Theory of planned behavior

This study was guided by the Theory of Planned Behavior [11], which explains why people do or do not engage in certain behaviors. The theory postulates that the intention to perform a certain behavior can be predicted by three factors: attitudes toward the behavior, subjective norms, and perceived behavioral control.

Attitudes toward the behavior refer to the degree to which a person has a favorable or unfavorable evaluation or appraisal of the behavior in question. The second predictor is subjective norm, which refers to the perceived social pressure to perform or not to perform the behavior. The third antecedent of intention is perceived behavioral control, which refers to the perceived ease or difficulty of performing the behavior, reflecting past experience as well as anticipated impediments and obstacles.

As a general rule, the more favorable the attitude and subjective norm concerning a behavior, and the greater the perceived behavioral control, the stronger an individual’s intention to perform the behavior. In the context of this study, the Theory of Planned Behavior provides a framework for understanding how social norms, attitudes, and perceived control over health decisions shape AGYW’s preferences for accessing SRH information and services.

Study design and context

This study employed a descriptive qualitative case study design. The methodological orientation underpinning the study was thematic analysis, used to identify and interpret patterns within the data. According to Lambert, [13] a qualitative descriptive study draws from naturalistic inquiry, dedicated to examining phenomena as closely as feasible in their natural state within the confines of the research domain. The study aimed to explore the preferences for accessing sexual and reproductive health information and services.

The study was conducted in Dodoma, Tanzania’s capital city, at two university campuses: the University of Dodoma and St. John’s University of Tanzania, the only two universities in the Dodoma region as well as Tanzania’s central zone. The Dodoma region has a higher prevalence of risky sexual behavior, including multiple sexual partners (4.1%), intercourse with non-spousal partners (22.2%), and non-use of condoms (74.8%) [12].

Sampling and participants

Purposive sampling was used to select both the universities and the study participants. A total of 13 participants were recruited; three additional eligible participants could not participate due to illness or emergency travel on the day of interview. Participant selection criteria included: being aged between 19 and 24 years, being enrolled in the second or third year of any degree programme, being sexually active, and having or having had multiple sexual partners.

Data collection and analysis

Interviews were conducted by the principal investigator, a registered nurse with a Master’s degree in Nursing Education and a PhD candidate in Sexual and Reproductive Health. The researcher has prior experience in qualitative research. There was no prior relationship between the interviewer and participants. The researcher acknowledges potential bias due to prior assumptions about gaps in sexual health knowledge; however, efforts were made to minimize this through the use of a semi-structured interview guide and neutral probing techniques.

Topic guides were developed in English and then translated into Swahili to ensure consistency. The study was guided by the Theory of Planned Behavior [11] which informed the development of the interview guide and interpretation of participants’ attitudes and behaviors. Interviews explored societal stigma, cultural taboos, economic constraints, access to SRH information and services, and the scope of sexual and reproductive health education. All interviews were conducted privately within university premises, with audio recording and concurrent field note-taking. Interviews were conducted in Swahili and ranged from 25 to 80 minutes in duration.

Data saturation was determined by the research team, concluding at the 13th interview, with no interviews being repeated. The data collection process spanned one month from November to December 2023. Initially, screening questionnaires were distributed to all eligible students, requesting their mobile phone numbers for interview invitation purposes. Participants received financial compensation for their involvement; this information was withheld during recruitment to prevent bias and undue influence.

Data were analyzed using thematic analysis. Interviews were transcribed verbatim and read multiple times to ensure familiarity with the data. Coding was conducted manually without the use of qualitative data analysis software. Initial codes were generated inductively and grouped into categories, which were further organized into themes and subthemes. Themes were reviewed and refined to ensure consistency and accurate representation of participants’ perspectives.

Trustworthiness

In qualitative research, “trustworthiness” denotes the extent to which data collected throughout the study are dependable, transferable, credible, and confirmable [14]. The trustworthiness of this study is described according to Korstjens and Moser [15].

Credibility refers to the assurance that research findings are accurate, derived from participants’ original data, and reflect their genuine opinions. Two strategies were employed: investigator triangulation and member checking. Investigator triangulation involved multiple researchers coding, analyzing, and interpreting the findings — two researchers collaborated, producing similar outputs. Member checking involved sharing results, interpretations, and conclusions with participants to enhance data robustness.

Transferability concerns the extent to which qualitative research findings can be applied to other contexts or settings. This study provides a comprehensive description of AGYW in higher learning institutions, including their behaviors, experiences, and contextual factors, thus enabling meaningful interpretation for individuals outside that context.

Dependability reflects the stability of findings over time, ensured through participant validation of findings, interpretations, and recommendations. Confirmability ensures that findings are not influenced by the researcher’s biases but are derived directly from the data. This study meticulously describes its steps up to the findings and adheres to established standards for qualitative descriptive study design during the analysis process.

Ethical considerations

This study received ethical approval from the Institution Review Board of the University of Dodoma (Ref. MA.84/261/02/A/61/592). Permission to conduct the study was obtained from the Vice-Chancellor of the University of Dodoma and the Vice-Chancellor of St. John’s University of Tanzania.

Before each interview, participants received a briefing on the aim of the study, potential benefits and risks, the voluntary nature of participation, and conditions regarding anonymity and withdrawal. All participants provided written informed consent and verbal consent before recording. Confidentiality and privacy were maintained through the use of anonymized participant identifiers, masking of institutional data, and confidential identification numbers.

Participant characteristics

A total of 13 unmarried adolescent girls and young women were interviewed: 6 were in the second year of study, and 7 were in the third year. The majority were in sexual relationships; their caregivers (head of family) had primary-level education, were self-employed, and had a monthly income below 350,000 Tanzanian Shillings. Most participants’ homes of origin were in rural areas; while at university, they resided on campus with education sponsored by the Higher Education Students’ Loans Board. Four themes were identified: community-based sources, media-based sources, healthcare-based sources, and diverse means for learning SRH information.

Theme 1: Community-based sources

Sexual and reproductive health information was reported to be accessed through family members, especially sisters, and through friends, who were identified as major sources of information for AGYW.

Theme 2: Media-Based Sources

The majority of AGYW reported being more comfortable using media sources to access SRH information, as this guarantees their privacy. Media sources mentioned included social media platforms (Instagram and Facebook) and search engines (Google).

Theme 3: Healthcare-Based Sources

Theme 4: Diverse Means for Learning Sexual Health Information

Community-based sources

The findings indicate that AGYW prefer to access SRH information through friends and certain family members. This preference arises in part due to significant barriers that limit open conversations within families, as the majority of parents and guardians are perceived as strict or unapproachable when it comes to discussing SRH. Despite being viewed as potentially reliable sources of information, many parents do not create an environment where such discussions feel safe. As a result, most young women turn to trusted friends, who they find more approachable and less judgmental. These results align with earlier studies: participants feel more comfortable asking experienced friends than approaching parents or healthcare specialists [16]. A study conducted in Kenya found that younger adolescents relied on their parents as a primary source of SRH information; however, some parents either avoided certain topics or provided insufficient detail [18]. Similarly, a study among young people in higher learning institutions in the Mbeya region, Tanzania, found that most participants reported difficulty discussing SRH matters with parents or guardians, preferring to talk to peers [19].

On the other hand, healthcare providers have influenced how AGYW prefer to access SRH services. Reports indicate that some providers use intimidating language, including remarks suggesting that infections are the consequence of frequent sexual activity [20]. According to the Theory of Planned Behavior, subjective norms — social pressures and influences — shape individual behavior [11]. The preference for family members and friends can be attributed to cultural and social norms in which young women feel more comfortable discussing sensitive topics with trusted individuals within their social circles. These findings imply that social influence from trusted sources should be integrated into SRH interventions.

Media-based sources

AGYW indicated that the most common sources of SRH information were social media and search engines. These findings align with a study done in Kenya [18] which found that most participants relied on the internet for SRH information, most often to complement other sources. Participants stressed that technology, including internet search engines, social media, and mobile phones, has been a useful tool in meeting adolescents’ SRH information needs, as these options are convenient, available whenever needed, and enhance confidentiality. However, respondents noted uncertainty about the reliability of online information and expressed the desire for more credible platforms.

Findings align with a study by Patterson et al. [21] among adolescents aged 16–19 years, which found that participants preferred online platforms due to the challenges of accessing SRH information through cultural norms that perceive them as too young to discuss sexual health. These findings can be analyzed through the Theory of Planned Behavior: [11] the preference for media-based sources highlights how attitudes toward accessing SRH information are shaped by the perceived advantages of online platforms. Concerns about reliability, however, suggest that AGYW’s trust in these sources is not absolute. Perceived behavioral control influences their preference for online sources, as social media and search engines provide more autonomy; however, uncertainty regarding information credibility limits their sense of control over obtaining reliable information [22]. These findings emphasize the importance of developing reliable, evidence-based, and youth-friendly online SRH platforms.

Healthcare-related sources

Most participants reported preferring over-the-counter medications over medical facilities when dealing with STIs or seeking contraception. The primary factor preventing this population group from favoring medical facilities was the lack of friendly healthcare providers. Participants also indicated that insufficient privacy created feelings of discomfort when discussing sensitive aspects of their sexual health, and they expressed concerns about being overheard. The Theory of Planned Behavior [11] provides a valuable framework for understanding these decisions. AGYW’s attitude toward over-the-counter medications is influenced by negative experiences and perceptions of formal healthcare settings, making over-the-counter options more appealing due to their perceived convenience and anonymity [23]. The findings align with a study done in Uganda, which showed that AGYW often lack information regarding available SRH services and face stigma and fear within healthcare settings [24]. The fear of judgment leads them to prefer over-the-counter options perceived as more accessible and less stigmatizing [25]. These findings underscore the urgent need to reform healthcare environments to be more youth-friendly, and to train healthcare providers to offer non-judgmental, confidential, and supportive care.

Diverse means for learning sexual health information

Participants shared that peer education and reliable online platforms for SRH would help inform the majority of young women. Respondents also stated that university health clubs would be a preferred method for accessing SRH information. In line with other findings, university students reported learning more about SRH when health clubs were available on campus [17]. These findings can be explained by the Theory of Planned Behavior: AGYW’s attitudes toward peer education and online platforms are shaped by the perceived benefits of these sources as accessible, relatable, and capable of providing accurate information without the fear of judgment [26]. The perceived social pressures in many sub-Saharan African communities, where discussions about sexual health are often stigmatized, further lead AGYW to seek information from peers and online sources [27].

These findings imply a need to strengthen peer-led SRH education, expand digital health strategies, and institutionalize university health clubs as safe spaces for AGYW to access SRH information without fear of stigma. Universities and health organizations should prioritize training peer educators to enhance credibility and cultural acceptability. The reliance on smartphones and social media for SRH information suggests the necessity of developing more reliable online platforms and digital literacy programmes. Addressing social norms and stigma in SRH discussions is essential; community-wide interventions engaging parents, educators, and religious leaders can help normalize SRH discussions. Healthcare providers must ensure youth-friendly, confidential, and accessible SRH services by improving provider training, enhancing privacy measures, and integrating digital consultation options.