Perceived barriers to the uptake of health services among first-year university students in Johannesburg, South Africa

The study aimed to identify perceived barriers to the uptake of health services among young adults entering the tertiary education system in South Africa. A cross-sectional study was conducted among first-year students aged 18-25 years, registered at one of three universities in Johannesburg, South Africa, in 2017. Participants completed a self-administered paper-based questionnaire. Perceived barriers to accessing services included long waiting times, attitude of health workers, lack of sufficient information/poor health literacy, and inability to leave/stay away from studies. Among participants who tested for HIV in the past 6 months, waiting time and attitude of health care workers were perceived as barriers to accessing services. Compared to males, females were more likely to view attitudes of health workers and inability to leave/stay away from studies as potential barriers. While just over half of the students in this study had accessed health services in the past 6 months, very few opted to use campus health services, and even less reported receiving information about HIV and TB from the university itself. The study found that despite perceived barriers to accessing HIV and TB services off campus, fewer than one in five students starting out at university opted to use campus health services. Campus health services could address many of the barriers unique to university students. The university campus represents a mode of delivery of youth-friendly services tailored to meeting the healthcare needs of young people. Each year over 1 million students enroll in universities across South Africa, with 20% being first-time students who have to cope with the social complexities of this new environment. The study highlights the importance of understanding the specific health needs of young adults to help countries tailor policies to address these specific needs and improve adolescent health. The entrance to comprehensive, quality health care is essential for health promotion and maintenance as well as disease prevention and management. Research has shown that adolescents and young adults face challenges utilizing appropriate health care services, including for HIV and TB. Potential barriers have been classified into individual, provider, and system barriers. The study was made possible by the generous support of the American People and the President's Emergency Plan for AIDS Relief (PEPFAR) through US Agency for International Development (USAID) under the terms of Cooperative Agreements AID-674-A-12-00029 and 72067419CA00004 to Health Economics and Epidemiology Research Office (DE, NOM, CN) and under the terms of Cooperative Agreement 674-A-00-09-00018-00 to Boston University (LL, JB). The funders had no role in the study design, data collection, analysis, and interpretation of the data, in manuscript preparation, or the decision to publish.