1
|
Brisson J, Volesky-Avellaneda KD. Internet-Based Access to Sexual and Reproductive Health Services Among Colombian Youth: A Cross-Sectional Study. HISPANIC HEALTH CARE INTERNATIONAL 2024; 22:150-159. [PMID: 38613383 DOI: 10.1177/15404153241246102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Introduction: Sexual and reproductive health (SRH) is a sensitive subject, and young people may be unfamiliar with how to access SRH services. In this cross-sectional study, we examined young people's internet use to understand how they accessed SRH clinics in Colombia. This study also explored Colombian youth's interest in online material teaching how to access SRH services. Methods: During August 2019-February 2020, patients aged 10-24 years old presenting at two SRH clinics in Colombia were invited to answer a survey. Chi-square tests were performed to assess possible differences in how participants inquired how to access the clinic according to sociodemographic characteristics. Results: Among the 812 patients who participated, 91.4% were female and the median age was 19 years. To inquire how to access the SRH clinic, 30.7% of participants asked their parent(s) and 24.0% used the internet. Participants aged 20-24 years old were more likely to use the internet compared to younger participants (p < .001). Most respondents (81.5%) were interested in the availability of online material explaining how to access SRH services. Conclusions: While Colombian youth learned about how to access SRH clinics from several different sources, the vast majority indicated their interest in having access to online materials explaining how to access SRH services.
Collapse
Affiliation(s)
- Julien Brisson
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Karena D Volesky-Avellaneda
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
2
|
Mohd Tohit NF, Haque M. Forbidden Conversations: A Comprehensive Exploration of Taboos in Sexual and Reproductive Health. Cureus 2024; 16:e66723. [PMID: 39139803 PMCID: PMC11319820 DOI: 10.7759/cureus.66723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2024] [Indexed: 08/15/2024] Open
Abstract
This scoping review aims to comprehensively explore the landscape of taboos and their impact on sexual and reproductive health. Titled "Forbidden Conversations," it delves into the intricate web of societal, cultural, and religious norms that have contributed to the elusive and often stigmatized nature of sexual and reproductive health topics. The review navigates through the multifaceted dimensions of these taboos, shedding light on their impact on individuals, communities, and public health while advocating for a paradigm shift toward open, inclusive, and informed dialogue. The analysis within this review spans a decade, capturing the most recent and relevant literature to map the landscape of taboos in sexual and reproductive health. It explores the persistent societal apprehensions and subsequent stigmatization surrounding topics such as menstruation, contraception, fertility, sexual orientation, and gender identity. The review contextualizes the multifaceted challenges presented by these prevailing norms by tracing historically rooted taboos and their evolution across different cultures and contexts. The scoping review identifies the profound implications of these taboos on public health, highlighting how they contribute to disparities in access to healthcare, perpetuate misinformation, and infringe upon the fundamental rights of individuals. It addresses the challenges in sexual education, emphasizing how these taboos impede comprehensive understanding and enforcement of sexual and reproductive health rights among adolescents and young adults. The intersectional approach taken in this review situates these taboos within broader systems of inequality, emphasizing the compounded impact they have on marginalized populations. Through this comprehensive exploration, the review aims to provide actionable insights and identify existing research, policy, and practice gaps. It seeks to lay the foundation for future initiatives that advocate for destigmatization, empowerment, and equity in sexual and reproductive health. Ultimately, "Forbidden Conversations" aims to steer the conversation toward openness and inclusivity while advocating for unbiased, comprehensive sexual and reproductive healthcare with dignity for all individuals.
Collapse
Affiliation(s)
- Nor Faiza Mohd Tohit
- Department of Community Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, MYS
| | - Mainul Haque
- Department of Research, Karnavati Scientific Research Center (KSRC) School of Dentistry, Karnavati University, Gandhinagar, IND
- Department of Pharmacology and Therapeutics, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, MYS
| |
Collapse
|
3
|
Aliyu TK. Situational context of home-based sexual education in urban slums of Ibadan, Nigeria-evidence from a qualitative study. PLoS One 2024; 19:e0304200. [PMID: 38885279 PMCID: PMC11182513 DOI: 10.1371/journal.pone.0304200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 05/07/2024] [Indexed: 06/20/2024] Open
Abstract
This study explores the influence of situational context on parent-adolescent communication about sexual and reproductive health (SRH) issues in the urban slums of Ibadan, Nigeria. A qualitative exploratory study was conducted in the Southeast and Northeast LGAs of Ibadan. Eight (8) vignette-based focus group discussions (FGDs) with parents and adolescents of both sexes were conducted in addition to four (4) key informant interviews (KIIs) with community and women's leaders. Interviews were tape-recorded, transcribed, and translated into English. Thematic analysis was adopted using ATLAS Ti 9 software. Findings portray SRH meanings and experiences, intergenerational cultural norms, and expectations for SRH, gender double standards in SRH discussion, streetwise SRH knowledge, and social media exposure as contexts that interfere with parent-adolescent communication on SRH issues. The findings show that despite understanding the need for SRH discussion, parents and adolescents lack effective communication on SRH issues due to the interference of unfiltered streetwise SRH knowledge and social media exposure. Also, SRH conversation between parents and adolescents promotes gender inequalities as different information is passed to adolescent girls and boys. Interventions that take into account situational occurrences must be geared towards enabling parents to give their adolescents early exposure to relevant, context-specific SRH knowledge.
Collapse
Affiliation(s)
- Taofeek Kolawole Aliyu
- Department of Sociology and Anthropology, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Sociology, Centre for Demographic and Ageing Research (CEDAR), Umeå University, Umeå, Sweden
| |
Collapse
|
4
|
Nabunya P, Byansi W, Muwanga J, Bahar OS, Namuwonge F, Ssentumbwe V, Ssewamala FM. Family Factors and Gender Norms as Protective Factors Against Sexual Risk-Taking Behaviors Among Adolescent Girls in Southern Uganda. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2024; 11:111-121. [PMID: 38859819 PMCID: PMC11164544 DOI: 10.1007/s40609-022-00237-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 06/11/2024]
Abstract
Adolescent girls and young women are at a higher risk for HIV infection stemming from barriers to accessing comprehensive sexual health education, unequal cultural, social, and economic statuses, limited access to education and health care services, and gender-based violence. This makes adolescent girls susceptible to high-risk sexual behaviors. This study examines the protective role of family, social support factors and gender norms against sexual risk-taking behaviors among secondary school adolescent girls in Uganda. Baseline data from the National Institute of Mental Health-funded Suubi4Her study were analyzed. A total of 1260 girls aged 14-17 years and enrolled in the first or second year of secondary school were recruited across 47 secondary schools. Hierarchical linear regression models were conducted to determine the role of family, social support factors and gender norms on sexual risk-taking behaviors. Results indicate that traditional gender norms, family care and relationships, and social support were all associated with lower levels of sexual risk-taking intentions-a proxy for engaging in sexual risk behaviors. Findings point to the need to develop family level support interventions to equip adolescent girls with adequate sexual health-related knowledge and skills to facilitate safer sexual practices and reduce high-risk sexual-taking behaviors, as they develop and transition into young adulthood.
Collapse
Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis, Brown School, 1 Brookings Drive, St. Louis, MO 63130, USA
| | - William Byansi
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA
| | - Joelynn Muwanga
- Department of Health and Human Services, New Hampshire, Division of Public Health, Littleton, USA
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis, Brown School, 1 Brookings Drive, St. Louis, MO 63130, USA
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis, Brown School, 1 Brookings Drive, St. Louis, MO 63130, USA
| | - Vicent Ssentumbwe
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis, Brown School, 1 Brookings Drive, St. Louis, MO 63130, USA
| | - Fred M. Ssewamala
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis, Brown School, 1 Brookings Drive, St. Louis, MO 63130, USA
| |
Collapse
|
5
|
Ampofo AG, Mackenzie LJ, Osei Asibey S, Oldmeadow C, Boyes AW. Prevalence and Correlates of Cervical Cancer Prevention Knowledge Among High School Students in Ghana. HEALTH EDUCATION & BEHAVIOR 2024; 51:185-196. [PMID: 38105234 PMCID: PMC10981191 DOI: 10.1177/10901981231217978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Cervical cancer is a preventable yet highly prevalent disease in Africa. Despite female adolescents and young women being a target group for cervical cancer prevention strategies, little research has examined their knowledge of how to prevent the disease. The study aimed to describe: (a) knowledge about cervical cancer prevention and (b) sociodemographic, social, and systemic factors associated with and interacting with knowledge among female senior high school students in Ghana. METHODS A cross-sectional survey assessed knowledge about (a) risk factors and (b) primary and secondary prevention of cervical cancer among 2,400 female students from 17 public senior high schools in the Ashanti region, Ghana. Descriptive statistics were used to describe knowledge. Linear mixed-effects regression models were used to examine factors associated with knowledge scores. RESULTS Knowledge gaps were observed for at least two-thirds (>65%) of students. Most students (mean age = 17) did not know that early sexual debut (before 18 years) is a risk factor for cervical cancer (72%) and that a blood test cannot detect cervical cancer (71%). Students in later stages of senior high school education and those who received sexual health education from teachers and parents had significantly greater cervical cancer knowledge scores than their counterparts. Interactive effects showed that school-based sexual health education was associated with higher knowledge scores than home-based education among students. CONCLUSIONS Most female senior high school students had gaps in knowledge about cervical cancer prevention. Finding new ways to strengthen the capacity of schools and parents to deliver accurate cervical cancer prevention information is warranted.
Collapse
Affiliation(s)
- Ama Gyamfua Ampofo
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Lisa J Mackenzie
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Shadrack Osei Asibey
- Faculty of Applied Sciences and Technology, Kumasi Technical University, Kumasi, Ghana
| | | | - Allison W Boyes
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| |
Collapse
|
6
|
Fernandes D, Kemigisha E, Achen D, Akatukwasa C, Ruzaaza GN, Coene G, Delobelle P, Nyakato VN, Michielsen K. Process evaluation of a parent-child communication intervention for adolescent sexual and reproductive health in Uganda. BMC Public Health 2024; 24:319. [PMID: 38287314 PMCID: PMC10826092 DOI: 10.1186/s12889-023-17513-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 12/18/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Previous initiatives concerning adolescent sexual and reproductive health (SRH) education in Low-or-Middle Income Countries (LMICs) have been limited by cultural norms and misinformation perpetuated within families. Responding to the paucity of research on the implementation of SRH interventions in LMICs and limited knowledge regarding their mechanisms, this study undertakes a process evaluation of a parent-focused intervention to promote parent-adolescent communication about SRH in Uganda. METHODS This paper explores the implementation, contextual factors and mechanisms of impact of the intervention, using the Medical Research Council (MRC) guidelines for process evaluations. Implementation was evaluated through indicators of dose, fidelity and adaptations, acceptability and feasibility. The contextual factors and mechanisms of impact were evaluated to refine the intervention's causal assumptions. Data was collected during April - October 2021 in South-Western Uganda using a mixed-methods approach, including document analysis, intervention observations, interviews, focus group discussions and most significant change stories. RESULTS The acceptability of the intervention was related to its community engagement, the strong rapport with delivery agents, and individual characteristics of participants. Five contextual factors influencing implementation were highlighted; (i) cultural norms, (ii) perceptions about youth SRH, (iii) poverty, (iv) Covid-19 pandemic, and (v) prior research projects in the community. When considering the intervention's mechanisms of impact, four causal pathways were identified; (i) Awareness of SRH needs helped parents overcome stigma, (ii) Parenting skills training improved SRH communication, (iii) Group learning stimulated shared parenting, and (iv) Group learning improved co-parenting. CONCLUSION The paper presented three key learnings and corresponding recommendations for future research. Firstly, implementation success was credited to meaningful community engagement which improved acceptability and uptake. Secondly, the complex influences of contextual factors highlighted the need for contextual analysis in research studies to inform intervention design. Finally, this evaluation recognised the interplay between mechanisms of impact and suggested further research consider such combined impacts when designing intervention content.
Collapse
Affiliation(s)
- Danielle Fernandes
- International Center for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, 9000, Belgium.
- Centre of Expertise on Gender, Diversity and Intersectionality, Vrije Universiteit Brussels, Brussels, 1090, Belgium.
| | - Elizabeth Kemigisha
- Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
- African Population and Health Research Center, P.O Box 10787-00100, Nairobi, Kenya
| | - Dorcus Achen
- Centre of Expertise on Gender, Diversity and Intersectionality, Vrije Universiteit Brussels, Brussels, 1090, Belgium
| | - Cecilia Akatukwasa
- International Center for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, 9000, Belgium
| | - Gad Ndaruhutse Ruzaaza
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Gily Coene
- Centre of Expertise on Gender, Diversity and Intersectionality, Vrije Universiteit Brussels, Brussels, 1090, Belgium
| | - Peter Delobelle
- Department of Public Health, Vrije Universiteit Brussels, Brussels, 1090, Belgium
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Viola N Nyakato
- Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Kristien Michielsen
- International Center for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, 9000, Belgium
- Institute for Family and Sexuality Studies, Dept. of Neurosciences, Fac. of Medicine, KU Leuven, Leuven, Belgium
| |
Collapse
|
7
|
Díaz-Rodríguez MV, Perelló VBI, Granero-Molina J, Fernández-Medina IM, Ventura-Miranda MI, Jiménez-Lasserrotte MDM. Insights from a Qualitative Exploration of Adolescents' Opinions on Sex Education. CHILDREN (BASEL, SWITZERLAND) 2024; 11:110. [PMID: 38255423 PMCID: PMC10814457 DOI: 10.3390/children11010110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Adolescence is a crucial time in the development of young people's identity, and sexuality is a key issue. Comprehensive sex education provides the knowledge and skills to help adolescents protect their sexual and reproductive health and rights. Policies on sex education in secondary schools are highly influential in the development of quality programmes that support comprehensive sex education. The aim of this study was to explore, describe and understand adolescents' experiences of sex education. METHODS A qualitative study based on Gadamer's phenomenology was used. Two focus groups and four in-depth interviews were conducted with 12 private school students, followed by inductive data analysis using ATLAS.ti software 9.0. RESULTS Two main themes were identified in the analysis: (1) sex education is a challenge for secondary schools and (2) student expectations of sex education. CONCLUSION It is essential for adolescents to have access to comprehensive sex education that is adapted to the different stages of their development, is provided by specialised teachers, and involves their families in the process.
Collapse
Affiliation(s)
| | - Vicent Bataller i Perelló
- Facultad Ciencias de la Salud, Universidad de Almería, 04120 Almería, Spain; (M.V.D.-R.); (V.B.i.P.)
| | - José Granero-Molina
- Department of Nursing Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (I.M.F.-M.); (M.I.V.-M.); (M.d.M.J.-L.)
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago 7500000, Chile
| | - Isabel María Fernández-Medina
- Department of Nursing Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (I.M.F.-M.); (M.I.V.-M.); (M.d.M.J.-L.)
| | - María Isabel Ventura-Miranda
- Department of Nursing Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (I.M.F.-M.); (M.I.V.-M.); (M.d.M.J.-L.)
| | - María del Mar Jiménez-Lasserrotte
- Department of Nursing Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (I.M.F.-M.); (M.I.V.-M.); (M.d.M.J.-L.)
| |
Collapse
|
8
|
Zango AB, Stutterheim SE, de Vries N, Crutzen R. Determinants of preventive sexual behaviours among first year university students in Beira city, central Mozambique: a cross-sectional study. Reprod Health 2024; 21:3. [PMID: 38191405 PMCID: PMC10773135 DOI: 10.1186/s12978-023-01733-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/28/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Understanding determinants of preventive sexual behaviours is important for intervention efforts to support these behaviours and, thereby, reduce STIs and HIV burden. In general, there is limited insight into determinants of preventive behaviours among university students in Mozambique. Therefore, this study set out to assess both the prevalence and the determinants of condom use and voluntary counselling and testing (VCT) service use in first year university students. METHODS We conducted a cross-sectional study in May-September 2021, at the Universidade Católica de Moçambique and the Universidade Licungo, in Beira central Mozambique. We collected data on sociodemographic characteristics, heterosexual relationship experiences and personal determinants posited to be associated with condom use and VCT service use. We included 819 participants, who were selected using a clustered and random sampling design. We used Pearson's chi-square test to compare proportion and estimate the crude odd ratio as the effect size measure at 95% confidence interval, and Confidence Interval-Based Estimation of Relevance to determine correlation coefficients of means and the behaviours of interest at 95% confidence interval. RESULTS Condoms were used by 96.1% of male participants and 95.0% of female participants. Additionally, 55.1% of male participants and 57.5% of female participants had previously used VCT services. Condom use was associated with discussing sexuality with mother, and self-efficacy for condom use negotiation, and negatively associated with attitudes that condoms reduce pleasure. VCT service use was associated with discussing sexuality with mother, sexual debut, having a sexual partner, and being in what they consider an important heterosexual relationship. Knowledge, attitude, self-efficacy and subjective norms were weakly associated with VCT service use. CONCLUSION In first year university students in Mozambique, reported condom use was high but VCT services were only used by about half of the participants. Interventions aiming to increase VCT service use should focus on improving communication between parents and their adolescent or young adult children, providing personalized risk information, demonstrating that VCT service use is pleasant and non-judgmental, improving users' confidence to schedule a visit, and preparing users for possible positive testing results.
Collapse
Affiliation(s)
- Arlinda Basílio Zango
- Departamento de Investigação, Faculdade de Ciências de Saúde, Universidade Católica de Moçambique, Beira, Mozambique.
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands.
| | - Sarah E Stutterheim
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Nanne de Vries
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Rik Crutzen
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
9
|
Parmar D, Berhe S, Bradley S, Fenny A, Aziato L, Ceesay H. Access to adolescent sexual and reproductive health services in Accra, Ghana: An exploratory qualitative study. Glob Public Health 2024; 19:2341420. [PMID: 38634489 DOI: 10.1080/17441692.2024.2341420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/05/2024] [Indexed: 04/19/2024]
Abstract
Nearly 31% of the Ghanaian population are adolescents, and these populations persistently face high rates of teenage pregnancies and unsafe abortions. This is despite sexual and reproductive health (SRH) being taught in the school curriculum. In this qualitative study, we explore the factors affecting adolescents' access to, and experiences of, SRH services in Accra, Ghana. We conducted 12 focus group discussions (FGDs) with adolescents and 13 key informant interviews (KIs) in Ghana. The FGDs were conducted with school-going and out-of-school adolescents. KIIs were conducted with various stakeholders working with adolescents or in SRH services. All interviews were conducted in English, audio recorded and transcribed verbatim. We applied the Dahlgren-Whitehead Rainbow model of health determinants and used a thematic analysis. Eight themes were identified, across micro, meso and macro levels, that influence adolescents' SRH access and experience in Accra. These included: family, social networks, the role of schools, health providers and services, the policy landscape, gender norms, cultural norms, and poverty. The findings highlight several factors that influence adolescents' access to appropriate SRH services in this context and demonstrate the need for a multisectoral effort to address structural factors such as harmful gender norms and persistent poverty.
Collapse
Affiliation(s)
- Divya Parmar
- Department of Population Health Sciences, King's College London, London, UK
| | - Semira Berhe
- Department of Population Health Sciences, King's College London, London, UK
| | - Susan Bradley
- School of Health Sciences, City, University of London, London, UK
| | - Ama Fenny
- Institute of Statistical Social and Economic Research (ISSER), University of Ghana, Legon, Ghana
| | - Lydia Aziato
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | | |
Collapse
|
10
|
Silva M, Loll D, Ezouatchi R, Kassegne S, Nagbe RHY, Babogou L, Moussa F, Werwie TR, Portillo E, Adou D, Vondrasek C, Rajan R, Dougherty L. Evaluating a youth-designed sexual and reproductive health mass and social media campaign in Côte d'Ivoire: triangulation of three independent evaluations. Sex Reprod Health Matters 2023; 31:2248748. [PMID: 37728549 PMCID: PMC10512782 DOI: 10.1080/26410397.2023.2248748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
Merci Mon Héros (MMH) is a youth-designed multi-media campaign seeking to improve sexual and reproductive health and family planning (SRH/FP) outcomes among youth living in nine francophone countries. A mixed methods approach was implemented to assess the MMH campaign progress and impact in Côte d'Ivoire. Three data sources were triangulated to evaluate the campaign: social media listening (October 2019-January 2021); a quantitative cross-sectional monitoring survey (September 2020) with 412 youth (aged 16-24) and 597 adults (aged 25-49); and a qualitative study using a Most Significant Change approach (March 2021), including a total of 24 focus group discussions with youth (aged 15-24) and adults (aged 25+) exposed to the MMH campaign. Data from all three studies were analysed independently and then brought together through a triangulation workshop where the study team compared findings to achieve convergence in evaluation results. Social listening results showed topic-specific online conversations related to MMH campaign spiked significantly during the two-week period after topic-specific campaign posts (p < .05), suggesting potential campaign impact. Survey results showed both adults and youth were more likely to have spoken with someone about FP in the past five months if exposed to the campaign (p < 0.01). Qualitative findings support the campaign's effect on shifting attitudes and behavioural uptake of intergenerational communication among adults and youth. This evaluation shows evidence of MMH's strong potential for impact in encouraging communication and the need to focus efforts on strategies to strengthen supportive adults' communication competencies and redefine what it means to act in support of SRH/FP for youth.
Collapse
Affiliation(s)
- Martha Silva
- Assistant Professor, Department of International Health and Sustainable Development, Tulane University Schools of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Dana Loll
- Research & Evaluation Officer, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | | | | | | | | | | | - Timothy R. Werwie
- Research Officer, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Erin Portillo
- Senior Program Officer, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Denise Adou
- Program Officer, Johns Hopkins Center for Communication Programs, Abidjan, Côte d’Ivoire
| | - Claudia Vondrasek
- Senior Program Officer II, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Radha Rajan
- Research & Evaluation Officer, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | | |
Collapse
|
11
|
Agyei FB, Kaura DMK, Bell JD. Exploring the culturally sensitive sexual and reproductive health information communication skill needs of parents in Ghana. Afr J Prim Health Care Fam Med 2023; 15:e1-e11. [PMID: 37916722 PMCID: PMC10623484 DOI: 10.4102/phcfm.v15i1.4101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Parents play a vital role in the sexual and reproductive health (SRH) of adolescents. Parents' communication with their adolescents regarding SRH is considered an important part of adolescent development, as this contributes to optimising safe SRH. AIM This phase of the study explored the culturally sensitive SRH information communication skill needs of parents, based on their personal and social motivation, within the Ghanaian context. SETTING The study was conducted at the Asante Akyem North Municipality of Ghana. METHODS This article describes the second phase of an explanatory, sequential, mixed-method study. Following on from the first phase systematic review, this second phase comprised a qualitative descriptive study where 10 purposively sampled parents of adolescents participated in semi-structured interviews to elicit data. Braun and Clarke's thematic data analysis process was applied. Data were saved and managed in Atlas.ti (version 23.0.7). RESULTS Four themes emerged on communication skills: SRH information, parent and adolescent factors, contextual factors and communication skill needs. Parent and adolescent communication on SRH takes place occasionally. Parents lack the skills to communicate with adolescents regarding SRH. CONCLUSION Parents in this context require skills to communicate SRH information with their adolescent children. A culturally appropriate intervention that supports SRH information communication between parents and adolescents may have value in guiding this communication process.Contribution: The findings of this study can contribute to the adaptation of a culturally sensitive SRH information communication intervention in Ghana which will promote adolescent SRH.
Collapse
Affiliation(s)
- Frank B Agyei
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg.
| | | | | |
Collapse
|
12
|
Ampofo AG, Boyes AW, Mackenzie LJ. Preference For Cervical Cancer Education: A Multisite Cross-Sectional Survey of Female Senior High School Students in Ghana. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1710-1718. [PMID: 37328710 PMCID: PMC10509060 DOI: 10.1007/s13187-023-02325-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 06/18/2023]
Abstract
Cervical cancer incidence continues to rise in Ghana. To enhance knowledge and prevention of cervical cancer among young people in Ghana, there is a need to better understand their education preferences. The study aimed to describe female senior school students' preferences for receiving cervical cancer education. A cross-sectional survey of students from 17 schools in the Ashanti Region of Ghana assessed the strength of preference for receiving cervical cancer education from a range of sources, settings and delivery mediums. Of the 2400 participants (aged 16-24 years), the majority endorsed doctors (87%, 95%CI: 85-88%), nurses (80%, 95%CI: 78-82%) and credible health organisations (78%, 95%CI%: 76-79%) as their preferred source of education, and hospitals 83% (95%CI: 81-84%) as the preferred setting. Nearly all students (92%) endorsed at least three cervical cancer education delivery mediums, with at least three quarters endorsing television (78%, 95%CI: 77-80%), one-on-one health consultation in-person or online (77%, 95%CI: 75-79%; 75%, 95%CI: 73-77%), and health information websites (75%, 95%CI: 73-77%). Findings suggest that cervical cancer education efforts among female senior school students in Ghana should consider the use of a range of more resource-intensive individualised approaches to low-cost anonymous, generic approaches from credible sources and institutions.
Collapse
Affiliation(s)
- Ama Gyamfua Ampofo
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, 2308, Australia.
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Allison W Boyes
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, 2308, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Lisa J Mackenzie
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, 2308, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| |
Collapse
|
13
|
Villani M. Changing gender norms around female genital mutilation/cutting (FGM/C): a key role for social work in the Global North. FRONTIERS IN SOCIOLOGY 2023; 8:1187981. [PMID: 37333066 PMCID: PMC10272554 DOI: 10.3389/fsoc.2023.1187981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/11/2023] [Indexed: 06/20/2023]
Abstract
"Female genital mutilation/cutting" (FGM/C) refers to procedures that involve altering the external female genitalia with the aim of reinforcing gendered body norms. The literature has consistently shown that, like various forms of discrimination, the practice is rooted in systems of gender inequality. As a result, FGM/C has increasingly come to be understood in terms of social norms that are by no means fixed. And yet, in the Global North, interventions remain primarily medical in nature, with clitoral reconstruction having emerged as a common means of dealing with related sexual issues. And although treatments can vary greatly depending on the hospitals and physicians involved, sexuality tends to be considered from a gynecological perspective, even when multidisciplinary care is offered. By contrast, gender norms and other socio-cultural factors receive little attention. In addition to highlighting three critical shortcomings in current responses to FGM/C, this literature review also describes how social work can play a key role in overcoming the associated barriers by (1) adopting a holistic approach to sex education, one capable of addressing those aspects of sexuality that lie beyond the scope of a medical consultation; (2) supporting family-based discussions on matters of sexuality; and (3) promoting gender equality, especially among younger generations.
Collapse
|
14
|
Hill SV, Sohail M, Bhagat D, Ball A, Smith TV, Coyne-Beasley T, Simpson TY, Elopre L, Matthews LT. "Sex. Maybe We Should Do Things to be Healthy About It." Adolescent-Caregiver Discussions About Sex. J Adolesc Health 2023; 72:746-753. [PMID: 36781324 DOI: 10.1016/j.jadohealth.2022.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 02/13/2023]
Abstract
PURPOSE Adolescents are disproportionately burdened with HIV. Numerous barriers limit adolescent pre-exposure prophylaxis (PrEP) use for HIV prevention. We explored adolescent-caregiver perspectives on discussing sexual health and PrEP to inform future caregiver interventions as a possible strategy to promote PrEP use. METHODS We conducted separate in-depth interviews with adolescents aged 14-18 living in Alabama and their parent/guardian (caregiver). Interviews explored attitudes about sex, knowledge and attitudes about HIV prevention and PrEP, and attitudes about PrEP communication within adolescent-caregiver groups. Thematic analysis of adolescent and caregiver interviews was conducted independently and then triangulated to compare shared themes. RESULTS Nine adolescents and seven caregivers contributed to five dyads and two triads. Adolescents had a median age of 16 years (range 14-18); five were girls (55%), and five were non-Hispanic Black (55%). Most caregivers were mothers (5, 71%), non-Hispanic Black (5, 71%), with a median age of 41 (36-56) years. All adolescents expressed willingness to involve their caregiver around PrEP use. Major themes included as follows: 1) caregiver efforts to overcome cultural taboos about sex and sexuality foster adolescents' willingness to talk with caregivers about sex; 2) evolving societal norms and reflections on their own upbringings motivate caregivers to discuss and support adolescents with sexual health; and 3) caregivers desire to engage in sexual health discussions with providers and support their teens with PrEP. DISCUSSION As socio-cultural norms around sex evolve, adolescent-caregiver discussions about sexual health and PrEP may be an opportunity to increase PrEP use and reduce HIV infections among select adolescent sub-populations.
Collapse
Affiliation(s)
- Samantha V Hill
- Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama.
| | - Maira Sohail
- Department of Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Delima Bhagat
- The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Amy Ball
- Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Theolishia V Smith
- Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Tamera Coyne-Beasley
- Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama; Department of Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Tina Y Simpson
- Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Latesha Elopre
- Department of Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Lynn T Matthews
- Department of Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| |
Collapse
|
15
|
James PB, Osborne A, Babawo LS, Bah AJ, Margao EK. The use of condoms and other birth control methods among sexually active school-going adolescents in nine sub-Saharan African countries. BMC Public Health 2022; 22:2358. [PMID: 36527019 PMCID: PMC9756616 DOI: 10.1186/s12889-022-14855-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Adolescents in sub-Saharan Africa still face sexual and reproductive health challenges. Contraceptives have been used to address these challenges. Despite efforts at national and global levels, contraceptive uptake among young people in Africa remains a challenge due to personal, societal, and health systems-based barriers. We estimated the prevalence and correlates of condom use and other birth control methods among sexually active school-going adolescents in nine sub-Saharan African (SSA) countries. METHODS We conducted a secondary analysis of the Global School-based Student Health Surveys (GSHS) datasets pooled from nine SSA countries. We included a sample of 27,504 school-going adolescents 11 years and younger and 18 years and older. We employed meta-analysis using a random-effects model to estimate the total prevalence of the use of condoms, other birth control methods other than a condom and any birth control method at last sexual intercourse. We conducted complex sample descriptive and logistic regression analyses to determine the characteristics and determinants of not using condoms and other birth control methods among sexually active school-going adolescents in nine sub-Saharan African countries, respectively. RESULTS More than half [n = 4430, 53.8% (43.9-63.8)], two-fifth [n = 3242, 39.5% (33.2-45.9) and two-thirds of adolescents [n = 4838, 65.6% (57.5-73.7)] of sexually active in school adolescents across the nine sub-Saharan African countries used condom, other birth control methods and any form birth control method during their last sexual intercourse, respectively. The non-use of condoms at last sex was associated with being younger (less than 16 years) [AOR = 1.48;95%CI: 1.12-1.94], early sexual debut [AOR = 1.81(1.47-2.22)], having two or more sexual partners [AOR = 1.30(1.06-1.58)] and no/minimal parental support [AOR = 1.54(1.17-2.03)]. The non-use of other birth control methods at last sex was associated with being male [AOR = 1.37 (1.09-1.73)], early sexual debut [AOR = 1.83(1.48-2.27) and having no parental support [AOR = 1.64(1.34-2.00)]. CONCLUSION Contraceptive need among sexually active school adolescents in the nine sub-Saharan African countries is high. Such a need calls for the development of country-specific and or the review of existing school-based sexual health education and youth-friendly sexual and reproductive health interventions that target risky adolescents and promote adolescent-parent effective communication, connectedness and support.
Collapse
Affiliation(s)
- Peter Bai James
- grid.1031.30000000121532610National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW 2480 Australia ,grid.442296.f0000 0001 2290 9707Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Augustus Osborne
- grid.469452.80000 0001 0721 6195Department of Biological Sciences, School of Environmental Sciences, Njala University, Njala, Sierra Leone
| | - Lawrence Sao Babawo
- grid.469452.80000 0001 0721 6195Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Bo, Sierra Leone
| | - Abdulai Jawo Bah
- grid.442296.f0000 0001 2290 9707Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone ,grid.104846.fInstitute for Global Health and Development, Queen Margaret University Edinburg, Musselburgh, Scotland, UK
| | - Emmanuel Kamanda Margao
- grid.442296.f0000 0001 2290 9707Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| |
Collapse
|
16
|
Bergam S, Sibaya T, Ndlela N, Kuzwayo M, Fomo M, Goldstein MH, Marconi VC, Haberer JE, Archary M, Zanoni BC. "I am not shy anymore": A qualitative study of the role of an interactive mHealth intervention on sexual health knowledge, attitudes, and behaviors of South African adolescents with perinatal HIV. Reprod Health 2022; 19:217. [PMID: 36457044 PMCID: PMC9713189 DOI: 10.1186/s12978-022-01519-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 10/21/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND South Africa has one of the highest burdens of adolescents with perinatally-acquired HIV (APHIV) in the world. APHIV in South Africa have limited access to sexual and reproductive health (SRH) education and services specific to their HIV status. When lacking comprehensive SRH education, APHIV are prone to sexual risk behaviors that can lead to unintended pregnancy, sexually transmitted infections, and HIV transmission. The use of mHealth interventions has been shown to deliver information, foster social support, and improve decision-making skills. In this study, we evaluate how an mHealth intervention influences sexual health knowledge and behaviors in APHIV. METHODS We purposively enrolled adolescents from the intervention arm of a randomized clinical trial assessing a multi-module, moderated WhatsApp-based intervention-Interactive Transition Support for Adolescents Living with HIV (InTSHA)-within a government supported clinic in KwaMashu, an urban township of KwaZulu-Natal, South Africa. We conducted in-depth interviews based on World Health Organization guidelines for asking adolescents about SRH. We thematically analyzed data through an iterative, team-based coding approach combining deductive and inductive elements to contextualize SRH attitudes, knowledge, and behaviors before and after receiving the InTSHA intervention. RESULTS Of the 21 participants, 13 (61.9%) were female and the mean age was 16.6 years. Most participants reported first learning about SRH as young teenagers in school through non-targeted and negative ways, seeking clarification through peers and the internet rather than clinicians or caregivers. Participants reported that InTSHA provided a holistic perspective on relationships, gender, and sexuality specific to growing up with HIV in South Africa. They praised the ability to give and receive information from peers in a moderated setting through the mHealth intervention, building their confidence, decision-making skills, and communication with partners and caregivers throughout their everyday lives. Despite reporting some technological challenges, adolescents agreed that InTSHA was convenient, confidential, and user-friendly. CONCLUSIONS South African APHIV receive incomplete and conflicting sexual education from peers, caregivers, teachers, and technology that can be supplemented by mHealth curricula targeted for the unique needs of APHIV. Future, scaled-up mHealth interventions can lower SRH stigma by expanding access to sexual education and peer support, supplementing adolescents' existing SRH education.
Collapse
Affiliation(s)
- Scarlett Bergam
- grid.16463.360000 0001 0723 4123Department of Paediatrics, Nelson Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa ,George Washington School of Medicine and Health Sciences, Washington, DC USA
| | - Thobekile Sibaya
- grid.16463.360000 0001 0723 4123Department of Paediatrics, Nelson Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Nompumelelo Ndlela
- grid.16463.360000 0001 0723 4123Department of Paediatrics, Nelson Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Mpume Kuzwayo
- grid.16463.360000 0001 0723 4123Department of Paediatrics, Nelson Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Messaline Fomo
- grid.189967.80000 0001 0941 6502Department of Global Health, Emory University’s Rollins School of Public Health, Atlanta, GA USA
| | | | - Vincent C. Marconi
- grid.189967.80000 0001 0941 6502Departments of Medicine and Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502Department of Global Health, Emory University’s Rollins School of Public Health, Atlanta, GA USA
| | - Jessica E. Haberer
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Moherndran Archary
- grid.16463.360000 0001 0723 4123Department of Paediatrics, Nelson Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Brian C. Zanoni
- grid.189967.80000 0001 0941 6502Departments of Medicine and Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502Department of Global Health, Emory University’s Rollins School of Public Health, Atlanta, GA USA ,grid.428158.20000 0004 0371 6071Children’s Healthcare of Atlanta, Atlanta, GA USA
| |
Collapse
|
17
|
Silva M, Kassegne S, Nagbe RHY, Babogou L, Ezouatchi R, Ado AL, Moussa F, Dougherty L. Changing the Script: Intergenerational Communication about Sexual and Reproductive Health in Niamey, Niger. JOURNAL OF HEALTH COMMUNICATION 2022; 27:755-763. [PMID: 36567672 DOI: 10.1080/10810730.2022.2160527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Most strategies to reduce adolescent pregnancies have been designed to educate adolescents directly about family planning (FP), while adolescents often cite peers and parents as their primary sources of sexual health information. Yet parents' lack of knowledge about sexual and reproductive health (SRH), low self-efficacy to initiate conversations, and adverse social norms act as barriers to open intergenerational communication. To better understand the normative environment influencing communication between parents and youth about FP/SRH in francophone West Africa, the USAID supported Breakthrough RESEARCH project conducted a multi-stage qualitative study in Niger. During Stage 1, the research team developed a screening tool (based on a literature review) to categorize research participants into those who practiced open intergenerational communication about FP/SRH, and those who did not. Stage 2 consisted of 40 in-depth interviews with young people (ages 15-24) and adults (≥25 years old), stratified by whether they practiced open intergenerational communication. Results showed restrictive social norms related to youth SRH and access to information and services. However, particularly among participants classified as open-communicators, there is a hierarchy of norms and normative beliefs, with abstinence as the most virtuous decision for youth, but approving communication about and access to SRH services in order to minimize harm. Participants rely on values such as the protection of youth, protection of family honor and promotion of well-being as means to act in counter-normative ways and communicate about FP/SRH. Implications for the field include demystifying and destigmatizing SRH topics, increasing adults' communication skills, and changing the "script" to a more life-affirming view of SRH.
Collapse
Affiliation(s)
- Martha Silva
- Department of International Health and Sustainable Development, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Santarato N, Barbosa NG, da Silva ALC, Monteiro JCDS, Gomes-Sponholz FA. Characterization of adolescent sexual practices. Rev Lat Am Enfermagem 2022. [PMID: 36197394 PMCID: PMC9647882 DOI: 10.1590/1518-8345.6289.3711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE to characterize adolescents' sexual practices and their association with sociodemographic variables, sources of information and behavioral habits. METHOD a descriptive, observational, cross-sectional study conducted with 85 adolescents from public elementary and high schools in a city in the state of São Paulo. Data were collected through a structured, self-administered and anonymous questionnaire. Statistical analysis was performed using the χ2 test and Fisher's test. RESULTS 21.2% had started their sexual life through oral sex, with a predominance of females (94.4%), self-reported brown color (55.0%). The practice of vaginal sex was reported in 31.8%, with a mean age of initiation at 14.5 years. The female sex was predominant (77.0%), with a self-reported brown color (40.0%). The practice of anal sex was detected in 7.1%, with a mean age of 14.4 years, prevalent in females (83.3%), with a self-reported black color (50.0%). There was an association of alcohol, drugs and tobacco use with sexual practices (p<0.05). CONCLUSION a diversity of sexual practices associated with substance use was detected, emphasizing the importance of the nurse's role in planning and carrying out health education interventions with adolescents and families. UNLABELLED (1) Analysis of the sequence and time of initiation of sexual practices, demonstrating the diversity of sexual activities performed by adolescents. (2) Family context and low openness to dialogue and its correlation with the initiation of adolescent sexual practices. (3) Behavioral habits: association of alcohol, tobacco and drug consumption by adolescents with sexual activities.
Collapse
Affiliation(s)
- Nathalia Santarato
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
| | - Nayara Gonçalves Barbosa
- Universidade Federal de Juiz de Fora, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Minas Gerais, Brasil
| | - Anderson Lima Cordeiro da Silva
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
| | - Juliana Cristina dos Santos Monteiro
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Ribeirão Preto, SP, Brasil
| | - Flávia Azevedo Gomes-Sponholz
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Ribeirão Preto, SP, Brasil
| |
Collapse
|
19
|
Santarato N, Barbosa NG, da Silva ALC, Monteiro JCDS, Gomes-Sponholz FA. Characterization of adolescent sexual practices. Rev Lat Am Enfermagem 2022; 30:e3712. [PMID: 36197394 PMCID: PMC9647882 DOI: 10.1590/1518-8345.6289.3712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/29/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE to characterize adolescents' sexual practices and their association with sociodemographic variables, sources of information and behavioral habits. METHOD a descriptive, observational, cross-sectional study conducted with 85 adolescents from public elementary and high schools in a city in the state of São Paulo. Data were collected through a structured, self-administered and anonymous questionnaire. Statistical analysis was performed using the χ2 test and Fisher's test. RESULTS 21.2% had started their sexual life through oral sex, with a predominance of females (94.4%), self-reported brown color (55.0%). The practice of vaginal sex was reported in 31.8%, with a mean age of initiation at 14.5 years. The female sex was predominant (77.0%), with a self-reported brown color (40.0%). The practice of anal sex was detected in 7.1%, with a mean age of 14.4 years, prevalent in females (83.3%), with a self-reported black color (50.0%). There was an association of alcohol, drugs and tobacco use with sexual practices (p<0.05). CONCLUSION a diversity of sexual practices associated with substance use was detected, emphasizing the importance of the nurse's role in planning and carrying out health education interventions with adolescents and families. UNLABELLED (1) Analysis of the sequence and time of initiation of sexual practices, demonstrating the diversity of sexual activities performed by adolescents. (2) Family context and low openness to dialogue and its correlation with the initiation of adolescent sexual practices. (3) Behavioral habits: association of alcohol, tobacco and drug consumption by adolescents with sexual activities.
Collapse
Affiliation(s)
- Nathalia Santarato
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
| | - Nayara Gonçalves Barbosa
- Universidade Federal de Juiz de Fora, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Minas Gerais, Brasil
| | - Anderson Lima Cordeiro da Silva
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
| | - Juliana Cristina dos Santos Monteiro
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Ribeirão Preto, SP, Brasil
| | - Flávia Azevedo Gomes-Sponholz
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Ribeirão Preto, SP, Brasil
| |
Collapse
|
20
|
Agyekum MP, Agyekum EO, Adjei A, Asare K, Akpakli DE, Asiamah S, Tsey I, Amankwah G, Manyeh AK, Williams JEO, Ross DA. Sexual behaviours and their associated factors among young people in the Dodowa Health and Demographic Surveillance Site (DHDSS) in Ghana. Ghana Med J 2022; 56:43-50. [PMID: 38322746 PMCID: PMC10630037 DOI: 10.4314/gmj.v56i3s.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Objective This paper describes sexual behaviours and their associated factors among young people. Design The study design is cross-sectional. Setting Dodowa Health and Demographic Surveillance Site (DHDSS) in Ghana's Shai-Osudoku and Ningo Prampram districts. Participants Young people aged 10 to 24 years, median age 17 years. Outcome measures Self-reported to have ever had sex, non-use of a condom at last sex, and ever been pregnant or gotten someone pregnant. Results Of the 1689 young people; 42% reported having ever had sex, not using a condom at last sexual activity (64%), and ever been pregnant or gotten someone pregnant (41%). The proportion of non-use of condoms at last sex was high across all age groups but was highest (93%) in a small proportion of 10 to 14-year-olds who have ever had sex. Higher proportions of females than males; were reported to have ever had sex (46%), not using a condom at their last sex (66%) and ever been pregnant or getting someone pregnant (56%). Age group (20 to 24), females, primary or junior high school, living alone and lower household socio-economic status were risk factors associated with all three outcome measures. Conclusion Risky sexual behaviour is high among young people in the Dodowa HDSS. Therefore, interventions that promote safer sexual practices and help young people make timely decisions on their sexual and reproductive health care needs are required. Funding No funding was obtained for this paper.
Collapse
Affiliation(s)
- Mary P Agyekum
- Dodowa Health Research Centre/Ghana Health Service, Dodowa, Ghana
| | | | - Alexander Adjei
- Dodowa Health Research Centre/Ghana Health Service, Dodowa, Ghana
| | - Kwabena Asare
- School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
| | - David E Akpakli
- Dodowa Health Research Centre/Ghana Health Service, Dodowa, Ghana
| | - Sabina Asiamah
- Dodowa Health Research Centre/Ghana Health Service, Dodowa, Ghana
| | - Irene Tsey
- School of Public Health, University of Ghana, Legon, Accra, Ghana
| | | | - Alfred K Manyeh
- Institute of Health Research, the University of Health and Allied Sciences, Ho, Ghana
| | | | - David A Ross
- Stellenbosch University, South Africa/ London School of Hygiene & Tropical Medicine, United Kingdom
| |
Collapse
|
21
|
Rahnavardi M, Bostani Khalesi Z, Rezaie-Chamani S. Parents’ and experts’ views on the sexual health education of adolescent girls: a qualitative study. SEXUAL AND RELATIONSHIP THERAPY 2022. [DOI: 10.1080/14681994.2022.2087870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mona Rahnavardi
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | | | | |
Collapse
|
22
|
Achen D, Nyakato VN, Akatukwasa C, Kemigisha E, Mlahagwa W, Kaziga R, Ruzaaza GN, Rukundo GZ, Michielsen K, Neema S, Coene G. Gendered Experiences of Parent-Child Communication on Sexual and Reproductive Health Issues: A Qualitative Study Employing Community-Based Participatory Methods among Primary Caregivers and Community Stakeholders in Rural South-Western Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095052. [PMID: 35564447 PMCID: PMC9104466 DOI: 10.3390/ijerph19095052] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/04/2022] [Accepted: 04/14/2022] [Indexed: 12/10/2022]
Abstract
Open and positive parent–child communication about sexual and reproductive health (SRH) is known to reduce negative SRH outcomes for young people. However, socio-cultural influences can inhibit meaningful SRH communication. Restrictive gender norms threaten the SRH of adolescents, as they make adolescent boys more likely to engage in risky sexual behavior and make girls more vulnerable to negative SRH outcomes. This study intended to critically understand the impact of gender norms and expectations on parent–child SRH communication in rural south-western Uganda. Methods: The study adopted a community-based participatory approach using community stakeholder engagement meetings (n = 2), in-depth interviews (n = 12), and three focus group discussions with parents (n = 18). The study considered biological parents, step-parents, grandparents, uncles and aunties, as long as they were primary caregivers of adolescents aged 10–14. Results: Participants elaborated on the socio-cultural aspects that shaped their experiences of parent–child SRH communication such as cultural gender norms, religion, and media influences. They also referred to socio-economic challenges, lack of knowledge, and the role of peers and schools. Conclusions: There is need for community-based interventions to improve parent–child SRH communication to address the deeply rooted cultural and gender contexts in rural south-western Uganda.
Collapse
Affiliation(s)
- Dorcus Achen
- Centre of Expertise on Gender, Diversity and Intersectionality, Vrije Universiteit Brussels, 1090 Brussels, Belgium;
- Correspondence:
| | - Viola N. Nyakato
- Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda; (V.N.N.); (E.K.); (W.M.)
| | - Cecilia Akatukwasa
- International Center for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium; (C.A.); (R.K.); (K.M.)
| | - Elizabeth Kemigisha
- Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda; (V.N.N.); (E.K.); (W.M.)
| | - Wendo Mlahagwa
- Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda; (V.N.N.); (E.K.); (W.M.)
| | - Ruth Kaziga
- International Center for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium; (C.A.); (R.K.); (K.M.)
| | - Gad Ndaruhutse Ruzaaza
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda;
| | - Godfrey Z. Rukundo
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda;
| | - Kristien Michielsen
- International Center for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium; (C.A.); (R.K.); (K.M.)
| | - Stella Neema
- College of Humanities, Makerere University, Kampala P.O. Box 7062, Uganda;
| | - Gily Coene
- Centre of Expertise on Gender, Diversity and Intersectionality, Vrije Universiteit Brussels, 1090 Brussels, Belgium;
| |
Collapse
|