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Zia Y, Upadhyay U, Rhew I, Kimanthi S, Congo O, Onono M, Barnabas R, Mugo N, Bukusi EA, Harrington EK. Confirmatory Factor Analysis and Validation of the Sexual and Reproductive Empowerment Scale for Adolescents and Young Adults in Kenya. Stud Fam Plann 2024; 55:85-103. [PMID: 38604945 DOI: 10.1111/sifp.12263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Understanding the levels of power that adolescent girls and young women exercise in their sexual and reproductive lives is imperative to inform interventions to help them meet their goals. We implemented an adapted version of the Sexual and Reproductive Health Empowerment (SRE) Scale for Adolescents and Young Adults among 500 adolescent girls and young women aged 15-20 in Kisumu, Kenya. We used confirmatory factor analysis (CFA) to assess factor structure, and logistic regression to examine construct validity through the relationship between empowerment scores and ability to mitigate risk of undesired pregnancy through consistent contraceptive use. Participants had a mean age of 17.5, and most were students (61 percent), were currently partnered (94 percent), and reported having sex in the past 3 months (70 percent). The final, 26-item CFA model had acceptable fit. All subscales had Cronbach's alpha scores >0.7, and all items had rotated factor loadings >0.5, indicating good internal consistency and robust factor-variable associations. The total SRE-Kenya (SRE-K) score was associated with increased odds of the consistent method used in the past three months (adjusted odds ratio: 1.98, 95 percent CI: 1.29-3.10). The SRE-K scale is a newly adapted and valid measure of sexual and reproductive empowerment specific to adolescent girls and young women in an East African setting.
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Harrington EK, Hauber B, Ouma DC, Kimanthi S, Dollah A, Onono M, Bukusi EA. Priorities for contraceptive method and service delivery attributes among adolescent girls and young women in Kenya: a qualitative study. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1360390. [PMID: 38774834 PMCID: PMC11107089 DOI: 10.3389/frph.2024.1360390] [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] [Received: 12/22/2023] [Accepted: 04/08/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction Despite increasing global commitment to meeting the family planning needs of adolescent girls and young women (AGYW), there is limited research on how they prioritize contraceptive method and service delivery characteristics. In this qualitative study, we examine the specific elements that drive the contraceptive choices of Kenyan AGYW, and apply our findings to the development of attributes and levels for a discrete choice experiment (DCE). Methods Our four-stage approach included data collection, data reduction, removing inappropriate attributes, and optimizing wording. Between June-October 2021, we conducted in-depth interviews with 30 sexually-active 15-24 year-old AGYW in Kisumu county, Kenya who were non-pregnant and desired to delay pregnancy. Interviews focused on priorities for contraceptive attributes, how AGYW make trade-offs between among these attributes, and the influences of preferences on contraceptive choice. Translated transcripts were qualitatively coded and analyzed with a constant comparative approach to identify key concepts. We developed and iteratively revised a list of attributes and levels, and pre-tested draft DCE choice tasks using cognitive interviews with an additional 15 AGYW to optimize comprehension and relevance. Results In-depth interview participants' median age was 18, 70% were current students, and 93% had a primary sexual partner. AGYW named a variety of priorities and preferences related to choosing and accessing contraceptive methods, which we distilled into six key themes: side effects; effectiveness; user control; privacy; source of services; and cost. Bleeding pattern was top of mind for participants; amenorrhea was generally considered an intolerable side effect. Many participants felt more strongly about privacy than effectiveness, though some prioritized duration of use and minimizing chance of pregnancy above other contraceptive characteristics. Most AGYW preferred a clinic setting for access, as they desired contraceptive counseling from a provider, but pharmacies were considered preferable for reasons of privacy. We selected, refined, and pre-tested 7 DCE attributes, each with 2-4 levels. Conclusions Identifying AGYW preferences for contraceptive method and service delivery characteristics is essential to developing innovative strategies to meet their unique SRH needs. DCE methods may provide valuable quantitative perspectives to guide and tailor contraceptive counseling and service delivery interventions for AGYW who want to use contraception.
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Affiliation(s)
- Elizabeth K. Harrington
- Department of OB/GYN, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Brett Hauber
- School of Pharmacy, Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, United States
- Pfizer, Inc., New York, NY, United States
| | - Dismas Congo Ouma
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Syovata Kimanthi
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Maricianah Onono
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth A. Bukusi
- Department of OB/GYN, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
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Chola M, Hlongwana K, Ginindza TG. Understanding adolescent girls' experiences with accessing and using contraceptives in Zambia. BMC Public Health 2023; 23:2149. [PMID: 37924036 PMCID: PMC10623822 DOI: 10.1186/s12889-023-17131-3] [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: 04/06/2023] [Accepted: 11/01/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Globally, the unmet need for contraception among adolescent girls is high and is driven by barriers to access and utilisation of contraceptives. Understanding adolescent girls' experiences with accessing and using contraceptives is crucial because it influences their decision to use and willingness to continue using health products and services. While determinants of contraceptive use have been extensively researched globally, few studies explore how adolescent girls experience contraceptive use in Zambia using qualitative methods. Therefore, this study aimed to understand Zambian adolescent girls' experiences using contraceptives. METHODS Thematic analysis was used to analyse data generated from 7 focus group discussions and three in-depth interviews with adolescent girls aged 15 to 19 years in 4 districts in Zambia. NVivo version 12 pro (QSR International) software was used to manage and organise the data. RESULTS Results revealed that adolescents' experiences concerning contraceptives across the continuum of care are shaped by various factors, including knowledge of contraceptives which comprises sources of information and contraceptives; experience with using contraceptives, challenges with access to contraceptives, and misconceptions about contraceptives; perspectives about existing contraceptives; and preferred types of contraceptives. CONCLUSION The multifactorial interaction relating to adolescents' personal experience, their community and the environment in which they access contraceptive services all contribute to their overall experience and influence their contraceptive decisions. Therefore, qualitative studies exploring adolescents' experiences with accessing and using contraceptives are vital for tailoring interventions responsive to the contraceptive needs of this age group.
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Affiliation(s)
- Mumbi Chola
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4041, South Africa.
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, 10101, Zambia.
| | - Khumbulani Hlongwana
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4041, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban, 4041, South Africa
| | - Themba G Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4041, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban, 4041, South Africa
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Taiwo MO, Oyekenu O, Hussaini R. Understanding how social norms influence access to and utilization of adolescent sexual and reproductive health services in Northern Nigeria. FRONTIERS IN SOCIOLOGY 2023; 8:865499. [PMID: 37899781 PMCID: PMC10603227 DOI: 10.3389/fsoc.2023.865499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 09/14/2023] [Indexed: 10/31/2023]
Abstract
Background This study explored the influence of social norms on the access and utilization of sexual and reproductive health services by adolescents. Apart from individual and environmental barriers, social norms influence contraceptive decisions and ultimately sexual and reproductive health outcomes. Social norms that shape group behavior describe acceptable standards of behavior and evoke sanctions when such behavior standards are not adhered to. Sexually active adolescents in Nigeria have a relatively low level of modern contraceptive use being influenced by social norms. Scaling up adolescent reproductive health interventions that integrate normative change for a wider impact of programs remains challenging. Methods Using data from 18 communities, 188 married and unmarried adolescents (F52% and M48%) and 69 (F37%; M63%) reference group participants were purposively sampled and participated in a social norms exploration intervention study conducted through focus group discussion and in-depth interviews between October and November 2019. The Advancing Learning and Innovation on Gender Norms (ALIGN) Social Norms Exploration Tool (SNET) was adapted for the data collection into discussion guides and vignettes. Pilot testing of the tools informed review and validation prior to actual data collection. Findings Low contraceptive uptake by adolescents was characterized by early and forced marriage in childhood; a prominent practice enshrined in social norms around girl-childchastity, family honor, and disapproval of pre-marital sex and pregnancy out of wedlock. Conclusion The understanding of harmful social norms, normative change actors, and potential norm-shifting factors for contraceptive decisions by adolescents is essential for effective adolescent sexual and reproductive health interventions for wider impact and adaptive programming in behavior change interventions for improving the access to and utilization of modern contraceptives by adolescents for improved sexual health outcomes, the attainment of the Family Planning (FP) 2030 commitment and universal health coverage policy.
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Affiliation(s)
| | | | - Rahinatu Hussaini
- Save the Children International, London, United Kingdom
- Global Alliance for Improved Nutrition, Abuja, Nigeria
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Kawuma R, Lunkuse JF, Ssembajjwe W, Kayesu I, Price MA, Brickley DB, Abaasa A, Mayanja Y. "I fear those things": non-uptake of contraceptives, and barriers to use among adolescent girls and young women at high risk of HIV infection in Kampala, Uganda. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1198672. [PMID: 37649966 PMCID: PMC10465063 DOI: 10.3389/frph.2023.1198672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023] Open
Abstract
Background Adolescent girls and young women involved in risky behaviors are vulnerable to multiple health problems, yet sexual and reproductive health services remain underutilized. We evaluated factors associated with non-uptake of contraceptives and barriers to use among adolescent girls and young women (14-24 years old) at high risk of HIV infection in an environment where contraceptives were provided at no cost. Methods We conducted a mixed methods study, utilizing data from a baseline cross sectional survey and qualitative in-depth interviews. Survey participants tested negative for pregnancy and reported willingness to use contraception. Non-uptake of contraceptives was defined as not taking contraception at any study visit (baseline and throughout the study). Logistic regression model was used to assess factors associated with non-uptake of contraceptives. We purposively selected participants for interviews to discuss their knowledge and experiences with contraceptives and make suggestions to improve uptake. Qualitative data were analyzed thematically. Results All 285 participants were included in the analysis. Out of the 285 participants 127 were not using contraceptives and of the 127, 44 (34.6%) did not take up any method throughout the study while 43 of the 83 remaining participants (who took up a method) chose male condoms only. Non-uptake of contraceptives was less likely among older women (20-24 years) (aOR = 0.32, 95% CI 0.16-0.89) compared to younger women (less than 20 years). Qualitative data showed that concerns about future fertility, fear of associated side effects and influence from close relations contributed to non-uptake of contraception. Conclusion Non-uptake of contraceptives was common despite the promotion and provision of contraceptives in the context of a research study mainly because adolescents lack autonomy while making contraceptive decisions. Identifying and addressing their concerns and continued counselling on contraceptive use alongside condom promotion may improve uptake and utilization of contraceptives.
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Affiliation(s)
- Rachel Kawuma
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Jane Frances Lunkuse
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Wilber Ssembajjwe
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Ivy Kayesu
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Matt A. Price
- Department of Epidemiology and Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA, United States
- IAVI, New York, NY, United States
| | - Debbie B. Brickley
- Institute for Global Health Sciences, University of California, San Francisco (UCSF), San Francisco, CA, United States
| | - Andrew Abaasa
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Yunia Mayanja
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
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Ayieko S, Nguku A, Kidula N. It's not just about pads! Adolescent reproductive health views in Kenya: A qualitative secondary analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001285. [PMID: 37216318 PMCID: PMC10202265 DOI: 10.1371/journal.pgph.0001285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/20/2023] [Indexed: 05/24/2023]
Abstract
Many adolescents face barriers to accessing reproductive health care even though quality reproductive health care is a fundamental human right. The objective of this study is to understand the requests of quality reproductive health among high school girls in Kenya. We conducted a secondary analysis of qualitative data from a sub-sample of adolescent girls in Kenya who participated in the What Women Want global campaign and analyzed interview data from key informants involved in the survey. We used pre-existing codes and current literature to design the coding framework and thematic analysis to describe emerging themes. Atlas. ti 8 was used to organize and analyze codes. Over 4,500 high school girls, ages 12 and 19 years, were included in the analysis, with 61.6% from all-girls boarding schools and 13.8% from mixed-day schools. Data from nine key informants complemented findings from the survey. Emerging themes included: 1) The need for improved menstrual health and hygiene: Sanitary towels and cleaner toilets; 2) Prevention of adolescent pregnancy: Access to contraception; 3) Respect and dignity: Participants want privacy and confidentiality; and 4) The need to address social determinants of health: Economic stability and a safe physical environment. This study indicated that adolescent high school girls have varied requests for reproductive health care and services. While menstrual health and hygiene are key issues, reproductive needs are beyond just sanitary products. The results suggest a need for targeted reproductive health interventions using a multi-sectoral approach.
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Affiliation(s)
- Sylvia Ayieko
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States of America
| | | | - Nancy Kidula
- Department of Reproductive Health and Research (RHR), World Health Organization, Genève, Switzerland
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Embleton L, Logie CH, Ngure K, Nelson L, Kimbo L, Ayuku D, Turan JM, Braitstein P. Intersectional Stigma and Implementation of HIV Prevention and Treatment Services for Adolescents Living with and at Risk for HIV: Opportunities for Improvement in the HIV Continuum in Sub-Saharan Africa. AIDS Behav 2023; 27:162-184. [PMID: 35907143 PMCID: PMC10192191 DOI: 10.1007/s10461-022-03793-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/01/2022]
Abstract
Adolescents in sub-Saharan Africa, specifically adolescent girls and young women, young men who have sex with men, transgender persons, persons who use substances, and adolescents experiencing homelessness experience intersectional stigma, have a high incidence of HIV and are less likely to be engaged in HIV prevention and care. We conducted a thematic analysis informed by the Health and Discrimination Framework using a multiple case study design with five case studies in 3 sub-Saharan African countries. Our analysis found commonalities in adolescents' intersectional stigma experiences across cases, despite different contexts. We characterize how intersectional stigma impacts the uptake and implementation of HIV prevention and treatment services along the continuum for adolescents. Findings reveal how intersectional stigma operates across social-ecological levels and worsens HIV-related outcomes for adolescents. We identify opportunities for implementation science research to address stigma-related barriers to the uptake and delivery of HIV services for adolescents in sub-Saharan Africa.
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Affiliation(s)
- Lonnie Embleton
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Kenneth Ngure
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - LaRon Nelson
- School of Nursing, Yale University, Orange, CT, USA
| | - Liza Kimbo
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David Ayuku
- Department of Behavioural Sciences, Moi University, College of Health Sciences, Eldoret, Kenya
| | - Janet M Turan
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paula Braitstein
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
- College of Health Sciences, School of Public Health, Moi University, Eldoret, Kenya.
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
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Chola M, Hlongwana KW, Ginindza TG. Motivators and Influencers of Adolescent Girls' Decision Making Regarding Contraceptive Use in Four Districts of Zambia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3614. [PMID: 36834308 PMCID: PMC9961957 DOI: 10.3390/ijerph20043614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Low contraceptive use in sub-Saharan Africa, and Zambia specifically, negates the potential benefits of contraception in preventing unwanted and early pregnancies. This study aimed to explore and understand the motivators and influencers of adolescent girls' contraceptive decision making. Using thematic analysis, we analysed qualitative data from seven focus group discussions and three key informant interviews with adolescent girls aged 15 to 19 years in four Zambian districts. The data were managed and organised using NVivo version 12 pro (QSR International). Fear of pregnancy, fear of diseases, fear of having more children, and spacing of children (especially among married adolescents) were key motivators for adolescents' contraceptive use. Friends and peers motivated them to use contraceptives while fear of side effects and fear of infertility drove non-use. Peer pressure and fear of mocking by their friends were important deterrents to contraceptive use. Parents, peers and friends, family members, partners, churches, and religious groups influenced adolescent girls' contraceptive decisions. Mixed messages from these influencers, with some in favour and others against contraceptives, make adolescents' decisions to use contraceptives complex. Therefore, interventions targeting increased contraceptive use should be all-inclusive, incorporating multiple influencers, including at institutional and policy levels, to empower adolescents and give them autonomy to make contraceptive decisions.
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Affiliation(s)
- Mumbi Chola
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Department of Epidemiology & Biostatistics, School of Public Health, University of Zambia, Lusaka 10101, Zambia
| | - Khumbulani W. Hlongwana
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Themba G. Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
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Thirugnanasampanthar SS, Embleton L, Di Ruggiero E, Braitstein P, Oduor C, Dibaba Wado Y. School attendance and sexual and reproductive health outcomes among adolescent girls in Kenya: a cross-sectional analysis. Reprod Health 2023; 20:29. [PMID: 36747291 PMCID: PMC9901832 DOI: 10.1186/s12978-023-01577-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/27/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Given the high burden of adverse sexual and reproductive health outcomes (SRH) and low levels of school attendance among adolescent girls in Kenya, this study sought to elucidate the association between school attendance and SRH outcomes among adolescent girls in Homa Bay and Narok counties. METHODS This study uses baseline quantitative data from the mixed-methods evaluation of the In Their Hands (ITH) program which occurred between September to October 2018 in Homa Bay and Narok counties. In total, 1840 adolescent girls aged 15-19 years participated in the baseline survey, of which 1810 were included in the present analysis. Multivariable logistic regression models were used to assess the association between school attendance (in- versus out-of-school) and ever having sex, condom use during last sex, and ever pregnant, controlling for age, orphan status, income generation, religion, county, relationship status, and correct SRH knowledge. RESULTS Across the 1810 participants included in our study, 61.3% were in-school and 38.7% were out-of-school. Compared to adolescent girls who were in-school, those out-of-school were more likely (AOR 5.74 95% CI 3.94, 8.46) to report ever having sex, less likely (AOR: 0.21, 95% CI 0.16, 0.31) to have used a condom during their last sexual intercourse, and more likely (AOR: 6.98, 95% CI 5.04, 9.74) to have ever been pregnant. CONCLUSIONS School attendance plays an integral role in adolescent girls' SRH outcomes, and it is imperative that policy actors coordinate with the government and community to develop and implement initiatives that support adolescent girls' school attendance and education.
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Affiliation(s)
- Sai Surabi Thirugnanasampanthar
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, Centre for Global Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7 Canada
| | - Lonnie Embleton
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, Centre for Global Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7 Canada ,grid.59734.3c0000 0001 0670 2351Present Address: Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, USA
| | - Erica Di Ruggiero
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, Centre for Global Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7 Canada
| | - Paula Braitstein
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, Centre for Global Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7 Canada ,grid.79730.3a0000 0001 0495 4256College of Health Sciences, School of Public Health, Division of Epidemiology, Moi University, Eldoret, Kenya ,grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Clement Oduor
- grid.413355.50000 0001 2221 4219African Population and Health Research Center, P. O. Box 10787-00100, Nairobi, Kenya
| | - Yohannes Dibaba Wado
- grid.413355.50000 0001 2221 4219African Population and Health Research Center, P. O. Box 10787-00100, Nairobi, Kenya
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Chola M, Hlongwana KW, Ginindza TG. Mapping Evidence Regarding Decision-Making on Contraceptive Use among Adolescents in Sub-Saharan Africa: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2744. [PMID: 36768107 PMCID: PMC9915938 DOI: 10.3390/ijerph20032744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/23/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
This scoping review mapped and synthesised existing evidence on the influence of individual, parental, peer, and societal-related factors on adolescents' decisions to use contraception in sub-Saharan Africa (SSA). Peer-reviewed and review articles published before May 2022, targeting adolescents aged 10-19 years were searched in PubMed, MEDLINE with Full Text via EBSCOhost, PsychINFO via EBSCOhost, CINAHL with Full Text via EBSCOhost, Google Scholar, Science Direct, and Scopus databases. Seven studies were included and analysed using thematic analysis based on the social-ecological model (SEM) and reported using the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Individual (fear of side effects, fear of infertility), parental (parental disappointment and disapproval), peer (social stigma), partner (association with promiscuity and multiple sexual partners), societal and community (contraceptive use disapproval and stigma), and institutional and environmental factors (lack of privacy and confidentiality) influence contraceptive decisions among adolescents. These also include a lack of accurate information, social exclusion, negative health provider attitudes, and a lack of infrastructure that provides privacy and safe spaces. Identifying and addressing core issues within the context of local cultural practices that restrict contraceptive use is important. Holistic, inclusive approaches that promote the well-being of adolescents must be utilised to provide a conducive environment that ensures privacy, confidentiality, safety, and easy access to contraceptive services.
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Affiliation(s)
- Mumbi Chola
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka 10101, Zambia
| | - Khumbulani W. Hlongwana
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Themba G. Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
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Lahiri S, Bingenheimer J, Sedlander E, Munar W, Rimal R. The role of social norms on adolescent family planning in rural Kilifi county, Kenya. PLoS One 2023; 18:e0275824. [PMID: 36730329 PMCID: PMC9894424 DOI: 10.1371/journal.pone.0275824] [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: 08/16/2021] [Accepted: 09/23/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Despite Kenya's encouraging progress in increasing access to modern contraception among youth, several barriers remain preventing large-scale efforts to reduce demand-side unmet need for family planning. Shifting social norms around the use and acceptability of modern contraception may represent a potent target for future interventions. However, the structure of normative influence on individual modern contraceptive use among youth needs to be determined. Therefore, our aim was to estimate the influence of individual and group-level normative influence on modern contraceptive use among adolescents from two villages in rural Kenya. METHODS Trained enumerators collected data from individuals aged 15-24 who provided oral informed consent, or parental informed consent, in two villages in rural Kilifi county. Participants completed a questionnaire related to modern contraceptive use and were asked to nominate one to five people (referents) with whom they spend free time. The enumerators photographed each individual who nominated at least one referent using Android phones and matched them with their nominated referents. Using this social network data, we estimated group-level normative influence by taking an average of referents' modern contraception use. We then explored associations between descriptive norms, injunctive norms, and network modern contraceptive use on individual modern contraceptive use, controlling for known confounders using logistic regression models. We also conducted sensitivity analyses to test a pattern of differential referent influence on individual modern contraceptive use. RESULTS There was a positive association between pro-modern contraception descriptive and injunctive norms and individual modern contraception use (adjusted Odds Ratio (aOR) = 1.29, 95% confidence interval (CI) = 1.05-1.6, and aOR = 1.31, CI = 1.06-1.62, respectively). Network modern contraceptive use was associated with individual use in the bivariate model (aOR = 2.57, CI = 1.6-4.12), but not in the multivariable model (aOR = 1.67, CI = 0.98-2.87). When stratified by sex and marital status, network modern contraceptive use was associated with individual modern contraceptive use among female participants (aOR = 2.9, CI = 1.31-6.42), and unmarried female participants (aOR = 5.26, CI = 1.34-20.69), but not among males. No interactive effects between norms variables were detected. Sensitivity analyses with a different estimate of network modern contraceptive use showed similar results. CONCLUSIONS Social norms are multilevel phenomena that influence youth modern contraceptive use, especially among young women in rural Kenya. Unmarried women with modern contraceptive users in their social network may feel less stigma to use contraception themselves. This may reflect gendered differences in norms and social influence effects for modern contraceptive use. Future research should investigate group-level normative influence in relation to family planning behaviors.
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Affiliation(s)
- Shaon Lahiri
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America
- Philosophy, Politics and Economics Program, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Center for Social Norms and Behavioral Dynamics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Jeffrey Bingenheimer
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America
| | - Erica Sedlander
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America
- Institute for Health and Aging, University of California, San Francisco, San Francisco, California, United States of America
| | - Wolfgang Munar
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America
| | - Rajiv Rimal
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland, United States of America
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Embleton L, Braitstein P, Di Ruggiero E, Oduor C, Wado YD. Sexual and reproductive health service utilization among adolescent girls in Kenya: A cross-sectional analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001508. [PMID: 36963079 PMCID: PMC10021741 DOI: 10.1371/journal.pgph.0001508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/28/2022] [Indexed: 02/25/2023]
Abstract
We examined the association between adolescents' sexual and reproductive health (SRH) service utilization in the past 12 months and structural, health facility, community, interpersonal, and individual level factors in Kenya. This cross-sectional analysis used baseline data collected in Homa Bay and Narok counties as part of the In Their Hands intervention evaluation from September to October 2018. In total, 1840 adolescent girls aged 15 to 19 years were recruited to complete a baseline survey. We used unadjusted and adjusted logistic regression to model factors associated with SRH utilization across the social-ecological framework levels. Overall, 36% of participants reported visiting a health facility for SRH services in the past 12 months. At the structural level being out-of-school (AOR: 2.12 95% CI: 1.60-2.82) and not needing to get permission to go (AOR: 1.37 95%CI: 1.04-1.82) were associated with SRH service utilization. At the interpersonal level, participants who reported being able to ask adults for help when they needed it were more likely to report using SRH services in the past 12 months (AOR: 1.98, 95% CI: 1.09-3.78). At the individual level, having knowledge about where to obtain family planning (AOR = 2.48 95% CI: 1.74-3.57) and receiving information on SRH services in the past year (AOR: 1.44 95% CI:1.15-1.80) were associated with SRH service utilization. Our findings demonstrate the need for interventions, policies, and practices to be implemented across structural, health facility, community, interpersonal, and individual levels to comprehensively support adolescent girls to access and use SRH services.
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Affiliation(s)
- Lonnie Embleton
- Dalla Lana School of Public Health, Centre for Global Health, University of Toronto, Toronto, Ontario, Canada
| | - Paula Braitstein
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, Centre for Global Health, University of Toronto, Toronto, Ontario, Canada
| | - Clement Oduor
- African Population and Health Research Center, Nairobi, Kenya
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Nyblade L, Ndirangu JW, Speizer IS, Browne FA, Bonner CP, Minnis A, Kline TL, Ahmed K, Howard BN, Cox EN, Rinderle A, Wechsberg WM. Stigma in the health clinic and implications for PrEP access and use by adolescent girls and young women: conflicting perspectives in South Africa. BMC Public Health 2022; 22:1916. [PMID: 36242000 PMCID: PMC9563466 DOI: 10.1186/s12889-022-14236-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/02/2022] [Accepted: 09/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Globally, an urgent need exists to expand access to HIV prevention among adolescent girls and young women (AGYW), but the need is particularly acute in sub-Saharan Africa. Oral pre-exposure prophylaxis (PrEP) offers an effective HIV prevention method. In many countries, however, accessing PrEP necessitates that AGYW visit their local health clinic, where they may face access challenges. Some countries have implemented youth-friendly services to reduce certain challenges in local health clinics, but barriers to access persist, including clinic stigma. However, evidence of clinic stigma toward AGYW, particularly with respect to PrEP service delivery, is still limited. This mixed methods study explores stigma toward AGYW seeking clinic services, in particular PrEP, from the perspective of both clinic staff (clinical and nonclinical) and AGYW who seek services at clinic sites in Tshwane province, South Africa. METHODS Six focus group discussions were conducted with AGYW (43 total participants) and four with clinic staff (42 total participants) and triangulated with survey data with AGYW (n = 449) and clinic staff (n = 130). Thematic analysis was applied to the qualitative data and descriptive statistics were conducted with the survey data. RESULTS Four common themes emerged across the qualitative and quantitative data and with both AGYW and clinic staff, although with varying degrees of resonance between these two groups. These themes included (1) clinic manifestations of stigma toward AGYW, (2) concerns about providing PrEP services for AGYW, (3) healthcare providers' identity as mothers, and (4) privacy and breaches of confidentiality. An additional theme identified mainly in the AGYW data pertained to stigma and access to healthcare. CONCLUSION Evidence is needed to inform strategies for addressing clinic stigma toward AGYW, with the goal of removing barriers to PrEP services for this group. While awareness has increased and progress has been achieved around the provision of comprehensive, youth-friendly sexual and reproductive health services, these programs need to be adapted for the specific concerns of young people seeking PrEP services. Our findings point to the four key areas noted above where programs seeking to address stigma toward AGYW in clinics can tailor their programming.
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Affiliation(s)
- Laura Nyblade
- grid.62562.350000000100301493Global Health Division, RTI International, Washington, DC USA
| | - Jacqueline W. Ndirangu
- grid.62562.350000000100301493Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC USA
| | - Ilene S. Speizer
- grid.10698.360000000122483208Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Felicia A. Browne
- grid.62562.350000000100301493Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC USA ,grid.10698.360000000122483208Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Courtney Peasant Bonner
- grid.62562.350000000100301493Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC USA ,grid.10698.360000000122483208Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Alexandra Minnis
- grid.62562.350000000100301493Women’s Global Health Imperative, RTI International, Berkeley, CA USA ,grid.47840.3f0000 0001 2181 7878School of Public Health, University of California, Berkeley, CA USA
| | - Tracy L. Kline
- grid.62562.350000000100301493Social Statistics Program, RTI International, Research Triangle Park, NC USA
| | - Khatija Ahmed
- grid.477887.3Setshaba Research Centre, Tshwane, South Africa ,grid.49697.350000 0001 2107 2298Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Brittni N. Howard
- grid.62562.350000000100301493Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC USA
| | - Erin N. Cox
- grid.62562.350000000100301493Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC USA
| | - Abigail Rinderle
- grid.10698.360000000122483208Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Wendee M. Wechsberg
- grid.62562.350000000100301493Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC USA ,grid.10698.360000000122483208Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA ,grid.40803.3f0000 0001 2173 6074Department of Psychology, North Carolina State University, Raleigh, NC USA ,grid.26009.3d0000 0004 1936 7961Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC USA
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