Qualitative insights on sexual health counselling from refugee youth in Bidi Bidi Refugee Settlement, Uganda: Advancing contextual considerations for brief sexuality-related communication in a humanitarian setting.

Trusting relationships with local healthcare practitioners, including practices that foster comfort and confidentiality, were identified as key relational factors enabling sexual health communication.

• Participants reported that trust in healthcare providers was a foundational element for engaging in sexual health discussions.
• Practices that fostered comfort and maintained confidentiality were specifically highlighted as important by youth participants.
• Local healthcare practitioners (as opposed to outside providers) were emphasized as important for building this trust.
• Study included 40 participants across four focus groups, mean age 20 years (SD: 2.2), equally split between young women (n=20) and young men (n=20).

Family, friends, and mentors served as additional and important sources of sexual health information for refugee youth beyond formal healthcare settings.

• These informal sources were categorized under the relational dimension of context.
• This finding suggests youth rely on social networks when formal healthcare communication about sexual health is limited or inaccessible.
• Participants were aged 16–24 and living in Bidi Bidi Refugee Settlement in Uganda.

Stigma toward STIs and HIV acted as a symbolic barrier to engaging in sexual health dialogue with healthcare providers.

• Symbolic contexts were defined as values, norms, and beliefs that reflect what is perceived as valuable and worthy, and what is devalued and stigmatized.
• STI and HIV stigma was specifically named as a deterrent to sexual health conversations.
• Generalized fear of doctors and disease was also identified as a symbolic barrier.
• The devaluation of women in healthcare settings was an additional symbolic barrier specifically reported by or about female participants.

The devaluation of women in healthcare settings was identified as a gendered symbolic barrier to sexual health communication.

• Two of the four focus groups were conducted with young women and two with young men, allowing for gender-specific insights.
• This finding was categorized within symbolic contexts (values, norms, and beliefs).
• The devaluation of women was discussed as reducing the likelihood of women engaging in sexual health dialogue with providers.

Positive experiences accessing medication to manage pain and infections increased youth willingness to engage in healthcare discussions.

• This finding was categorized under material contexts, which include agency linked with resource access and experiences.
• Prior positive material experiences with healthcare (e.g., receiving effective treatment) acted as an enabler for future health engagement.
• This suggests that general healthcare quality and responsiveness may be a gateway to sexual health communication.

Clinic layouts and dynamics that compromised confidentiality and privacy reduced the likelihood of sexual health dialogue among refugee youth.

• Physical environment factors were classified under material contexts.
• Lack of privacy in clinic settings was identified as a specific structural barrier.
• This finding highlights how facility design in humanitarian settings can undermine sexual health communication.
• Thematic analysis was informed by a social contextual theoretical framework exploring enabling environments for sexual health promotion.

Language barriers and healthcare provider time constraints were identified as additional material factors reducing healthcare engagement among refugee youth.

• Both factors were categorized within material contexts.
• Language barriers are particularly relevant in the context of a refugee settlement where providers and patients may not share a common language.
• Time constraints on healthcare providers limited the opportunity for extended sexual health conversations.
• The study was conducted in Bidi Bidi Refugee Settlement, one of the largest refugee settlements in the world, located in Uganda.

The study used a qualitative design with four focus groups applying thematic analysis informed by a social contextual theoretical framework.

• Four focus groups were implemented: two with young women and two with young men.
• Total sample: n=40 participants; mean age 20 years, SD 2.2; women n=20, men n=20.
• Participants were refugee youth aged 16–24 living in Bidi Bidi Refugee Settlement, Uganda.
• The social contextual theoretical framework was used to explore enabling environments for sexual health promotion across relational, symbolic, and material dimensions.