# Assessment of Youth-Friendly Service Quality and Associated Factors in Bole Sub-city, Addis Ababa, Ethiopia: A Cross-Sectional Study

## TL;DR

This study assesses the quality of youth-friendly health services in Ethiopia and finds it to be poor, with factors like stigma and gender disparities playing a role.

## Contribution

The study provides new insights into the quality of youth-friendly services and identifies key factors influencing their effectiveness in a specific Ethiopian context.

## Key findings

- Youth-friendly service quality was rated as sub-optimal at 46%.
- Higher YFS process quality and awareness were associated with better service quality.
- Stigma, discrimination, and being female were linked to poorer service quality.

## Abstract

Background: Youth-Friendly Service (YFS) quality is a comprehensive YFS standard that encompasses utilization, community participation, teenagers' participation in planning, monitoring, and evaluation, inclusive YFS, and a sense of support and satisfaction with the overall YFS. These output characteristics are instrumental in promoting increased engagement with YFS among youth, communities, and healthcare providers. However, YFS quality is an underexplored dimension within current YFS standards, evidenced by a scarcity of research and limited dissemination of findings, best practices, and policy initiatives. This study was therefore conducted to investigate the quality of YFS and its determinants in Bole Sub-City, Addis Ababa, Ethiopia.

Methodology: A total of 365 participants were selected using a multi-stage probability sampling technique. Data were collected through structured questionnaires and analyzed using both descriptive and inferential statistics. Inferential statistics included a one-sample binomial test of proportion and binary logistic regression.

Results: The study findings showed that the YFS quality was sub-optimal, at 46%. Several factors significantly influenced whether YFS quality was rated as good or poor. Specifically, a better YFS process was strongly associated with higher odds of good YFS quality (adjusted odds ratio [AOR] = 1.11, 95% confidence interval [CI] = 1.07-1.14). Increased YFS awareness also led to greater odds of good YFS quality (AOR = 1.03, 95% CI = 1.01-1.04). Conversely, higher levels of stigma and discrimination were linked to lower odds of good YFS quality (AOR = 0.95, 95% CI = 0.93-0.97). Additionally, being female was associated with significantly lower odds of good YFS quality compared to being male (AOR = 0.47, 95% CI = 0.56-3.18).

Conclusions: YFS quality in Bole Sub-City, Addis Ababa, was sub-optimal. This can be attributed to several influencing factors, including gender-related disparities (particularly impacting female beneficiaries), suboptimal YFS process quality, insufficient YFS awareness among beneficiaries, and the presence of stigma and discrimination. These findings critically underscore the importance of not only improving the procedural aspects of YFS delivery but also significantly enhancing youth awareness and actively combating stigma and discrimination within healthcare settings. Therefore, targeted interventions are urgently needed to elevate service standards and ensure equitable, high-quality YFS for all youth.