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Table 1 Generating Themes

From: Healthcare workers’ beliefs, motivations and behaviours affecting adequate provision of sexual and reproductive healthcare services to adolescents in Cape Town, South Africa: a qualitative study

Probe questions Quotes Sub-themes Themes
Do you think your own personal opinions (feelings) about adolescents’ sexual activity have an effect on how you deal with adolescents seeking sexual and reproductive healthcare services, like family planning? Please elaborate “Its better they use family planning than getting unwanted pregnancy in my opinion.” Certificate qualified nurse -Reduce teenage pregnancy Nurses’ motivations
“We cannot run away from that reality, we advise, we say be careful we give condoms, come for HIV testing but we can’t run away from that people are gonna have sex,…” Diploma qualified nurse -Reduce STI and HIV rates -Nurses personal views Nurses’ beliefs and personal views
“But I’ll admit I do tend to discourage pills because I think they are more likely to miss their tablets. Not all of them do, but they’re more like to forget to take the pill.” Degree qualified nurse -Nurses personal views and professional duties
“It doesn’t matter if I don’t agree with termination of pregnancy, if that person is coming for those services; it is my duty as a professional nurse to provide what I’m supposed to do.” Degree qualified male nurse -Nurses beliefs and personal views on TOP
“it’s very sad you know it touches my heart, so that is the only thing [termination of pregnancy] in nursing that is actually impractical for me you know.” Diploma qualified nurse  
Are there any obstacles or reasons for you, personally that discourage (prevent) you from providing sexual and reproductive healthcare services to adolescents? E.g. Religious or cultural beliefs? “Now my belief says, if I give condoms, I’m actually encouraging that child to go have sex. If the child isn’t sexually active, then I’m saying okay, take the condom and you can start.” Diploma qualified nurse -Nurses views on policy guidelines in ASRH services Nurses’ beliefs and personal views
I do not feel comfortable dealing with teen coming for termination of pregnancy, I just refer to another sister.” Diploma qualified nurse -Nurses personal views on TOP
I’m not pro-abortion, I feel that its murder but I will discuss that at home with my family when I’m here someone walk through that door all I see is someone who is desperate for help…” Diploma qualified nurse -Nurses personal views on TOP
“From my side it would be very difficult for me to give somebody a referral letter [for termination of pregnancy], just because I am a born again Christian.” Diploma qualified nurse -Nurses personal views on TOP
Do you think certain things/circumstances in the facility (obstacles) facilitate the situations where you will NOT provide SRH services? “Sometimes lack of equipment, it actually hinders our work… for example, now we don’t have the reproductive health form, we out of stock” Degree qualified nurse -Limited SRH resources Challenges in SRH services
“Shortage of staff.” Diploma qualified nurse -Staff shortage
“…but if anything happens in the sense that there’s no staff or something happens, they will need me or her to help the other patients in other sections then my patients will be sent home or my patients will be cancelled for the day because that is not a priority.” Diploma qualified nurse -Staff shortage
“And its worse if you get a newly diagnosed HIV patient, you have to spend an hour with the patient, oh that one is worse, it actually gets to you… Sometimes you even leave a patient feeling like maybe I didn’t do enough, but because you have to see others waiting for you and there’s no time.” Degree qualified nurse -Time pressure
“Its just like you say next, and then next, so you don’t really give attention and information. For example if they want to change the method, you don’t ask why you just say ok, and just give, while if you have time you would have dealt with her better. Then you feel like 10 is overwhelming from 3-4 pm and you just rush, you asking the color of discharge, when did you start experiencing the symptoms, you not even looking at her you writing because you think what’s important is to treat, not think you must reiterate because you rushing. You do like rush-rush with them, because you don’t have time, due to the short staff so it does happen.” Degree qualified nurse -Quantity over quality
“I have done the course [family planning course] but also I do not have the implanon training so I can’t insert it so sometimes they come and want the implanon and maybe she’s [the nurse who inserts implanon] not in so now you have to tell them there’s no one to do it at that moment, so we have to give them another appointment.” Diploma qualified nurse - SRH skills
And the patients only come after school and most schools closes at 3 pm so they come here after 3, and there’s only an hour to see more than 30 patients and we are only 3 nurses, so there is no time to do the talk.” Diploma qualified nurse -Time pressure
“…We are struggling to get family planning services in some high schools around the clinic, and most of the teenagers who are coming for TOP are coming from these schools we are not allowed to go to… And that shows that these schools need our FP outreach services…” Diploma qualified nurse -School access
Are there any reasons for you, personally that encourage (promote) you to provide sexual and reproductive healthcare services to adolescents? For example, what makes you more willing (motivates you) to provide sexual and reproductive healthcare services to adolescents? “There is a lot of teenage pregnancies because I see a lot of pregnant girls and that worries me because these girls’ future is ruined… she might not be able to go back to school and finish, depending on the family situations… some girls’ schooling really end with their pregnancy and now she has to go find a job, any job because she is not educated…but if she was on family planning that would not happen. That is why I am happy when I see the girls on family planning, I want to help them not get pregnant.” Diploma qualified nurse -Nurses concerns for adolescents’ future -Reduce teenage pregnancy Nurses motivations
“Sometimes there are lots of babies who are dumped, the unexpected pregnancy, the problems we see in our communities, we see those babies who are not having parents, the struggling families, the babies who don’t have parents. This teenager that is not at school now because she got pregnant and had to dropout.” Certificate qualified nurse -Reduce unwanted pregnancy and TOPs -Nurses concerns for adolescents’ future
“We actually want to decrease the number unplanned pregnancy and abortions…” Diploma qualified nurse -Reduce unwanted pregnancy and TOPs
“What motivates me is the rate of HIV and the rate of teenage pregnancy, and that of STIs, so that makes me want to help them, to educate them, make them understand…” Diploma qualified nurse -Reduce STIs and HIV rates
“Personal experiences, you’ve got someone at home who’s infected with HIV, your own family member got pregnant as a teenager, so you look into yourself and your experiences.” Degree qualified nurse -Personal experiences