Adolescent health services in a primary care facility in Northern Ghana: a qualitative investigation of patients’, guardians’, and staff’s perceptions of care

BACKGROUND: Ghana's population of 30.8 million people is predominantly young, with a median and mean age of 21 and 25.2 years, respectively. Yet, there are limited studies on quality of care for Adolescent and Young Adult (AYA) aged 10-24years in Ghana. To better understand barriers and facilitators to AYA primary care, we conducted a qualitative study at the Tamale Teaching Hospital polyclinic as part of a broader quality improvement initiative for youth care. METHODS: Convenience sampling was used to identify and recruit 12 youth, 8 guardians, and 22 staff for in-depth interviews and focus group discussions. In-depth interviews were conducted with AYAs and guardians, and focus group discussions were conducted with staff. Interviews and focus group discussions explored topics including: previous care experiences and reasons for visits, experiences and perceptions of service at registration or booking points, nursing services, consultations with doctors, services at the laboratory, pharmacy, and cash payment point. The study employed inductive and deductive reflexive thematic analysis of interviews and focus group discussions. All qualitative data were transcribed. The qualitative software NVivo 14 was used for coding and theme development. RESULTS: Five themes emerged: Healthcare quality and accessibility, systemic and administrative challenges, Autonomy, confidentiality and privacy, adolescent health conditions and needs, and participants' perspectives on improvement. The major barriers to adolescent responsive care are system inefficiencies and negative staff attitudes, and the major facilitators are trust and confidence in doctors' competence, perceived superior care in a Teaching Hospital, and convenient services and proximity. CONCLUSION: AYAs and guardians desire convenient, easily accessible, and high-quality care, delivered by a friendly and trusted team. The staff members envision the same kind of care for youth and believe that restructuring mainstream care and providing adequate training makes this possible.