Methods: The study team conducted in-depth semi-structured interviews and focus groups with 35 female YEH aged 14-22 (M=17.5) years who participated in Wahine Talk. We also conducted in-depth interviews and focus groups with seven Wahine Talk program providers. The data were transcribed verbatim and analyzed using inductive thematic analysis. We coded the transcripts in NVivo using a codebook informed by the levels of the social-ecological model: individual, interpersonal, organizational, community, and societal. We then developed and refined themes and sub-themes reflecting youth and providers’ perceptions of multilevel factors influencing the SRH of YEH.
Findings: Study findings illustrate the complex interplay between individual, interpersonal, organizational, community, and societal level factors in the lives of YEH, which influence their SRH. Participants shared that lack of knowledge around safe sex and reproductive options affected their ability to achieve optimal SRH and exercise their SRH rights. Their confidence in their ability to assert their SRH choices was influenced by their perceived knowledge and skill along with the attitudes of their partner. Participants described the challenges of reconciling their own SRH decisions with the cultures, religions, traditions, and values of their families and communities in which they live. The challenges of parenting, navigating relationships with partners, and conflict with family also influenced YEH’s well being and SRH. Overarching structural challenges of housing, education, employment, finances, healthcare, safety and security, and basic needs permeate YEH’s lives and subsequently affect their SRH.
Conclusions and Implications: Study findings illustrate that YEH face myriad challenges at multiple levels that impact their SRH. Thus, SRH programs must address these challenges to best serve these populations, including providing structural-level interventions to complement individual and interpersonal programming. These findings provide further nuance about the interplay of multilevel factors, many of which are directly modifiable, to inform future iterations of Wahine Talk and other SRH programs. Appropriate programming that addresses the multilevel factors that influence YEH’s ability to achieve optimal SRH and exercise their SRH rights is essential to achieve health equity and to improve the lives of this historically marginalized and overlooked population. These findings can be applied to future social work research and practice that centers equity and justice for YEH.