Características generales del pensamiento peirceano 12

As indicated in the help-seeking definition above, sources of help can be categorized as formal or informal. Formal sources of help consist of counsellors and modern health care providers, in contrast, informal sources of help consist of parents, friends, school/teachers, traditional health care providers, and the media (Schonert-Reichl and Muller, 1996; Raviv et al., 2000). Although these same categories are used in this thesis, they can at times be confusing. For example, Van der Reit and Knoetze (2004 p.233) argue that “while teachers are in ‘formal’ role relationships with youth, they do not necessarily have professional helping skills and their role as a potential help source is often closer to the ‘informal’ category of helpers.” Similar to these authors, in the current study, a formal help source is those whose primary relationship to the adolescent is that of a help source, such as a health worker. In this thesis, informal sources of help are also referred to as social network sources, and sources of help are used interchangeably with “helpers” for ease of reading. Figure 2-1 shows the diversity of help sources that adolescents reportedly utilize to deal with their SRH concerns – the broken line indicates concurrent use of formal and informal sources.

Figure 2-1 Sources from which adolescents seek help

2.3.1 Informal help sources

Although patterns of ASRH help-seeking are not always consistent, most studies indicate that adolescents prefer to seek and utilize help from informal sources (Marcell and Halpern-Felsher, 2007; Boldero and Fallon, 1995; Okereke, 2010; Bankole et al., 2007; Char et al., 2011; Tengia-Kessy and Kamugisha, 2006; Namisi et al., 2009; Van der Reit and Knoetze, 2004; Ackard and Neumark-Sztainer, 2001; Berhane et al., 2005). For example, in national household surveys among adolescents ages 12-14 in Burkina Faso, Ghana, Malawi and Uganda, the mass media, teachers and schools, other family members, and friends were the most dominant information sources reportedly utilized for information related to HIV, STIs and contraceptives (Bankole et al., 2007). However, in the same study, health providers were also a dominant source of information for adolescents in Malawi.

HELP-SEEKING

NO

Self

No-one

YES

Informal source

Media

Parents (mother)

Friends

Teachers/school

Formal source

Health provider

Counselor

Despite mixed findings regarding informal sources, parents, especially mothers appeared to be preferred and/or the most valuable informal source for SRH concerns, such as sexuality, HIV/AIDS, abstinence, condoms, and even general health concerns (Jones and Biddlecom, 2011; Berhane et al., 2005; Namisi et al., 2009; Ackard and Neumark-Sztainer, 2001).

Furthermore, there was also indication of preference for same sex parental communication.

For example, mothers were preferred by a majority of female adolescents in all three sites, while males in two (1 Tanzanian and 1 South African) of the three sites preferred to communicate with fathers (47% to 27%). Although, Namisi et al. (2009) did not separate the scale for measuring communication with parents for mother and father, among students in the United States of America (USA), Ackard and Neumark-Sztainer (2001) also found that mothers were the most used source by both male and female adolescents, and also the first source from which help was sought for health care information relating to general health concerns.

Only a few studies reported peers as an important source of help for adolescents with SRH concerns (Tangia-Kessy and Kamugisha, 2006; Van der Reit and Knoetze, 2004; Char et al., 2011; Jones and Biddlecom, 2008). However, Masatu et al. (2003) pointed out that peers may not be a main source of information and advice for SRH concerns, because of their lack of credibility to provide accurate information. Similarly, a recent qualitative study (Jones and Biddlecom, 2011) among public high school students (ages 16-19) in the USA found that few students used the Internet as a source of SRH information related to abstinence and contraception, and majority were wary and distrustful of it as a source of SRH information.

However, some studies reported that adolescents preferred to seek and utilize help (e.g.

information) from media sources, such as television (Tengia-Kessy and Kamugisha, 2006; Char et al., 2011) and the Internet (Borzekowski and Rickert, 2001; Pearson and Madkazange, 2008).

Teachers, who may be viewed as more credible sources of information, were only reported as the most popular source at sites in two studies (Bankole et al., 2007; Namisi et al., 2009).

Interestingly, most of the students in Bankole et al. study reported not receiving family life or sex education in school, whereas teachers were not an important source of information for adolescents in Dar es Salaam, Tanzania where family life education is integrated into the school curriculum (Tangia-Kessy and Kamugisha, 2006). However, Van der Reit and Knoetze (2004) posited that teachers in their qualitative study among school age youth (14-22 years), were most often approached when other potential helpers were absent and if teachers were deemed trustworthy.

2.3.2 Formal help sources

Similar to the findings regarding informal sources, adolescents’ utilization of formal sources for SRH concerns were inconsistent (Langhaug et al., 2003; Berhane et al., 2005; Kaipa-Iwa and Hart, 2004; Agampodi et al., 2008; Biddlecom et al., 2007; Miles et al., 2001; Char et al., 2011). For example, in Bankole et al.’ (2007) surveys in four African countries, only in Malawi were health facilities a major source of SRH information for adolescents, and more girls (50%) than boys (36%) reported having gotten information from health professionals (Bankole et al., 2007). Ackard and Neumark-Sztainer (2001) found that both female and male in-school adolescents reported doctors/nurses as the second source from whom they sought health care information. Among young men in rural India, only 23% of young men in the study reported health workers as a principal source of SRH information, however, 72% of young men reported a preference for talking to health providers face-to-face for SRH concerns (Char et al., 2011).

The authors suggest that this highlights the young men’s wish for communication with credible sources, as was discussed by Masatu et al. (2003) in section 2.3.1.

Although Biddlecom et al. (2007) reported that the adolescents in their study underutilized STI services and HIV testing, those who obtained care did so from clinics, hospitals and doctors than from other sources, such as traditional healers. However, traditional healers and herbalists were also commonly mentioned as hospitals and public clinics. Interestingly, the majority of the adolescents in Biddlecom et al.’ study preferred public over private clinics. One study reporting on access to contraceptives in Jamaica, indicated gender differences in access.

Crawford et al. (2009) reported that about 12% of female adolescents in Jamaica accessed contraceptives from health centres compared to 3% of male adolescents. And that 20% of female adolescents accessed contraceptives from private pharmacies compared to 9% males (Crawford et al., 2009). In Jamaica more female adolescents access contraceptives from public health facilities than males; however there appears to be a preference for private providers compared to public providers, as is assumed of adolescents in Grenada (section 1.3).

The above shows that there are variations in the sources of help that adolescents utilize. In the literature, these variations are attributed to many factors. These are discussed in section 2.4 below as contextual factors.