A qualitative study on patients' selection in the scarcity of resources in the COVID-19 pandemic in a communal culture.

The scarcity of resources during the COVID-19 pandemic caused ethical dilemmas in prioritizing patients for treatment. Medical and ethical guidance only emphasizes clinical procedures but does not consider the sociocultural aspect. This study explored the perception of former COVID-19 patients and their families on the decision-making process of the patient's selection at a time of scarcity of resources. The result will inform the development of an ethical guide for allocating scarce resources that aligns with Indonesian culture. We conducted qualitative research with in-depth interviews between May - December 2022 involving sixteen participants from various cities in Indonesia. We transcribed the interviews and analyzed the results using thematic analysis. This study found that doctor's decisions often differed from patient's expectations in allocating scarce resources, and therefore, it should be communicated appropriately. Medical decisions were not sufficiently made ethically, but must also be made communicatively. In Indonesia's strong communal culture, community involvement was essential to distributing limited resources. A better approach to ethical education, including adequate communication skills, is necessary to prepare health professionals for facing unpredictable future pandemics.

Fertility intentions and family size among married men in Khartoum, Sudan.

Numerous factors contribute to high fertility within a specific context some of which are related to women's fertility practices. What has been less frequently examined, however, is how men's preferences and behaviours contribute to high fertility rates. This is imperative in a country such as Sudan which has reported continuously high fertility rates. This study aimed to analyse the socio-cultural factors affecting husbands' preferences and behaviours contributing to high fertility in Sudan. Participants were recruited from the Fertility and Reproductive Health Services Centre in Khartoum and Ahfad Family Health Centre in Omdurman city. Qualitative interviews were used to examine men's fertility preferences and behaviours. The main study findings suggest that husband's fertility preferences and the desire for a large family were prominent, being determined by local socio-cultural factors and religious norms. The data presented offers insight into key factors sustaining high fertility.

"It's like asking for a necktie when you don't have underwear": Discourses on patient rights in southern Karnataka, India.

BACKGROUND: Ensuring patient rights is an extension of applying human rights principles to health care. A critical examination of how the notion of patient rights is perceived and enacted by various actors through critical discourse analysis (CDA) can help understand the impediments to its realization in practice. METHODS: We studied the discourses and discursive practices on patient rights in subnational policies and in ten health facilities in southern Karnataka, India. We conducted interviews (78), focus group discussions (3) with care-seeking individuals, care-providers, health care administrators and public health officials. We also conducted participant observation in selected health facilities and examined subnational policy documents of Karnataka pertaining to patient rights. We analyzed the qualitative data for major and minor themes. RESULTS: Patient rights discourses were not based upon human rights notions. In the context of neoliberalism, they were predominantly embedded within the logic of quality of care, economic, and consumerist perspectives. Relatively powerful actors such as care-providers and health facility administrators used a panoply of discursive strategies such as emphasizing alternate discourses and controlling discursive resources to suppress the promotion of patient rights among care-seeking individuals in health facilities. As a result, the capacity of care-seeking individuals to know and claim patient rights was restricted. With neoliberal health policies promoting austerity measures on public health care system and weak implementation of health care regulations, patient rights discourses remained subdued in health facilities in Karnataka, India. CONCLUSIONS: The empirical findings on the local expression of patient rights in the discourses allowed for theoretical insights on the translation of conceptual understandings of patient rights to practice in the everyday lives of health system actors and care-seeking individuals. The CDA approach was helpful to identify the problematic aspects of discourses and discursive practices on patient rights where health facility administrators and care-providers wielded power to oppress care-seeking individuals. From the practical point of view, the study demonstrated the limitations of care-seeking individuals in the discursive realms to assert their agency as practitioners of (patient) rights in health facilities.

Towards understanding accountability for physicians practice in India.

The lack of accountability is considered to be a major cause of the crisis in health care in India. Physicians as key stakeholders in the health care delivery system have traditionally been accountable for health concerns at the doctor-patient interface. Following social and organizational dynamics, the interpretations of accountability have broadened and shifted in the recent literature, expanding accountability to the community, national and global levels and to social domains. The objective of this study is to provide a comprehensive framework of accountability in medical practice that can be used as a vehicle for further contextualized research and policy input. Through literature review, this paper is presented in two parts. First, a description of accountability of a physician inclusive of the social domains is extracted by posing three pertinent questions: who is accountable? accountability to whom? and accountability for what? which addresses the roles, relationships with other stakeholders and domains of accountability. Second, a framework of accountability of a physician is designed and presented to illustrate the professional and social domains. This study revealed a shift from individual physician's accountability to collective accountability involving multiple stakeholders through complex reciprocal and multi-layered mechanisms inclusive of the social dimensions. We propose a comprehensive framework of accountability of the physician to include the social domains that its multidimensional and integrative of all stakeholders. Furthermore, we discuss the utility of the framework in the Indian health care system and how this can facilitate further research in understanding the social dimensions of all stakeholders.

Crying baby gets the milk? The governmentality of grievance redressal for patient rights violations in Karnataka, India.

BACKGROUND: Patient rights aim to protect the dignity of healthcare-seeking individuals. Realisation of these rights is predicated on effective grievance redressal for the victims of patient rights violations. METHODS: We used a critical case (that yields the most information) of patient rights violations reported in Karnataka state (South India) to explore the power dynamics involved in resolving grievances raised by healthcare-seeking individuals. Using interviews, media reports and other documents pertaining to the case, we explored the 'governmentality' of grievance redressal for patient rights violations, that is, the interaction of micropractices and techniques of power employed by actors to govern the processes and outcomes. We also examined whether existing governmentality ensured procedural and substantive justice to care-seeking individuals. RESULTS: Collective action was necessary by the aggrieved women in terms of protests, media engagement, petitions and follow-up to ensure that the State accepted a complaint against a medical professional. Each institution, and especially the medical professional council, exercised its power by problematising the grievance in its own way which was distinct from the problematisation of the grievance by the collective. The State bureaucracy enacted its power by creating a maze of organisational units and by fragmenting the grievance redressal across various bureaucratic units. CONCLUSION: There is a need for measures guaranteeing accountability, transparency, promptness, fairness, credibility and trustworthiness in the patient grievance redressal system. Governmentality as a framework enabled to study how subjects (care-seeking individuals) are rendered governable and resist dominant forces in the grievance redressal system for patient rights violations.

Is the healthcare provision in the Netherlands compliant with universal health coverage based on the right to health? A narrative literature review.

Universal health coverage, as one of the targets of the Sustainable Development Goals, is the access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost. It is a practical expression of the concern for health equity and the right to health, and a goal for all countries. This review is a novel attempt to explore the healthcare provision in the Netherlands as an expression of universal health coverage based on the right to health.The study adopted a narrative review approach using a framework that consists of 10 universal health coverage indicators which are derived from seven human rights principles. The techno-economic approach to healthcare provision by the Dutch state achieves a healthcare system where most of the population is covered for most of the services for most of the costs. The Dutch state complies with its minimum core obligations, while less attention is paid to participatory decision making and non-discrimination principles. However, with the fiscal sustainability of healthcare provision showing erosion, basing healthcare policy on values based on human rights principles might prevent a regressive policy.

Suicide and deliberate self-harm among women in Nepal: a scoping review.

BACKGROUND: Suicide is a growing public health problem globally. Suicide accounts for 70% of violent deaths among women in low and middle income countries. In Nepal suicide is the single leading cause of death among women of reproductive age. The aim of this scoping review is to explore and understand the various contexts related to vulnerability of Nepalese woman towards suicide and deliberate self-harm. METHODS: A scoping review based on Arksey and O'Malley's methodological framework including a combination of peer-reviewed publications and grey literature was conducted. The National Library of Medicine's PubMed and Google Scholar search engines were used during July 2019 applying a Boolean search strategy. RESULTS: Suicide incidence was found to be higher among younger age group and married women, with poisoning as the most common means of suicide. Psychosocial and economic factors such as abuse, interpersonal conflicts, marital disputes, relationship problems, adjustment problems, unpaid loans and financial losses; and mental health conditions such as mood disorder, adjustment disorder and substance abuse disorder were found to be contributing factors for suicide and deliberate self-harm among women in Nepal. CONCLUSION: Socio-cultural and economic factors shape family and marital relationships which impacts psycho-social and mental wellbeing of women in Nepal inciting suicidal attempts and deliberate self-harm. However, very few studies were found that explore the context of poverty, social exclusion, gender inequality, education, traditional/cultural and patriarchal system in which suicide among women in Nepal occurs.

Multilevel governance framework on grievance redressal for patient rights violations in India.

The notion of patient rights encompasses the obligations of the state and healthcare providers to respect the dignity, autonomy and equality of care-seeking individuals in healthcare processes. Functional patient grievance redressal systems are key to ensuring that the rights of individuals seeking healthcare are protected. We critically examined the published literature from high-income and upper-middle-income countries to establish an analytical framework on grievance redressal for patient rights violations in health facilities. We then used lawsuits on patient rights violations from the Supreme Court of India to analyse the relevance of the developed framework to the Indian context. With market perspectives pervading the health sector, there is an increasing trend of adopting a consumerist approach to protecting patient rights. In this line, avenues for grievance redressal for patient rights violations are gaining traction. Some of the methods and instruments for patient rights implementation include charters, ombudsmen, tribunals, health professional councils, separating rules for redressal and professional liability in patient rights violations, blame-free reporting systems, direct community monitoring and the court system. The grievance redressal mechanisms for patient rights violations in health facilities showcase multilevel governance arrangements with overlapping decision-making units at the national and subnational levels. The privileged position of medical professionals in multilevel governance arrangements for grievance redressal puts care-seeking individuals at a disadvantaged position during dispute resolution processes. Inclusion of external structures in health services and the healthcare profession and laypersons in the grievance redressal processes is heavily contested. Normatively speaking, a patient grievance redressal system should be accessible, impartial and independent in its function, possess the required competence, have adequate authority, seek continuous quality improvement, offer feedback to the health system and be comprehensive and integrated within the larger healthcare regulatory architecture.

Is a 'culture of plus-size women' the independent effect of neighborhood disadvantage on female BMI? A cross-sectional study in two Chilean Municipalities.

Research has shown that neighborhood disadvantage has an effect on BMI that is independent of individual disadvantage, much more pronounced in women than in men. The mechanisms that explain this gender-specific effect are not yet clear. Since women's body size dissatisfaction is closely linked to gender differences in BMI inequalities, the independent effect of neighborhood disadvantage on female BMI may relate to a local culture of acceptance of female large bodies, that could influence women's parameters for body size dissatisfaction. This study explored how the relation between female BMI, neighborhood income, individual income and education is influenced by body size dissatisfaction in a random sample of 882 women aged 20-60 that reside in two Chilean Municipalities. Data have a two level structure (women nested in 17 neighborhoods); it was collected by direct survey, height and weight were measured with portable instruments. Disadvantaged neighborhoods house mainly poor and low educated women, whereas the wealthier ones were inhabited mostly by affluent women with postsecondary education. The proportion of women without a husband/partner and with more than three children in disadvantaged neighborhoods was higher than better off areas. Multilevel linear regression showed that neighborhood disadvantage had an effect on female BMI that was independent of women's income and education, which was explained by body size dissatisfaction. The mean BMI for body size satisfaction among women in disadvantaged neighborhoods was 2 kg/m2 higher than in affluent areas, which suggests that a 'culture of plus-size women' would emerge in urban clusters of poverty. The findings signal that neighborhood effects on BMI would relate to the socioeconomic polarization of urban areas, with marked concentrations of poverty and wealth, and might be explained by the psychosocial pathways associated to social disadvantage that act in addition to the effects of material conditions to influence people's health.

Providers' perspectives on the performance of primary healthcare centres in India: The missing link.

BACKGROUND: Primary healthcare centres (PHCs) form the foundation of the Indian public health system, and thus their effective functioning is paramount in ensuring the population's health. The World Health Organisation (WHO) has set six aspects of performance assessment for general health systems, which are hardly applicable to the PHC setup in a low- and middle-income country. The Primary Health Care Performance Initiative (PHCPI) has prescribed a framework with five domains consisting of 36 indicators for primary healthcare performance assessment from a policy point of view. For the assessment to be realistic, it should include inputs from stakeholders involved in care delivery, so this study examines the perspectives of healthcare providers at PHCs in India. METHODOLOGY: The authors used qualitative research methodology in the form of responsive evaluations of healthcare provider's interviews to understand the indicators of PHC performance. RESULTS AND CONCLUSION: The study results showed that healthcare providers considered efficient teamwork, opportunities for enhancing provider skills and knowledge, job satisfaction, effective PHC administration, and good community relationship as PHC performance assessment. These domains of performance could be considered the 'missing link' in PHC assessment, since they are deemed important by providers and did not coincide with the WHO aspects and the PHCPI performance assessment framework.

'You're only there on the phone'? A qualitative exploration of community, affect and agential capacity in HIV self-testing using a smartphone app.

Mobile health (mHealth) technologies for HIV care are developed to provide diagnostic support, health education, risk assessment and self-monitoring. They aim to either improve or replace part of the therapeutic relationship. Part of the therapeutic relationship is affective, with the emergence of feelings and emotion, yet little research on mHealth for HIV care focuses on affect and HIV testing practices. Furthermore, most of the literature exploring affect and care relations with the introduction of mHealth is limited to the European and Australian context. This article explores affective dimensions of HIV self-testing using a smartphone app strategy in Cape Town, South Africa and Montréal, Canada. This study is based on observation notes, 41 interviews and 1 focus group discussion with study participants and trained HIV healthcare providers from two quantitative studies evaluating the app-based self-test strategy. Our paper reveals how fear, apathy, judgement, frustration and comfort arise in testing encounters using the app and in previous testing experiences, as well as how this relates to care providers and test materials. Attending to affective aspects of this app-based self-testing practice makes visible certain affordances and limitations of the app within the therapeutic encounter and illustrates how mHealth can contribute to HIV care.

Towards a multilevel governance framework on the implementation of patient rights in health facilities: a protocol for a systematic scoping review.

INTRODUCTION: Patient rights are "those rights that are attributed to a person seeking healthcare". Patient rights have implications for quality of healthcare and acts as a key accountability tool. It can galvanise structural improvements in the health system and reinforces ethical healthcare. States are duty bound to respect, protect and promote patient rights. The rhetoric on patient rights is burgeoning across the globe. With changing modes of governance arrangements, a number of state and non-state actors and institutions at various levels play a role in the design and implementation of (patient rights) policies. However, there is limited understanding on the multilevel institutional mechanisms for patient rights implementation in health facilities. We attempt to fill this gap by analysing the available scholarship on patient rights through a critical interpretive synthesis approach in a systematic scoping review. METHODS: The review question is 'how do the multilevel actors, institutional structures, processes interact and influence the patient rights implementation in healthcare facilities? How do they work at what level and in which contexts?" Three databases PubMed, LexisNexis and Web of Science will be systematically searched until 30 th April 2020, for empirical and non-empirical literature in English from both lower middle-income countries and high-income countries. Targeted search will be performed in grey literature and through citation and reference tracking of key records. Using the critical interpretive synthesis approach, a multilevel governance framework on the implementation of patient rights in health facilities which is grounded in the data will be developed. ETHICS AND DISSEMINATION: The review uses published literature hence ethics approval is not required. The findings of the review will be published in a peer-reviewed journal. REGISTRATION NUMBER: PROSPERO 2020 CRD42020176939.

Experiences of pregnancy in adolescence of internally displaced women in Bogotá: an ethnographic approach.

BACKGROUND: Pregnancy in adolescence is higher among internally displaced women in Colombia than non-displaced women. It is defined as a problem with significant negative outcomes by both biomedical and epidemiological approaches. However, little is known about pregnancy during adolescence from the perspective of women who experienced this in the specific context of armed conflict and displacement. AIM: This article focuses on how internally displaced women understand their experiences of pregnancy in adolescence in the context of armed conflict through an ethnographic approach in a receptor community of internally displaced women in Bogotá, Colombia. METHODS: Based on 10 years of experience in the community, we conducted 1 year of fieldwork, using an ethnographic approach. We collected life stories of 20 internally displaced women through in-depth interviews and ran 8 workshops with them and other women from the community. We used thematic analysis to analyse the responses of internally-displaced women and understand how they made meaning around their experiences of adolescent pregnancy in the context of displacement. RESULTS: The main themes that emerged from participants' experiences include rural violence, early family life (characterized by violence and mistreatment at home), meanings of pregnancy at an early age (including being challenged and feelings of love), and reactions to their pregnancies during adolescence (such as stigmatization) from their families and partners. CONCLUSION: Our analysis of the in-depth interviews and the workshops suggests that adolescent pregnancy among women who are internally displaced has complex dynamics, characterized by the violent context of the rural areas, but primarily by the violence experienced during their childhood. The experience of pregnancy during adolescence brings feelings of ownership and also challenges, together with the forced displacement. This understanding will provide insights for policy makers and healthcare providers on how to work with this specific population who have experienced pregnancy in adolescence.

The 'exotic other' in medical curricula: Rethinking cultural diversity in course manuals.

Introduction: Implementation of cultural diversity training in medical education faces challenges, including ambiguity about the interpretation of 'cultural diversity'. This is worrisome as research has demonstrated that the interpretation employed matters greatly to practices and people concerned. This study therefore explored the construction of cultural diversity in medical curricula.Methods: Using a constructivist approach we performed a content analysis of course materials of three purposefully selected undergraduate curricula in the Netherlands. Via open coding we looked for text references that identified differences labelled in terms of culture. Iteratively, we developed themes from the text fragments.Results: We identified four mechanisms, showing together that culture is unconsciously constructed as something or someone exotic, deviant from the standard Dutch or Western patient or disease, and therefore problematic.Conclusions: We complemented earlier identified mechanisms of othering and stereotyping by showing how these mechanisms are embedded in educational materials themselves and reinforce each other. We argue that the embedded notion of 'problematic stranger' can lead to a lack of tools for taking appropriate medical action and to insecurity among doctors. This study suggests that integrating more attention to biological and contextual differences in the entire medical curriculum and leaving out static references such as ethnicity and nationality, can enhance quality of medical training and care.

Alone But Supported: A Qualitative Study of an HIV Self-testing App in an Observational Cohort Study in South Africa.

HIV self-testing has the potential to improve test access and uptake, but concerns remain regarding counselling and support during and after HIV self-testing. We investigated an oral HIV self-testing strategy together with a mobile phone/tablet application to see if and how it provided counselling and support, and how it might impact test access. This ethnographic study was nested within an ongoing observational cohort study in Cape Town, South Africa. Qualitative data was collected from study participants and study staff using 33 semi-structured interviews, one focus group discussion, and observation notes. The app provided information and guidance while also addressing privacy concerns. The flexibility and support provided by the strategy gave participants more control in choosing whom they included during testing. Accessibility concerns included smartphone access and usability issues for older and rural users. The adaptable access and support of this strategy could aid in expanding test access in South Africa.

Valuing Simplicity: Developing a Good Point of Care Diagnostic.

Point-of-care testing promises laboratory-based precision in settings that do not have easy access to laboratories or where processing tests takes too long or is too costly. Developers and global health actors stress values and norms such as simplicity, rapidity and accuracy for realizing diagnostic innovations that work at point of care and are aligned to the specific requirements of point-of-care settings. This paper uses fieldwork among diagnostic manufacturers, scientists, donors, members of civil society, industry consultants, international organizations, regulators, policymakers, programme officers, lab technicians, and clinicians involved in development and implementation of tuberculosis and HIV diagnostics, to examine how norms and values of what constitutes a good point-of-care diagnostic are operating in practice through both top-down and bottom-up dynamics. It draws the link between design, evidence and adoption of diagnostics and how the different actors interpret the values underpinning the new practice. The analysis draws on literature on valuation practices, evidence-making and technology design in science and technology studies and medical sociology. The findings reveal how these values constitute innovation, implementation, and evaluation practices across global and local (India) sites, with important consequences for funding of health infrastructure, capacity, and training resources for addressing some of the existing structural inequalities. Dominant values currently defining point of care diagnostics risk exacerbating health inequalities between those who do and do not have the necessary social and financial resources to access better equipped and functioning healthcare facilities, especially in resource constrained settings.

'We are the advocates for the babies' - understanding interactions between patients and health care providers during the prevention of mother-to-child transmission of HIV in South Africa: a qualitative study.

Background: HIV/AIDS has had a significant impact on maternal and child health in South Africa. It is thus of vital importance to implement interventions to prevent mother-to-child transmission of HIV (PMTCT) as early as possible during pregnancy. Negative interactions between patients and health care providers (HCPs) can be an important barrier to antenatal care, PMTCT use and PMTCT adherence. Research about respectful maternity care has focused more on the patient perspective. We therefore compared the patient and HCP perspectives and reflected on how interactions between HCPs and patients can be improved. Objective: To obtain insights into the attitudes of HCPs in the context of HIV and PMTCT-related care, by studying patient and HCP perceptions of their interactions, in a peri-urban hospital setting in Gauteng province, South Africa. Methods: A qualitative study was conducted in a public tertiary-level hospital. Fourteen semi-structured in-depth interviews were conducted with nurses and doctors in the antenatal clinic and postnatal ward. Thirty-one semi-structured in-depth interviews and two focus group discussions were conducted with HIV positive and negative women on the postnatal ward. Results: HCPs experienced a difficult work environment due to a high workload. This was combined with frustrations when they felt that patients did not take responsibility for their own or their child's health. They were motivated by the need to help the child. Patients experienced judging comments by HCPs especially towards younger, older and foreign women. They expressed fear to ask questions and self-blame, which in some cases delayed health care seeking. No discrimination or isolation of HIV infected patients was reported by patients and HCPs. Conclusion: We hypothesize that more humane working conditions for obstetric HCPs and a caring, personalised approach to patient management can improve patient-provider interactions and access to respectful care. These are critical to preventing mother-to-child transmission of HIV.

'We just been forced to do it': exploring victimization and agency among internally displaced young mothers in Bogotá.

BACKGROUND: Armed conflict in Colombia has a history of 50 years that continues to this day. According to the Victims Record of Colombia, from 1985 to 2013 2.683.335 women have been victims of the armed conflict. Women have been described as the main victims of the armed conflict, especially in the Colombian cultural context that in some regions is still considered to be a 'machista' and patriarchal one. In contrast, some authors have explicitly stressed Colombian women's agency instead of positioning them only as victims. Some of them are described as 'survivors' of the war, emphasizing their impressive resistance to the outcomes of war and forced displacement. In contrast to the background of these scholarly discussions, our study focused on how displaced women living in Bogotá themselves articulate their experiences of agency and victimization. This paper will therefore explore how women, in reconstructing their life stories, expressed the tussles between victimization and agency. METHODS: We used qualitative methods conducted within an ethnographic approach. Based on ten years of experience in the neighborhood and one year of fieldwork, we collected the life stories of twenty internally displaced mothers, and ran eight workshops with them. We analyzed the narratives with a specific focus on how women expressed victimization and agency in four important periods in their life that related to the process of displacement: when they left home, when they became pregnant, when they were forced to leave their towns, and when they arrived in Bogotá. RESULTS: Participants' life stories showed how they struggled with agency during their lives. They were victims of abuse and violence during childhood and finally decided to leave their homes. They decided to have their babies despite the fact that they were abandoned by their partners and families, and after doubts about and attempts to have an abortion. Throughout the process of displacement the participants had been engaged in ambiguous relationships with armed groups. Finally they arrived in Bogotá and faced adverse circumstances but were looking for better opportunities for them and their children. CONCLUSION: The analysis of how internally displaced women narrated their life stories showed us that the concepts that dominate scholarly debates about agency, victimization and survivorship do not do justice to the life stories of the participants in our study. These stories show that changes with a major impact were loaded with ambiguity and were characterized by helplessness, lack of control and agency simultaneously. The reconstruction of these life stories goes beyond the stereotype of displaced women as only 'victims', but points also to their agency and courageous decisions they made in contexts that were not controlled by them and where support was often lacking. Instead of label them, it is important to understand the complexity of the life experiences of IDW, in order to build policies that offer them aids as victims, but also build policies and intervention programs that empower them as agents in order to support them during resettlement.

Nurses' perceptions of adolescents accessing and utilizing sexual and reproductive healthcare services in Cape Town, South Africa: A qualitative study.

BACKGROUND: In Sub-Saharan Africa access to and utilization of sexual and reproductive healthcare is unsatisfactory. Consequently, rates of teenage pregnancy and unsafe abortions among adolescents in Sub-Saharan Africa, including in South Africa remain a public health challenge. The aim of this study was to explore nurses' views on and perceptions of adolescent girls' barriers and needs to accessing and utilizing sexual and reproductive healthcare services. METHODS: Twenty-four purposively selected healthcare workers from nine public healthcare facilities in Cape Town, South Africa participated in this qualitative descriptive study. Data were collected through nine group discussions, and audio-recorded with hand-written notes taken during the discussions. Data were analyzed using thematic analysis, following the Tesch's eight steps for coding and analysing qualitative data. RESULTS: Sexual and reproductive healthcare nurses are generally supportive of adolescents who ask for and use contraceptives. Non-compliance to family planning regimens and repeated requests for termination of pregnancies were perceived by nurses as irresponsible behaviours which are particularly frustrating to them and not in concordance with their personal values. The subsequent nurse-adolescent interactions sometimes appeared to hinder access to and utilization of sexual and reproductive healthcare services by adolescents. CONCLUSIONS: Nurses perceive certain behaviours of adolescent girls as irresponsible and warrant their negative attitudes and reactions toward them. The negative attitudes and reactions of nurses potentially further compromises access to and utilization of sexual and reproductive healthcare services by adolescent girls in South Africa and requires urgent attention. Adolescent-friendly clinic hours together with youth-friendly nurses is likely to encourage adolescent girls to access sexual and reproductive healthcare services and improve the use thereof.