Evaluation of three adolescent sexual health programs in ha noi and khanh hoa province, Vietnam

Involving men and boys in family planning: A systematic review of the effective components and characteristics of complex interventions in low- and middle-income countries

Background

Involving men and boys as both users and supporters of Family Planning (FP) is now considered essential for optimising maternal and child health outcomes. Evidence on how to engage men and boys to meet FP needs is therefore important.

Objectives

The main objective of this review was to assess the strength of evidence in the area and uncover the effective components and critical process- and system-level characteristics of successful interventions.

Search Methods

We searched nine electronic databases, seven grey literature databases, organisational websites, and the reference lists of systematic reviews relating to FP. To identify process evaluations and qualitative papers associated with the included experimental studies, we used Connected Papers and hand searches of reference lists.

Selection Criteria

Experimental and quasi-experimental studies of behavioural and service-level interventions involving males aged 10 years or over in low- and middle-income countries to increase uptake of FP methods were included in this review.

Data Collection and Analysis

Methodology was a causal chain analysis involving the development and testing of a logic model of intervention components based on stakeholder consultation and prior research. Qualitative and quantitative data relating to the evaluation studies and interventions were extracted based on the principles of 'effectiveness-plus' reviews. Quantitative analysis was undertaken using r with robust variance estimation (RVE), meta-analysis and meta-regression. Qualitative analysis involved 'best fit' framework synthesis.

Results

We identified 8885 potentially relevant records and included 127 in the review. Fifty-nine (46%) of these were randomised trials, the remainder were quasi-experimental studies with a comparison group. Fifty-four percent of the included studies were assessed as having a high risk of bias. A meta-analysis of 72 studies (k = 265) showed that the included group of interventions had statistically significantly higher odds of improving contraceptive use when compared to comparison groups (odds ratio = 1.38, confidence interval = 1.21 to 1.57, prediction interval = 0.36 to 5.31, p < 0.0001), but there were substantial variations in the effect sizes of the studies (Q = 40,647, df = 264, p < 0.0001; I 2 = 98%) and 73% was within cluster/study. Multi-variate meta-regression revealed several significant intervention delivery characteristics that moderate contraceptive use. These included community-based educational FP interventions, interventions delivered to women as well as men and interventions delivered by trained facilitators, professionals, or peers in community, home and community, or school settings. None of the eight identified intervention components or 33 combinations of components were significant moderators of effects on contraceptive use. Qualitative analysis highlighted some of the barriers and facilitators of effective models of FP that should be considered in future practice and research.

Authors' Conclusions

FP interventions that involve men and boys alongside women and girls are effective in improving uptake and use of contraceptives. The evidence suggests that policy should continue to promote the involvement of men and boys in FP in ways that also promote gender equality. Recommendations for research include the need for evaluations during conflict and disease outbreaks, and evaluation of gender transformative interventions which engage men and boys as contraceptive users and supporters in helping to achieve desired family size, fertility promotion, safe conception, as well as promoting equitable family planning decision-making for women and girls.

Stigmatizing Attitudes toward People Living with HIV among Young Women Migrant Workers in Vietnam

Despite intensive HIV education and prevention efforts in the past few years, stigmatizing attitudes toward people living with HIV (PLWH) remain a major barrier to HIV prevention and treatment efforts in Vietnam. The purpose of this study was to examine the prevalence of stigmatizing attitudes regarding HIV and identify correlative factors that impact the perceptions of PLWH among a heretofore overlooked demographic in Vietnamese society: women who are migrant workers in designated industrial zones (IZs). A cross-sectional study was conducted among 1061 women migrant workers aged 18 to 29 from January 2020 to November 2020 in Hanoi, Vietnam. Stigmatizing attitudes toward PLWH were measured using a four-item scale. Multiple logistic regression was conducted to examine the factors associated with stigmatizing attitudes. Our findings indicate both substantial levels of stigma persisting among this demographic group as well as the influence of important mitigating factors on the expression of HIV-related stigma. Over seventy-six percent (76.2%) of the participants reported having at least one of the four stigmatizing attitudes. Greater levels of stigmatizing attitudes toward PLWH were significantly associated with lower HIV knowledge, lower levels of education, and identifying as Kinh (the ethnic majority in Vietnam). Additionally, this study found that questions framing HIV infection through a familial lens were significantly associated with lower rates of stigmatizing responses. The high overall levels of stigmatizing attitudes toward PLWH among the study participants suggests that there is an urgent need for the development of culturally appropriate interventions and outreach education activities to reduce stigmatizing attitudes toward PLWH among women who are migrant workers working in the IZs in Vietnam. This study adds to both the existing literature and current efforts and policies around HIV in Vietnam by empirically suggesting that familial-based messaging may be a powerful potential narrative for interventions addressing HIV-related issues such as stigma.

Gaps of Knowledge about HIV and Sexually Transmitted Infections Among Industrial Workers in Northern Vietnam

Industrial workers are a vulnerable population for HIV and sexually transmitted infections (STIs). This cross-sectional study assessed the general knowledge about sexually transmitted infections (STIs) and HIV transmission risk among 289 industrial workers in Northern Vietnam. Results indicated that most workers could identify common routes of HIV transmissions and were aware of common STIs. However, insufficient knowledge about HIV transmission via anal sex practices, as well as common signs and symptoms of STIs were observed. Gender, marital status, education, locality status and health information sources were associated with the knowledge. This study reveals a gap of knowledge about HIV and other STIs, and suggested further tailored education interventions to improve the knowledge and promote sexual health-seeking behaviors in industrial workers.

Protection Motivation Theory and Rabies Protective Behaviors Among School Students in Chonburi Province, Thailand

Objectives

The aim of this study was to predict rabies protective behaviors (RPB) based on protection motivation theory (PMT) among fourth-grade students at schools in Chonburi Province, Thailand.

Methods

This cross-sectional study was conducted from December 2020 to February 2021. A multistage sampling technique was used for sample selection. The questionnaire was divided into socio-demographic data and questions related to PMT and RPB. Descriptive statistical analysis was conducted using the EpiData program and inferential statistics, and the results were tested using the partial least squares model with a significance level of less than 5%.

Results

In total, 287 subjects were included, of whom 62.4% were girls and 40.4% reported that YouTube was their favorite media platform. Most participants had good perceived vulnerability, response efficacy, and self efficacy levels related to rabies (43.9, 68.6, and 73.2%, respectively). However, 54.5% had only fair perceived severity levels related to rabies. Significant positive correlations were found between RPB and the PMT constructs related to rabies (β, 0.298; p<0.001), and the school variable (S4) was also a predictor of RPB (β, -0.228; p<0.001). Among the PMT constructs, self efficacy was the strongest predictor of RPB (β, 0.741; p<0.001).

Conclusions

PMT is a useful framework for predicting RPB. Future RPB or prevention/protection intervention studies based on PMT should focus on improving self efficacy and response efficacy, with a particular focus on teaching students not to intervene with fighting animals. The most influential PMT constructs can be used for designing tools and implementing and evaluating future educational interventions to prevent rabies in children.

Close to Home: Evidence on the Impact of Community-Based Girl Groups

PURPOSE

Community-based programming to promote gender equity, often delivered through community-based girl groups (CBGGs, sometimes called "safe spaces"), is increasing. However, evidence is weak on how CBGGs are implemented and their effect on adolescent girls' health and well-being. We conducted a comprehensive literature review to identify relevant CBGG programs.

METHODS

The review included programs with impact evaluations that used experimental or quasi-experimental design, data from 2 time points, control/comparison groups, and quantitative program effects and P values.

RESULTS

We analyzed evaluations of 30 programs (14 randomized controlled trials, 16 quasi-experimental). Although program designs varied, most programs targeted unmarried girls aged 13 to 18 years who were both in school and not in school, and who met weekly in groups of 15 to 25 girls. Nearly all programs used multisectoral approaches focusing on life skills and often economic and financial content, such as financial literacy and microsavings. Complementary activities with community members, boys, and health services were common. Across programs, evaluations reported statistically significant effects (P<.05) the majority (>50%) of times they measured outcomes related to gender and health attitudes and knowledge, education, psychosocial well-being, and economic and financial outcomes. Measures of outcomes related to girls' health behaviors and health status had majority null findings.

CONCLUSIONS

CBGG program evaluations found positive effects on girl-level outcomes that are independent of external factors, like gender norm attitudes, and suboptimal performance on health behavior and health status, which rely on other people and systems. This delivery model has promise for building girls' assets. Complementary actions to engage girls' social environments and structures are needed to change behaviors and health status.

Latkin C, C. M. Ho R, S. H. Ho C. Patterns of Risky Sexual Behaviors and Associated Factors among Youths and Adolescents in Vietnam

Youths and adolescents are vulnerable to HIV/STIs from unprotected sex. Promotion of young population's awareness about risky sexual behaviors is essential to develop contextualized interventions. A cross-sectional study was conducted in five Vietnamese provinces to document current attitudes and practices regarding sexual behaviors among youths. The information on sociodemographic characteristics, substance use, and sexual behaviors was collected via self-reported questionnaires. The factors associated with risky sexual behaviors were identified by the multivariate logistic regression. Among the 1200 participants, 73.5% reported having sex in their lifetime, and 48.1% used condoms at their latest sexual intercourse. Participants in urban areas were more likely not to intend to use condoms and had a higher unintended pregnancy rate than in rural areas. Older age was positively associated with not wanting to use and not using condoms. Substance-using participants were more likely to not use condoms. The participants taking alcohol or other stimulants before sex had a higher likelihood of unintended pregnancy. Respondents' attitudes and practices regarding sexual behaviors were associated with gender and employment. This study indicated that young population's awareness in Vietnam is high, however, risky sexual behaviors also remain common. Sex-related educational programs about the consequences of substance use, multiple sex partners, and unprotected sex should be developed.

Effect of education based on protection motivation theory on adolescents' reproductive health self-care: a randomized controlled trial

BACKGROUND

Adolescents should be empowered to improve their reproductive and sexual health needs. The present study aimed to investigate effects of protection motivation theory-based education on student girls' reproductive and sexual health self-care.

METHODS

This randomized controlled trial was conducted in parallel on 90 female students living in dormitories of the Alborz University of Medical Sciences in Iran. The data collection lasted from January 2017 to May 2018. Convenience sampling was performed, and samples were put into intervention and control groups by block randomization. The intervention group received six educational sessions based on the protection motivation theory(PMT). The data collection tool of this research consisted of the protection motivation theory and reproductive health self-care questionnaires.

RESULTS

There was no significant difference between control and intervention groups in demographic characteristics. The results of the repeated measures test indicated that the reproductive health self-care variable had a significant change (p = 0.000), and there was a significant difference between groups (p = 0.000). The total score of the Protection Motivation Theory Questionnaire was not changed over time (p = 0.54) and there was no significant difference between groups (p = 0.51) according to results of the repeated measures test.

CONCLUSION

According to effects of an educational intervention based on the protection motivation theory, it is suggested to utilize this model as an educational framework for adolescents' reproductive and sexual health by healthcare providers, schools and universities as well as holding periodic courses educating adolescents within short-term intervals in order to achieve the higher sustainability of the educational results.

A Systematic Review of Adolescent Girl Program Implementation in Low- and Middle-Income Countries: Evidence Gaps and Insights

Increasing attention to adolescent girls has generated an abundance of programs and a growing body of research on adolescent girls in low- and middle-income countries. Despite this, questions remain about what implementation approaches in program design are most effective, hindering efficient resource allocation, program scale-up, and replication across settings. To address these questions, we conducted a systematic review to identify lessons learned and gaps in the evidence base. We searched four electronic databases to identify studies published between 1990 and 2014 that evaluated health, social, and/or economic development programs targeting adolescent girls in low- and middle-income countries. Seventy-seven (77) studies meeting specified criteria were identified, of which 19 presented results that allowed conclusions relevant to implementation science. Studies examining the following questions were assessed: To what extent, if any, do multicomponent interventions (as opposed to single-component interventions) improve outcomes for girls? What is the added value of involving actors in addition to the girl herself such as parents, guardians, husbands (i.e., multilevel interventions)? What is the threshold proportion of girls who need to participate in a program to bring about normative and behavior changes at the community level? Is a greater level of program exposure associated with greater programmatic benefit for girls? Can supplemental "booster" activities extend the benefits of a program after it ends? We found evidence to support associations between multicomponent (vs. single component) programs, and longer program exposure (vs. less program exposure), with more favorable outcomes for girls, although both conclusions include methodological limitations. Overall, few studies assessed boosters or program saturation, and evidence on multilevel versus single-level programs was inconclusive. Few studies assessed implementation science questions by design, exposing large gaps in the evidence base. We call for future research to explicitly test such implementation science questions to inform more effective use of resources and to improve outcomes for girls.