BACKGROUND The status of adolescent sexual and reproductive health (SRH) in Nepal is alarming. Adolescent-friendly services (AFS) were introduced to cater the health needs of adolescents. Optimal utilization of the services with wider accessibility is required to prevent adolescents from adopting life-threatening behaviors that result in poor SRH-related outcomes. Despite the upgrading of health facilities to adolescent-friendly sites, studies reveal low utilization of the service. However, these studies failed to explore the factors influencing the low levels of service utilization in these adolescent-friendly facilities. This study quantified the utilization of AFS and identified factors associated with its utilization among adolescents of Bhaktapur district. METHODS A cross-sectional survey of 362 systematic randomly selected adolescents from four village development committees of Bhaktapur district was conducted, using a self-administered questionnaire. Relationships between utilization of AFS and associated factors were determined by multivariate logistic regression at a level of significance with a p value of less than 0.05 and adjusted odds ratio. Key informant interviews and focus group discussions with adolescents were used to collect qualitative data which were then described using thematic analysis. RESULT About a quarter (24.7%) of the respondents had utilized the adolescent-friendly services. Factors positively associated with the utilization of services included adolescents aged 15-19 years, female, heard about AFS, lack of fear of being seen while getting SRH services, lack of shyness about receiving SRH services, and the perceived need for SRH services as soon as illness became apparent. The qualitative findings revealed lack of awareness about the services, socio-cultural barriers, confidentiality, feasible service hours, and the preference for of same-sex service providers as the factors affecting utilization. CONCLUSION The utilization of adolescent-friendly services was very low in Bhaktapur district. Most of the adolescents were unaware of the existence of the AFS which emphasizes the need to focus on the increasing awareness of SRH and AFS by the government in coordination with local schools, clubs, etc. Creating an enabling environment in the service delivery sites, and ensuring privacy and confidentiality, as well as ensuring same-sex service providers and feasible service hours to adolescents, could increase the service utilization.

中文翻译：

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与尼泊尔巴克塔普尔区青少年友好服务利用相关的因素。

背景 尼泊尔青少年性与生殖健康 (SRH) 的状况令人担忧。引入青少年友好服务（AFS）是为了满足青少年的健康需要。需要以更广泛的方式优化利用服务，以防止青少年采取危及生命的行为，从而导致与 SRH 相关的结果不佳。尽管卫生设施已升级为适合青少年使用的场所，但研究表明该服务的利用率较低。然而，这些研究未能探讨影响这些青少年友好设施中服务利用率低的因素。本研究量化了 AFS 的使用情况，并确定了与 Bhaktapur 地区青少年使用 AFS 相关的因素。方法 对来自巴克塔普尔区四个村发展委员会的 362 名系统随机选择的青少年进行横断面调查，使用自填式问卷调查。AFS 的利用与相关因素之间的关系通过多变量逻辑回归在显着性水平上确定，p 值小于 0.05 和调整的优势比。与青少年的关键知情人访谈和焦点小组讨论被用来收集定性数据，然后使用主题分析进行描述。结果 约四分之一 (24.7%) 的受访者使用过青少年友好型服务。与服务利用正相关的因素包括 15-19 岁的青少年、女性、听说过 AFS、在获得 SRH 服务时不怕被人看到、缺乏对接受 SRH 服务的害羞，以及一旦疾病变得明显就意识到需要 SRH 服务。定性调查结果显示，对服务缺乏认识、社会文化障碍、保密性、可行的服务时间以及对同性服务提供者的偏好是影响利用的因素。结论 在 Bhaktapur 地区，青少年友好服务的利用率非常低。大多数青少年不知道 AFS 的存在，这强调需要政府与当地学校、俱乐部等协调，提高对 SRH 和 AFS 的认识。 在服务提供场所创造有利环境，以及确保隐私和保密，并确保同性服务提供者和青少年可行的服务时间，