الفهرس 
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Abstract
Adolescence is the transitional stage from childhood to adulthood generally occurs during the period from puberty to legal adulthood (age of maturity). It is a stressful period of life characterized by rapid phases of human development.
According to United Nations Children’s Emergency Fund (UNICEF 2018) and The World Health Organization (WHO), adolescents constitute 1.2 billion in the world today, making up to 16 percent of the world’s population. In Egypt according to Central Agency of Public Mobilization and Statistics (CAPMAS 2015), adolescents constitute 17 million, representing approximately 19 percent of the total population.
Adolescents in this stage do not understand their own sexual needs and physical changes that occur during their development. Therefore, they have the right to cope appropriately with the physical, emotional and social changes that support sexual and reproductive wellbeing. Also, they have the right to receive information and education for healthy sexual development and reproductive health.
Communication of sexual and reproductive health is the principal mean for parents to transmit sexual values, beliefs, expectations and knowledge to their adolescents which lead to increase awareness on sexual and reproductive matters and protect adolescent’s sexual and reproductive health.
Conversations between parents and adolescents about reproductive health issues are rarely occurred due to many barriers including individual, social, cultural, economic and environmental barriers.
These barriers can prevent communication between parents and their adolescents regarding sexual and reproductive health issues, which lead to exposure of the adolescents to high-risk behaviors such as unwanted pregnancy, early marriage, and sexual transmitted diseases.
This study was conducted to identify communication barriers with parents regarding reproductive health issues from the adolescents’ perspective in Alexandria.
Descriptive research design was used to conduct this study. It had been carried out in 8 youth centers in Alexandria, affiliated to the directorate of Youth and Sporting, which were selected randomly .Youth centers are; Smoha youth center affiliated to East zone, El-Amrawi youth center affiliated to El-Montazah zone, Elshlalat youth center affiliated to Middle zone, El-Qabari youth center affiliated to West zone, Eldkhila youth center affiliated to El-Ajmi zone, EL-ameriya youth center affiliated to EL-Ameriya zone, Borj Al Arab youth center affiliated to Borg El Arab zone and El-anfushi youth center affiliated to Elgomrok zone. The study was conducted on 450 adolescents who are attending the previously selected youth centers.
Tools of study
Three tools were used in this study to collect the necessary date. The first tool: Parents and adolescents socio-demographic characteristics structured interview schedule. It includes two parts: socio- demographic characteristics of the parents and socio- demographic characteristics of the adolescents. The second tool: Reproductive health Knowledge of adolescent’s and communication with parents concerning reproductive health issues structured interview schedule. It includes three parts: knowledge of adolescents regarding reproductive health, knowledge of adolescents regarding changes during puberty and importance of communication between adolescents and their parents. The third tool: Communication barriers check list. It includes two parts Communication barriers check list and the effect of poor communication check list.
Approvals were obtained for conducting the study at the specified settings. A pilot study was carried out on 45 adolescents representing (10% of total sample) to test feasibility of the study and comprehensives to the tool. The Data collection took 4 months (from the beginning of September 2019 December 2019) and then the relevant descriptive and analytical statistics were preformed.
The main findings obtained from the study were as follows:
The first section includes parents and adolescents socio-demographic characteristics:
Part (1): the adolescent’s socio-demographic characteristics.
• More than one tenth (14.2%) of the adolescents aged from10 to less than 12 years, while 1.8% of them aged from 18 to19 years with a mean of 13.80±2.005 years.
• Less than two thirds (61.1%) of the adolescents were males, and the rest (38.8%) of them were females
• Around one fifth (21.1%) of the adolescents were enrolled in primary schools, preparatory (54.0%) and secondary (24.9%) schools.
• More than one third (39.1% and 38.9% respectively) of adolescents were ranking the third or the fourth child
• Nearly three quarters (74.4%) of the adolescents were living in urban areas
• The majority (85.6%) of the adolescents were living with both parents
• Less than two thirds (61.8%) of adolescents had excellent academic achievement, while around two thirds (66.7%) of them experienced academic failure once.
• More than one third (41.1% and 36.7%) of them were attending the youth center three or four times respectively
Part (2): The parents’ socio- demographic characteristics:
• The majority (85.6%) of parents were married
• The mean age of fathers of 48.78±5.969 years, while for mothers was 42.18±5.638 years
• More than one quarter (29.2%) of fathers had university education, compared to 26.4% of mothers.
• Only 3.2% of fathers were on retirement or not working, compared to75.8% of mothers were house wives
• More than three quarters (76.7%) of the adolescents reported that their income was enough
The second section includes reproductive health; knowledge of adolescent’s
Part (1): Knowledge of adolescents regarding reproductive health
• More than one quarter (28.0%) of the adolescents reported having knowledge about reproductive health. and 79.4% of them reported knowledge insufficiency.
• Nearly two fifths (39.7%) of the adolescents reported that their main sources of knowledge were mothers, followed by internet (34.1%), fathers (22.2%) and friends (19.8%).
• More than two fifths of adolescents had knowledge about sexual transmitted diseases and family planning(43.8%,40.2% respectively) while ,around two thirds of them had knowledge about violence against women and early marriage (68.7%, 66.4% respectively).On the other hand, lesser percentage of them had knowledge about infertility and female genital mutilation (36.4% , 33.1% respectively)
Part (2): Knowledge of the adolescents regarding changes during puberty
• More than one third (35.6%) of the adolescents had knowledge about female reproductive system, compared to 43.8% of them who had knowledge about male reproductive system.
• More than two fifths (43.6%) of the adolescents had knowledge about female puberty related change, while (36.2%) of them had knowledge about menstruation
- Adolescents level of knowledge about reproductive health
• Less than three quarters (72%) of the adolescents had poor level of knowledge, while only 3.3% of them had good level of knowledge about reproductive health.
• All of the adolescents (100%) had poor level of knowledge about female genital mutilation and infertility. while, the vast majority (99.8%) of them had poor level of knowledge about early marriage.
• More than half of the adolescents had poor level of knowledge regarding family planning, and sexually transmitted diseases (59.8% and 56.2% respectively),while, less than one third (31.3%) of them had poor level of knowledge about violence against women.
• More than two thirds (67.1%) of the adolescents had poor level of knowledge about female reproduction. In addition to, less than two thirds of the adolescents had poor knowledge about female anatomy, puberty change and menstruation (64.4%, 56.9% and 63.8% respectively).
• More than half (56.2%) of the adolescents had poor level of knowledge, about male reproduction, male anatomy and puberty changes.
• The vast majority (91.3%) of the adolescents had poor total level of knowledge, while the rest 8.7% of them had fair total level of knowledge about reproductive health.
The third section: Communication with parents about reproductive health issues
Part (1): Communication experience with parents about reproductive health
• Regarding, Importance of communication, More than half (54.2%) of the adolescents stated that they don’t know, while around 29.3% of them reported that it provides adequate knowledge about reproduction, and more than one fifth (24.4%and 23.8%) of them stated that it reduces stress related to reproductive changes and protects against risky behaviors respectively.
• More than one quarter (29.3%) of the adolescents stated that they prefer to communicate with their mothers, followed by friends (16.4%), fathers (13.6%) and to lesser extent sisters, brothers and teachers (7.1%, 5.8% and 1.6% respectively)
• Two fifths (40%) of the adolescents stated that they had communicated with their parents regarding reproductive health, either once (28.9%), twice (33.9), three times (21.7%) and only 15.6% of them declared that they communicated with their parents four times and more.
• The main topics of communication were family planning as reported by (43.3%), followed by menstruation (39.4%), early marriage (35.6%) and violence against women (34.4%), and sexually transmitted diseases (23.3%) .
• With respect to parents reactions to communication, shyness (40.0 %), giving limited or insufficient information (32.2%),verbal or physical aggression (18.3% and 8.3% respectively) and refer the adolescents to another person to communicate with (12.8%).
Part (2): Communication barriers about reproductive health
• The main individual barriers was feeling ashamed of parents as mentioned by (62.9%) of the adolescents.
• The main environmental barriers was place of discussion is inappropriate as mentioned by (62%) of the adolescents.
• The main social barriers was the feeling of lack of friendship during talking with parents as mentioned by (67.6%) of the adolescents.
• The main cultural barriers was the believing that talking about reproductive health is inappropriate for the adolescents’ age as mentioned by (68.9%) of the adolescents.
• The main economic barriers was that the parents are busy most of the time at work, as they have additional work as mentioned by (59.8%) of the adolescents.
- The adolescents’ level of barriers communication about reproductive health
• Concerning the effect of poor communication about reproductive health ,less than one quarter (23.3%) of the adolescents had many individual barriers, and 28.4% of them had many environmental barriers .On the other hand less than half of them had many social and cultural barriers(37.6% and 43.8% respectively).while ,59.8% of them had many economic barriers.
• Regarding to the total barriers, more than one third (35.6%) of the adolescents had few barriers, while, more than two fifths (42.9%) of them had some barriers, and less than quarter (21.6%) of them had many barriers.
Part (3): The effect of poor communication about reproductive health
• The main social effects was weak ability to deal and discuss with others as mentioned by 66.9% of the adolescents.
• The main Psychological effects was addiction to some drugs, and alcohol as mentioned by 60.9% of the adolescents.
• The main physical effects was exposure to abortion unsafe manner as mentioned by 60.0% of the adolescents.
- The level of effect of poor communication about reproductive health
• Less than half of the adolescents perceived major social and psychological effects of poor communication (45.3% and 45.1% respectively) ,while 22.0% of them perceived major physical effects
• Concerning total effects, more than one third (36.9%) of the adolescents had minor effect of poor communication compared to 48.2% of them who had moderate effect. On the other hand, more than one tenth (14.9%) of the adolescents had major effects as a results of poor communication about reproductive health
The fourth section: the correlation tables
The relation between the adolescents’ basic characteristics and their knowledge
• All the adolescents (100%) aged from 10 less than 12 years had poor level of knowledge compared to 62.5% adolescents aged from 18 to19 years, with a statistically significant relation between the age of adolescents and their level of knowledge (X2=37.330, P = 0.000).
• Poor level of knowledge was higher (95.2%) among males than females (85, 1%) with a statistically significant relation between the sex of adolescents and their level of knowledge (X2=13.864, P = 0.000).
• All adolescents (100%) in primary education had poor level of knowledge compared to 93.0% of those in preparatory school and 80.4%of those in secondary school, with a statistically significant relation between level of education of adolescents and their level of knowledge (X2=26.918, P = 0.000).,
• A statistically significant relation was found between birth order of adolescents and their level of knowledge (X2=13.672, P = 0.008) as poor level of knowledge was higher among forth child (90.9%) in comparison to the first child (60.0%).
• Poor level of knowledge was prevalent among adolescents who are resident in urban area (91.6%) than those from rural area (80.0%) or squatter (90.9%).
• All (100%) the adolescents who live with father only had poor level of knowledge compared to the majority of those who live with their mothers only or with both parents (91.9% and 91.2% respectively)
• All (100%) the adolescents’ who have poor academic achievement had poor level of knowledge compared to 91.7% of those with excellent academic performance.
The relation between the adolescents’ knowledge level and their families’ characteristics.
• All (100%) adolescents whose mothers were died and 75% of those whose fathers were died had poor knowledge level compared to 92.5% of adolescents whose parents were married.
• Poor knowledge level was more prevalent among adolescents whose fathers aged less than 40 years (100%) compared to 92.9% of adolescents whose fathers aged 60 to 70 years old.
• Poor level of knowledge was more common among those adolescents whose fathers’ education is university and basic education (92.2%) compared to 75% of those adolescents with illiterate fathers.
• The fathers’ occupation had significant impact on level knowledge of adolescents(X2=13.606, P= 0.000), as poor level of knowledge was higher among adolescents with working father (92.2%) than those with not working fathers (64.3%).
• Poor level of knowledge was less encountered among adolescents whose mothers aged 50 to 60 years compared to those adolescents whose mothers aged 30 to less than 40 years old.
• Poor level of knowledge was lesser among adolescent whose mothers were illiterate (83.3%) compared to 91.5%of adolescents whose mother had university education.
• Poor level of knowledge was higher among adolescents whose mothers were house wives (92%) in comparison to adolescents with working mothers (88.9%).
• Poor knowledge level was less encountered among those adolescents who declared having enough income (91.0%) with a statistically significant relation between sufficiency of income and their level knowledge of (X2=4.136, P= 0.042).
The relation between the adolescents’’ knowledge level and their perceived barriers to communication about reproductive health and effect of poor communication.
• A statistically significant relation between actual communication with parents about reproductive health and the adolescents level of knowledge (X2=31.462 P= 0.000) as poor level of knowledge was higher among adolescents who reported no actual communication with parents (97.4%) than those who had communication with their parent (82.2%).
• Poor knowledge level was more encountered among adolescents with many perceived barriers (93.8%) compared to 88.1% of those who perceived few barriers.
• Poor knowledge level was less present among adolescents who perceived minor effects of poor communication (88.6%) in comparison to the vast majority (97.0%) of those adolescents who perceived major effects.
In the light of the present study findings, the following recommendations could be made:
• Develop parents’ counseling classes and support programs on how to communicate with adolescents regarding reproductive health issues, coping with their needs, problems and risky behaviors.
• Provide particular care and attention to the students during the period of preadolescence and early adolescence to prepare them for the puberty associated changes and equip them with needed information to overcome these changes safely.
• Awareness raising campaigns should be developed through primary health care services targeting children and adolescents and their parents’ knowledge about different reproductive health and sexuality issues.
• Strengthen role of school health nurses with respect to teaching and counseling the students regarding reproductive health issues.
• Design interventions to coach parents, equipping them with clear and practical tools to help them develop their confidence, knowledge and skills to improve parental capacity for discussion of reproductive health and sexuality issues with their children and adolescents.
• Promote the services provided through youth friendly clinics to address the adolescents’ reproductive needs.
• Reach out to a larger number of adolescents particularly in places which young people tend to attend frequent such as youth centers, sporting clubs, churches and mosques
• Maintain positive parenting controlling practices, responsive parenting style and mutual communication between parents and their children and adolescents.
• Encourage parental guided and responsible supervision and support through proper monitoring of the adolescent’s behaviors.
• Encourage and empower parents to start to communicate with their adolescents on sexual matters while the adolescents are still in late childhood or early teenage years.
• Maintain open and comfortable communication with adolescents on regular basis in conductive environment.
• Barriers of parents- adolescents communication regarding reproductive health from parents’ perspectives.
• Community based study on the barriers of communication with children and adolescents regarding reproductive health