A decade of Acceptability Research with Adolescents in Africa: Systematic review and evidence map

Abstract

Interventions aimed at improving adolescent developmental outcomes are more likely to be successful if the young people they target find them acceptable. However, no standard definitions or indicators exist to assess acceptability, acceptability research with adolescents in LMICs is still limited, and no known reviews synthesise the evidence from Africa.We conducted a systematic review of peer-reviewed studies assessing intervention acceptability with young adults (aged 10-24) in Africa, published between January 2010 and June 2020. This paper maps and qualitatively synthesizes the scope, characteristics, and findings of these studies, including definitions of acceptability, methods used, the type and objectives of interventions assessed, and overall findings on adolescent acceptability.The review was carried out in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Key word searches generated 4692 unique records and 55 final eligible studies, assessing 60 interventions. Most studies were conducted in Southern Africa, of which 32 jointly in South Africa and Uganda. The majority of interventions assessed for acceptability could be classified as HIV or HPV vaccine interventions (10), E-health (10), HIV testing interventions (8), support group interventions (7) and contraceptive interventions (6). The objectives of most interventions were linked to SDG3, specifically to HIV and sexual and reproductive health. Acceptability was overall high among these published studies. 22 studies provided reasons for acceptability or lack thereof, some specific to particular types of interventions and others common across intervention types.Our review exposes considerable scope for future acceptability research and review work. This should include: extending acceptability research beyond the health (and particularly HIV) sector and to regions in Africa where this type of research is still scarce; including adolescents earlier, and potentially throughout the intervention process; further conceptualising the construct of acceptability among adolescents and beyond, and examining the relationship between acceptability and uptake.Key QuestionsWhat is already known?Addressing the developmental needs of adolescents in African countries is critical if the continent is to achieve its sustainable development goals (SDGs).Many interventions aimed at strengthening adolescent developmental outcomes have not achieved desired impact, and adolescent involvement is often poorly envisaged and implemented.Uptake and effectiveness of interventions is likely to be higher if these interventions are acceptable to adolescent end-users.What are the new findings?Acceptability of interventions assessed in Africa was generally high among adolescents.Understanding of the intervention, ease of use, adequate emotional support, autonomy, confidentiality and protection from stigma were key overarching themes explaining why young people found interventions acceptableWhat do the new findings imply?Intervention developers and implementers across the continent should pay attention to these key aspects of interventions and their delivery.It is important to strengthen adolescents’ understanding of interventions, involve adolescents early on in intervention development, and engage with the broader context within which adolescent acceptability is shaped.There is a need for more acceptability research in important areas for adolescent development beyond (physical) health and, within the health sector, beyond HIV.