Community based interventions for strengthening adolescent sexual reproductive health and rights: how can they be integrated and sustained? A realist evaluation protocol from Zambia

Zulu, Joseph Mumba; Goicolea, Isabel; Kinsman, John; Sandøy, Ingvild Fossgard; Blystad, Astrid; Mulubwa, Chama; Makasa, Mpundu; Michelo, Charles; Musonda, Patrick; Hurtig, Anna-Karin

doi:10.1186/s12978-018-0590-8

Cited by 32 publications

(33 citation statements)

References 29 publications

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“…The main aim of the RISE project was to test interventions for enhancing opportunities for communities to support adolescent girls to continue going to school, and for increasing girls' possibilities to postpone pregnancy and marriage. Details of the RISE project have been reported elsewhere [25,26]. Briefly, RISE is a three-arm cluster randomized controlled trial involving 157 schools and targeting approximately 4900 girls.…”

Section: The Community-based Health System In Zambiamentioning

confidence: 99%

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Can sexual health interventions make community-based health systems more responsive to adolescents? A realist informed study in rural Zambia

Mulubwa¹,

Hurtig²,

Zulu³

et al. 2020

Reprod Health

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116

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Introduction: Community-based sexual reproductive interventions are key in attaining universal health coverage for all by 2030, yet adolescents in many countries still lack health services that are responsive to their sexual reproductive health and rights' needs. As the first step of realist evaluation, this study provides a programme theory that explains how, why and under what circumstances community-based sexual reproductive health interventions can transform (or not) 'ordinary' community-based health systems (CBHSs) into systems that are responsive to the sexual reproductive health of adolescents.Methods: This realist approach adopted a case study design. We nested the study in the full intervention arm of the Research Initiative to Support the Empowerment of Girls trial in Zambia. Sixteen in-depth interviews were conducted with stakeholders involved in the development and/or implementation of the trial. All the interviews were recorded and analysed using NVIVO version 12.0. Thematic analysis was used guided by realist evaluation concepts. The findings were later synthesized using the Intervention−Context−Actors−Mechanism−Outcomes conceptualization tool. Using the retroduction approach, we summarized the findings into two programme theories. Results: We identified two initial testable programme theories. The first theory presumes that adolescent sexual reproductive health and rights (SRHR) interventions that are supported by contextual factors, such as existing policies and guidelines related to SRHR, socio-cultural norms and CBHS structures are more likely to trigger mechanisms among the different actors that can encourage uptake of the interventions, and thus contribute to making the CBHS responsive to the SRHR needs of adolescents. The second and alternative theory suggests that SRHR interventions, if not supported by contextual factors, are less likely to transform the CBHSs in which they are implemented. At individual level the mechanisms, awareness and knowledge were expected to lead to value clarification', which was also expected would lead to individuals developing a 'supportive attitude towards adolescent SRHR. It was anticipated that these individual mechanisms would in turn trigger the collective mechanisms, communication, cohesion, social connection and linkages.

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Section: The Community-based Health System In Zambiamentioning

confidence: 99%

“…In 2016, the trial enrolled girls who were in grade 7 (average age approximately 14 years). The interventions were provided for two years from Septemebr, 2016 to Novermber, 2018 [25,26].…”

Section: The Community-based Health System In Zambiamentioning

confidence: 99%

Can sexual health interventions make community-based health systems more responsive to adolescents? A realist informed study in rural Zambia

Mulubwa¹,

Hurtig²,

Zulu³

et al. 2020

Reprod Health

Self Cite

116

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“…Although there has been an increase in the number of countries integrating CSRHE in their education systems, studies on the integration of these programmes into the education systems in low and middle income countries shows that the integration has not been optimal [6,7]. Meanwhile, there is limited knowledge on the factors that shape the acceptability and adoption of such innovations.…”

Section: Introductionmentioning

confidence: 99%

Acceptability of youth clubs focusing on comprehensive sexual and reproductive health education in rural Zambian schools: a case of Central Province

Chirwa-Kambole

Svanemyr

Sandøy

et al. 2020

BMC Health Serv Res

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Background: The youths in Zambia have limited access to information concerning Sexual Reproductive Health (SRH) and this puts them at risk of unwanted pregnancies. Talking about other methods of preventing pregnancy or sexually transmitted infections than abstinence is regarded as culturally unacceptable. The Research Initiative to Support the Empowerment of Girls (RISE) is a cluster randomised controlled trial testing the effectiveness of different support packages on teenage pregnancies, early marriages and school drop-out rates. One of the support packages included youth clubs focusing on Comprehensive Sexual and Reproductive Health Education (CSRHE). Although similar interventions have been implemented in other settings, their integration process has been complex and comprehensive assessments of factors shaping acceptability of CSRHE are lacking. This article qualitatively aimed at identifying factors that shaped the acceptability of CSRHE youth clubs in rural schools in Central Province. Method: A qualitative case study was conducted after the youth clubs had been running for a year. Data were gathered through eight focus group discussions with grade eight pupils and eight individual interviews with teachers. Data were analysed using thematic analysis. Results: The perceived advantage and simplicity of the clubs related to the use of participatory learning methods, films and role plays to communicate sensitive reproductive health information made the learners like the youth clubs. Further, the perceived compatibility of the content of the sessions with the science curriculum increased the learners' interest in the youth clubs as the meetings also helped them to prepare for the school examinations. However, cultural and religious beliefs among teachers and parents regarding the use of contraceptives complicated the delivery of reproductive health messages and the acceptability of youth clubs' information among the learners. Conclusion: The study indicated that CSRHE youth clubs may be acceptable in rural schools if participatory learning methods are used and head-teachers, teachers as well as parents appreciate and support the clubs.

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“…The RISE trial was conducted in 12 districts of Zambia and measured the effects of economic support and community dialogue on adolescent childbearing, early marriage and education [14,19]. RISE has three study arms and recruited approximately 4900 girls enrolled in grade 7 in 157 schools in 2016.…”

Section: Methodsmentioning

confidence: 99%

Acceptability of an economic support component to reduce early pregnancy and school dropout in Zambia: a qualitative case study

Banda

Svanemyr

Sandøy

et al. 2019

Global Health Action

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Background: Cash Transfer (CT) schemes have become popular poverty reducing measures in many low and middle-income countries. Research indicates that when provided to girls in resource poor settings, cash transfers can increase education and postpone marriage and pregnancy. However, a few studies indicate that they can also have negative effects which can affect their acceptability, such as generating intra-community tensions.Objective: Conceptually informed by Rogers’ diffusion of innovation theory, this paper explores factors affecting the acceptability of economic support in a randomized controlled trial in rural Monze and Pemba Districts of Southern Province in Zambia.Methods: Qualitative data were collected through five focus group discussions and six in-depth, semi-structured interviews and analysed using thematic analysis. This study was done in the combined arm of a trial where girls received both economic support and participated in youth clubs offering sexuality and life-skills education.Results: In the study communities, acceptability was encouraging by the belief that economic support provided benefits beyond beneficiaries and that it improved access to education, and reduced teen pregnancies, marriages and school drop-out. However, provision of economic support only to selected girls and their parents and fear among some that the support was linked to satanic practices negatively affected acceptability. These fears were mitigated through community sensitisations.Conclusion: The study demonstrated that relative advantage, observability, simplicity and compatibility were key factors in influencing acceptability of the economic support. However, to enhance acceptability of cash transfer schemes aimed at addressing early marriage and pregnancy, it is important to explore socio-cultural factors that create suspicions and negative perceptions and to provide schemes that are perceived as relatively better than available similar schemes, understood, compatible and viable beyond the immediate beneficiary.

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Community based interventions for strengthening adolescent sexual reproductive health and rights: how can they be integrated and sustained? A realist evaluation protocol from Zambia

Cited by 32 publications

References 29 publications

Can sexual health interventions make community-based health systems more responsive to adolescents? A realist informed study in rural Zambia

Can sexual health interventions make community-based health systems more responsive to adolescents? A realist informed study in rural Zambia

Acceptability of youth clubs focusing on comprehensive sexual and reproductive health education in rural Zambian schools: a case of Central Province

Acceptability of an economic support component to reduce early pregnancy and school dropout in Zambia: a qualitative case study

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