Fifteen young adults within the age group 18–35 years, including seven females and eight males, participated in the study. Five young adults were recruited from Clinic A, six from Clinic B and four from Clinic C. The sampling frame consisted of all eligible young people attending the selected clinic for SRH services during the data collection period. A convenience sampling approach was used to recruit participants from this population. Routine statistics on daily or monthly attendance disaggregated by the study’s eligibility criteria were not available at the time of data collection. Therefore, all eligible attendees present at the clinic during the recruitment visit were invited to participate in the study. Potential participants were approached in the SRH waiting area either before or after their consultation. While participant recruitment occurred at times convenient to participants, inclusion was not based on availability alone but also on eligibility criteria and consent to participate. This recruitment approach ensured that participants had direct and recent experience with SRH services and were therefore well positioned to respond to the research questions.

Five SRH providers participated in the study: one from Clinic A, two from Clinic B and two from Clinic C. Sexual and reproductive health providers were defined as frontline health providers and peer educators directly involved in delivering SRH services to young adults. Purposive sampling was used to recruit participants and ensure the inclusion of participants with relevant expertise and daily experience in delivering SRH services to young people. The providers are specifically trained to provide SRH care and to work with young people. Although small, the sample provided diversity in gender, years of experience and professional background, offering a snapshot of the SRH provider population accessible to young adults in the study area.

Young adults eligible for inclusion were required to be between 18 years and 35 years of age, to be current users of SRH services at the clinic and to be available during the data collection period. Exclusion criteria included communication impairments, non-South African citizenship and attending the clinic solely to accompany others.

To be included in the study, SRH providers were required to have 6–12 months of experience and be actively working with young people aged 18–35 years within SRH services and to be present at the clinic during the data collection period. Providers working exclusively with other age groups or in SRH departments (antenatal care or labour wards) that were not related to youth-friendly SRH services were excluded. In the study setting, doctors were excluded because they have limited routine involvement in youth-friendly SRH services and are typically only involved when patients are referred. Youth-friendly SRH services are primarily delivered at the first point of contact by nurses, trained peer educators and counsellors.

Permission to conduct research in clinics was obtained through initial verbal and email communication with clinic managers.

Participants were recruited from the clinic waiting areas. Interested individuals were escorted to a private interview room designated by facility managers to ensure confidentiality, where they received comprehensive verbal and written information about the study. Upon signing informed consent forms, interviews were conducted in English. A male assistant conducted interviews with male participants to ensure gender-sensitive engagement.

Relevant SRH providers were identified with the assistance of facility managers. After receiving study information and providing written consent, they participated in one-on-one interviews, again in a private room.

The data were analysed using thematic analysis, guided by Thompson’s²⁰ abductive reasoning framework, which integrates both deductive and inductive logic to capture complex, subjective experiences. The process began with verbatim transcription of all interviews, followed by repeated reading of the transcripts alongside field notes. This step allowed for thorough familiarisation with the content and context of participants’ responses. Coding was conducted manually, drawing both from the SEM as a deductive framework and from subthemes that emerged inductively from the data. Two distinct codebooks were developed, one for young adults and one for SRH providers. Each codebook included definitions, usage instructions and illustrative quotes to ensure consistency and clarity. Related codes were then grouped into themes and subthemes, aligned with the different levels of the SEM. These themes were theorised in relation to existing literature and the SEM framework to interpret emerging behavioural patterns. To deepen the analysis, the analysis explored thematic patterns across young adults and SRH providers, with attention to how perspectives were expressed across gender, without undertaking formal comparative analyses. Findings were organised into thematic tables, supported by illustrative quotes that captured the richness of participants’ experiences. These insights were then woven into the broader discussion, offering nuanced interpretations and drawing out implications for policy and practice.

Trustworthiness of the qualitative findings was ensured through a comprehensive application of established criteria, including credibility, transferability, dependability and confirmability. To ensure that these methodological principles were rigorously applied, credibility was enhanced through data triangulation by incorporating two sets of perspectives – those of young adults and of SRH service providers.²¹ Transferability was addressed by providing thick, contextual descriptions of the research setting, participant demographics and the socio-cultural landscape of Soshanguve, enabling assessment of the applicability of the findings to other contexts. To ensure dependability, an audit trail was maintained, including comprehensive documentation of the research design, data collection procedures and analytical decisions.²² Confirmability was supported through systematic data management and the use of reflective practices, allowing the findings to be clearly traced back to the data and minimising researcher bias. The first author also maintained a reflexive journal to critically engage with her positionality, acknowledge potential biases and enhance transparency throughout the research process.²¹ These strategies collectively reinforced the integrity and rigour of the qualitative inquiry.

Participants’ responses reflected a binary pattern of knowledge, where some were informed while others lacked understanding. For example, one participant explained RSB as:

Another participant explained RSB as:

Some participants demonstrated limited familiarity with the concept of RSB. When asked to describe the term, they were unable to provide a definition until the interviewer clarified its meaning. For example, participant Y14 indicated that she did not know what RSB referred to, prompting the interviewer to explain the concept before continuing with the discussion:

In response, the interviewer briefly clarified the meaning of RSB before continuing the discussion:

However, knowledge about the SRH issue related to RSB was sometimes gained only after negative health experiences. One participant described learning about family planning after experiencing both an STI and a termination of pregnancy:

Negative attitudes towards sexual health were reported as barriers to preventive behaviour and SRH service utilisation. One participant observed that sexual health issues are often not taken seriously, particularly among older men who perceive themselves as capable of managing their health independently:

Misconceptions about contraceptives were frequently mentioned. Some participants believed that condom use reduces sexual pleasure. One participant said:

Fear and misinformation about HIV testing and prevention methods were also reported as barriers to service utilisation. One participant explained that some individuals avoid preventive services because they fear injections and are afraid to test for HIV due to uncertainty about the results:

Family settings played an important role in shaping knowledge and access to SRH services. Some participants described supportive family environments where open communication about sexual health helped them understand risks and facilitated access to SRH services:

Participants indicated that family encouragement positively influenced help-seeking behaviours and access to services:

Families influenced knowledge indirectly through media exposure. One participant described how television programmes were used to educate them:

However, other participants reported limited or shallow communication at home. One participant explained that although sexual health was occasionally mentioned at home, conversations rarely went deeper:

Peer influence was also described as a controlling factor affecting behaviour. Some participants explained that peer norms shaped attitudes towards condom use and risk-taking:

One participant explained that among some young men, condoms were perceived as reducing sexual pleasure, and peers often encouraged each other to have unprotected sex in order to experience ‘full’ sexual pleasure:

Fear of judgement also influenced decisions about accessing SRH services. Participants explained that visiting a clinic for sexual health services could lead to negative assumptions or social labelling within the community. One participant noted that men who visit clinics may be perceived as being sick, which discourages them from seeking care due to fear of community gossip:

Others reported that seeking STI testing could lead to negative assumptions about an individual’s sexual behaviour. One participant explained that people who go for testing may be judged by others as having engaged in risky sexual activity, such as unprotected sex:

Stigma and fear of judgement were described as barriers to utilising SRH services. Participants reported feeling uncomfortable being seen at clinics or discussing sexual health openly within their communities. A participant noted that community stigma surrounding SRH services discourages open conversations and prevents individuals from seeking care:

Similarly, another participant explained that individuals may avoid HIV or STI testing because they fear being judged for engaging in RSB:

Another participant highlighted that cultural norms and stigma related to certain sexual health issues, such as circumcision and STIs, also create barriers to accessing services:

Cultural beliefs and practices were also reported as influencing help-seeking behaviour. Some participants described growing up in communities where traditional remedies were commonly used to address sexual health concerns. One participant said:

Religious teachings were also described as influencing attitudes towards sexual behaviour and discussions about SRH. One participant explained that religious teachings emphasising abstinence before marriage shape perceptions of sexual behaviour and are intended to prevent sexual health problems:

Another participant described how religious beliefs limited open sexual intercourse discussions:

Some participants expressed a preference for private healthcare services, mainly due to concerns about confidentiality and comfort. One participant explained:

Similarly, another participant noted that this preference was common among young people:

These responses suggest that perceptions of privacy and confidentiality strongly influence where young adults seek SRH services.

Several participants reported that SRH services were often accessed only when problems had already occurred. One participant described using services because there was no alternative:

Another participant explained that preventive education and care were often delayed until individuals were already facing health problems:

Some participants indicated that men may prefer traditional health services to avoid stigma and judgement associated with clinics:

Although many challenges were reported, some participants described positive experiences with healthcare services, particularly when waiting times were short and staff were approachable:

Another participant highlighted differences between facilities:

Some participants reported negative experiences with healthcare providers, particularly judgemental attitudes that discouraged service utilisation. One participant described feeling judged by nurses:

Others also reported unfriendly behaviour:

Stigma within clinics was also mentioned as affecting men’s willingness to seek care:

Cultural norms were also described as shaping provider and community reactions:

Concerns about privacy were frequently reported as barriers to accessing services. One participant explained:

Some participants believed that SRH services were mainly designed for women, which discouraged male engagement. The participant said:

Financial barriers were also reported as limiting access to SRH services, indicating that economic factors remain an important determinant of access. One participant said:

Operational challenges such as long queues and delays were also described as barriers to accessing SRH services. One participant explained that inefficiencies within clinics, particularly long waiting times, discourage young people from utilising services:

Participants believed that access to SRH services should be recognised as a basic right and made widely accessible. One participant said:

Some participants recommended that healthcare facilities need to implement systems to evaluate service quality. The participants said:

Participants also emphasised the importance of training and capacity-building for healthcare providers. As one participant reported:

Participants identified the need for increased education and awareness campaigns to improve knowledge and access to SRH services. One participant explained that while some young people are aware of certain legal aspects of SRH services, broader knowledge about SRH rights and services remains limited, highlighting the need for more education:

Similarly, another participant emphasised the importance of community awareness campaigns to ensure that people have access to accurate information about SRH services:

Participants emphasised the importance of addressing stigma at the community level in order to improve access to SRH services. One participant explained that increasing community awareness and education could help reduce stigma and encourage individuals to seek services without fear of judgement:

Participants also highlighted the importance of introducing SRH education at an early stage through school-based programmes. One participant suggested that providing education in schools, particularly at the secondary level, could help young people gain knowledge before they become sexually active:

Service providers reported that many young adults have limited knowledge of SRH and often seek care only after experiencing sexual health problems such as STIs. One provider explained:

Another provider observed that some young people believed they already knew enough about SRH and were reluctant to learn additional information, even when education is available:

Similarly, inadequate understanding of prevention methods was also reported, particularly misconceptions about abortion and contraception:

Providers also described negative attitudes among young people towards SRH education and counselling. One provider explained that some young people were described as resisting formal educational approaches and showing little interest in structured health education:

Service providers frequently reported myths and misconceptions about contraceptives as barriers to service utilisation. Myths of weight gain and infertility were commonly mentioned. One provided share that:

Another provider described fears related to infertility and health complications:

Service providers reported that limited communication between parents and young people contributes to low awareness and delayed utilisation of SRH services. Many young people were described as feeling uncomfortable discussing sexual health issues at home:

Peer influence was also identified as a strong factor shaping behaviour. Providers explained that young people often adopt behaviours based on peer norms, even when these behaviours increase health risks:

Another provider similarly noted that peer group norms influence sexual behaviour:

Service providers reported that stigma and fear of judgement within communities discourage young adults from seeking SRH services. Young people were described by providers as being concerned about how others might perceive them if they accessed these services. One provider explained that young women who seek family planning services are often judged and assumed to be sexually active:

Another provider described how fear of disappointing parents prevents young people from seeking care:

Similarly, service providers reported that fear of being questioned by healthcare staff may discourage young people from visiting clinics for SRH services. One provider explained that some young people worry that they will be interrogated about their reasons for seeking family planning, particularly when they attend the clinic with their parents:

Community perceptions were also described as highly judgemental. One provider explained that young people who attempt to access condoms may be labelled as promiscuous, which discourages them from seeking SRH services openly:

Service providers also reported that some communities rely on traditional remedies before seeking biomedical care, which may delay treatment:

Another provider similarly noted:

Religious teachings were also described as influencing attitudes towards contraception and SRH services. One provider explained that some churches discourage the use of family planning methods, as these practices may conflict with religious teachings or beliefs about fertility:

Service providers reported that clinic booking systems sometimes limit access to SRH services. One provider explained that when appointment slots are fully booked, young people may be asked to return another day, which can discourage them from accessing services when they need them:

Limited clinic operating hours were also described as a barrier to accessing SRH services. One provider noted that the standard clinic hours may not always align with the schedules of young adults, making it difficult for them to attend:

Concerns about confidentiality were also highlighted. One provider explained that clinic procedures may compromise privacy. One provider explained that certain clinic procedures, such as being required to explain the reason for visiting at the entrance, may compromise privacy and discourage young people from seeking services:

Another provider emphasised the importance of maintaining confidentiality during consultations to ensure that young clients feel safe discussing sensitive issues:

Despite these challenges, providers described efforts to create supportive and non-judgemental environments for young clients. One provider explained that consultations are conducted privately to encourage open discussions and reassure clients that their information will remain confidential:

Another provider noted that using a friendly and respectful approach helps young people feel comfortable asking questions and seeking services:

Another provider noted that using a friendly and respectful approach helps young people feel comfortable asking questions and seeking services:

Service providers emphasised that young people have the right to access SRH services without being denied care. One provider explained that healthcare workers are obligated to provide services such as family planning in accordance with patient rights and legal provisions:

Providers also described health education activities conducted within healthcare facilities to increase awareness of available SRH services. One provider explained that health promoters regularly provide information to patients in waiting areas about contraceptive methods and where these services can be accessed:

Providers highlighted the importance of educating parents about SRH services in order to support preventive health behaviours among young people. One provider explained that some parents focus on confirming pregnancy rather than supporting preventive measures such as contraception:

Another provider emphasised that increasing parents’ awareness of SRH services could help them encourage their children to access these services when needed:

Mobile outreach programmes were identified as effective strategies for improving access to SRH services in communities. One provider explained that outreach campaigns using mobile clinics help reach young people who may be reluctant to visit health facilities:

Another provider noted that young people may feel more comfortable accessing SRH information and services when they are offered within their communities rather than at clinics:

Similarly, one provider explained that outreach programmes also include youth-focused activities that create opportunities for open discussions about SRH:

Providers also recommended strengthening school-based health services to improve early SRH education and access. One provider suggested that increasing the presence of school health nurses could help deliver SRH education and services directly within schools: