolescent health seeking behaviors of most communities therefore they were of benefit in this study. 4.1.2.3 Education level of respondents Table 4: 3 showing education level of the respondents Education level Attending primary education Frequency 20 Percentage 40% Completed P.7 17 34% Never completed P.7 10 20% Attending lower secondary 3 6% Total 50 100 Source: Primary Data (2019) 17 The study found out that (40%) of respondents were attending primary education and 34% completed P.7, 34% of the respondents while 20% of them never completed P.7 of education meanwhile 6% of the respondents were attending lower secondary education. Respondents’ level of education determines the ability to give valid information to the study. Findings from the study revealed that most of the adolescent’s respondents had the ability to seek for health care services. 4.2 Findings on the favorable factors contributing to health care seeking behaviors among adolescence. Table 4: 6 showing responses on favorable factors contributing to health care seeking behaviors among adolescence. Responses Frequency Percentage relocating services to reach adolescents 28 56% The service are not expensive 12 24% The health centre is not far 6 12% Nurses loves when we are at the health centre 4 8% Total 50 100 Source: Primary Data (2019) The study finding from the table above found out that 56% of the respondents stated that relocating services to reach adolescents contributes to health care seeking behaviors among adolescence. In a key informant interview this came out; “….In some places, people have found that it useful to locate or relocate health services that favors us adolescents things like school dispensary which is helping so much while at school because when u start to mesutrate from school, senior woman teacher takes you to the school nurse for help and some NGOs are teaching us how to make reusable pads.(Key informant interview with one of the community member at his home in Abiting trading centre) Meanwhile 24% of the respondents also stated that adolescence service are not expensive where everyone can access because from school they are not paying and at home, they go to health centers for government because the services are there for free. 18 12% of the respondents stated that the health centre is not far and most of them you can walk while going to and this favors adolescence hence promoting them towards adolescent health seeking behavior. Finally 8% of the respondents stated that nurses at the health centre and school dispensaries loves them and gives them quality services and care. 4.3 Findings on the limitation factors influencing health seeking behavior of adolescence. Table 4: 7 showing responses on the limitation factors contributing to health care seeking behaviors among adolescence. Responses Frequency Percentage Availability of services, service infrastructure, case loads, costs of services and costs associated with referrals Distance to sources of help 26 52% 10 20% Cultural and community norms related to help- and health-seeking behavior Personal coping skills 8 16% 4 8% Previous experiences with seeking help 2 4% Total 50 100 Source: Primary Data (2019) The study found out that 52% of the respondents strongly agreed that availability of services, service infrastructure, case loads, costs of services and costs associated with referrals are one of the limitation factors influencing health seeking behavior of adolescence. this finding was also in line with (Hughes & McCauley, 1998) who said that with increased reliance on private health care in some countries and settings, the costs of some kinds of help have increased in some settings; for young people, who generally have less disposable income than adults, these costs are even more onerous. Meanwhile in a key informant interview, one of the respondents said this; “You see in terms of availability of services, mismatches between the kinds of help adolescents want or need and the kinds of services offered can occur. For example, most existing Adolescent services address the unhealthy consequences of unprotected sexual activity. However, in terms of sexuality and reproductive health, some researchers have argued that the majority of adolescents in most parts of the world need mainly information and counseling”. (Key informant interview with one of the NGO staff dealing with Adolescence groups at their office in Alebtong town) 19 The study also found that the distance to sources of help was one of the limitation factors influencing health seeking behavior of adolescence and here 20% of the respondents gave their responses. This findings was also in line with (Islam, 1995) who said that in rural areas, distances to public health clinics and other institutional sources of help were not considerable and transportation costs were high and low use of government health facilities by adolescents was related to distance followed by lack of trust of the treatment available at the centre. Meanwhile the study also found out that 16% of the respondents mentioned that Cultural and community norms related to help- and health-seeking behavior was one of the limitation factors influencing health seeking behavior of adolescence. In a key informant interview, this was said; “ …Indeed, it was argued that even when formal health and social service infrastructures exist, adolescents generally prefer to rely on family and friends first and only subsequently turn to formal services, health or otherwise and sometimes suggest a progression from home treatment, in the case of illness, to the use of traditional healers to the use of modern or public health facilities as a last resort”(Key informant interview with a community member at his home in Akuki Village, Abiting Parish) Meanwhile the study also found that strongly 8% of the respondents also agreed that personal coping skills was one of the limiting factors affecting adolescence health seeking behaviors. On the other hand, the study also found out that previous experience with seeking help was one of the limitation factors towards adolescent health seeking behavior. In a key informant interview it was noted that; “….. Adolescents who have had negative experiences in seeking help may be reluctant to trust such persons or services in the future. This indicates the need for targeted efforts to overcome mistrust and win trust, a point that various key informants also stressed and young people often report having turned to social support (persons or institutions) in times of need and lost trust because of the ways those individuals or institutions responded to their need i.e. in judgmental terms, by betraying their confidence, by offering advice instead of listening or by rejecting or ridiculing the young persons.”(Key informant interview with the Community Development Officer Apala sub county at his office) 20 4.4 Findings on the measures that can be undertaken to improve health seeking behavior of adolescence. Table 4: 8 showing responses on the measures that can be undertaken to improve health seeking behavior of adolescence. Responses Frequency Percentage 29 56% Cultural leaders should not interfere with our health issues 14 29% There should be frequent health talk both to boys and girls 10 20% Nurses should continue to show love and care while at the 2 4% 50 100 Schools should have school dispensaries and there should community health centres with adolescent services health centres Total Source: Primary Data (2019) The study found out that 56% of respondents stated that Schools should have school dispensaries and there should community health centre with adolescent services in order to improve health seeking behavior of adolescence. And 29% of the respondents stated that cultural leaders should not interfere with their health related issues Meanwhile 20% of the respondents stated there should be frequent health talk both to boys and 4% of the respondents said that Nurses should continue to show love and care while at the health centres. 21 CHAPTER FIVE DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS 5.1 Introduction This chapter gives a summary of the study, draws conclusions and makes recommendations and suggestions for further research. The main focus of the study was to determine the favorable factors contributing to health care seeking behaviors among adolescences also identify the limitation factors influencing health seeking behavior of adolescence and investigate measures that can be undertaken to improve health seeking behavior of adolescence. 5.2 Discussion of the findings 5.2.1 Discussions on the favorable factors contributing to health care seeking behaviors among adolescence. In the study, there were more female respondents compared to male respondents and when you looked at the ages of the respondents, they were mainly from the age brackets of 13 years to 19 years of age respectively and here they helped so much in giving the responses to the questions as they were beneficiaries of these adolescent services that are always provided and furthermore, most of the respondents were still attending school and here their level of education determines the ability to give valid information to the study. Therefore, on the favorable factors contributing to health care seeking behaviors among adolescence, the study found out that relocating services to reach adolescents contributes to health care seeking behaviors among adolescence as people have found that it useful to locate or relocate health services that favors us adolescents things like school dispensary which is helping so much while at school because when u start to menstruate from school, senior woman teacher takes you to the school nurse for help and some NGOs are teaching us how to make reusable pads. Meanwhile that availability of adolescent health seeking services was found to be favoring the adolescents to seek the health care services as they won’t be experiencing more costs in transport and there is low cost of health services regarding adolescence where there are many NGOs training them on how to make reusable sanitary pads as favorable factor towards adolescent health seeking behavior and looking at the distances to the health facility where it is short and many adolescence are accessing the health facilities to receive the services. 22 Finally the love exhibited by the Nurses loves when at the health centre was found to be a motivating factor to adolescence to continue seeking these adolescent health services. It was found that both nurses at the school dispensaries and at health always provide good quality care to the adolescent groups whenever they seek for these services. 5.2.2 Discussions on the limitation factors influencing health seeking behavior of adolescence. It was found out that lack of adolescent health services, service infrastructure, case loads, costs of services and costs associated with referrals are one of the limitation factors influencing health seeking behavior of adolescence and through all these costs, it’s very hard for adolescents who generally have less money to access these services. It was found that the distance to sources of help was one of the limitation factors influencing health seeking behavior of adolescence citing an example of rural areas, distances to public health clinics and other institutional sources of help were not considerable and transportation costs were high and low use of government health facilities by adolescents was related to distance followed by lack of trust of the treatment available at the centre. Meanwhile the study also found that some cultural and community norms related to help- and health-seeking behavior was one of the limitation factors influencing health seeking behavior of adolescence as in some family sometimes suggest a progression from home treatment, in the case of illness, to the use of traditional healers to the use of modern or public health facilities as a last resort and there were issue that personal coping skills was one of the limiting factors affecting adolescence health seeking behaviors as some adolescents who had negative experiences in seeking help may be reluctant to trust such persons or services in the future because of what might had happened the first time they went to seek for health services. 5.2.3 Discussions on the measures that can be undertaken to improve health seeking behavior of adolescence. Here the discussion was that schools should have school dispensaries and there should community health centre with adolescent services in order to improve health seeking behavior of adolescence as this will motivate the adolescence youth to seek for health services and it was stated that cultural leaders should not interfere with their health related issues as there were instances where family members would first start by taking their children to the witch doctors thereafter to the health centers and on the other hand it was stated that there should be frequent health talk both to boys and Nurses should continue to show love and care while at the health centres to the adolescence who always go to seek health care services from them. 23 5.3 Conclusion 5.3.1 Conclusion on the favorable factors contributing to health care seeking behaviors among adolescence. The study concluded that relocating services to reach adolescents contributes to health care seeking behaviors among adolescence and things like school dispensary which is helping so much while at school because when u start to menstruate from school, senior women teachers takes them to the school nurse for help and some NGOs are teaching them on how to make reusable pads and when there was availability of adolescent health seeking services , the adolescents won’t be experiencing more costs in transport and there was low cost of health services regarding adolescence where there are many NGOs training them on how to make reusable sanitary and finally the love exhibited by the Nurses loves when at the health centre was a motivating factor to adolescence to continue seeking these adolescent health services as both nurses at the school dispensaries and at health always provide good quality care to the adolescent groups whenever they seek for these services. 5.3.2 Conclusions on the limitation factors influencing health seeking behavior of adolescence. It was concluded that lack of adolescent health services, costs of services and costs associated with referrals were one of the limitation factors influencing health seeking behavior of adolescence and through all these costs, it was very hard for adolescents who generally have less money to access these services meanwhile the distance to sources of help was one of the limitation factors influencing health seeking behavior of adolescence citing an example of rural areas, distances to public health clinics and other institutional sources of help were not considerable and transportation costs were high and low use of government health facilities by adolescents was related to distance followed by lack of trust of the treatment available at the centre. Meanwhile the study also concluded that some cultural and community norms related to help- and health-seeking behavior limits health seeking behavior of adolescence as in some family sometimes suggest a progression from home treatment, in the case of illness, to the use of traditional healers to the use of modern or public health facilities as a last resort and there were issue that personal coping skills was one of the limiting factors affecting adolescence health seeking behaviors as some adolescents who had negative experiences in seeking help may be reluctant to trust such persons or services in the future because of what might had happened the first time they went to seek for health services. 24 5.2.3 Conclusions on the measures that can be undertaken to improve health seeking behavior of adolescence. The study concluded that schools should have school dispensaries and there should community health centre with adolescent services in order to improve health seeking behavior of adolescence as this will motivate the adolescence youth to seek for health services and cultural leaders should not interfere with their health related issues as there were instances where family members would first start by taking their children to the witch doctors thereafter to the health centers and there should be frequent health talk both to boys and girls and nurses should continue to show love and care while at the health centres to the adolescence who always go to seek health care services from them. 5.4 Recommendations The study recommends that tight policies should be put in place to address the issues adolescent seeking behaviors among adolescents. The cultural leaders and families should be sensitized on the importance of taking adolescent to health centre when they want to get health services rather than the witch doctors The study recommends that there should be frequent health talk both to boys and girls and this should be done by community health promoters, VHTs and private partners. There is need for the government to construct a adolescent friendly home in each district in order to favor those who cannot easily access the health services. 5.5 Suggestions for Further Research The suggestions for further researcher are as follows. That a national wide survey be conducted on the impact of adolescent health seeking behavior on academic performance in primary school in Uganda. That the study be conducted to assess the nature of abuse, vulnerable and orphaned children experience in health seeking behaviors. 25 REFERENCES Agaba et al, 2011). 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New Delhi. 7th edition. 27 APPENDICES APPENDIX I: QUESTIONAIRES Dear Sir/ Madam, I am Ongom Horrish, a student of Lira University undertaking a Bachelor’s Degree in Community Psychology and Psychotherapy of Lira University. I am carrying out a research study on the factors contributing to adolescent health seeking behaviors; experiences of adolescence in a rural community in Abiting Parish, Apala Sub County Alebtong District. . This is part of the researcher’s effort in fulfilling the requirements for the award of a Bachelor’s Degree in Community Psychology and Psychotherapy of Lira University. This questionnaire is therefore intended to seek information on the above subject matter. The information that will be provided will purely be for academic purposes and all the responses will be handled with utmost confidentially. I, therefore humbly request that you complete this questionnaire correctly in the spaces provided or options given (please, tick the appropriate answers where options are given). SECTION A: BIO DATA 1-Gender: i) Male ii) Female 2. Age: i. Between 13-16 ii. Between 16-19 3. What is your level of Education? i) Attending primary education ii) Completed P.7 iii) Never completed P.7 iv) Attending lower secondary 28 Section B C. The favorable factors contributing to health care seeking behaviors among adolescence RESPONSES (Tick inside the box) √ Relocating services to reach adolescents The service are not expensive The health centre is not far Nurses loves when we are at the health centre Section C: The limitation factors influencing health seeking behavior of adolescence. Responses √ Availability of services, service infrastructure, case loads, costs of services and costs associated with referrals Distance to sources of help Cultural and community norms related to help- and health-seeking behavior Personal coping skills Previous experiences with seeking help Section D: The measures that can be undertaken to improve health seeking behavior of adolescence. Responses √ Schools should have school dispensaries and there should community health centres with adolescent services Cultural leaders should not interfere with our health issues There should be frequent health talk both to boys and girls Nurses should continue to show love and care while at the health centres 29 E. Adolescents’ awareness of sources of support: How would you rate the awareness on the part of adolescents about existing sources of support and services in your community? High Medium Low Comment: 30 Appendix II: INTERVIEW GUIDE FOR PUPILS. Dear respondent, I am Ongom Horrish, a student of Lira University undertaking a Bachelor’s Degree in Community Psychology and Psychotherapy of Lira University. I am carrying out a research study on the factors contributing to adolescent health seeking behaviors; experiences of adolescence in a rural community in Abiting Parish, Apala Sub County Alebtong District. . This is part of the researcher’s effort in fulfilling the requirements for the award of a Bachelor’s Degree in Community Psychology and Psychotherapy of Lira University. This questionnaire is therefore intended to seek information on the above subject matter. The information that will be provided will purely be for academic purposes and all the responses will be handled with utmost confidentially. I, therefore humbly request that you complete this questionnaire correctly in the spaces provided or options given (please, tick the appropriate answers where options are given). SECTION A: BIO DATA 1-Gender: i. Male ii. Female 2.Age: i. Between 13-16 ii. Between 16-19 3.What is your level of Education? i. Attending primary education ii. Completed P.7 iii. Never completed P.7 iv. Attending lower secondary 4. What are the favorable factors contributing to health care seeking behaviors of adolescence in Abiting Parish Apala Sub County Alebtong District? 5. What are the limitation factors that influence health care seeking behaviors of adolescence in Abiting Parish Apala Sub County Alebtong District? 6. What are measures that can be undertaken to improve health seeking behaviors of adolescence in Abiting Parish Apala Sub County Alebtong District? 31 APPENDIX III: WORK PLAN OF THE STUDY Table 9 showing the work plan of the study MONTHS OF THE YEAR No Activities 1 Writing Synopsis 2 Proposal writing & Nov-Dec Jan-Feb Mar-Apr May-June 2019 2019 2019 2019 submission 3 Data collection & analysis 4 Drafting & final report writing 5 Submission of final report 6 Others 32 APPENDIX IV: BUDGET OF THE STUDY Items Amount Stationeries typing & printing 30,000 Stationeries, typing, printing, internet & 150,000 consultation Transport & facilitation 100,000 Stationeries typing & binding 50,000 Transport printing & binding final copy 50,000 Miscellaneous 90,000 Total 460,000 33