Adolescent sexual and reproductive health assessment in clinical practice in India: a qualitative study triangulating clinician practices and young adults' experiences.

چکیده اصلی

OBJECTIVES: To characterise current practices in adolescent sexual and reproductive health (SRH) assessment during routine clinical encounters in a tertiary care setting and to triangulate these findings with young adults' experiences of adolescent healthcare, identifying gaps between recommended assessment approaches and real-world clinical practice. DESIGN: Qualitative study using semistructured in-depth interviews (IDIs) and group discussions with clinicians, followed by a sequential triangulation phase involving IDIs with young adults. Data were analysed using Braun and Clarke's reflexive thematic analysis. SETTING: A tertiary care hospital in South Karnataka, India. PARTICIPANTS: 33 clinicians across six departments participated in four IDIs and five group discussions (focus-group or small-group discussions). 10 undergraduate young adults were recruited for IDIs in the triangulation phase. Sampling was guided by the information power principle. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Current patterns and practices of SRH assessment, perceived barriers and challenges and concordance between clinician-reported practices and young adults' experiences of care. RESULTS: Three domains emerged: current assessment practices, contextual challenges and improvement strategies. SRH assessment was largely symptom-driven and reactive rather than routinely integrated into consultations. Clinicians described practices shaped by sociocultural stigma, parental presence, privacy limitations and medicolegal uncertainty. In response, many relied on informal strategies such as rapport-building, indirect questioning or referral pathways. Triangulation with young adults' experiences confirmed the reactive nature of SRH enquiry, but revealed critical mismatches: young adults perceived consent processes as opaque, investigations as unexplained and confidentiality as inconsistently protected, contrasting with clinician intentions to be protective and pragmatic. CONCLUSIONS: Adolescent SRH assessment in tertiary care settings remains constrained by sociocultural, infrastructural and communication barriers. Clinicians often compensate through informal practices that lack standardised protocols. Integrating adolescent-focused communication training, standardised assessment approaches and supportive system-level and community interventions may strengthen disclosure and improve adolescent-centred SRH care. By triangulating provider and patient perspectives, this study reveals a systematic gap between clinician adaptive strategies, constructed as protective and adolescents' experiences as opaque, non-participatory care offering contextually grounded implications for strengthening adolescent-centred SRH services in comparable LMIC settings. TRIAL REGISTRATION NUMBER: Not applicable (Qualitative Study).

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