The Indian Journal of Pediatrics

, Volume 86, Issue 2, pp 132–139 | Cite as

A Mixed Methods Evaluation of Adolescent Friendly Health Clinic Under National Adolescent Health Program, Puducherry, India

  • Thulasingam MahalakshmyEmail author
  • Kariyarath Cheriyath Premarajan
  • Kathirvel Soundappan
  • Kanagarethinam Rajarethinam
  • Yuvaraj Krishnamoorthy
  • Adhisakthi Rajalatchumi
  • Vijayageetha Mathavaswami
  • Deepika Chandar
  • Palanivel Chinnakali
  • Amol R. Dongre
Original Article



To assess the awareness and utilization of Adolescent Friendly Health Clinic (AFHC) services among school going adolescents (14–19 y) and to explore the forces ‘for’ and ‘against’ the utilization of AFHC services in Puducherry, India.


This mixed-methods study was conducted in two primary health centres. Record review assessed the utilization of AFHC service. Survey assessed the awareness on AFHC services and self-reported illnesses and their treatment seeking behavior. Group interviews were conducted with adolescent girls, boys and healthcare providers. A summative content analysis was done to organize the ‘for’ and ‘against’ forces for service utilization.


Of the 311 adolescents, less than 50% were aware of the services available at AFHC. Utilization of Weekly Iron and Folic Acid Supplementation was good. Only 2–10% of adolescents consulted the outpatient services of the Primary Health Centre for the treatment of their health problems. The authors found low utilization of AFHC services (15% among girls, zero among boys). One of the reasons for low utilization was poor awareness. Though free sanitary napkins motivated the girls to avail the services, boys considered the AFHC as a girl’s clinic. Healthcare providers suggested that building rapport and trust with adolescents and their parents, involving school teachers and ensuring privacy in the clinic would increase the utilization.


There is a huge gap between the awareness and utilization of AFHC services. The reasons for non-utilization were poor awareness and misconceptions about the clinic. Training of health staffs on communication skills, and supportive supervision could improve the utilization.


Adolescent friendly health clinic India Mixed methods Awareness Utilization 



This research was conducted through the Structured Operational Research and Training Initiative (SORT IT), a global partnership led by the Special Programme for Research and Training in Tropical Diseases at the World Health Organization (WHO/TDR). The model is based on a course developed jointly by the International Union Against Tuberculosis and Lung Disease (The Union) and Medécins sans Frontières (MSF/Doctors Without Borders). The specific SORT IT programme which resulted in this publication was jointly developed and implemented by: The Union South-East Asia Office, New Delhi, India; the Centre for Operational Research, The Union, Paris, France; the Operational Research Unit (LUXOR), MSF Brussels Operational Center, Luxembourg; Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India; Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India; Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India; Department of Community Medicine, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu; Narotam Sekhsaria Foundation, Mumbai, India; and National Institute for Research in Tuberculosis, Chennai, India.


TM conceptualised the study. TM, KCP, KS, ARD designed the study. TM, VM collected the data. All the authors have reviewed and finalized the protocol. The first author was involved in conceptualisation, designing, data collection, analysis and manuscript preparation. All authors critically reviewed and finally approved the manuscript. KCP will act as guarantor for the paper.

Compliance with Ethical Standards

Conflict of Interest


Source of Funding

The training programme were funded by the Department for International Development (DFID), UK. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.


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Copyright information

© Dr. K C Chaudhuri Foundation 2018

Authors and Affiliations

  • Thulasingam Mahalakshmy
    • 1
    Email author
  • Kariyarath Cheriyath Premarajan
    • 1
  • Kathirvel Soundappan
    • 2
  • Kanagarethinam Rajarethinam
    • 1
  • Yuvaraj Krishnamoorthy
    • 1
  • Adhisakthi Rajalatchumi
    • 1
  • Vijayageetha Mathavaswami
    • 1
  • Deepika Chandar
    • 1
  • Palanivel Chinnakali
    • 1
  • Amol R. Dongre
    • 3
  1. 1.Department of Preventive and Social MedicineJawaharlal Institute of Postgraduate Medical Education and ResearchPuducherryIndia
  2. 2.Department of Community Medicine, School of Public HealthPost Graduate Institute of Medical Education and ResearchChandigarhIndia
  3. 3.Department of Community MedicineSri Manakula Vinayagar Medical College and HospitalPuducherryIndia

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