A scoping review of qualitative studies on sexual and reproductive health and rights in Uganda: Exploring factors at multiple levels.

Julie M Buser, Edward Kumakech, Ella August, Gurpreet K Rana, Rachel Gray, Anna Grace Auma, Faelan E Jacobson-Davies, Tamrat Endale, Pebalo Francis Pebolo, Yolanda R Smith
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Abstract

Background: Uganda is burdened by high unintended and teen pregnancies, high sexually transmitted infections, and harm caused by unsafe abortion.

Objectives: Explore factors influencing sexual and reproductive health and rights (SRHR) in Uganda by synthesizing evidence from qualitative studies using a scoping review.

Eligibility criteria: Original qualitative peer-reviewed research studies published between 2002 and 2023 in any language exploring factors influencing SRHR in Uganda.

Sources of evidence: Eight databases searched using qualitative/mixed methods search filters and no language limits.

Charting methods: Information extracted included author, article title, publication year, study aims, participant description, data collection type, sample size, main findings, factors at the individual, interpersonal, community, and policy levels, implications for SRHR in Uganda, and study limitations. Quality of the selected articles was assessed using the Critical Appraisal Skills Programme tool.

Results: One hundred seventy-three studies met inclusion criteria. At the individual level, knowledge and attitudes toward SRHR, risky sexual behavior, and access to maternal SRHR services were identified as critical factors influencing health outcomes. Interpersonal factors included communication with sexual partners and relationships with family, school, and community members. Healthcare organization factors included adolescent access to education, SRHR services, and HIV prevention. Cultural and social factors included gendered norms and male involvement in SRHR. Policy-level factors included the importance of aligning policy and practice.

Conclusions: Multiple factors at individual, interpersonal, community, healthcare, cultural, and policy levels were found to influence SRHR in Uganda. The findings suggest that interventions targeting multiple levels of the socio-ecological system may be necessary to improve SRHR outcomes. This review highlights the need for a holistic approach that considers the broader socio-ecological context. Reducing identified gaps in the literature, particularly between policy and practice related to SRHR, is urgently needed in Uganda. We hope this review will inform the development of policies and interventions to improve SRHR outcomes.

对乌干达性健康和生殖健康及权利定性研究的范围审查:探索多层次因素。
背景:乌干达意外怀孕和少女怀孕率高,性传播感染率高,不安全堕胎造成的伤害大:乌干达意外怀孕和少女怀孕率高,性传播感染率高,不安全堕胎造成的伤害大:通过范围界定审查综合定性研究的证据,探讨影响乌干达性与生殖健康和权利(SRHR)的因素:资格标准:2002 年至 2023 年期间以任何语言发表的、探讨影响乌干达性与生殖健康和权利因素的原创性定性同行评审研究:使用定性/混合方法搜索过滤器搜索了八个数据库,没有语言限制:提取的信息包括作者、文章标题、出版年份、研究目的、参与者描述、数据收集类型、样本大小、主要发现、个人、人际、社区和政策层面的因素、对乌干达性健康和生殖健康及权利的影响以及研究局限性。采用批判性评价技能计划工具对所选文章的质量进行了评估:结果:173 项研究符合纳入标准。在个人层面,对性健康和生殖健康及权利的认识和态度、危险的性行为以及获得孕产妇性健康和生殖健康及权利服务被认为是影响健康结果的关键因素。人际因素包括与性伴侣的沟通以及与家庭、学校和社区成员的关系。医疗机构因素包括青少年获得教育、性健康和生殖健康及权利服务以及艾滋病预防的机会。文化和社会因素包括性别规范和男性对性健康和生殖健康及权利的参与。政策层面的因素包括政策与实践相一致的重要性:在乌干达,个人、人际、社区、医疗保健、文化和政策层面的多种因素都对性健康和生殖健康及权利产生了影响。研究结果表明,有必要针对社会生态系统的多个层面采取干预措施,以改善性健康和生殖健康及权利的成果。本次审查强调,有必要采取一种考虑到更广泛的社会生态环境的整体方法。乌干达迫切需要缩小文献中已发现的差距,特别是与性健康和生殖健康及权利相关的政策与实践之间的差距。我们希望本综述将为制定政策和干预措施提供信息,以改善性健康和生殖健康及权利成果。
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