Participant characteristics

See Tables 2, 3.

Table 2 Demographic characteristics of adolescents (n = 18)Table 3 Characteristics of service providers (n = 15)Key findings

Three broad themes emerged from the adolescents’ and service providers' qualitative interviews: (1) COVID-19 SRH experience, (2) barriers to SRH, and (3) adolescent SRH service access strategies. These themes were then further divided into sub-themes, which are presented below.

1) COVID-19 SRH experience

The COVID-19 pandemic influenced many institutions including adolescents' access to sexual and reproductive health. We found that adolescents had both positive and negative experiences during the pandemic.

Impact of the COVID-19 pandemic

Many adolescents reported both positive and negative changes in their SRH services before and during the pandemic. These changes were associated with the challenges of accessing walk-in clinics and longer times to seek SRH services:

…It was definitely a lot harder to find that kind of access as well because of I assume, less staff working and more pandemic measures, so, while I assume it should have taken about a week it took a month to get the service that we did. (Adolescent Participant-1)

Service providers commented on the de-prioritization of SRH services during the pandemic: "I think this kind of got pushed aside – like sexual health like wasn’t people’s priority, of course, with COVID going on." (Health Educator).

Another service provider also mentioned:

Definitely not having the walk-in impacted youth, not providing the open access, you know, all the screening tools, the mask. It just became a whole ordeal just to even come in and pick up their birth control or, you know, get emergency contraceptives, or get tested. It was, you know, a whole lot, where it was just before, it was easy. They’d just come, they could go. So definitely, our access, and the walk-in, not having that available for them was probably that. (Public Health Nurse)

As consultation moved from in-person to online, some adolescents expressed their dissatisfaction with online services, especially with matters regarding counselling and family planning. They reported feeling uncomfortable with a healthcare provider in a virtual setting:

I needed to talk to my doctor about something and I wanted her to like look at something or like have a visual she only does phone appointments now most of the time, and then, if she didn't do for an appointment it's like she's only in office, I think, like two days a week, and that's changed definitely because she used to be an office I think. (AP-9)

Alternatively, many adolescents indicated online services to be a positive outcome of the pandemic: “Discussing with my doctor over the phone was very efficient and faster than it would have been in person” (AP-14).

Some participants stated that there was no impact of the pandemic on their SRH: “Personally, no. I don’t think it’s done anything like about my reproductive health, really. Like before and after, or even during, it was nothing’s really changed.” (AP-11).

Availability and accessibility of SRH products and services

Several adolescents reported the easy accessibility of using alternate (online) services for their SRH needs and highlighted the use of newer resources like mobile applications to support their SRH. Although some adolescents appreciated the online services, many struggled with lengthy waiting times and securing SRH products (contraceptives). They recalled the ease of obtaining free contraceptives and medical advice from clinics on a walk-in basis before the pandemic: “It’s also a lot harder to find free like birth control, like condoms or whatever versus before I just would pick them up in my local clinic.” (AP-4).

Another participant also expressed:

There's definitely a decrease in in-person services and I also think that there's much more of a wait time when it comes to picking up stuff like birth control or asking basic questions that I could easily have asked my physician before the pandemic. (AP-10)

Service providers talked about the challenges that were introduced in the system during the pandemic: "During the worst of the pandemic, there was only one nurse. It was by appointment only, which kids don’t do great with appointments. And it was symptomatic testing only." (Intake Coordinator).

Additionally, workforce shortages because of redeployment to COVID-19 response further compromised SRH operations:

So, staff shortages were – were typically because of redeployment to COVID-19 efforts, and so when your staff is doing something else, then you have limited access in terms of all of it (Public Health Nurse)

2) Barriers to SRH

We explored the barriers that adolescents encountered during the pandemic as many challenges were brought on by the closure of schools, limited hours of stores, and the absence of support systems.

Reduced SRH education through schools

Many adolescents indicated that the majority of their SRH education was obtained through the school. Formal classes on sexual education (sex-ed), as well as other courses, helped them to gain an understanding of their bodies and SRH, which got interrupted. As participant 14 mentioned: “I mean most of my information has come from school resources such as reproductive health classes and biology classes, so that is my main means for understanding reproductive and sexual [health].”

Another participant expressed:

During the pandemic, you know, due to the closure of schools, it affected the information I used to get, and you know, libraries. Like in most cases, I used to go to the library to, you know, have access to library materials to read more about sexual education and reproduction. (AP-12)

A service provider commented on how the pandemic led to the suspension of SRH outreach education initiatives:

So, before the pandemic, our clinic did a lot of outreach, so we’d go to like – it’s at the high school for kids that struggle in regular high school. We would go there. We would go to other little places around the community, and then with COVID, that obviously stopped. (Health Educator)

During the later stages of the pandemic when educational institutions switched to online platforms, SRH education was not given a higher priority:

It definitely like affected it, because I missed out on my grade ten and eleven – well, sorry, eleven and half of twelve school year, so it was like – like that’s like prime age for kids to start like exploring, and like I didn’t get that sex ed during those years, so like it was definitely more of a figure it out yourself kind of thing that happened, to like the age group that I belonged in, because we didn’t get taught it, because it wasn’t a priority, so they didn’t teach it over Zoom. (AP-16)

Limited store hours

Participants reported that reduced hours of stores during the pandemic decreased access to SRH products, like contraceptives and menstrual hygiene products: “I guess during the pandemic it definitely got a little bit harder, because of like the mandates and stuff like that, some stores were closed (AP-11).

Another participant expressed:

The ability to go to the store became a little bit harder because of limited capacities and things a lot of stores have only 25% capacity or 30% capacity, so it was hard just having to like wait in lines and things but that's just like a general inconvenience. (AP-17)

Another participant reported difficulties securing contraceptives: “Like if I was getting contraceptives, it was definitely harder to get during the pandemic because stores were closed down.” (AP-11).

Reduced supply of SRH products during the pandemic, such as contraceptives was also reported: “Lower store capacities or stock of items, especially when like toilet paper and, like other hygiene products things became a little bit harder.” (AP-17).

Lack of social support

Many adolescents expressed the loss of social support and connectedness during the pandemic. Social distancing mandates made it difficult to meet peers and share common concerns:

Like it's a lot harder to find a group like I said and to find people that you can rely on to support you as well, I felt like it was like I was discouraged during the beginning of the pandemic and during peak or like when there was more cases to go and get tested. (AP-8)

Another participant talked about losing other forms of support, such as counselling: “Yeah, kind of both, because the only counselling I would have had access to would have been school, and when schools went online, there was really no way to do that.” (AP-16).

One participant expressed the difficult journey of exploring their sexual orientation during the pandemic without any support:

So I found that has really impacted me and my sexual and reproductive health, during the pandemic I can't really talk about that, before because I don't think I would have gone through the journey that I've gone through with my sexuality if it wasn't for this pandemic but I do know that resources have been a lot harder for LGBTQ+ individuals during this time. (AP-4)

3) Adolescent SRH service access strategies

We inquired about adolescents’ perceptions of the development of a mobile application to access SRH resources and what strategies proved to be useful to them during the pandemic. Participants recommended strategies that they believed would be more beneficial for the adolescents.

Outlook on SRH digital strategies

The majority of the participants in this study supported the idea of developing a mobile application for SRH resources and indicated that it would increase access to SRH resources. One participant stated their preference for mobile applications over other digital platforms:

Yeah, I definitely would recommend that (mobile applications) I think would be really useful, especially because I'm on websites sometimes the university website sometimes just in general websites on the Internet, it can be hard to navigate them like they aren't made in a way that it's easy to know where things are located. (AP-1)

Service providers shared their experiences of using digital strategies for SRH education:

Like there’s actually a lot of good technology out there that I knew about and could use. Most of the time it was tech problems on the school side. Like there was lots of problems getting – if there was two classes, getting both teachers to log in, because the person who made the Google lead had to let them in. I couldn’t let them in. So, like there was like those little issues. (Health Educator)

On one hand, participants expressed that mobile applications would provide adolescents with the privacy to seek SRH help confidentially: “That's really cool and it could be super useful, especially for like people who are in families that don't feel comfortable talking about those things are no” (AP-13). On the other hand, some had concerns regarding the safety features of such applications and the possibility of receiving unreliable information:

Oh yes, and mobile apps I tend to be a bit more wary because there is a lot of misinformation and bad apps, I guess, but the online websites if it looks credible than I do, listen to what they say and they have helped me get more information on productive health and, what is needed to ensure that I'm being healthy and safe. (AP-14)

Supporting SRH through various strategies

We explored various strategies and recommendations from participants that would help in developing targeted interventions to support adolescents’ SRH. Participants talked about various features to facilitate the delivery of SRH resources and provide a holistic platform for adolescents to receive support. One participant indicated the importance of a simple interface design:

Maybe simplifying the online website would be helpful, so making the interface easier to navigate and having more information summarized - because sometimes some aspects aren't very clearly explained so just summarizing where things and having an easier interface would be very helpful. (AP-14)

Another participant recommended anonymous forums where adolescents with similar interests can freely discuss SRH with care providers:

Just a mobile app that makes information easy to consume because some people are like shy to look things up and just some maybe anonymous forums like so we can have this community of adolescents, to discuss freely about their problems rather than being embarrassed by having their public identity revealed so just some forums and some information and maybe some clinicians, if possible. (AP-7)

Service providers highlighted how they supported adolescents’ SRH by implementing various strategies:

I did a lot of texting with our youth patients during the pandemic. And I found that that was a really helpful way to sort of deliver a lot of information at once delivered in a way that's like immediate and accessible to the youth. (Public Health Nurse)

Along with videos, Zoom, like virtual sessions were also effective, because again, I can reach more rural. And we made a frequently asked questions PDF because usually we get really similar questions... And so that was really helpful because they can just read that and get their questions answered. (Partner Notification Nurse)

Many participants also expressed seeing various features to help them get quick access to resources and nearby SRH services:

I think that an app or like a website with like STI testing centers or different clinics and areas that you can go and get you know condoms birth control, whatever we can get all of this help just one app or one website that has all of that information there with very minimal searching. I think that would be something that would really benefit society because it's very hard to find information. (AP-4)

One service provider indicated how virtual strategies can target adolescents effectively and reduce barriers to their SRH and well-being:

I think like it’s the younger generations that are really doing well with like the virtual appointments. I think if they could find a way to make access to that more easier, I think kids would be more comfortable getting tested, instead of having to – you know, it’s intimidating for a 15 or 16-year-old kid to walk into a health building all by themselves, try to register themselves, sign in, go to the right desk, answer all these medical questions. So, it’d be nice if there was a more comfortable environment for them, perhaps. (Public Health Nurse)