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. 2025 Apr 16;25(1):1422.
doi: 10.1186/s12889-025-22595-6.

Finding knowledge: how youth identify their candidacy and sources of information regarding sexual and reproductive health in rural KwaZulu-Natal. South Africa

Ntombizonke A Gumede  1 , Siphesihle Hlongwane  1 , Vuyiswa Nxumalo  1 , Dumile Gumede  2 , Maryam Shahmanesh  1   3 , Janet Seeley  1   4   5 , Guy Harling  6   7   8   9
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Finding knowledge: how youth identify their candidacy and sources of information regarding sexual and reproductive health in rural KwaZulu-Natal. South Africa

Ntombizonke A Gumede et al. BMC Public Health. .

Abstract

Background: Despite efforts by government, non-governmental organizations, local communities and families, sexual and reproductive health (SRH) behavior and outcomes among adolescents and young adults ("youth") remain of concern in South Africa. Improving outcomes requires better understanding of how youth navigate and engage with potential sources of SRH information, so interventions can align with the contextual landscape.

Methods: We conducted secondary analysis of qualitative data, including interviews and group discussions, from five studies conducted in uMkhanyakude district, KwaZulu-Natal. We adapted the existing Candidacy Framework from its original focus on service use to apply to communication. We re-coded the transcripts using a thematic coding framework.

Results: Youth identified their candidacy for SRH information when they could not understand what others were saying about sexual health, when they feared illness in themselves or significant others, and when experiencing a health issue. Participants expected different types of information from healthcare providers, family members and peers, and had a nuanced understanding of the strengths and weaknesses of each source. Stigma related to youths' SRH and their precarious socioeconomic circumstances limited channels for communication and the ability for shared interpersonal knowledge to impact health behavior.

Conclusions: Identification of candidacy for SRH information in this setting was largely ad-hoc, but once aware of need, youth were able to identify and discriminate between multiple information sources. However, this information landscape was strongly shaped by formal provider and parent views of what youth should know and do, and peer sources limited own knowledge. Future interventions could address concerns at various points on the candidacy journey.

Keywords: Candidacy framework; Health communication; Sexual and reproductive health; South Africa; Youth.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: No data was collected for this analysis. All five underlying studies were previously approved by research ethics committees (REC) at University of the KwaZulu-Natal (UKZN) or Human Sciences Research Council in South Africa and the London School of Hygiene and Tropical Medicine or University of Southampton in the United Kingdom (depending on the study). This analysis was approved by UKZN’s Biomedical REC (reference BE352-19) and University College London’s REC (15231-001) as falling within the scope of the original studies. Both the original studies and this reanalysis were reviewed and approved by AHRI’s Community Advisory Board. All participants in the original studies provided written informed consent; where children under 18 years of age were interviewed, written informed consent from parents or guardians was also obtained. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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