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Aventin Á, Rabie S, Skeen S, Tomlinson M, Makhetha M, Siqabatiso Z, Lohan M, Clarke M, Lohfeld L, Thurston A, Stewart J. Adaptation of a gender-transformative sexual and reproductive health intervention for adolescent boys in South Africa and Lesotho using intervention mapping. Glob Health Action 2021; 14:1927329. [PMID: 34106036 PMCID: PMC8205055 DOI: 10.1080/16549716.2021.1927329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 05/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Rates of adolescent HIV and unintended pregnancy in southern Africa are amongst the highest in the world. Gender-transformative interventions that address underlying gender inequalities and engage both males and females have been emphasised by the World Health Organisation, amongst others, to target prevention. However, few such gender-transformative interventions have been rigorously developed or evaluated.Objective: To expedite potential impact and reduce development costs, we conducted a needs assessment to inform the co-design, in consultation with local stakeholders, of adapted versions of an existing gender-transformative Relationships and Sexuality Education intervention for use in South Africa and Lesotho.Methods: Adaptation of the intervention was guided by a modified version of Intervention Mapping (IM). This process involved consultation with separate adolescent, community and expert advisory groups and a collaboratively conducted needs assessment, which drew on focus groups with adolescents (8 groups, n = 55) and adults (4 groups, n = 22) in South Africa and Lesotho, and was informed by our systematic review of the literature on the determinants of condom use among adolescents in the region.Results: The findings clarified how the intervention should be adapted, which individual- and environmental-level determinants of condom use to target, and actions for facilitating successful adoption, evaluation and implementation in the new settings.Conclusions: The IM approach allows for a systematic appraisal of whether components and processes of an existing intervention are appropriate for a new target population before costly evaluation studies are conducted. The findings will be of interest to those wishing to rigourously develop and evaluate gender-transformative interventions engaging men to improve health for all.
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Affiliation(s)
- Áine Aventin
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Stephan Rabie
- Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Cape Town, South Africa
| | - Sarah Skeen
- Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Mark Tomlinson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland, UK
- Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | | | - Zenele Siqabatiso
- Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Maria Lohan
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Mike Clarke
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Lynne Lohfeld
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Allen Thurston
- School of Education, Social Sciences, Education and Social Work, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Jackie Stewart
- Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
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Upadhyay UD, Danza PY, Neilands TB, Gipson JD, Brindis CD, Hindin MJ, Foster DG, Dworkin SL. Development and Validation of the Sexual and Reproductive Empowerment Scale for Adolescents and Young Adults. J Adolesc Health 2021; 68:86-94. [PMID: 32690468 PMCID: PMC7755733 DOI: 10.1016/j.jadohealth.2020.05.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE We developed and validated a measure that assesses the latent construct of sexual and reproductive empowerment among adolescents and young adults. A specific measure for this group is critical because of their unique life stage and circumstances, which often includes frequent changes in sexual partners and involvement from parents in decision-making. METHODS After formative qualitative research, a review of the literature, and cognitive interviews, we developed 95 items representing nine dimensions of sexual and reproductive empowerment. Items were then fielded among a national sample of young people aged 15-24 years, and those who identified as sexually active completed a 3-month follow-up survey. We conducted psychometric analysis and scale validation. RESULTS Exploratory factor analysis on responses from 1,117 participants resulted in the Sexual and Reproductive Empowerment Scale for Adolescents and Young Adults, containing 23 items captured by seven subscales: comfort talking with partner; choice of partners, marriage, and children; parental support; sexual safety; self-love; sense of future; and sexual pleasure. Validation using logistic regression demonstrated that the subscales were consistently associated with sexual and reproductive health information and access to sexual and reproductive health services measured at baseline and moderately associated with the use of desired contraceptive methods at 3-month follow-up. CONCLUSIONS The Sexual and Reproductive Empowerment Scale for Adolescents and Young Adults is a new measure that assesses young people's empowerment regarding sexual and reproductive health. It can be used by researchers, public health practitioners, and clinicians to measure sexual and reproductive empowerment among young people.
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Affiliation(s)
- Ushma D Upadhyay
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, Oakland, California; Center of Expertise in Women's Health, Gender, and Empowerment, University of California Global Health Institute, California.
| | | | - Torsten B Neilands
- School of Medicine, University of California San Francisco, San Francisco, California
| | - Jessica D Gipson
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California; Center of Expertise in Women's Health, Gender, and Empowerment, University of California Global Health Institute, California
| | - Claire D Brindis
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, Oakland, California; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California; Adolescent and Young Adult Health National Resource Center, Department of Pediatrics, University of California San Francisco, San Francisco, California
| | | | - Diana Greene Foster
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, Oakland, California
| | - Shari L Dworkin
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, Washington
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Nair S, Adhikari T, Juneja A, Gulati KB, Kaur A, Rao MVV. Community Perspectives on Men's Role in the Utilisation of Maternal Health Services Among Saharia Tribes in Gwalior, Madhya Pradesh, India: Insights from a Qualitative Study. Matern Child Health J 2020; 25:769-776. [PMID: 33215331 DOI: 10.1007/s10995-020-03029-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Utilization of maternal health care services by tribal population could be detrimental in reducing high maternal mortality in Madhya Pradesh, India. A growing body of evidence indicates the positive association between male involvement and increased use of antenatal care services. Further research is required to understand barriers and possible solutions to develop culturally appropriate interventions to engage men to promote the utilization of maternal health care services. METHODS The study used qualitative data collected through 8 focus group discussions with men and women and 8 key informant interviews with either a community representative or health worker in two blocks dominated by Saharia tribes in Gwalior district, Madhya Pradesh, India in 2018. Information on the perception of utilization of maternal and child health services, male involvement, challenges and opportunities were elicited using a structured guide. Framework analysis was used to analyse the data. RESULTS Findings document barriers at the individual (poor knowledge, fear of loss of wage, choice of home as a place of delivery), community (practices that reinforced the prevailing gender norms) and health care facility level (quality and attitude of health care providers) to male engagement in utilization of maternal health services. Community perceptions on possible solutions to address these were more likely to be gender exploitative interventions. CONCLUSION To promote utilization of maternal health care services among Saharia tribes, this study highlights the importance of developing gender sensitive interventions that addresses the individual, community and health care facility level barriers of male involvement and do not reinforce existing gender norms.
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Affiliation(s)
- Saritha Nair
- ICMR-National Institute of Medical Statistics (NIMS), ICMR-NIMS, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India
| | - Tulsi Adhikari
- ICMR-National Institute of Medical Statistics (NIMS), ICMR-NIMS, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India.
| | - Atul Juneja
- ICMR-National Institute of Medical Statistics (NIMS), ICMR-NIMS, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India
| | - K Bal Gulati
- ICMR-National Institute of Medical Statistics (NIMS), ICMR-NIMS, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India
| | - Ashpinder Kaur
- ICMR-National Institute of Medical Statistics (NIMS), ICMR-NIMS, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India
| | - M Vishnu Vardhana Rao
- ICMR-National Institute of Medical Statistics (NIMS), ICMR-NIMS, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India
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Makleff S, Billowitz M, Garduño J, Cruz M, Silva Márquez VI, Marston C. Applying a complex adaptive systems approach to the evaluation of a school-based intervention for intimate partner violence prevention in Mexico. Health Policy Plan 2020; 35:993-1002. [PMID: 32761146 PMCID: PMC7553757 DOI: 10.1093/heapol/czaa067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2020] [Indexed: 11/13/2022] Open
Abstract
Despite calls for evaluation practice to take a complex systems approach, there are few examples of how to incorporate complexity into real-life evaluations. This article presents the case for using a complex systems approach to evaluate a school-based intimate partner violence-prevention intervention. We conducted a post hoc analysis of qualitative evaluation data to examine the intervention as a potential system disruptor. We analysed data in relation to complexity concepts particularly relevant to schools: 'diverse and dynamic agents', 'interaction', 'unpredictability', 'emergence' and 'context dependency'. The data-two focus groups with facilitators and 33 repeat interviews with 14-17-year-old students-came from an evaluation of a comprehensive sexuality education intervention in Mexico City, which serves as a case study for this analysis. The findings demonstrate an application of complex adaptive systems concepts to qualitative evaluation data. We provide examples of how this approach can shed light on the ways in which interpersonal interactions, group dynamics, the core messages of the course and context influenced the implementation and outcomes of this intervention. This gender-transformative intervention appeared to disrupt pervasive gender norms and reshape beliefs about how to engage in relationships. An intervention comprises multiple dynamic and interacting elements, all of which are unlikely to be consistent across implementation settings. Applying complexity concepts to our analysis added value by helping reframe implementation-related data to focus on how the 'social' aspects of complexity influenced the intervention. Without examining both individual and group processes, evaluations may miss key insights about how the intervention generates change, for whom, and how it interacts with its context. A social complex adaptive systems approach is well-suited to the evaluation of gender-transformative interventions and can help identify how such interventions disrupt the complex social systems in which they are implemented to address intractable societal problems.
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Affiliation(s)
- Shelly Makleff
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Marissa Billowitz
- Independent, Juárez 208, Col. Tlalpan Centro, 14000 Mexico City, Mexico
| | - Jovita Garduño
- Fundación Mexicana para la Planeación Familiar, A.C. (Mexfam), Juárez 208, Col. Tlalpan Centro, 14000 Mexico City, Mexico
| | - Mariana Cruz
- IPPF/WHR Mexico, Juárez 208, Col. Tlalpan Centro, 14000 Mexico City, Mexico
| | - Vanessa Ivon Silva Márquez
- Fundación Mexicana para la Planeación Familiar, A.C. (Mexfam), Juárez 208, Col. Tlalpan Centro, 14000 Mexico City, Mexico
| | - Cicely Marston
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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