Improving engagement with sexual and reproductive health services among young African migrants in Australia
Humaira Maheen
A * , Negin Mirzaei Damabi B and Zohra S. Lassi B
A
B
Abstract
Sexual and reproductive health (SRH) services are underutilised by young people from migrant and refugee backgrounds in many Western countries, including Australia. Young African migrants, a growing demographic in Australia, face unique challenges, including stigma associated with seeking sexual health care and limited sexual health literacy, which lead to adverse SRH outcomes. The study aims to (1) develop an understanding of young African migrants’ knowledge of existing sexual health services in Australia and (2) explore young people’s perceptions of youth-friendly SRH services for optimal engagement by young migrants from African backgrounds.
A qualitative study was conducted in Melbourne, Australia, in 2019, using three participatory workshops involving 30 young African migrants aged 18–24 years. The data was analysed thematically.
Thematic analysis identified three key themes: (1) lack of visibility and information of existing sexual health services affects service use, (2) cultural stigma associated with sexual health affects help-seeking and health service engagement, and (3) key attributes of youth-friendly SRH care for young African migrants. None of the participants were aware of sexual health services in Australia. Although general practitioners were the most commonly known healthcare providers, many participants avoided seeking SRH care from them due to concerns about confidentiality. Participants emphasised the importance of accessible, youth-friendly SRH services, recommending culturally informed approaches and highlighting preferences for provider characteristics, such as younger age, strong confidentiality assurances, and gender-specific options in provider selection.
The lack of awareness about sexual health services among young African migrants hinders their ability to access appropriate care. Efforts to promote SRH services should include targeted, culturally sensitive outreach and clear communication to address misconceptions and barriers. Adopting a cultural lens in designing youth-friendly SRH services may enhance their utilisation and improve SRH outcomes among this population.
Keywords: adolescents, African, migrants, sex education, sexual and reproductive health, stigma, young people, youth friendly services.
Introduction
Universal access to sexual and reproductive healthcare services for adolescents and young people aged 10–24 years is a crucial indicator for achieving the 2030 Sustainable Development Goals.1 Adolescence, a critical transitional period, brings in physical, psychological, and emotional changes. Limited access to sexual and reproductive health (SRH) services during this period can drastically affect life outcomes, especially for adolescent girls at risk of early pregnancies, which can jeopardise their well-being, educational attainment, and economic prospects.2,3 For all genders, insufficient sexual health literacy and a lack of access to SRH services increases the risks of sexually transmitted infections (STIs)4 or engaging in risky sexual behaviours,5 profoundly affecting young peoples’ physical health and well-being.
In the past two decades, migration from the Global South to the Global North has rapidly increased for many reasons, including civil conflict, economic instability, and climate change.6 This has led to an increase in the culturally diverse youth population in host countries, many of whom relocate during pre-adolescence or adolescence.7 Evidence suggests a lack of or delayed engagement with SRH services among young people from migrant and refugee backgrounds.8–10 Factors that are associated with poor engagement include structural barriers (including cost, waiting hours, lack of information about services); health providers’ discriminatory attitudes towards ethnic minority youth seeking sexual health care; community stigmatised attitudes towards pre-marital sex, abortion, STI; and young peoples’ transnational understanding of their SRH rights and access to services.8,11 Davidson et al. suggest that cultural ideologies surrounding sexuality can influence migrants’ perceptions of SRH services, leading them to avoid seeking care, which they may view as incompatible with their cultural beliefs.12 As a result of these dynamics, the seemingly ‘available’ services can become effectively out of reach for young people.8,13
The 2021 Australian Census recorded around 40,000 African migrants aged 10–24 years from the Northern and Eastern African regions living in Australia, with the majority arriving in the past 20 years.14 Previous studies from the UK,15 Canada,16 and Australia17,18 have noted young African migrants’ experiences of intergenerational cultural conflict, given that many reported challenges of navigating two cultures – one at home and one as a broader society. For some culturally stigmatised health issues, such as sexual health, this cultural conflict can affect health-seeking choices. In Australia, Dean et al.19 examined the sexual health knowledge of young Sudanese as sub-optimal, and when combined with the self-reported patterns of sexual risk behaviour, this group is particularly vulnerable to poor sexual health outcomes during early resettlement years.19 McMichael and Gifford20 made similar observations in a young cohort of African migrants, stressing the need to promote sexual health during the resettlement phase. Current literature provides knowledge about barriers to SRH services among young African migrants; however, a critical gap exists regarding what young people consider to be youth-friendly and culturally appropriate SRH services that could potentially increase their service engagement. To address this gap, our study aims to (1) develop an understanding of young African migrants’ knowledge of existing sexual health services in Australia and (2) explore young people’s perceptions of youth-friendly SRH services for optimal engagement by young migrants from African backgrounds.
Methods
Recruitment and data collection
Recruitment strategies included English-language online advertisements on multicultural community organisations’ social media accounts and notice boards at two universities in Melbourne. We hired a female African youth worker who was trained as a peer researcher to lead the participatory workshops and help with recruitment. Some participants knew the youth worker, which helped us establish rapport with them. Participants also shared the study invitation with their networks, thus expanding our reach.
The study was conducted in Melbourne between July and December 2019. We recruited 30 individuals (24 females and 6 males) of Northern and Eastern African descent who arrived in Australia with their parents on either migrant or refugee visas in the past 10 years. All participants were bilingual, but they chose to communicate in English during the workshops, which eliminated the need for translation services. They provided written consent for participation and audio recording. No identifiable information is reported in this paper. Participants were reimbursed for their time with a AUD 30 gift voucher. All audio recordings were transcribed verbatim by the second author (NMD) and were proofed for accuracy before being deidentified.
Participatory workshops
Participatory research workshops effectively engage young people using a strength-based approach, acknowledging their agency and capabilities.21 These workshops shift traditional power dynamics between researchers and participants, giving more control to the participants to co-create knowledge by recognising their agency. This study used participatory workshops as a data collection tool, allowing young people to share and reflect on their life experiences in a collaborative and creative environment. The workshops were led by a youth worker and co-facilitated by the lead researcher (HM).
Three participatory workshops (two with females and one with males) were conducted. Each workshop spanned 60–90 min and consisted of three activities: (1) an individual reflection exercise where participants identified health providers and services for SRH care, (2) a group discussion using a vignette to explore knowledge and stigma related to SRH, and (3) an interactive review of a sexual health clinic website to assess youth-friendly service attributes and discuss potential improvements. During the first activity, participants were asked to identify health providers and services for SRH care they know and identify reasons why they would choose to seek care from them. This prompted discussions on the cultural stigma surrounding sexual health, sex education in schools, parental openness to discussing sexual health at home, young people’s knowledge of SRH services, preferences for providers, and other healthcare experiences influencing their choice of SRH providers. Following this, the second activity was a group activity, where participants were presented with a vignette to comment on a situation involving a young person from a migrant background dealing with an STI. This activity sparked discussions on common knowledge about STIs, the stigma surrounding STIs and pre-marital sex, and the role of service providers in delivering culturally sensitive SRH care to young migrants. The third activity focused on the characteristics of youth-friendly services using the sexual health clinic website as an example. Participants explored what it means to be a youth-friendly service and discussed ways such services can become more inclusive for culturally diverse youth. All workshops were audio-recorded and transcribed verbatim for analysis.
Researchers’ reflexivity
In our qualitative study on sexual health among migrant youth, all team members have migrant backgrounds. Given that the lead and senior researchers (HM, ZL) were not within the youth demographic, maintaining reflexivity throughout the research process was essential, particularly during data collection and analysis. Two young researchers (aged 18–30 years) were actively involved in both data collection (youth worker) and analysis (NMB), ensuring that the perspectives of young people were central to the research process.
To address potential power imbalances between researchers and participants, a trained youth worker led the participatory workshops while the lead researcher (HM) co-facilitated, occasionally interjecting with probes to stimulate discussion. Prior to the commencement of the workshops, facilitators emphasised that participants were not required to disclose personal SRH experiences, fostering a comfortable environment for discussing sensitive topics.9,19,22 The use of third-person scenarios was particularly effective in facilitating discussions about sensitive topics, as it allowed participants to engage with the subject matter indirectly, making it easier for them to share insights without feeling personally exposed. This approach helped mitigate discomfort and fostered richer insights into the barriers and facilitators of SRH service engagement. Data analysis was also led by a young researcher (NMB), who conducted the thematic analysis independently before discussing and finalising themes collaboratively with the research team. The participatory nature of this research helped minimise researcher bias and ensure that young people’s voices remained at the forefront of the study.
Data analysis
We analysed workshop transcripts using thematic analysis, following Braun and Clark’s approach.23 The data were coded and analysed using NVivo 15. Two researchers independently coded the data and discussed the theme identification. Despite some overlaps, all authors discussed the initial themes, refining them through an iterative process. The final analysis identified themes and sub-themes (see Table 1).
| Themes | Sub-theme | Quote | |
|---|---|---|---|
| Lack of visibility and information about sexual health services affects service engagement | ‘Like we all know about Beyond Blue or Headspace, but not so much about sexual health services’. (Workshop 1, female group) ‘I do not remember if we had the opportunity to discuss services as such, it was very much anatomy-focused’. (Workshop 1, female group) | ||
| Cultural stigma associated with sexual health affects help-seeking and health service engagement | ‘In some cultures, there’s stigma […], and you wouldn’t want to talk to your parents or something like that. As it (sexual health concerns) is a taboo and a bit more personal’. (Workshop, male group) | ||
‘Like sometimes, from what I’ve heard, if you see a GP, they say, ‘This was another patient I had’ and start describing them, and I think he shouldn’t be going into that much detail about somebody else. Sometimes, it does feel like, just when they’re letting out that much, it feels a bit too specific. And then you feel they could be saying the same thing to somebody else about you’. (Workshop, male group) ‘I think confidentiality is important specifically because the topic I am discussing is not the one they usually discuss. They might feel embarrassed about that, making them feel much more vulnerable. So, it’s very important to keep that private, just for that kind of trust between them and the doctor’. (Workshop 2, female group) | |||
| I think they did it [sex education] in like grade seven or eight, and then they kind of just didn’t, and then they kind of just shut that off’. (Workshop 1, female group) | |||
| Key attributes of youth-friendly SRH care for youth of African descent | Accessibility of the SRH service | ‘I would go to the youth sexual health services (as I got to know now) Because I have already been through the GP system, and since it is not helping me, I have [now] found another solution which I will use’. (Workshop 1, female group) ‘If it’s something specifically concerned about an STI, then I would [prefer] go to a specialised sexual health clinic’. (Workshop, male group) | |
| Service provider characteristics | |||
| Preferably young | ‘As a young person, I think services directed at young people would be better because I think they might understand you a bit more’. (Workshop, male group) ‘They [health providers] should know how to deal with diverse communities and young people from such communities’. (Workshop 1, female group) | ||
| Preference for a female provider among young females | ‘Women [service providers] come off like more understanding and more inviting’. (Workshop 1, female group) | ||
| Communication style | ‘I prefer more sympathetic. The way they present it to you would be important if they [healthcare providers] try to get you in a comfortable position first. So you’re prepared to learn and understand more about what the doctor’s saying’. (Workshop, male group) ‘I prefer more friendly and more human interaction (healthcare provider)’. (Workshop 1, female group) | ||
| Cultural background | ‘When I speak to a white doctor […] I feel like, are you listening? […] they will be like, let us get down to it, get this medicine and get out of here […]. Also, the way I communicate […] when I am talking to a white doctor, they do not understand how serious I am just because I am talking with respect to be polite and not saying much. I prefer seeing a person of colour, […] I feel like they take me seriously when I am talking’. (Workshop 1, female group) ‘I would go to the white doctor because I feel they are more direct and on point’. (Workshop 2, female group) ‘I wanted to go to the GP and talk about sex. I would not be comfortable talking to someone who was from my background. I can’t trust the GP from my background because of the stigma and confidentiality; they might tell other people who are from my background’. (Workshop, male group) | ||
| Respectful attitude towards young people’s privacy and confidentiality concern | ‘I want to feel safe […] a sense of confidentiality because it is taboo in our community, and you do not want it to go out – because of the backlash you might face, as it is a sensitive topic’. (Workshop 1, female group) ‘I think confidentiality is important specifically because the topic I am discussing is not the one they usually discuss. They might feel embarrassed about that, making them feel much more vulnerable. So, it’s very important to keep that private, just for that kind of trust between them and the doctor’. (Workshop 2, female group) | ||
Results
Our analysis identified three themes related to the SRH services of African migrants: (1) lack of visibility and information of existing sexual health services affect service use, (2) cultural stigma associated with sexual health affects help-seeking and health service engagement, and (3) key attributes of youth-friendly SRH care for youth of African descent.
Theme 1: lack of visibility and information about existing sexual health services affects service engagement
None of the participants in the study were aware of specialised SRH services in Victoria. They all cited local general practitioners (GPs) as their primary source for SRH-related care. During the workshop, participants performed online searches for available SRH services in Melbourne, which many found to be information they had never encountered before. Some participants compared their knowledge of mental health service providers to that of SRH services, pointing out that mental health information is readily available through educational institutions, mainstream media, and social networking sites. In contrast, SRH services lack the same level of visibility, which participants thought could be the reason for poor engagement. They stressed the need for improved information dissemination about dedicated SRH services aimed specifically at young people.
Like we all know about Beyond Blue or Headspace, but not so much about sexual health clinics. (Workshop 1, female group)
Like, I have never been to any sexual health clinic or youth service other than GP. I actually did not know if they even exist. (Workshop 2, Male).
There is very limited information out there about any specialised services – I think also because of our limited knowledge of sexual health, in general. (Workshop 2, female group)
Furthermore, the discussion highlighted school-based sex education as a potentially effective means to increase awareness of SRH services. Female attendees particularly shared their experiences with school sex education programs that covered anatomy in depth. They proposed that these programs could also include practical advice on where to find information or assistance for sexual health care, thus helping to close the knowledge gap surrounding specialised services.
I do not remember if we had the opportunity to discuss services as such; it was very much anatomy-focused. (Workshop 1, female group)
I went to a public school in Perth. The sexual health education started in grade 6, we were also talked about drugs and alcohol, but nothing about youth services, or sexual health services. (Workshop 2, female group)
Theme 2: cultural stigma associated with sexual health affects help-seeking and health service engagement
Participants highlighted that the stigma surrounding pre-marital sexual activity and STIs creates significant barriers to discussing sexual health, both within families and with healthcare providers. This stigma particularly affects young females, who emphasised the need for open and supportive conversations with parents about sexual health. The absence of such discussions limits their understanding of SRH topics and reduces awareness of available healthcare services, including specialised SRH services.
From my perspective, I feel like it is taboo to speak about these kinds of things [at home]. If you go to a doctor (for sexual health matters), it must be private. I do not know much about where else (alternative services – other than local GP) to go. (Workshop 1, female group)
The culturally stigmatised views toward sexual health also led to poor help-seeking behaviour. Some male and female participants said that they do not want to seek sexual health care from their local GPs, as they might disclose their sexual health-related visits to their parents. This fear was grounded in the assumption that the local GP, who may have conservative attitudes towards sex and STIs and is from similar cultural backgrounds, might want to ‘warn’ their parents about their children’s sexual behaviours.
I fear that this doctor (local GP) might tell (other) people what I am going through, so I probably would not open up as much or disclose things that may be critical for diagnosis. (Workshop, male group)
‘If I go to a doctor [local GP], they won’t say to my face, but then they will probably discuss that with my parents’ (Workshop 1, female group). In the male workshop, the issue of ‘potential confidentiality breach’ was highlighted as a major help-seeking deterrent because of the perceived risk of information being shared with others who might identify them. When researchers probed further about specific incidents of privacy breaches by medical professionals, none of the participants could identify the events where this occurred. Instead, it appears to be largely based on collective perceptions and stigma surrounding sexual health matters. The most significant impact of this ‘perception’ is that it compels young males to withhold crucial information from their doctors, information that may be critical to their health.
Theme 3: key attributes of youth-friendly SRH care for youth of African descent
The accessibility of SRH services plays an important role in young people’s service engagement. During the workshops, participants explored the sexual health care clinic’s website as an example, leading to diverse responses regarding culturally responsive and youth-friendly services. Female participants appreciated that the service did not require Medicare information, allowing them to use it discreetly without their parent’s knowledge, which instilled a sense of relief about the service’s confidentiality. These services are universally free and have enhanced accessibility. Participants also noted the interpreter’s availability option, although language proficiency was not a concern for any of them. Male participants liked the website’s clear layout, appointment instructions, free services, STI symptoms, and seeking help. However, some participants preferred seeing pictures of healthcare providers and reading reviews, underscoring the significance of visual and testimonial cues in establishing trust in healthcare services.
I would go to the youth sexual health services (as I got to know now) because I have already been through the GP system, and since it is not helping me, I have [now] found another solution which I will use. (Workshop 1, female group)
I guess like I would prefer a place that welcome diversity, […], whoever walks in, is treated kindly and respectfully. (Workshop 2, female group)
Participants noted that younger doctors might have a better understanding of the challenges faced by today’s youth. Given that many participants come from cultural backgrounds that emphasise respect for adult authority figures, young adults may find it difficult to engage in open discussions about sexual health with senior doctors. They believe that more senior doctors, due to their authoritative demeanour, may unintentionally create barriers to open communication, making it harder for young adults to express their concerns. As a result, participants preferred younger healthcare providers, whom they perceived as more approachable and better able to foster a comfortable environment for discussing sexual health.
I prefer young doctors. I feel like with older doctors, it is like talking to my parents. Every time I go to my doctor, they give me the dad’s answer. (Workshop 2, female group)
A preference for the provider’s gender was strong among female participants, citing a higher level of comfort and ease, although this preference was not noted by male participants.
Women [service providers] are more comfortable to talk to about that stuff. (Workshop 2, female group)
For preference, first would be a female service provider because they can relate to what you are discussing. (Workshop 1, female group)
Young individuals expect their care providers to be open and non-judgmental about their sexual choices, a fundamental quality they value. Some participants shared instances where, after meeting health professionals, they did not fully grasp the information provided. In the context of culture and community, participants generally agreed that healthcare providers should recognise how culture influences their approach to seeking care. This recognition should affect how health providers deliver information and understand the context of sexual health issues and a young person’s knowledge about health matters. Clear information, without ambiguity, is crucial. Additionally, providers need to be more empathetic, especially considering that many of these young people come from a culture in which sexual health is often associated with shame and guilt.
Healthcare services have to be approachable and friendly […] if they are scary; you do not want to talk to them. (Workshop 2, female group)
I did not like the way he [GP] talks, the way he explains things, makes it [more] complicated. (Workshop, male group)
Cultural background emerged as an important factor that influenced participants’ preferences for SRH providers. Although opinions on this matter varied, it was evident that female participants leaned towards seeking healthcare providers from their cultural backgrounds, whereas male participants preferred SRH health providers from a different culture. What remains common, however, is that providers should be non-judgemental and have more understanding of the cultural aspect of sexual health.
I prefer someone whom I’ve never seen before, like, someone you’ve never met, like someone that probably doesn’t know anything about you. (Workshop, male group)
In the female group, several participants voiced concerns about certain doctors [white] displaying insensitivity towards recognising the influence of culture on sexual health knowledge. Discussing sexual health can be particularly uncomfortable for some young people as they may feel ashamed or guilty. When they encounter challenges opening up, and healthcare providers fail to grasp their concerns, this leads to frustration. Consequently, young females believe doctors from similar cultural backgrounds might better understand and empathise with their discomfort, acknowledging the stigma associated with these issues.
I think you would want someone born in your cultural background so that they understand that […] in some cultures that’s stigma [...] and that you would not want to talk to your parents or something like that. (Workshop 1, female group)
Some participants preferred healthcare providers from different cultural backgrounds. They felt that doctors with similar cultural backgrounds might be influenced by their own cultural beliefs, potentially leading to biased care. Consequently, consulting a doctor unfamiliar with their cultural nuances could ensure more private and less awkward discussions on sexual health issues.
When you go to a GP, you want it to be private and confidential; part of that is wanting to disassociate. You wouldn’t even want your friends to be around […]. You know, when you see someone from the same culture, it feels like there’s already a connection, even before you actually get to know each other. Sometimes, you might even want to push that feeling away, maybe unconsciously. (Workshop, male group)
The primary concern for almost all male and female participants was the confidentiality of their sexual health care visits. This concern was rooted in the fear that if someone discovered that they had sought care at an STI clinic, they would face ostracism or judgment from their community. Importantly, this privacy concern extends beyond that of parents.
I want to feel safe […] a sense of confidentiality because it is taboo in our community, and you do not want it to go out – because of the backlash you might face, as it is a sensitive topic. (Workshop 1, female group)
Young people not only wished to keep their use of sexual health care hidden from their parents but also from the broader community, given the prevailing stigma around pre-marital sex and STIs. The heightened anxiety around privacy makes it challenging for them to seek care openly. Therefore, an effective youth service for SRH care must ensure that these concerns are acknowledged and addressed by health providers.
Discussion
This study showed that young people from African migrant and refugee backgrounds lack knowledge about specialised sexual health services in Australia. The prevailing stigma and shame associated with pre-marital sex and STIs significantly affect young people’s help-seeking behaviours. Our study noted that the lack of information about services is perhaps the biggest barrier to accessing those services. The findings underscore the crucial need for safe spaces for young migrants that offer culturally sensitive care tailored to young adolescents, where they can access essential knowledge and services without fear of judgment or disclosure.
Our study identified two key barriers to young African individuals’ engagement with the healthcare system, particularly in accessing sexual health services. First, there is a significant lack of awareness about existing sexual health services, resulting in underutilisation. Second, while GP services are widely known, study participants shared a pervasive mistrust of GPs. This mistrust is often based on assumptions rather than direct experiences, creating additional obstacles to seeking care.
The finding is consistent with studies involving other populations, such as young Māori in New Zealand24 and migrants from Australia’s culturally and linguistically diverse backgrounds.9 For instance, Botfield et al. found that young migrants and refugees in Australia from diverse backgrounds fear that their regular GPs may inform their parents about their SRH visits.9 Since the local GP is the most accessible and familiar with their health history, this unfounded fear, based on anecdotal evidence, prevents young people from seeking assistance. The combination of these two factors – limited knowledge of specialised services and mistrust of GPs – results in a critical gap, where many young people are not accessing any sexual health services. These barriers are further compounded by cultural stigma, which significantly impacts young people’s willingness to seek help for sexual health concerns.
Addressing these challenges requires a more comprehensive public health approach that removes physical and social barriers associated with the use of sexual health services for young people. Findings from our study suggest that school-based sex education may be a good place to address the fear of ‘mistrust of GPs’ or ‘assumed confidentiality breaches’ among young people. This benefits not only African migrant youth, which is the focus of our study, but also young individuals from various other cultural backgrounds, as highlighted in the existing literature.9,22 Furthermore, school-based sex education should also integrate information about youth-friendly sexual health services, which directly addresses several social and physical access barriers. School-based sex education has been noted as an important intervention point in recent studies, considering its universal reach to young and adolescent populations.22,24 Particularly for young refugees and migrants, the proposed integration would enhance their understanding of sexual health while fostering the confidence to seek help when needed. As previously done in Sweden, youth-friendly SRH services could bridge this gap by developing outreach programs that complement school-based education.11 Although similar programs specifically targeting young migrants and refugees are lacking in Australia, initiatives have been implemented for Aboriginal and Torres Strait Islander youth. For example, the Australian Institute of Health and Welfare evaluated demonstration projects aimed at improving sexual health outcomes among Aboriginal and Torres Strait Islander young people.25 Similarly, Mikhailovich and Arabena assessed the impact of an Indigenous sexual health peer education project, highlighting the effectiveness of peer-led approaches in promoting sexual health awareness. Lessons from these initiatives could inform the development of culturally responsive programs for migrant and refugee youth.26
The participants emphasised the need for dedicated, safe, confidential spaces for young and adolescent migrants and refugees. They preferred youth-friendly environments with non-judgemental, culturally aware service providers, preferably female, due to their cultural sensitivity and approachability. This was also noted in other literature.9,27–30 Additionally, they preferred younger health providers who had a contemporary understanding of the challenges of the younger demographic seeking SRH services.29 The participants articulated diverse perspectives on the cultural background preferences of sexual health care providers, some preferring providers from their cultural backgrounds who would understand cultural stigma and confidentiality concerns,10,31 whereas others preferring providers from different backgrounds, finding it easier to open up to them. This was observed in other studies, where young individuals preferred health providers from various cultural backgrounds to avoid potential exposure to cultural value judgements.9,28,31,32 This perspective highlights the need to balance cultural familiarity with the perceived impartiality of healthcare providers from diverse backgrounds, acknowledging that individual preferences and experiences vary and there is no one-size-fits-all approach in addressing the needs of individuals seeking SRH care. We also note that a clearly outlined webpage with information about health services, health providers, and costs, including details about the health provider, may increase young people’s confidence in using the service. The findings of our study argue that, although the cultural stigma surrounding pre-marital sex and STIs is significant in some cultures and may be complex to address, accessible, high-quality services can empower young people to make informed health choices, prioritising their safety, health, and well-being.
Limitations
This study has some limitations, which should be considered when interpreting the findings. First, the study was conducted in metropolitan Melbourne, which may limit the representation of young people from migrant and refugee backgrounds from regional or rural areas. Young people from regional or rural areas may face unique challenges in accessing sexual health services that were not captured in this study. Second, recruitment materials were advertised in English, likely restricting participation from individuals with limited English proficiency, such as newly arrived migrants or refugees. While our cohort primarily consisted of young people who had developed English proficiency through Australian schooling, we acknowledge that those who have not yet had the opportunity to improve their language skills may face even greater barriers to accessing SRH care. This represents an important area for future research, particularly in exploring targeted language-support services and culturally tailored health communication strategies. Additionally, the refugee backgrounds and settlement challenges of the participants likely provide valuable insights into the barriers faced by similar populations. Third, the group-based nature of the discussions may have introduced social desirability bias. Participants may have moderated their responses to align with perceived group norms or avoided discussing sensitive topics in a shared setting. Recruiting male participants posed significant challenges, resulting in a gender imbalance (24 females, 6 males) and only half of the expected participants attending the workshop. Although we initially planned to include a young male facilitator for the male participants, this was not possible. However, we believe that the involvement of a youth worker with extensive experience working with diverse youth populations helped address potential challenges and facilitated meaningful engagement.
Conclusion
This study highlights the importance of culturally appropriate, youth-friendly SRH services for young migrants and refugees. It emphasises strategies such as integrating culturally sensitive education into school-based programs, promoting awareness of available services, and fostering trust in healthcare providers. Findings suggest that although the cultural stigma surrounding pre-marital sex and STIs is complex to address, accessible, high-quality services can empower young people to make informed health decisions, leading to better health and well-being.
Data availability
Deidentified workshop summaries can be provided upon request in the form of a Word document.
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