Perspectives on family planning services among adolescents at a Boston community health center

Study protocol for a type-II hybrid effectiveness-implementation trial to reach teenagers using mobile money shops to reduce unintended pregnancies in Uganda

INTRODUCTION

Unintended teenage pregnancies have become a global public health challenge, particularly in sub-Saharan Africa. There is a notably high prevalence of unintended pregnancies among unmarried teenagers in Uganda. This study will develop an intervention programme using mobile money shops (vendors) as a platform to deliver sexual and reproductive health and rights (SRHR) services to teenagers and assess its effectiveness and scalability in Uganda.

METHODS AND ANALYSES

This hybrid study comprises two integral components: an intervention study to assess the effectiveness of vendor-mediated intervention and implementation research to evaluate the implementation process. 30 vendors will be recruited for both intervention and control arms in 2 municipalities in Eastern Uganda, which have a high unintended pregnancy prevalence rate among unmarried teens aged 15-19 years. A preintervention and postintervention repeated survey involving 600 participants for each arm will be conducted over 4 months. The primary outcome is the rate of condom users among teenage vendor users. The secondary outcomes include the rate of preference for receiving SRHR services at vendors and knowledge regarding SRHR. A difference-in-differences analysis will be used to determine the effectiveness of the intervention. The Bowen model will be employed to evaluate the implementation design.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Ethics Review Committee of Uganda Christen University and JICA Ogata Sadako Research Institute for Peace and Development in Japan. The findings will be widely disseminated. This study was registered with the University Hospital Medical Information Network in Japan (UMIN000053332) on 12 January 2024.

TRIAL REGISTRATION NUMBER

UMIN000053332.

"I feel like it gives me what I need to know": A qualitative study on adolescent perceptions of two contraceptive decision aids

OBJECTIVES

We sought to understand how adolescents perceive two commonly used contraceptive decision aids and which elements adolescents identified as most important to them.

STUDY DESIGN

We conducted a cross-sectional qualitative study of adolescents' perceptions of two decision aids, Your Birth Control Choices designed by the Reproductive Health Access Project and Birth Control: What's Important to You? designed by Power to Decide for Bedsider.org. We conducted semistructured interviews with 20 adolescents (aged 15-19 years) who were assigned female sex at birth and attended a single clinic in North Carolina. Interview questions addressed the decision aids' aesthetic design, informational content, inclusivity, and comprehensibility. We transcribed and analyzed interviews using Dedoose software. We developed a codebook using a combination of a priori and inductive codes followed by content analysis to identify themes.

RESULTS

All participants agreed that both decision aids could be helpful with contraceptive decision-making and with patient-provider discussions. However, some phrasing and descriptions of contraceptive methods were confusing. Participants preferred realistic imagery, clear explanations of side effects, and details on method use. Participants expressed a preference for the information contained in the detailed Reproductive Health Access Project decision aid, while most favored the aesthetic design and layout of the Bedsider decision aid.

CONCLUSIONS

Although adolescents expressed sentiments of increased knowledge and empowerment after reviewing the decision aids, this study suggests neither decision aid completely meets adolescent needs and preferences. Additional adaptations are necessary to create adolescent-centered contraceptive decision aids.

IMPLICATIONS

Adolescents in this study found two contraceptive decision aids as useful adjuncts to conversations with providers. The decision aids improved contraceptive knowledge and may facilitate decision-making. However, neither of the studied decision aids fully met the perceived needs of adolescents. Future adaptations or designs should include additional adolescent-centered content.

Factors associated with pregnancy and induced abortion among street-involved female adolescents in two Nigerian urban cities: a mixed-method study

OBJECTIVES

This study determined the correlates of unwanted pregnancy and induced abortion among sexually active female street-involved adolescents (SIAs) aged 10-19 years in two urban cities in South-west, Nigeria.

METHODS

The data for this study were extracted from a larger mixed-method survey dataset on the sexual and reproductive health (SRH) of 1505 street-involved young people aged 10 to 24 years. For the quantitative data, the explanatory variables were age, history of school attendance, employment status, religion, living arrangement and city of residence. The study outcomes were a history of pregnancy and a history of induced abortion of last pregnancy. Binomial regression analysis was performed to determine the association between the explanatory and outcome variables. For the qualitative data generated through focus group discussions and in-depth-interviews, inductive and deductive approaches were used in conducting a thematic analysis to explore the perspectives and experiences of SIA on pregnancy and induced abortion.

RESULTS

Of the 424 female SIAs, 270 (63.7%) reported having had sex. Sixty-four (23.7%) respondents had a history of pregnancy, of which 38 (59.4%) gave a history of induced abortion of the last pregnancy. A history of school attendance significantly reduced the likelihood of being pregnant (AOR: 0.42, 95% C.I: 0.19-0.91), while 15-19-years-old SIAs who were pregnant were significantly less likely to abort (AOR: 0.13, 95% C.I: 0.02-0.77). Qualitative reports indicated that unintended pregnancy and induced abortion was a common experience among the sexually active SIAs. Many participants were aware of the methods of, and places to induce abortion.

CONCLUSION

A large proportion of SIAs are sexually active with a high incidence of unintended pregnancy and a high rate of unsafe abortion. Access of female SIAs to education can reduce the risk of unintended pregnancy. Attention needs to be paid to how SIAs can have access to contraception.

Adolescents' perceived barriers to accessing sexual and reproductive health services in California: a cross-sectional survey

Background

Adolescents may forego needed sexual and reproductive health (SRH) services due to a variety of concerns and barriers. The purpose of this study is to compare adolescents’ perceptions of these barriers by participant characteristics including race/ethnicity, gender, sexual orientation, housing situation, and sexual experience.

Methods

Adolescents in a California-wide sexual health education program completed an anonymous survey at baseline (N = 10,015) about perceived barriers to using SRH services. Logistic regression analyses that accounted for the clustered data structure assessed differences by gender, age, sexual orientation, race/ethnicity, living situation, and sexual experience.

Results

The majority of participants were Hispanic/Latino (76.4%) with an average age of 14.9 years, and 28.8% had sexual experience. Half of the youth reported concerns about test results (52.7%), cost of services (52.0%), and confidentiality of services (49.8%). When controlling for other characteristics, youth identifying as transgender/non-binary/multiple genders had the highest odds of perceiving cost (odds ratio (OR) 1.89) and confidentiality (OR 1.51) as barriers. Increasing age was associated with decreasing odds of all barriers. Sexual orientation was a consistent predictor, with LGBQ+ youth having higher odds of perceiving test results (OR 1.21), cost (OR 1.36), and confidentiality (OR 1.24) as barriers. Asian or Pacific Islander/Native Hawaiian youth had higher odds of perceiving test results (OR 1.68) and cost (OR 1.37) as barriers. In contrast, Black youth had lower odds of reporting cost (OR 0.65) and confidentiality (OR 0.77) as barriers. Younger respondents and youth who identified as female, transgender/non-binary/multiple genders, LGBQ+, and Asian or Pacific Islander/Native Hawaiian had higher odds of reporting five or more barriers compared to reference groups.

Conclusions

The majority of adolescents face barriers to accessing appropriate SRH services, with females, gender-minority youth, younger adolescents, LGBQ+ youth, and Asian and Pacific Islander/Native Hawaiian youth more likely than others to report barriers. Access to SRH services can be improved through strengthening linkages between clinics and SRH education programs, providing youth-friendly clinical services, and ensuring youth have sufficient information, skills, and support to access care.

Trial registration

Approved by California Health and Human Services Agency’s Committee for the Protection of Human Subjects [12-08-0658, 11/30/2017].

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07278-3.

Youth-Friendly Family Planning Services for Young People: A Systematic Review Update

CONTEXT

Youth-friendly family planning services may improve youth reproductive health outcomes. A systematic review conducted in 2011 was updated in 2016 to incorporate recent data examining the effects of youth-friendly family planning services on reproductive health outcomes and the facilitators and barriers facing young people in accessing family planning services.

EVIDENCE ACQUISITION

PubMed, POPLINE, EMBASE, and other databases were used to identify relevant articles published from March 2011 through April 2016.

EVIDENCE SYNTHESIS

Eighteen studies met inclusion criteria and were added to 19 studies from the review conducted in 2011. Of these, seven assessed the effect of youth-friendly services on outcomes: two showed a positive effect on reducing teen pregnancy, three on contraceptive use, and three on knowledge and patient satisfaction (not mutually exclusive). Facilitators or barriers were described in 32 studies. However, none were RCTs and most were at high risk for bias due to selection, self-report, and recall bias among others.

CONCLUSIONS

The studies in this review suggest some positive effects of youth-friendly family planning services on reproductive health outcomes, but the need for more rigorous research persists. This review identified numerous factors relevant to young people's access to family planning services, reaffirming findings from the initial review: young people value confidentiality, supportive provider interaction, specialized provider training, and the removal of logistic barriers. Further, it illuminates the importance young people place on receiving comprehensive, client-centered family planning counseling. These findings should be considered when developing, implementing, and evaluating reproductive health services for young people.

THEME INFORMATION

This article is part of a theme issue entitled Updating the Systematic Reviews Used to Develop the U.S. Recommendations for Providing Quality Family Planning Services, which is sponsored by the Office of Population Affairs, U.S. Department of Health and Human Services.

Client Preferences for Contraceptive Counseling: A Systematic Review

CONTEXT

Providers can help clients achieve their personal reproductive goals by providing high-quality, client-centered contraceptive counseling. Given the individualized nature of contraceptive decision making, provider attention to clients' preferences for counseling interactions can enhance client centeredness. The objective of this systematic review was to summarize the evidence on what preferences clients have for the contraceptive counseling they receive.

EVIDENCE ACQUISITION

This systematic review is part of an update to a prior review series to inform contraceptive counseling in clinical settings. Sixteen electronic bibliographic databases were searched for studies related to client preferences for contraceptive counseling published in the U.S. or similar settings from March 2011 through November 2016. Because studies on client preferences were not included in the prior review series, a limited search was conducted for earlier research published from October 1992 through February 2011.

EVIDENCE SYNTHESIS

In total, 26 articles met inclusion criteria, including 17 from the search of literature published March 2011 or later and nine from the search of literature from October 1992 through February 2011. Nineteen articles included results about client preferences for information received during counseling, 13 articles included results about preferences for the decision-making process, 13 articles included results about preferences for the relationship between providers and clients, and 11 articles included results about preferences for the context in which contraceptive counseling is delivered.

CONCLUSIONS

Evidence from the mostly small, qualitative studies included in this review describes preferences for the contraceptive counseling interaction. Provider attention to these preferences may improve the quality of family planning care; future research is needed to explore interventions designed to meet preferences.

THEME INFORMATION

This article is part of a theme issue entitled Updating the Systematic Reviews Used to Develop the U.S. Recommendations for Providing Quality Family Planning Services, which is sponsored by the Office of Population Affairs, U.S. Department of Health and Human Services.

Integrating Long-Acting Reversible Contraception Services into New York City School-Based Health Centers: Quality Improvement to Ensure Provision of Youth-Friendly Services

STUDY OBJECTIVE, DESIGN, AND SETTING

Adolescents face barriers to accessing youth-friendly family planning services, specifically long-acting reversible contraception (LARC). School-based health centers (SBHCs) can provide youth-friendly care. A quality improvement project was undertaken to assess quality of care before, during, and after LARC services at 3 SBHCs, and to identify specific strategies for improving these LARC services.

PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES

We interviewed 18 female adolescents who received LARC services. Two independent reviewers coded deidentified verbatim transcripts; discrepancies were resolved by consensus with a third reviewer. A guide of themes was structured corresponding to Ambresin's domains of youth-friendly services. From these domains, we identified emerging themes using grounded theory, with a focus on practical suggestions for improving LARC services in SBHCs.

RESULTS

Interviewees ranged in age from 15 to 19 (average: 17) years. Most had insertions (12 levonorgestrel intrauterine system (LNG-IUS); Mirena^®), 1 copper intrauterine device (Paragard^®), 5 contraceptive implant (Nexplanon^®). Overall, participants were highly satisfied with SBHC LARC services. Within the domain of communication, 2 key themes emerged: balancing need for information with concerns about being overwhelmed by information; and interest in information that directly addresses misconceptions about LARCs. Suggested strategies included providing postprocedure "care packages" with information and supplies, and supporting a peer-based network of adolescent LARC users and previous patients to serve as a resource for new patients.

CONCLUSION

This quality improvement project, conducted in a unique setting, gave adolescents a voice. The identified strategies for improving health education, social support, and outreach might be generalizable to other SBHCs. Future research could explore the effect of implementing these suggested strategies on reproductive health care use and outcomes at SBHCs.

Adolescents' Responses to an Unintended Pregnancy in Ghana: A Qualitative Study

STUDY OBJECTIVE

To investigate the experiences and perceptions of adolescents who have experienced a recent pregnancy and undergone a termination of pregnancy.

DESIGN

A vignette-based focus group approach was used to have adolescents reflect on scenarios that happen to others during an unwanted pregnancy.

SETTING

The study was conducted in public health facilities in the 3 major urban areas of Ghana-Accra, Kumasi, and Tamale.

PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES

Adolescents, aged 10-19 years, who had a recent termination of pregnancy were recruited from public health facilities in the 3 sites. Fifteen focus groups were conducted and digitally recorded in English, Twi, Ga, and Dagbani. Transcripts were transcribed and translated, and thematic analysis was used for the analysis.

RESULTS

Adolescents reported that the characters in the vignettes would feel sadness, depression, and regret from an unintended pregnancy and some male partners would "deny" the pregnancy or suggest an abortion. They suggested some parents would "be angry" and "sack" their children for becoming pregnant while others would "support" them. Parents might send the pregnant girl to a distant friend or grandparents until she delivers to avoid shame and gossip. Health professionals might encourage the pregnant girl or insult/gossip about the girl.

CONCLUSION

Adolescent unintended pregnancies in Ghana are met with a range of reactions and these reactions influence the pregnancy choices young women make for continuation or termination of pregnancy.