Barriers and facilitators to community-based, peer-led sexual and reproductive health intervention for adolescent girls and young women in northeastern Uganda: A qualitative study
Loading...
Date
2026-06-11
Journal Title
Journal ISSN
Volume Title
Publisher
PLOS (Public Library of Science)
Abstract
Peer-led interventions can effectively improve sexual and reproductive health (SRH) knowledge, promote safer sexual behaviors among adolescents and young people, especially where health system capacity is limited. To inform a planned pre-post study, we explored the barriers and facilitators to the implementation of a community-based, peer-led SRH intervention for adolescent girls and young women (AGYW) aged 15–24 years in northeastern Uganda. We designed a qualitative case study and collected data through focus group discussions across AGYW in six categories: in-school, out-of-school, ever given birth, and never given birth, aged 15–17 years, and aged ≥18 years. We also conducted key informant interviews with SRH officials in the district and at two health facilities. Data collection was guided by the socioecological model. We performed thematic analysis and reported findings using themes along with the participants’ quotes mapped onto the socioecological model. A total of 51 adolescent girls and young women, and five key informant interviews with the district and health facility level officials were conducted. Findings show that the anticipated barriers and facilitators to implementation occur across socioecological levels. At the individual level, stigma and fear of judgment hindered participation, whereas trust in peers supported engagement. Limited autonomy hindered access at the interpersonal level, but support from family and friends helped. Institutional barriers included judgmental provider attitudes and confidentiality concerns; existing youth-friendly services and school clubs were facilitators. At the community level, myths, misconceptions, and restrictive cultural norms posed challenges, while community dialogues and champions encouraged acceptance. No major policy barriers were noted; however, supportive SRH policies and existing partnerships were facilitators. The implementation of the intervention may be influenced by several factors across individual, interpersonal, institutional, community, and policy levels. Future implementation should consider addressing the barriers while leveraging the facilitators to enhance implementation outcomes among AGYW
Description
This study advances Sustainable Development Goal (SDG) 3 (Target 3.7) and SDG 5 (Target 5.6) by identifying multi-level barriers and facilitators to peer-led sexual and reproductive health (SRH) interventions for marginalized adolescent girls in Uganda, while also supporting SDG 10 (Target 10.2). The findings align with Uganda’s Fourth National Development Plan (NDP IV) by contributing to human capital development, adolescent health, and cross-cutting priorities related to equity and youth empowerment. The evidence generated informs scalable and context-sensitive implementation strategies. Recommended policy actions include strengthening youth-friendly services with confidentiality safeguards, investing in peer educator training, and fostering community-level norm change to address stigma and gendered power dynamics that limit adolescent health-seeking behavior.
Keywords
Peer-led interventions, Adolescent reproductive health, Socioecological model, Uganda
Citation
Komuhangi, A., Kajabwangu, R., & Izudi, J. (2026). Barriers and facilitators to community-based, peer-led sexual and reproductive health intervention for adolescent girls and young women in northeastern Uganda: A qualitative study. PLOS Global Public Health, 6(6), e0005828.