title: Primary healthcare providers' views on improving sexual and reproductive healthcare for adolescents in Bolivia, Ecuador, and Nicaragua.
abstract: OBJECTIVE
  To elicit the views of primary healthcare providers from Bolivia, Ecuador, and Nicaragua on how adolescent sexual and reproductive health (ASRH) care in their communities can be improved.
  
  
  METHODS
  Overall, 126 healthcare providers (46 from Bolivia, 39 from Ecuador, and 41 from Nicaragua) took part in this qualitative study. During a series of moderated discussions, they provided written opinions about the accessibility and appropriateness of ASRH services and suggestions for its improvement. The data were analyzed by employing a content analysis methodology.
  
  
  RESULTS
  Study participants emphasized managerial issues such as the prioritization of adolescents as a patient group and increased healthcare providers' awareness about adolescent-friendly approaches. They noted that such an approach needs to be extended beyond primary healthcare centers. Schools, parents, and the community in general should be encouraged to integrate issues related to ASRH in the everyday life of adolescents and become 'gate-openers' to ASRH services. To ensure the success of such measures, action at the policy level would be required. For example, decision-makers could call for developing clinical guidelines for this population group and coordinate multisectoral efforts.
  
  
  CONCLUSIONS
  To improve ASRH services within primary healthcare institutions in three Latin American countries, primary healthcare providers call for focusing on improving the youth-friendliness of health settings. To facilitate this, they suggested engaging with key stakeholders, such as parents, schools, and decision-makers at the policy level.
authors.affiliation: Department of Family Medicine, Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania. ljaruseviciene@gmail.com
authors.forename: Lina
authors.initials: L
authors.lastname: Jaruseviciene
authors.forename: Miguel
authors.initials: M
authors.lastname: Orozco
authors.forename: Marcia
authors.initials: M
authors.lastname: Ibarra
authors.forename: Freddy Cordova
authors.initials: FC
authors.lastname: Ossio
authors.forename: Bernardo
authors.initials: B
authors.lastname: Vega
authors.forename: Nancy
authors.initials: N
authors.lastname: Auquilla
authors.forename: Joel
authors.initials: J
authors.lastname: Medina
authors.forename: Anna C
authors.initials: AC
authors.lastname: Gorter
authors.forename: Peter
authors.initials: P
authors.lastname: Decat
authors.forename: Sara De
authors.initials: SD
authors.lastname: Meyer
authors.forename: Marleen
authors.initials: M
authors.lastname: Temmerman
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Edmonds
authors.forename: Leonas
authors.initials: L
authors.lastname: Valius
authors.forename: Jeffrey V
authors.initials: JV
authors.lastname: Lazarus
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D001838:Bolivia; D004484:Ecuador; D005260:Female; D006282:Health Personnel / Q000523:psychology; D006292:Health Priorities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009527:Nicaragua; D058996:Quality Improvement; D060728:Reproductive Health; D034121:Reproductive Health Services / Q000592:standards*
keywords: Latin America; adolescents; healthcare personnel; primary healthcare; reproductive health services