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Table 2 Barriers and enablers to sexual health service use among university undergraduate student

From: Barriers and enablers to sexual health service use among university students: a qualitative descriptive study using the Theoretical Domains Framework and COM-B model

COM-B

TDF Domain

Themes

Belief Statements

Participanta

Students

HCP/Admin

Capability

Knowledge

1. Limited sexual health knowledge and awareness

Knowledge and awareness of the services is important to know when and how to access

First year students lack sexual health-related knowledge and find it difficult to remember where to go or how to access services

Students have questions but do not know where to go, which can lead to a cycle of misinformation

Students have go-to informants for sexual health information, including Residence Assistants (RAs) and the internet

✔

✔

2. Lack of clarity for LGBTQ students

LGBTQ students do not always understand what they are at risk for or what services they should be accessing

Some health care providers do not feel confident providing sexual health care to LGBTQ students

✔

✔

Memory, Attention, Decision-Making Processes

3. Visibility of sexual health services

Certain prompts and reminders help students to remember to access their sexual health services, including emails, posters, Facebook groups

Sexual health service use can be a game of hide and seek – students have to go searching for information related to the health clinic

✔

✔

Opportunity

Social Influences

4. Health care provider interaction

Students favour seeing the same health care provider for continuity in their care

Student-HCP interaction (both positive and negative) during a sexual health visit impacts their experience with care and willingness to return

✔

✔

5. Peer influence

Supportive friends promote access of sexual health services

There is a stigma related to accessing sexual health services which prevents service use

Seeing classmates at the clinic is uncomfortable

Female students felt a sense of responsibility to access sexual health services to protect both themselves and their partner’s health.

✔

–

Environmental Context and Resources

6. Campus culture

University culture promotes sexual experimentation and exploration, risk taking behaviour, and avoidance of health promotion behaviours such as sexual health service use

It is important to have sexual health services available in an environment that promotes risk-taking behaviour

✔

–

7. Accessibility of services

Financial access: students are paying into the wellness fund, so they feel as so they should use the services

Hours of operation can help or hinder students’ access depending on their flexibility

Location of services is an important characteristic

Wait times hinder students’ access; students are forced to miss class due to wait times

✔

✔

Motivation

Beliefs about Consequences

8. Period of exploration and experimentation

University is a time of sexual exploration and risk-taking behaviours; it is important to have these services available during this period

✔

–

Optimism

9. Normalizing sexual health

Some students are seeing trends towards normalizing sexual health and access of sexual health services

There is a trend towards sex-positivity which supports service use

✔

✔

Beliefs about Consequences and Emotions

10. Stigma, privacy and confidentiality

There is still a stigma related to accessing sexual health services

Students feel a range of emotions when accessing sexual health services (awkward, discomfort, frustration, shame)

Services that value privacy and confidentiality can mitigate the negative emotions

✔

✔

  1. a✔ = Agreement by participants; − = Silence by participants; HCP, health care provider; Admin, university administrator