Abstract
BACKGROUND: Adolescent-Friendly Health Services (AFHS) are crucial for addressing the sexual and reproductive health needs of adolescents. Despite AFHS integration into public health facilities in Nepal since 2009, the utilization of these services remains suboptimal and concerning. The purpose of this study was to investigate the utilization and key determinants of AFHS in Pokhara, Nepal. METHODS: An analytical quantitative study involving 569 adolescents aged 12–19 years was conducted from July 12 to October 25, 2023. Study participants were selected using simple random sampling and proportionate stratified sampling methods. The study utilized a self-administered questionnaire, and key determinants of AFHS usage were identified using logistic regression analyses. RESULTS: The mean age of the participants was 14.66 ± 1.09 years. Only 37.1% of the adolescents had utilized AFHS at the time of the study. More than half of the participants (51.7%) mentioned the need for AFHS. The key determinants of AFHS utilization were: perceived healthcare need as seeking health facilities directly (AOR: 1.62, 95% CI: 1.07–2.46, vs. seeking care after home remedies); hospital as the first treatment point (AOR: 2.50, 95% CI: 1.68–3.72, vs. grassroots health facilities); perceived need for AFHS (AOR: 1.57, 95% CI: 1.06–2.33); not paying for AFHS (AOR: 2.06, 95% CI: 1.39–3.04), feasible service time (AOR: 1.51, 95% CI: 1.02–2.46); proper counselling services (AOR: 1.97, 95% CI: 1.19–3.26); and adequacy of AFHS facilities (adequate water supply and sanitation facilities, AOR: 1.70, 95% CI: 1.12–2.58). CONCLUSIONS: The utilization of AFHS remains low within the study population. Key factors influencing AFHS utilization include perceived healthcare need, the first point of treatment, payment for services, perceived necessity of AFHS, service time feasibility, availability of counselling services, and access to reliable water supply and sanitation facilities. Therefore, it is crucial to establish proper infrastructure, implement effective planning, allocate adequate budgets, train personnel, and provide comprehensive counselling services tailored to adolescents’ needs to ultimately enhance AFHS utilization. CLINICAL TRIAL NUMBER: Not applicable. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-025-13157-y.