{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T06:12:50Z","timestamp":1790662370389,"version":"4.1.0"},"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Peer-led interventions can effectively improve sexual and reproductive health (SRH) knowledge, promote safer sexual behaviors among adolescents and young people, especially where health system capacity is limited. To inform a planned pre-post study, we explored the barriers and facilitators to the implementation of a community-based, peer-led SRH intervention for adolescent girls and young women (AGYW) aged 15\u201324 years in northeastern Uganda. We designed a qualitative case study and collected data through focus group discussions across AGYW in six categories: in-school, out-of-school, ever given birth, and never given birth, aged 15\u201317 years, and aged \u226518 years. We also conducted key informant interviews with SRH officials in the district and at two health facilities. Data collection was guided by the socioecological model. We performed thematic analysis and reported findings using themes along with the participants\u2019 quotes mapped onto the socioecological model. A total of 51 adolescent girls and young women, and five key informant interviews with the district and health facility level officials were conducted. Findings show that the anticipated barriers and facilitators to implementation occur across socioecological levels. At the individual level, stigma and fear of judgment hindered participation, whereas trust in peers supported engagement. Limited autonomy hindered access at the interpersonal level, but support from family and friends helped. Institutional barriers included judgmental provider attitudes and confidentiality concerns; existing youth-friendly services and school clubs were facilitators. At the community level, myths, misconceptions, and restrictive cultural norms posed challenges, while community dialogues and champions encouraged acceptance. No major policy barriers were noted; however, supportive SRH policies and existing partnerships were facilitators. The implementation of the intervention may be influenced by several factors across individual, interpersonal, institutional, community, and policy levels. Future implementation should consider addressing the barriers while leveraging the facilitators to enhance implementation outcomes among AGYW.<\/jats:p>","DOI":"10.1371\/journal.pgph.0005828","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T17:22:09Z","timestamp":1781198529000},"page":"e0005828","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Barriers and facilitators to community-based, peer-led sexual and reproductive health intervention for adolescent girls and young women in northeastern Uganda: A qualitative study"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4871-8698","authenticated-orcid":true,"given":"Alimah","family":"Komuhangi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4101-011X","authenticated-orcid":true,"given":"Rogers","family":"Kajabwangu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9065-0389","authenticated-orcid":true,"given":"Jonathan","family":"Izudi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"pgph.0005828.ref001","volume-title":"Uganda Bureau of Statistics","author":"Uganda K","year":"2016"},{"key":"pgph.0005828.ref002","volume-title":"Karamoja situational analysis. Northern Uganda Women\u2019s Empowerment Programme (NUWEP)","author":"S Ayoo","year":"2013"},{"issue":"2","key":"pgph.0005828.ref003","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1080\/14678802.2025.2459410","article-title":"Mechanisms of securitisation and counter-securitisation on the Uganda-Kenya border","volume":"25","author":"P Scott-Villiers","year":"2025","journal-title":"Confl Secur Dev"},{"issue":"3","key":"pgph.0005828.ref004","doi-asserted-by":"crossref","first-page":"333","DOI":"10.9745\/GHSP-D-15-00126","article-title":"What does not work in adolescent sexual and reproductive health: a review of evidence on interventions commonly accepted as best practices","volume":"3","author":"V Chandra-Mouli","year":"2015","journal-title":"Glob Health Sci Pract"},{"issue":"4","key":"pgph.0005828.ref005","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-054277","article-title":"Acceptability of family planning in a changing context in Uganda: a realist evaluation at two time points","volume":"12","author":"S Krishnaratne","year":"2022","journal-title":"BMJ Open"},{"key":"pgph.0005828.ref006","volume-title":"Global education monitoring report 2020: inclusion and education-all means all","author":"Unesco","year":"2020"},{"issue":"1","key":"pgph.0005828.ref007","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s13570-020-00188-9","article-title":"The role of culture in influencing sexual and reproductive health of pastoral adolescent girls in Karamoja sub-region in Uganda","volume":"11","author":"S Achen","year":"2021","journal-title":"Pastoralism"},{"issue":"3","key":"pgph.0005828.ref008","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1207\/s15430421tip3903_2","article-title":"Determining validity in qualitative inquiry","volume":"39","author":"JW Creswell","year":"2000","journal-title":"Theory Pract"},{"key":"pgph.0005828.ref009","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/1471-2288-11-26","article-title":"What about N? A methodological study of sample-size reporting in focus group studies","volume":"11","author":"B Carlsen","year":"2011","journal-title":"BMC Med Res Methodol"},{"key":"pgph.0005828.ref010","doi-asserted-by":"crossref","DOI":"10.4159\/9780674028845","volume-title":"The ecology of human development: experiments by nature and design","author":"U Bronfenbrenner","year":"1979"},{"issue":"6","key":"pgph.0005828.ref011","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups","volume":"19","author":"A Tong","year":"2007","journal-title":"Int J Qual Health Care"},{"issue":"4","key":"pgph.0005828.ref012","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1177\/109019818801500401","article-title":"An ecological perspective on health promotion programs","volume":"15","author":"KR McLeroy","year":"1988","journal-title":"Health Educ Q"},{"issue":"3","key":"pgph.0005828.ref013","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1177\/1090198111418634","article-title":"Social ecological approaches to individuals and their contexts: twenty years of health education & behavior health promotion interventions","volume":"39","author":"SD Golden","year":"2012","journal-title":"Health Educ Behav"},{"issue":"8","key":"pgph.0005828.ref014","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0255954","article-title":"\u201cSpoiled\u201d girls: understanding social influences on adolescent contraceptive decision-making in Kenya","volume":"16","author":"EK Harrington","year":"2021","journal-title":"PloS One"},{"issue":"1","key":"pgph.0005828.ref015","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1186\/s12978-021-01107-w","article-title":"\u201cThose are things for married people\u201d exploring parents\u2019\/adults\u2019 and adolescents\u2019 perspectives on contraceptives in Narok and Homa Bay Counties, Kenya","volume":"18","author":"J Mwaisaka","year":"2021","journal-title":"Reprod Health"},{"issue":"6","key":"pgph.0005828.ref016","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1016\/j.jadohealth.2023.05.035","article-title":"Can peer-based interventions improve adolescent sexual and reproductive health outcomes? An overview of reviews","volume":"73","author":"AJ Mason-Jones","year":"2023","journal-title":"J Adolesc Health"},{"issue":"1","key":"pgph.0005828.ref017","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1186\/s12889-024-18894-z","article-title":"The impact of an innovative community-based peer-led intervention on uptake and coverage of sexual and reproductive health services among adolescents and young people 15\u201324 years old: results from the Yathu Yathu cluster randomised trial","volume":"24","author":"MM Phiri","year":"2024","journal-title":"BMC Public Health"},{"issue":"2","key":"pgph.0005828.ref018","first-page":"134","article-title":"Views of service providers and adolescents on use of sexual and reproductive health services by adolescents: a systematic review","volume":"23","author":"FI Onukwugha","year":"2019","journal-title":"Afr J Reprod Health"},{"issue":"1","key":"pgph.0005828.ref019","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1186\/s12978-021-01183-y","article-title":"Factors influencing access to and utilisation of youth-friendly sexual and reproductive health services in sub-Saharan Africa: a systematic review","volume":"18","author":"LR Ninsiima","year":"2021","journal-title":"Reprod Health"},{"issue":"1","key":"pgph.0005828.ref020","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1186\/s12913-025-12344-1","article-title":"Are facility service delivery models meeting the sexual and reproductive health needs of adolescents in Sub-Saharan Africa? A qualitative evidence synthesis","volume":"25","author":"Y Sanyang","year":"2025","journal-title":"BMC Health Serv Res"},{"issue":"12","key":"pgph.0005828.ref021","article-title":"The sexual and reproductive health needs and preferences of youths in sub-Saharan Africa: a meta-synthesis","volume":"19","author":"VK Uka","year":"2024","journal-title":"PLoS One"},{"issue":"1","key":"pgph.0005828.ref022","doi-asserted-by":"crossref","first-page":"2374137","DOI":"10.1080\/26410397.2024.2374137","article-title":"Socio-ecological influences on access to abortion care in Costa Rica: a qualitative analysis of key perspectives from clinical and policy stakeholders","volume":"32","author":"E Halper","year":"2024","journal-title":"Sex Reprod Health Matters"},{"key":"pgph.0005828.ref023","doi-asserted-by":"crossref","first-page":"960089","DOI":"10.3389\/frph.2022.960089","article-title":"Rumours, myths, and misperceptions as barriers to contraceptive use among adolescent girls and young women in South Africa","volume":"4","author":"K Jonas","year":"2022","journal-title":"Front Reprod Health"},{"issue":"1","key":"pgph.0005828.ref024","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1186\/s12913-022-08860-z","article-title":"Key informants\u2019 perspectives on policy- and service-level challenges and opportunities for delivering adolescent and youth-friendly health services in public health facilities in a Nigerian setting","volume":"22","author":"O Arije","year":"2022","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pgph.0005828.ref025","doi-asserted-by":"crossref","first-page":"2570579","DOI":"10.1080\/26410397.2025.2570579","article-title":"Beyond reproductive rights: implementing the Africentric reproductive justice framework in sexual and reproductive health and rights litigations in Africa","volume":"33","author":"M Mulumba","year":"2025","journal-title":"Sex Reprod Health Matters"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005828","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T17:22:14Z","timestamp":1781198534000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005828"}},"subtitle":[],"editor":[{"given":"Janet","family":"Seeley","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,11]]},"references-count":25,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0005828","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,11]]}}}