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Zeglin A, Lazebnik R. Teaching About Contraception: Adolescent Attitudes Surrounding Sexual Education. Open Access J Contracept 2023; 14:181-188. [PMID: 38059115 PMCID: PMC10697143 DOI: 10.2147/oajc.s402443] [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: 06/28/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023] Open
Abstract
Purpose Adolescent pregnancy remains an important public health issue in the United States as it has profound health consequences for both mother and child. Evidence shows that improved contraception use is a critical factor in decreasing rates of adolescent pregnancy. In order to provide effective and engaging contraception education, it is important to understand adolescents' attitudes, questions, and misconceptions around the topic and its delivery. Methods Two searches were conducted using PubMed. Articles were limited to those published in the last 10 years that were written in English. The first search was completed using the search terms "Adolescent attitudes on sex education in the United States", and resulted in 688 articles. The second search was completed using the search terms "Adolescent attitudes on contraception in the United States", and resulted in 840 articles. Articles including contraception but focusing more on HIV, pre-exposure prophylaxis (PrEP), LGBTQ+ health and practices, human papillomavirus (HPV) vaccination, and studies completed in other countries were excluded. Remaining articles were screened by the authors for inclusion, and articles were included if they addressed information on adolescent attitudes on both contraception for pregnancy prevention and sex education, including education by schools, community organizations, the media, peers, parents, and physicians. A total of 56 articles were included in the review. Results The overwhelming theme that emerged from the review is that adolescents prefer comprehensive sex education in a safe space that allows for exploration and questioning. Adolescents want to ask their parents questions about sexual health without fear of punishment, and they desire the opportunity to learn from their physicians in a confidential environment. Conclusion The foundation of effective sex education is a non-judgmental, confidential, and safe space where adolescents can ask questions. There are multiple resources that adolescents use to gather information and establish their preferences and attitudes.
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Affiliation(s)
- Alissa Zeglin
- Internal Medicine and Pediatrics, Froedtert and the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rina Lazebnik
- General Pediatrics and Adolescent Medicine, Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
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2
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Ho CH, Denton AH, Blackstone SR, Saif N, MacIntyre K, Ozkaynak M, Valdez RS, Hauck FR. Access to Healthcare Among US Adult Refugees: A Systematic Qualitative Review. J Immigr Minor Health 2023; 25:1426-1462. [PMID: 37009980 DOI: 10.1007/s10903-023-01477-2] [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] [Accepted: 03/16/2023] [Indexed: 04/04/2023]
Abstract
Refugees encounter numerous healthcare access barriers in host countries, leading to lower utilization rates and poorer health outcomes. In the US, social inequities and fragmented health systems may exacerbate these disparities. Understanding these factors is necessary to ensure equitable care of refugee populations. A systematic literature review of qualitative studies on US adult refugee healthcare access from January 2000 to June 2021 was performed in accordance with PRISMA. Studies were analyzed deductively and then inductively to incorporate previous findings in other resettlement countries and emergence of US-specific themes. 64 articles representing 16+ countries of origin emerged from the final analysis, yielding nine interrelated themes related to health literacy, cost of services, cultural beliefs, and social supports, among others. The main challenges to refugees' healthcare access emerge from the interactions of care fragmentation with adverse social determinants. Given diverse barriers, integrated care models are recommended in treating refugee populations.
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Affiliation(s)
- Chi H Ho
- Department of Public Health Sciences, Frank Batten School of Leadership and Public Policy, University of Virginia, Charlottesville, VA, USA
| | - Andrea H Denton
- Claude Moore Health Sciences Library, University of Virginia, Charlottesville, VA, USA
| | - Sarah R Blackstone
- Office of Institutional Research, James Madison University, Harrisonburg, VA, USA
| | - Nadia Saif
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Baltimore, MD, USA
| | - Kara MacIntyre
- Office of Institutional Research, James Madison University, Harrisonburg, VA, USA
| | - Mustafa Ozkaynak
- College of Nursing, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Rupa S Valdez
- Department of Public Health Sciences, Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA, USA
| | - Fern R Hauck
- Department of Family Medicine, Department of Public Health Sciences, University of Virginia, PO Box 800729, Charlottesville, VA, 22908-0729, USA.
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Morrison-Beedy D, Wegener R, Ewart A, Ross S, Spitz A. Reflections from Refugee Adolescent Girls on Participation in a US-Based Teen Sexual Health Promotion Project. J Immigr Minor Health 2022; 25:680-684. [DOI: 10.1007/s10903-022-01415-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 11/29/2022]
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Mbarushimana V, Conco DN, Goldstein S. "Such conversations are not had in the families": a qualitative study of the determinants of young adolescents' access to sexual and reproductive health and rights information in Rwanda. BMC Public Health 2022; 22:1867. [PMID: 36207718 PMCID: PMC9541074 DOI: 10.1186/s12889-022-14256-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Access to sexual and reproductive health and rights (SRHR) information during adolescence has become a global concern. This study explored factors that enable or prevent young adolescents from accessing to SRHR information from the perspective of the key informants in Rwanda. Methods We conducted a qualitative study using semi-structured interviews with 16 purposively selected key informants from public and private institutions in Rwanda. This selection was based on their positions and expertise in delivering SRHR information to adolescents. The interview guide questions were designed based on the social-ecological theoretical framework of adolescent health. The interview transcripts were recorded, transcribed, translated and thematically analysed in Nvivo 11. Results The study reflected that multiple enablers and barriers at the individual, relationship, community and societal levels determined young adolescents’ access to SRHR information. These determinants include information-seeking behaviour and age of starting sexuality education at the individual level; and parents’ limited communication with young adolescents due to taboos, lack of skills, limited parental availability, beliefs, lack of appropriate language and peer norms at the relationships level. Enablers and barriers at the community level were the diversity of SRHR sources, the scope of sexuality education programmes, and cultural and religious beliefs. Finally, the perceived enablers and barriers at the societal level consisted of inadequate resources, inappropriate SRHR policy-making processes and unfriendly SRHR laws. Conclusion Enabling access to SRHR information requires addressing multiple factors within the social-ecological environment of young adolescents. Addressing these factors may facilitate improved access to SRHR information for this age group.
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Affiliation(s)
- Valens Mbarushimana
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. .,School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
| | - Daphney Nozizwe Conco
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Susan Goldstein
- SAMRC/Centre for Health Economics and Decision Science, PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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5
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Alomair N, Alageel S, Davies N, Bailey JV. Sexual and reproductive health knowledge, perceptions and experiences of women in Saudi Arabia: a qualitative study. ETHNICITY & HEALTH 2022; 27:1310-1328. [PMID: 33554633 DOI: 10.1080/13557858.2021.1873251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND There is no formal sexual and reproductive health (SRH) education currently offered in Saudi Arabia. Lack of knowledge and misconceptions are evident among Saudi women, which can lead to negative sexual and reproductive experiences. The aim of this study is to explore Saudi women's SRH knowledge, perceptions and experiences. METHODS Qualitative semi-structured interviews with Saudi women were conducted. Interviews took place in a public hospital in Riyadh, Saudi Arabia. Interviews were conducted in Arabic, recorded and transcribed verbatim, to allow for thematic analysis of the data. The following themes were identified: experience with menarche, deep-rooted negative views towards sex, difficulty discussing SRH topics, knowledge of sex and reproduction, generational gap, sources of SRH information and the role of the mother. RESULTS A total of 28 women, both married and unmarried, aged 20-50 years were interviewed. A profound lack of SRH knowledge was observed among Saudi women which contributed greatly to negative experiences both in childhood and adulthood. Lack of knowledge about menstruation often caused emotional distress for young girls, and menarche was associated with bad memories and negative emotions. Lack of knowledge about sexual intercourse and the deep-rooted negative views towards sex were linked with physical and psychological issues for women. Women rarely received information from their parents or teachers and preferred the internet for their SRH information. CONCLUSION There is a substantial unmet need for SRH education for women in Saudi Arabia. It is our recommendation that SRH education should be tailored to meet Saudi women's unique needs, while understanding specific socio-cultural barriers to SRH education and discussions. Research and policy efforts should be directed towards regulating and producing evidence-based health information on the internet, particularly Arabic language websites.
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Affiliation(s)
- Noura Alomair
- Research Department of Primary Care and Population Health, University College London, London, UK
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Samah Alageel
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Nathan Davies
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Julia V Bailey
- Research Department of Primary Care and Population Health, University College London, London, UK
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Tirado V, Engberg S, Holmblad IS, Strömdahl S, Ekström AM, Hurtig AK. "One-time interventions, it doesn't lead to much" - healthcare provider views to improving sexual and reproductive health services for young migrants in Sweden. BMC Health Serv Res 2022; 22:668. [PMID: 35585585 PMCID: PMC9115984 DOI: 10.1186/s12913-022-07945-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 04/11/2022] [Indexed: 11/14/2022] Open
Abstract
Background Sexual and reproductive health and rights (SRHR) is an important aspect for young people. In Sweden, young migrants often encounter barriers to accessing and using sexual and reproductive health (SRH) services, despite that these services are free of charge for young people (ages 15–25). Healthcare providers’ views and best practices are of great importance for improving the utilisation of existing SRH services, particularly for young people. This study aims to understand healthcare providers’ experiences and perspectives on barriers to SRHR among young migrants and their suggestions for strategies to improve the provision of SRH services to this group. Methods Midwives, counsellors and nurses with at least five years of professional experience within SRHR were reached through a purposeful sample at primary care clinics, specialised clinics and youth-friendly clinics, which provide SRH services to migrant youths in Stockholm. Twelve interviews were conducted from May 2018 to February 2020. Qualitative content analysis was performed. Results The analysis identified one theme: Improving the fragmentation in the SRH services, and four sub-themes: 1. Being unaware of SRHR; 2. Creating trust and responsive interactions; 3. Communicating in the same language; and 4. Collaborating to build bridges. The barriers included distrust in the healthcare system, socio-cultural norms surrounding SRHR, incomplete translations, and a need for long-lasting collaboration with SRH services and other range of services for migrants. The strategies for improvement as suggested by participants included involving existing cultural groups and organisations to enable trust, consistent and dependable interpreters, a streamline of SRH services with other healthcare staff and health facilities, and collaborations with homes designated for young migrants and language schools for a direct linkage to service providers. Conclusions Findings indicate that there are fragmentations in SRH services, and these include lack of knowledge about SRHR among migrant youth, language and communication barriers, and a lack of structure needed to build dependable services that go beyond one-time interventions. While initiatives and strategies from healthcare providers for improvement of SRH services exist, the implementation of some strategies may also require involving the regional and national decision-makers and multi-stakeholders like communities, civil society and young migrants themselves.
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Affiliation(s)
- Veronika Tirado
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Siri Engberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Susanne Strömdahl
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Sciences, Infectious Medicine, Uppsala University, Uppsala, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Venhälsan, Södersjukhuset, Stockholm, Sweden
| | - Anna Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Chalmiers MA, Karaki F, Muriki M, Mody S, Chen A, de Bocanegra HT. Refugee women's experiences with contraceptive care after resettlement in high-income countries: A Critical Interpretive Synthesis. Contraception 2021; 108:7-18. [PMID: 34971601 DOI: 10.1016/j.contraception.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 11/03/2022]
Abstract
Refugee women often share histories of forced displacement, economic hardship, or gender-based violence and may face common barriers to reproductive healthcare access after resettlement in high-income countries. This Critical Interpretive Synthesis integrates the available data on contraceptive care for refugee women after resettlement. The review examined shared aspects of the refugee experience that impact women's access to high-quality contraceptive care and transcend the particularities of specific health systems or countries of origin. These include possible shifts in gendered norms and fertility preferences after resettlement, prior experiences with contraception in home countries, refugee camps, and other sites of first-asylum, and negative experiences with healthcare providers after resettlement (i.e. communication barriers or experiencing discrimination). Our findings demonstrate the need for further methodologically-rigorous research in the field of refugee reproductive health, specifically in relation to evidence-based approaches to training interpreters and providers in contraceptive care for refugees and on male partners and their influence on contraceptive use.
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Affiliation(s)
- Morgen A Chalmiers
- Department of Anthropology, Medical Scientist Training Program, University of California, San Diego.
| | - Fatima Karaki
- Department of Medicine, University of California San Francisco.
| | - Maneesha Muriki
- Public Health Sciences, School of Medicine, University of California Davis.
| | - Sheila Mody
- School of Medicine, Department of Gynecology, Obstetrics and Reproductive Sciences, University of California, San Diego.
| | - Andy Chen
- School of Medicine, Loyola University.
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Austrian K, Soler-Hampejsek E, Kangwana B, Wado YD, Abuya B, Maluccio JA. Impacts of two-year multisectoral cash plus programs on young adolescent girls' education, health and economic outcomes: Adolescent Girls Initiative-Kenya (AGI-K) randomized trial. BMC Public Health 2021; 21:2159. [PMID: 34819047 PMCID: PMC8613919 DOI: 10.1186/s12889-021-12224-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Early adolescence is a critical window for intervention when it is possible to lay a foundation for a safe transition to adulthood, before negative outcomes occur. The Adolescent Girls Initiative–Kenya randomized trial tested the effects of combinations of interventions for young adolescent girls in two sites – the Kibera informal settlement in Nairobi and rural Wajir County in the Northeastern region. Methods The interventions included community dialogues on the role and value of girls (violence prevention), a conditional cash transfer (education), weekly group meetings for girls with health and life skills training (health), and training and incentives for financial literacy and savings activities (wealth creation). Participants were randomized to one of four study arms: 1) violence prevention only, 2) violence prevention and education, 3) violence prevention, education and health or 4) violence prevention, education, health and wealth creation. An intent-to-treat (ITT) analysis was conducted using longitudinal data to estimate the impact of each combination of interventions and various sensitivity analyses conducted addressing potential attrition bias and multiple hypothesis testing concerns. Results In Kibera, the education conditional cash transfer had small effects on grade attainment but larger impacts on completion of primary school and the transition to secondary school in the most comprehensive arm; the health intervention improved sexual and reproductive health knowledge and condom self-efficacy; and the wealth intervention improved financial literacy and savings behavior. In Wajir, the education conditional cash transfer increased school enrollment and grade attainment, and the wealth intervention improved savings behavior. Conclusions The results indicate that when trying to improve a range of outcomes related to adolescent wellbeing for young girls, a multisectoral intervention with components addressing household economic constraints is a promising approach. Trial registration Trial Registry: ISRCTN, ISRCTN77455458. Registered 24/12/2015 - Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12224-3.
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Affiliation(s)
- Karen Austrian
- Population Council, Avenue 5, 3rd Floor, Rose Avenue, PO Box 17643-00500, Nairobi, Kenya.
| | | | - Beth Kangwana
- Population Council, Avenue 5, 3rd Floor, Rose Avenue, PO Box 17643-00500, Nairobi, Kenya
| | - Yohannes Dibaba Wado
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya
| | - Benta Abuya
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya
| | - John A Maluccio
- Department of Economics, Middlebury College, 14 Old Chapel Road, Middlebury, VT, 05753, USA
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9
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Celentano I, Winer RL, Jang SH, Ibrahim A, Mohamed FB, Lin J, Amsalu F, Ali AA, Taylor VM, Ko LK. Development of a theory-based HPV vaccine promotion comic book for East African adolescents in the US. BMC Public Health 2021; 21:1137. [PMID: 34126968 PMCID: PMC8201717 DOI: 10.1186/s12889-021-11005-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 05/06/2021] [Indexed: 11/26/2022] Open
Abstract
Background Human Papillomavirus (HPV) vaccine uptake is low among East African adolescents in the US. Adolescents’ preferences influence HPV vaccine decisions, yet few interventions exist that address East African adolescents’ beliefs about HPV vaccines. We describe a multi-step process on how to create a theory-based comic book by integrating empirical findings, theory and focus group data from East African parents in the US. Methods Our multi-methods process included conducting focus groups with Somali, Ethiopian, and Eritrean mothers (n = 30) to understand mothers and adolescents socio-cultural beliefs and information needs about the HPV vaccine, creating comic book messages integrating the focus group findings, and assessing the acceptability of the finalized comic book among Somali, Ethiopian, and Eritrean adolescents (n = 134). Results We identified categories around socio-cultural beliefs (such ethnic representation and concerns about pork gelatin in vaccines), HPV vaccine information needs, and diffusion of information. We then mapped the categories to theoretical constructs and operationalized them into the comic book. Finally, we describe the overall acceptability of the comic book and specifics on comic book structure, appeal of characters, and message relevance. Conclusions A rigorous multi-step process that integrates theory and focus group data can help create culturally appropriate health messages that can educate and appeal to the community. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11005-2.
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Affiliation(s)
- Isabelle Celentano
- Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific Street, Magnuson Health Sciences Bldg., Box 357660, Seattle, WA, 98195, USA
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Box 359933, 325 9th Ave, Seattle, WA, 98104, USA
| | - Sou Hyun Jang
- Department of Sociology, Sungkyunkwan University, Seoul, South Korea
| | - Anisa Ibrahim
- Department of Pediatrics, University of Washington, Harborview Medical Center, 325 9th Ave, Seattle, WA, 98104, USA
| | - Farah Bille Mohamed
- Department of Epidemiology, University of Washington, Box 359933, 325 9th Ave, Seattle, WA, 98104, USA
| | - John Lin
- Department of Epidemiology, University of Washington, Box 359933, 325 9th Ave, Seattle, WA, 98104, USA
| | - Fanaye Amsalu
- Department of Epidemiology, University of Washington, Box 359933, 325 9th Ave, Seattle, WA, 98104, USA
| | - Ahmed A Ali
- Somali Health Board, 625 Strander Blvd Building, Tukwila, WA, 98188, USA
| | - Victoria M Taylor
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N, M3-B232, Seattle, WA, 98102, USA
| | - Linda K Ko
- Department of Health Services, University of Washington and Division of Public Health Science, Fred Hutchinson Cancer Research Center, Hans Rosling Center for Public Health, 3980 15th Avenue NE, UW Mailbox 351621, Seattle, WA, 98195, USA.
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10
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Afroz T, Gele A, Thorsen VC. Culture clash of female Somali adolescents and sexual and reproductive health services in Oslo, Norway. EUR J CONTRACEP REPR 2021; 26:296-302. [PMID: 33724125 DOI: 10.1080/13625187.2021.1895109] [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: 10/21/2022]
Abstract
OBJECTIVE Culture influences an individual's perception of health needs. The influence of culture also applies to Somali individuals' perception of their sexual and reproductive health (SRH) and uptake of related services. An understanding of female Somali adolescents' SRH needs is vital to achieve inclusive health coverage. No research has, however, been conducted to explore the SRH needs of this population group in Oslo; hence, the aim of this qualitative study was to minimise the knowledge gap. METHODS Fourteen young women aged 16-20 years were recruited using the snowball technique with purposive sampling. In-depth interviews using a semi-structured interview guide were used to collect data, and thematic analysis was applied. RESULTS Participants perceived SRH as a very private matter and open discussion of SRH was extremely limited owing to certain Somali cultural beliefs and values. As the participants intend to practise chastity before marriage, they believed that existing SRH services were largely irrelevant and inappropriate. Where they felt the need to access SRH services, participants wished to do so in a way they considered culturally appropriate. CONCLUSION Somali culture markedly influences individuals' perceptions of SRH services. It is recommended to modify existing SRH services by increasing confidentiality and anonymity in order to take into account the cultural requirements of female Somali adolescents.
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Affiliation(s)
- Tamanna Afroz
- Institute of Health and Society, Department of Community Medicine, University of Oslo, Oslo, Norway
| | - Abdi Gele
- Department of Migration and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Viva Combs Thorsen
- Institute of Health and Society, Department of Community Medicine, University of Oslo, Oslo, Norway
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11
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Brewer SE. Patterns of Primary Care Use Among Young Adult Refugees Resettled in Colorado. J Immigr Minor Health 2020; 23:1249-1258. [PMID: 33095323 DOI: 10.1007/s10903-020-01116-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 11/30/2022]
Abstract
Little is known about the prevalence of young adult refugees' primary care use following resettlement in Colorado. Among a sample of Bhutanese and Burmese young adult refugees resettled in Colorado, proportions with a primary care provider (PCP), physical exam in the last 12 months, and knowledge to make an appointment were calculated across 4 years and compared within the refugee population by demographics using Pearson's Chi-Squared tests and compared to older refugees and to the general population using two-tailed tests of proportions. Greater than 70% of young adult refugees reported a physical exam in the last 12 months during the 4 years after arrival. Disparities were identified within young adult refugees by sex, marital status and country of origin. Young adult refugees were significantly different than both refugees over 55 and the general population in terms of their primary care use. Young adult refugees need support to identify PCPs earlier in resettlement and maintain primary care use years after resettlement.
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Affiliation(s)
- Sarah E Brewer
- Department of Family Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA. .,ACCORDS, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.
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12
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Anyango CN, Nkulu Kalengayi FK, Goicolea I, Linander I. "A one-size-fits-all model is not good"?: ambivalent perceptions and experiences of African immigrant parents towards Swedish sexual and reproductive health services for young people. BMC Res Notes 2020; 13:449. [PMID: 32958036 PMCID: PMC7507643 DOI: 10.1186/s13104-020-05289-7] [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: 06/10/2020] [Accepted: 09/11/2020] [Indexed: 11/24/2022] Open
Abstract
Objective Parents have a key role regarding young people’s access to sexual and reproductive health services, thus their perceptions go a long way towards promoting or discouraging young people from using such services. Research has revealed that immigrant young people in Sweden access these essential services to a lesser extent than their native peers, and that they perceive their parents as unsupportive of such visits. This pilot study’s objective was to explore immigrant parents’ perceptions and experiences of the sexual and reproductive health services provided by Swedish youth clinics. Results Two categories were developed from the data analysis: (i) Youth clinics are well-known (to some) and appreciated (to a certain extent), and (ii) Parents feel left out from youth clinics and that the clinics have taken over parental responsibility. This study presents an ambivalent scenario connected to immigrant parents’ experiences and perceptions of having neither a space nor a voice within the existing youth clinic model. Parents expressed the desire for the youth clinics to recognise their cultural backgrounds, norms, and beliefs while providing sexual and reproductive health services to their children.
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Affiliation(s)
| | | | - Isabel Goicolea
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden
| | - Ida Linander
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden
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13
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Kaczkowski W, Swartout KM. Exploring gender differences in sexual and reproductive health literacy among young people from refugee backgrounds. CULTURE, HEALTH & SEXUALITY 2020; 22:369-384. [PMID: 31032722 DOI: 10.1080/13691058.2019.1601772] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 03/27/2019] [Indexed: 06/09/2023]
Abstract
Young refugees often have limited access to sexual health information and resources in their places of resettlement. However, there is currently little research examining differences in sexual health literacy between young refugee men and women. Consequently, this study employed qualitative research methods to better understand sexual health literacy, sources of information and perceived barriers to access across groups of refugee men and women between the ages of 18 and 24 years old. Three focus groups and 12 interviews were conducted with 25 refugee men and women living in the metropolitan Atlanta area. Both men and women appeared to have limited knowledge about sexual health. School was their primary source of information; women also talked with their parents, whereas men preferred to reach out to teachers, peers and online sources. For both groups, barriers to access included language difficulties and lack of money, insurance and transport. Men also stressed concerns about confidentiality, whereas women focused on shame and embarrassment when discussing sexual health. Overall, study findings emphasise the need for sexual health education as part of resettlement services. Moreover, programmes need to be independently designed for men and women to address gender differences in sexual health literacy and concerns.
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Affiliation(s)
| | - Kevin M Swartout
- Department of Psychology, Georgia State University, Atlanta, GA, USA
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14
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Unmet needs for contraception: A comparative study among Somali immigrant women in Oslo and their original population in Mogadishu, Somalia. PLoS One 2019; 14:e0220783. [PMID: 31415575 PMCID: PMC6695179 DOI: 10.1371/journal.pone.0220783] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/23/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Unmet need for contraception is defined as the proportion of fertile individuals who do not use contraceptives despite wanting to space or limit their childbearing. Studies show that immigrant women in Europe, have higher rates of unintended pregnancies and abortion than native born women. Somali women, have the highest fertility rate in Norway which is much higher than the total fertility rate in Norway (4.0 vs. 1.7). This study investigates the unmet need for contraception among Somali immigrant women in Oslo, Norway, compared to their original population in Mogadishu, Somalia. Methods A community based, cross sectional study was carried out among Somali women in Oslo (N = 228) and Mogadishu (N = 229) from May to December 2018. Pre-structured questionnaires were given to women who were recruited through snow-ball sampling. Data was analyzed using SPSS version 25. We performed a chi-square test for the analyses of categorical variables, a t-test for continuous variables and multivariate logistic analysis to determine the association between exposure and outcome variable. Results The unmet needs for contraception among Somali women in Oslo was 20.2%, which is similar to unmet needs for contraception of women in many sub-Saharan African countries. The unmet needs for Somali immigrant women in Oslo (20.2) is two times lower than that of their original population in Somalia (48.5). The odds of having unmet needs for contraception was nearly, three times higher among Somali women in Mogadishu compared to those in Oslo (OR: 2.6, CI: 2.56–7.68). The mean intended fertility was 4 among the women in Oslo and 10.8 in Mogadishu. About 13.4% of study participants in Oslo and 86.6% of those in Mogadishu consider modern contraception irrelevant for women’s health. Nearly 50% of women in both places had unintended childbirth on one or more occasion. Conclusion The study results show the prevalence of unmet needs for contraception among Somali immigrant women Oslo, is 4 fold higher than that of Norway (20.2 vs 5.5). Information Education Communication to both men and women, may reduce the high unmet need for contraception and also improve partner communication on family planning among Somali immigrants in Oslo. Training primary health providers for provision of tailored information about the modern contraception to immigrant women, which includes an individualized counselling may improve partners’ knowledge, demand and uptake of modern contraception.
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Cox CM, Ahmed F, Mitchell A, Ganey A, Kahin A, Kahin A. Decision Making and Communication About Child Spacing Among Somali Couples in Minnesota. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2019; 51:63-69. [PMID: 30977958 DOI: 10.1363/psrh.12100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 06/09/2023]
Abstract
CONTEXT Since civil unrest broke out in Somalia in the 1990s, large numbers of Somalis have immigrated to Western countries, including the United States. It is unknown whether these immigrants maintain their cultural norms of low contraceptive use and high fertility when they live in settings with different norms. METHODS In 2016, interviews were conducted in Minnesota with Somali immigrants and refugees to explore couple communication and decision making regarding child spacing. Nineteen married men and women aged 25-51 were interviewed. After a coding scheme was developed, key themes were identified and examined by participants' sex, number of children and age of arrival in the United States. RESULTS Most participants discussed child spacing with their spouse and had positive or neutral experiences. Some participants, especially those with multiple children, stated that living in their new country had influenced their fertility desires. Only those who had arrived after the age of 20 mentioned that experiencing closely spaced births had motivated them to discuss child spacing. Participants emphasized the importance of information sharing, compromise and joint decision making with their spouse. Priority for child-spacing decision making was granted to women, largely because of their primary role in childbirth. Men who had arrived in the United States before turning 20 were more definitive about giving women decision-making priority. CONCLUSIONS These findings provide insight into how Somali immigrant and refugee couples communicate and make decisions about child spacing, and may be helpful in informing the development of culturally specific reproductive health programs.
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Affiliation(s)
| | - Fathi Ahmed
- Program Navigator, International Institute of Minnesota, St. Paul
| | - Ashley Mitchell
- Instructor, Rothenberger Institute, University of Minnesota School of Public Health, Minneapolis
| | - Abdillahi Ganey
- Consultant, Tusmo Research and Consulting, Hargeisa, Somaliland
| | - Adar Kahin
- Community Health Organizer, WellShare International, Minneapolis
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