A qualitative exploration of the sexual and reproductive health knowledge of adolescent mothers from indigenous populations in Ratanak Kiri Province, Cambodia.

BackgroundHumanitarian crises and migration make girls and women more vulnerable to poor sexual and reproductive health (SRH) outcomes. Nevertheless, there is still a dearth of information on SRH outcomes and access to SRH services among refugee girls and young women in Africa. We conducted a mixed-methods study to assess SRH experiences, knowledge and access to services of refugee girls in the Nakivale settlement, Uganda.MethodsA cross-sectional survey among 260 adolescent girls 13–19 years old was conducted between March and May 2018. Concurrently, in-depth interviews were conducted among a subset of 28 adolescents. For both methods, information was collected regarding SRH knowledge, experiences and access to services and commodities. The questionnaire was entered directly on the tablets using the Magpi® app. Descriptive statistical analysis and multinomial logistic regression were performed. Qualitative data was transcribed and analysed using thematic content analysis.ResultsA total of 260 participants were interviewed, with a median age of 15.9 years. The majority of girls were born in DR Congo and Burundi. Of the 93% of girls who had experienced menstruation, 43% had ever missed school due to menstruation. Regarding SRH knowledge, a total of 11.7% were not aware of how HIV is prevented, 15.7% did not know any STI and 13.8% were not familiar with any method to prevent pregnancy. A total of 30 girls from 260 were sexually active, of which 11 had experienced forced sexual intercourse. The latter occurred during conflict, in transit or within the camp. A total of 27 of 260 participants had undergone female genital mutilation (FGM). The most preferred sources for SRH information was parents or guardians, although participants expressed that they were afraid or shy to discuss other sexuality topics apart from menstruation with parents. A total of 30% of the female adolescents had ever visited a SRH service centre, mostly to test for HIV and to seek medical aid for menstrual problems.ConclusionsAdolescent refugee girls lack adequate SRH information, experience poor SRH outcomes including school absence due to menstruation, sexual violence and FGM. Comprehensive SRH services including sexuality education, barrier-free access to SRH services and parental involvement are recommended.

Following China’s rapid socioeconomic transition, the sexual attitudes and behaviours of Chinese youth have changed considerably, raising serious concerns about their sexual and reproductive health (SRH). While comprehensive and high-quality formal sexuality education has been shown to lead to safer sexual behaviour, the delivery of formal SRH education in China remains insufficient, especially in Western regions. This study used qualitative approaches to evaluate the implementation of a live-streaming comprehensive sexuality education (CSE) programme in Western China between 2019 and 2021. Nineteen participants were recruited to participate in this study. Ten face-to-face, semi-structured interviews were conducted privately with specialists, school principals, and live-streaming tutors. Two focus groups were conducted with classroom teachers and junior secondary students, respectively. Findings reveal that both programme implementers and students demonstrated high satisfaction with CSE implementation. They indicated that CSE provision helped enhance adolescents’ SRH knowledge and attitudes so as to better prepare them for a healthy and secure future. Findings demonstrate the effectiveness, efficiency, relevance, sustainability, and scale-up possibilities of the both the CSE curriculum and the live-streaming delivery approach. Findings may help guide future implementation of CSE at all levels, and thus improve access to CSE for vulnerable populations and diminish SRH disparities more effectively.

BackgroundCanada is one of the world’s most ethnically diverse countries, with over 7 million individuals out of a population of 38 million being born in a foreign country. Immigrant adolescents (aged 10 to 19 years) make up a substantial proportion of newcomers to Canada. Religious and cultural practices can influence adolescents’ sexual attitudes and behaviors, as well as the uptake of sexual and reproductive health (SRH) services among this population. Adolescence is a time to establish lifelong healthy behaviors. Research indicates an alarming gap in adolescents’ SRH knowledge, yet there is limited research on the SRH needs of immigrant adolescents in Canada.ObjectiveThe purpose of this study is to actively engage with immigrant adolescents to develop, implement, and evaluate a mobile health (mHealth) intervention (ie, mobile app). The interactive mobile app will aim to deliver accurate and evidence-based SRH information to adolescents.MethodsWe will use community-based participatory action research to guide our study. This research project will be conducted in 4 stages based on user-centered co-design principles. In Stage 1 (Empathize), we will recruit and convene 3 adolescent advisory groups in Edmonton, Toronto, and Vancouver. Members will be engaged as coresearchers and receive training in qualitative and quantitative methodologies, sexual health, and the social determinants of health. In Stage 2 (Define and Ideate), we will explore SRH information and service needs through focus group discussions with immigrant adolescents. In Stage 3 (Prototype), we will collaborate with mobile developers to build and iteratively design the app with support from the adolescent advisory groups. Finally, in Stage 4 (Test), we will return to focus group settings to share the app prototype, gather feedback on usability, and refine and release the app.ResultsRecruitment and data collection will be completed by February 2023, and mobile app development will begin in March 2023. The mHealth app will be our core output and is expected to be released in the spring of 2024.ConclusionsOur study will advance the limited knowledge base on SRH and the information needs of immigrant adolescents in Canada as well as the science underpinning participatory action research methods with immigrant adolescents. This study will address gaps by exploring SRH priorities, health information needs, and innovative strategies to improve the SRH of immigrant adolescents. Engaging adolescents throughout the study will increase their involvement in SRH care decision-making, expand efficiencies in SRH care utilization, and ultimately improve adolescents' SRH outcomes. The app we develop will be transferable to all adolescent groups, is scalable in international contexts, and simultaneously leverages significant economies of scale.International Registered Report Identifier (IRRID)PRR1-10.2196/45389

Background Little is known about how events in slum settings interfere with informal sexual education in Nigeria. This study explores the influence of situational context on parent-adolescent communication about sexual and reproductive health (SRH) issues in the urban slums of Ibadan, Nigeria. Methods A qualitative exploratory study was conducted in the Southeast and Northeast local government areas of Ibadan. Eight (8) vignette-based focus group discussions (FGDs) with parents and adolescents of both sexes were conducted in addition to four (4) key informant interviews (KIIs) with community and women's leaders. Interviews were audio-recorded, transcribed, and translated into English. Descriptive and interpretative analyses were conducted with the aid of ATLAS Ti 9 software. Results Findings portray SRH meanings and experiences, intergenerational cultural norms, and expectations for SRH, gender double standards in SRH discussion, streetwise SRH knowledge, and social media exposure to SRH as contexts that interfere with parent-adolescent communication on SRH issues. The findings show that although parents and teenagers understood SRH issues and their consequences, there was no effective communication about them. Also, the conversation between parents and adolescents promotes gender inequalities as different SRH information is passed to adolescent girls and boys. Streetwise SRH knowledge was identified to impede effective parent-adolescent conversation on SRH issues. Social media exposure had a significant impact on where teenagers got their unfiltered SRH knowledge, interfering with and distorting SRH discussion between parents and adolescents. Conclusions Interventions that enable parents to give and allow their children early access to appropriate SRH knowledge, considering their context, are urgently needed. Key messages • The study emphasizes the need for tailored sexual education programs that are culturally sensitive, age-appropriate, and accessible to parents and children in urban slums. • The study highlights the absence of formal sexual education in schools and communities in urban slums of Ibadan, Nigeria.

The provision of comprehensive sexuality education (CSE) accords opportunities for scientifically accurate information about sexual and reproductive health (SRH). We used a mixed-methods study to characterise adolescent SRH knowledge, attitudes and service utilisation experiences in the context of CSE implementation in Zambia. In-school young people aged 12–24 years (N = 1,612) in the North-Western Province were randomly surveyed. A 29-item index was constructed to measure alignment of knowledge, attitudes and values (KAV) with the CSE curriculum. Logistic regression, stratifying by sexual debut status, modelled associations of past-year HIV counselling and testing and family planning service access, respectively, with CSE-KAV index scores. Focus group discussions further explored perceptions of and experiences accessing SRH services. Despite moderate SRH knowledge and acceptability of SRH services, fewer than half of sexually experienced young people reported accessing SRH services. Among sexually experienced youth, neither HIV testing nor family planning service utilisation in the previous year were associated with higher CSE-KAV index scores. Salient barriers to SRH service uptake included limited perceived benefits, unsupportive household and community environments, and negative interactions with health providers. To increase accessibility and uptake of youth SRH services, linking school-based CSE to SRH services is recommended.

Young people from culturally and linguistically diverse backgrounds experience barriers accessing sexual and reproductive health (SRH) information and care. This systematic review, utilising a pre-determined protocol, performed according to PRISMA guidelines, explored SRH knowledge, attitudes and information sources for young (16–24 years) culturally and linguistically diverse background people living in Australia, to gain understanding of their sexual health literacy. CINAHL, Embase, MEDLINE, PubMed and Scopus were systematically searched with inclusion criteria applied to 216 articles. After title and abstract screening, backward/forward searching, and full-text review of 58 articles, 13 articles from eight studies were identified. Thematic analysis, guided by core constructs from cultural care theory, identified three themes: (1) SRH knowledge varied by topic but was generally low; (2) young people’s attitudes and beliefs were influenced by family and culture; however, ‘silence’ was the main barrier to sexual health literacy; and (3) Access to SRH information was limited. To attain sexual health literacy and equitable access to culturally-congruent and responsive SRH information and care, there is a need for theory-informed strategies and policies that address the diverse social, cultural and structural factors affecting young culturally and linguistically diverse background people, especially the ‘silence’ or lack of open SRH communication they experience.

BackgroundAlthough several studies have attempted investigating sex-related knowledge, attitudes, and practices among young people in China, deeper insights were still needed to further understand how this population could be supported to make healthy and safe sexual choices. Against this background, this study used a large set of secondary data to examine associations among sexual and reproductive health (SRH) knowledge, sexual attitudes, and sexual behaviour.MethodsA cross-sectional study was employed to explore the associations among SRH knowledge, sexual attitudes, and sexual behaviour with a publicly available survey data among the 1196 university students from freshmen to Ph.D. candidates. Descriptive analysis was used to describe the sociodemographic characteristics of the university students by gender. Associations of sociodemographic factors with sources and categories of SRH knowledge, categories of contraceptive knowledge, sexual attitudes, and sexual behavior were explored with Poisson regressions and logistic regressions, respectively. The mediating effects of sociodemographic factors on the associations between SRH knowledge and sexual behavior, observed sexual attitudes on the associations of SRH knowledge with sexual behavior, and latent sexual attitudes on the relationship between SRH knowledge and sexual behavior were analyzed in order.ResultsDescriptive analysis showed that the sample was dominated by age group (18 to 24 years), undergraduates, females, limited contraceptive knowledge, unfavorable sexual attitudes, and insufficient knowledge sources. Regression analyses showed that sociodemographic factors had significant associations with SRH knowledge, sexual attitudes, and sexual behavior. Subsequently, the mediating effects of sociodemographic factors on the associations of SRH knowledge and sexual attitudes with sexual behavior were confirmed. Controlling for sociodemographic factors, the effects of sexual attitudes on the associations between SRH knowledge and sexual behaviour could be verified. Structural equation modeling indicated that the linear sequence of sources and categories of SRH knowledge → sexual attitudes → sexual behaviour model and the triangle mediating effects of sexual behaviour → sexual attitudes → SRH knowledge model existed.ConclusionsSociodemographic factors and observed sexual attitudes mediated the associations between SRH knowledge and sexual behaviour. The sequence relationship: sources and categories of SRH knowledge → sexual attitudes → sexual behavior and the mediating relationship: sexual behavior → sexual attitude → sources and categories of SRH knowledge & sexual behavior → sources and categories of SRH knowledge and sexual behavior → sexual attitude → categories of contraceptive knowledge & sexual behavior → categories of contraceptive knowledge were confirmed in the sample. This study also identified an urgent need for the university students to access to SRH comprehensive knowledge.

Chinese universities have been conducting a variety of sexuality education programs, including a sexuality curriculum (SC) to increase sexual and reproductive health (SRH) knowledge and improve sexual attitudes and practices among college students. However, little is known regarding the effect of SC on students' sexual attitudes and behaviors. The purpose of this study was to evaluate the effect of SC on SRH knowledge, sexual attitudes, and practices among college students of Shandong University. To assess these issues, an online cross-sectional survey was conducted via a WeChat applet. Four hundred and forty-nine freshmen were recruited from Shandong University, including 209 students with SC and 240 students without SC. We assessed their SRH knowledge, sexual attitude, and practice. We found that 15.8% engaged in sexual activities, while 59.2% had viewed nonscientific books or videos describing sexual behavior within the past 2 weeks. Regarding the initial source of their SRH information, 65.9% taught themselves through reading or viewing SRH content in the media, and 46.8% participated in school lectures on SRH, while only 31.2% of the participants discussed SRH matters with their parents. As compared with students without SC, students with SC had significantly greater total scores with regard to reproductive health knowledge (P < 0.001) and sexual health knowledge (P < 0.001). Students without SC showed a significant degree of prejudice against sexually transmitted disease patients and were more resistant to interact with acquaintances infected with human immunodeficiency virus (P < 0.001). Exposure to a school-based SC had a beneficial effect on increasing the SRH knowledge of these students as well as mitigating risky sexual attitudes and behaviors.NEW & NOTEWORTHY To assess the SRH knowledge, sexual attitudes, and practices in freshmen of Shandong University and assess the effect of SC, an online cross-sectional survey was conducted via a WeChat applet. Our findings indicate that these freshmen demonstrate a high prevalence of being sexually active and exposure to a school-based SC had a beneficial effect on increasing the SRH knowledge of these students as well as mitigating risky sexual attitudes and behaviors.

Achieving equity in sexual and reproductive health (SRH) outcomes for adolescents across geography, ethnicity, and gender remains a global public health challenge. Access to accurate information is a basic and important determinant of SRH, but for many young people, social norms and expectations limit what they can access. We know little about how SRH knowledge is accessed in the Asia Pacific, a region diversely rich in culture and related norms, and with persistently wide inequities in SRH outcomes. This study conducted face-to-face interviews with 20 adolescent girls (16–18 years) and their female carers (n = 20) from the Tay community—the largest ethnic minority group in Vietnam. Reflexive thematic analysis was used to construct three themes from the data. First, SRH issues relating to pre-marital sex, unwanted pregnancy, and the repercussions were the most important topics for adolescent girls and their female carers. Second, SRH topics were considered sensitive and personal, inhibiting interpersonal communication about SRH between women, their families, and across generations. Third, adolescent girls were accessing conflicting SRH information from a diverse range of sources, and both adolescent girls and female carers were reliant on SRH sources online. There is an opportunity to ensure reliable SRH information is available through a variety of sources: by focussing content and delivery of comprehensive sexuality education on pregnancy prevention at the high school level, contextualizing community-based health promotion to address sensitivities around SRH, and expanding national-level programmes to provide online safety skills and digital literacy for adolescents and parents.

The global trend of early onset of puberty combined with increased age at marriage leading to an increase in premarital sex is also observed in Sri Lanka. In contrast, less priority is given for sexual and reproductive health education in Sri Lankan schools. The objective of this study was to plan, implement and evaluate the effectiveness of an educational intervention on Sexual and Reproductive Health (SRH). A quasi-experimental study was designed based on a situational analysis of existing SRH education in schools and its effectiveness was evaluated. A four-day teacher- training workshop was carried out for the thirty one teachers in the intervention group. Thirty teachers in the control area were exposed to the pre-existing SRH seminars. After the intervention, teachers in both groups were made to teach SRH lessons to Grade Nine students in their respective schools to measure the impact of the intervention. Sixty-one teachers and 914 students aged 15-16 years completed self-reported pre and post intervention questionnaires on SRH knowledge and attitudes. Scores for pre-post tests of each study group and post-post tests between intervention and control groups were compared. Post intervention teaching skills of teachers in both study groups were also assessed using standard checklists. Teachers in the intervention group had higher mean scores for post intervention knowledge on pregnancy and related issues [intervention group - 21.9(11.5), control group - 19.6(13.0); p-0.02]; and Sexually Transmitted Infections [intervention group - 12.9(9.5), control group - 7.5(4.6); p-0.01]. Mean scores for teaching skills were significantly improved in the intervention group [intervention group -83.0 (20.3), control group-58.8 (33.1); p-0.002]. There was also a significant improvement in SRH knowledge [intervention group – 28.5(13.6), control group - 21.8 (12.9); p-0.02] and attitude [intervention group - 8.4, control group -3.1; p-0.017] among students in the intervention group. Developing and delivering a new educational intervention for SRH education based on situational analysis proved successful with regard to the improvement of SRH teaching skills and knowledge among teachers and students. Thus it is recommended to use this intervention in more settings and to include it into the school curriculum. DOI: http://dx.doi.org/10.4038/sljss.v31i1-2.5461 Sri Lanka Journal of Social Sciences 2008/2009 31/32 (1 & 2) 17-25

BackgroundPersons with disabilities comprise more than one billion people in the world, yet they are one of the most discriminated groups and face significant health disparities. Particularly in developing countries, which contain 80% of the entire population with disabilities, these individuals experience major barriers in accessing sexual and reproductive health (SRH) services. Education is an important factor that greatly affects individuals’ SRH service utilization. Hence, we sought to investigate the relationship between education and SRH service utilization for persons with disabilities in Bangladesh.MethodsUsing an explanatory sequential mixed-methods design, a total of 5000 persons with disabilities were surveyed for the quantitative component and 15 mini-ethnographic case studies were conducted with persons with disabilities for the qualitative component. Chi-squared tests and logistic regression analyses were performed on the survey data, while the qualitative interviews were coded and their SRH themes synthesized accordingly.ResultsOur quantitative findings show that education statistically significantly increases persons with disabilities’ SRH service utilization of antenatal care, delivery care, postnatal care, and family planning (P < 0.05). Interestingly, for persons with disabilities, primary education shows increased adjusted odds of family planning use but is likely not enough to increase antenatal care, delivery care, or postnatal care use; secondary or post-secondary education may be required to improve utilization of these latter services. Qualitative findings support the association between higher education levels and greater SRH service use. Persons with disabilities of lower educational attainment held misinformation and distrust in SRH services and experienced mistreatment by SRH healthcare providers, discouraging them from seeking future SRH services.ConclusionsWe report that higher formal education level is associated with greater SRH service use for persons with disabilities in Bangladesh. Formally educating persons with disabilities expands their SRH knowledge and familiarity with SRH services, as well as leads to more economic opportunities so they can afford SRH services. Increasing formal education levels for persons with disabilities, paired with integrating comprehensive sexuality education (CSE) in their schools, will likely help close the gap in SRH health disparities for this vulnerable population.

“They're scared that somebody's gonna judge them”: Female African American youth in foster care's perspectives on sexual and reproductive health communication with caregivers

Introduction. Despite progress in Sexual and Reproductive Health (SRH) in Moldova, adolescents still face barriers accessing accurate health information and services. To address these issues, a digital resource called the YK App was developed to enhance health literacy and healthcare access for Moldovan and refugee youth. Material and methods. Three regional focus group discussions were conducted with 50 youths aged 15-24, including Ukrainian refugees. These discussions, held in multiple languages, explored participants' SRH knowledge, information sources, barriers, and enablers Qualitative data and socio-demographic profiles were analyzed thematically and descriptively. Results. Participants rely strongly on social media for SRH information, revealing significant gaps in awareness, particularly on contraception, sexually transmitted infections, puberty and menstruation. While healthcare professionals are seen as credible sources, shame and fear of rejection often prevent direct involvement with healthcare services. Anonymity, confidentiality, and use of digital platforms were identified as key facilitators for accessing SRH information. Conclusions. The findings emphasize the potential of a digital, youth-focused SRH resource that adolescents can use independently. Key elements include clear, easy-to-understand formats such as audio and video content, and collaboration with health professionals and official health organizations to ensure credibility.

ObjectiveIn China, policy and social taboo prevent unmarried adolescents from accessing sexual and reproductive health (SRH) services. Research is needed to determine the SRH needs of highly disadvantaged groups, such as adolescent female sex workers (FSWs). This study describes SRH knowledge, contraception use, pregnancy, and factors associated with unmet need for modern contraception among adolescent FSWs in Kunming, China.MethodsA cross-sectional study using a one-stage cluster sampling method was employed to recruit adolescents aged 15 to 20 years, and who self-reported having received money or gifts in exchange for sex in the past 6 months. A semi-structured questionnaire was administered by trained peer educators or health workers. Multivariable logistic regression was conducted to determine correlates of low knowledge and unmet need for modern contraception.ResultsSRH knowledge was poor among the 310 adolescents surveyed; only 39% had heard of any long-acting reversible contraception (implant, injection or IUD). Despite 98% reporting not wanting to get pregnant, just 43% reported consistent condom use and 28% currently used another form of modern contraception. Unmet need for modern contraception was found in 35% of adolescents, and was associated with having a current non-paying partner, regular alcohol use, and having poorer SRH knowledge. Past abortion was common (136, 44%). In the past year, 76% had reported a contraception consultation but only 27% reported ever receiving SRH information from a health service.ConclusionsThis study demonstrated a low level of SRH knowledge, a high unmet need for modern contraception and a high prevalence of unintended pregnancy among adolescent FSWs in Kunming. Most girls relied on condoms, emergency contraception, or traditional methods, putting them at risk of unwanted pregnancy. This study identifies an urgent need for Chinese adolescent FSWs to be able to access quality SRH information and effective modern contraception.

Comprehensive sexuality education (CSE), including critical reflection on gender norms and unfavourable power relations, has been theorised to affect various health and social outcomes among adolescents. This systematic review aimed to synthesise evidence on the effectiveness of school-based CSE addressing gender and power topics on adolescents’ sexual and reproductive health (SRH) and relationships outcomes. We screened six databases for evaluations of school-based CSE programmes. We included outcome evaluations of interventions addressing SRH, gender, and power through a critical reflection and empowerment approach. Intervention effects were synthesised in effect direction plots. We identified 12 articles evaluating 11 interventions in four countries. Positive effects were found for most healthy relationships outcomes and for outcomes related to adolescents’ SRH knowledge, attitudes, and intentions. Effects on SRH behaviours were more mixed. CSE programmes addressing gender and power appeared more effective than sexuality education without this content. Gender roles and norms play a crucial role in shaping adolescents’ relationships and should be addressed as part of a comprehensive approach to sexuality education. However, in the light of some inconclusive outcomes, CSE with gender and power content needs to be more rigorously evaluated than hitherto in more diverse social and cultural contexts.