AYAs' preferences for SRH services in Africa were mainly influenced by cost, treatment effectiveness, and incentive distribution methods, suggesting policymakers need to develop affordable and effective SRH programmes with tailored incentives to improve service uptake.
Key Findings
Methods
From 8,329 identified records, 16 studies with 8,005 participants from six African countries were included in the final analysis of AYA stated preferences for SRH services.
Searches were conducted across six databases (MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus and Global Health) and Google Scholar for grey literature on 24 April 2024.
The review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD42023386944).
Studies were from only six African countries, limiting the generalizability of findings across the continent.
Studies used hypothetical choice-based scenarios (stated preference methodology).
Results
The attributes used to measure SRH preferences were classified as structural (44.3%), process (41.7%), and outcome-related (13.9%) dimensions based on the Donabedian quality of healthcare framework.
Structural attributes accounted for the largest share at 44.3% of all attributes used.
Process-related attributes comprised 41.7% of the attributes examined.
Outcome-related attributes were the least represented at 13.9% of the total attributes.
The Donabedian quality of healthcare framework was used as the classification system for organizing these attributes.
Results
The most important attributes shaping AYA preferences for SRH services were cost of services, effectiveness of treatment, and treatment frequency.
Cost of services was identified as a primary driver of stated preferences among adolescents and young adults.
Treatment effectiveness was the second most important attribute influencing AYA preferences.
Treatment frequency (visit frequency) was also identified as a key factor shaping preferences.
These top attributes spanned both structural and process dimensions of the Donabedian framework.
Results
The least important attributes for AYA SRH service preferences were treatment side effects, treatment and medical test sample collection characteristics, provider characteristics, and incentive type and recipient.
Provider characteristics specifically identified as least important included provider age, gender, and profession.
Treatment side effects were rated among the least influential factors in AYA decision-making for SRH services.
Incentive type and the recipient of incentives were also among the least valued attributes.
Medical test sample collection characteristics were also identified as relatively unimportant to AYAs.
Results
Incentive distribution methods were identified as a key factor influencing AYA preferences for SRH services, despite incentive type and recipient being rated as least important attributes.
While the type of incentive and who receives it were rated least important, how incentives are distributed was found to influence preferences.
This distinction suggests AYAs are sensitive to the method of incentive delivery rather than the nature of the incentive itself.
The review recommends that policymakers provide incentives to attract AYAs to use SRH facilities in Africa.
Tailored incentives aligned with AYA preferences were highlighted as a policy priority.
Background
Adolescents and young adults constitute approximately 30% of the African population and face significant challenges in accessing SRH services, with low service uptake potentially reflecting a mismatch between service provision and AYA preferences.
Low service uptake despite availability was characterized as indicating 'service provision misalignment with AYAs' preferences.'
This misalignment was framed as reflecting 'the health sector gap' that 'will partly compromise AYAs' rights.'
SRH services are described as part of primary healthcare services, yet many AYAs do not benefit from them.
The review positions preference alignment as a key strategy for improving uptake.
What This Means
This research synthesized 16 studies involving over 8,000 young people (adolescents and young adults, ages roughly 10–24) across six African countries to understand what factors most influence whether they choose to use sexual and reproductive health (SRH) services. The studies used hypothetical scenarios to ask participants what service features mattered most to them — a method called 'stated preference' research. The review found that the cost of services, how effective treatments are, and how often they need to visit a health facility were the top concerns for young people. Interestingly, they cared relatively little about who provides the service (the provider's age, gender, or professional background) or about treatment side effects.
This research suggests that young Africans are primarily practical and economic in their healthcare decision-making — they want treatments that work, that they can afford, and that don't require too many visits. The finding that provider characteristics (like gender or age) were low priorities challenges assumptions that matching patients with certain provider types is the primary driver of youth health service uptake. The role of incentives was nuanced: while the specific type of incentive and who receives it mattered less, how incentives are distributed did influence preferences, suggesting that the delivery mechanism of any reward or support program deserves careful design.
This research suggests that health policymakers and program designers in Africa should focus on making SRH services financially accessible and clinically effective, with convenient treatment schedules, rather than primarily investing in matching provider demographics to youth preferences. However, the findings are based on data from only six of Africa's 54 countries, so caution is needed in applying these conclusions broadly across the continent's diverse populations and contexts.
Alemu M, Norman R, Dantas J, Belay D, Haile T, Pereira G, et al.. (2025). Stated preferences of adolescents and young adults for sexual and reproductive health services in Africa: a systematic review.. Sexual and reproductive health matters. https://doi.org/10.1080/26410397.2025.2520682