Abstract
BACKGROUND: It has been identified that rural young people face barriers to accessing support for their sexual well-being such as availability and transport, knowing healthcare staff personally, and fear of being judged negatively within their community. These factors may contribute to widening health inequalities and expose young people living in rural areas to increased risk of poor sexual well-being. Little is known about the current needs of adolescents residing in remote rural island communities (RRICs). METHODS: A cross sectional mixed methods study was conducted with 473 adolescents aged 13-18 across the islands of the Outer Hebrides of Scotland. Analysis included descriptive, inferential statistics and thematic analysis. RESULTS: 59% (n=279) of participants held the perception there was no support, or did not know if there was support, about condoms and contraception in their local area. 48% (n=227) said that free condoms were not easily available for local young people. 60% (n=283) said they would not use youth services if they were locally available. 59% (n=279) said they did not receive enough relationships, sexual health and parenthood (RSHP) education. Opinion differed significantly by gender, school year group, and sexual orientation. Qualitative analysis identified three key themes: (1) alone yet visible, (2) silence and disapproval, and (3) safe spaces, with an underpinning theme of island cultures. CONCLUSIONS: A need for further sexual well-being support that addresses the complexities and challenges for young people residing in RRICs is identified. The intersectionality of being LGBT+ and residing in this context may increase the experience of inequality in sexual well-being support.