title: Healthcare workers' behaviors and personal determinants associated with providing adequate sexual and reproductive healthcare services in sub-Saharan Africa: a systematic review.
abstract: Healthcare workers may affect the utilization of sexual and reproductive healthcare (SRH) services, and quality of care thereof, for example by their behaviours or attitudes they hold. This can become a hindrance to accessing and utilizing SRH services, particularly by young people, and thus a better understanding of these behaviours and associated factors is needed to improve access to and utilization of SRH services.
  
  
  
  A systematic review of literature was conducted to identify studies focusing on healthcare workers' behaviors and personal determinants associated with providing adequate SRH services in sub-Saharan Africa (January 1990 - October 2015). Five databases were searched until 30th October 2015, using a search strategy that was adapted based on the technical requirements of each specific database. Articles were independently screened for eligibility by two researchers. Of the 125-screened full-text articles, 35 studies met all the inclusion criteria.
  
  
  
  Negative behaviours and attitudes of healthcare workers, as well as other personal determinants, such as poor knowledge and skills of SRH services, and related factors, like availability of essential drugs and equipment are associated with provision of inadequate SRH services. Some healthcare workers still have negative attitudes towards young people using contraceptives and are more likely to limit access to and utilization of SRH by adolescents especially. Knowledge of and implementation of specific SRH components are below optimum levels according to the WHO recommended guidelines.
  
  
  
  Healthcare workers' negative behaviours and attitudes are unlikely to encourage women in general to access and utilize SRH services, but more specifically young women. Knowledge of SRH services, including basic emergency obstetric care (EmOC) is insufficient among healthcare workers in SSA.
  
  
  
  A protocol for this systematic review was registered with PROSPERO and the registration number is: CRD42015017509 .
authors.affiliation: Department of Health Promotion, School of Public Health and Primary Care (CAPHRI), Faculty of Heath, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. kim.jonas@maastrichtuniversityt.nl.
authors.forename: Kim
authors.identifier: 0000-0002-4469-6674
authors.initials: K
authors.lastname: Jonas
authors.affiliation: Department of Health Promotion, School of Public Health and Primary Care (CAPHRI), Faculty of Heath, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
authors.forename: Rik
authors.initials: R
authors.lastname: Crutzen
authors.affiliation: Department of Health Promotion, School of Public Health and Primary Care (CAPHRI), Faculty of Heath, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: van den Borne
authors.affiliation: Faculty of Community and Health Science, University of the Western Cape, Cape Town, South Africa.|Human Sciences Research Council (HSRC), Population Health, Health Systems and Innovation Unit, Cape Town, South Africa.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Reddy
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000592:standards*; D017954:Africa South of the Sahara; D000367:Age Factors; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003270:Contraceptive Agents; D006282:Health Personnel; D006297:Health Services Accessibility; D006801:Humans; D008427:Maternal Health Services / Q000592:standards; D011787:Quality of Health Care; D034121:Reproductive Health Services / Q000592:standards*
chemical_list: D003270:Contraceptive Agents
keywords: Adolescent health; Child health; Healthcare services; Healthcare worker behaviour; Maternal health; Personal determinants; Sexual and reproductive healthcare; Systematic review