Adolescent Sexual And Reproductive Health Research Articles

Understanding the contents and gaps in sexual and reproductive health toolkits designed for adolescence and young adults: a scoping review.

Adolescence is a crucial stage of physical and sexual maturation and development and a period in which understanding sexual and reproductive health (SRH) is important. SRH interventions and toolkits provide a range of valuable resources and information to young people, educators, and members of the community on numerous topics, including contraception and puberty. The usefulness and reliability of these available toolkits have not been previously studied, thus limiting our understanding of their appropriateness and contents. Hence, this scoping review aimed to synthesize the available toolkits aimed at the SRH of adolescents and young adults to understand the contents, design, and information gaps. A systematic search was conducted of 6 medical databases and 12 gray literature sites. Sixteen toolkits published globally before May 2023 were included in our review. The majority of toolkits (n = 12) contained information related to general SRH knowledge and contraception, whereas only 3 contained information on teenage pregnancy. We found that aiming the toolkits toward educators and health care workers was a favorable design over targeting adolescents and young adults directly and that vulnerable youth-including LGBTQI+ (lesbian, gay, bisexual, transgender, queer or questioning, asexual or allied, intersex, and additional identities) and youth from humanitarian settings-were not well represented. We identified key gaps in the inclusion of information in a range of SRH topics, such as LGBTQI+ sexuality, teenage pregnancy, and safe abortion, in the currently available SRH toolkits and their lack of applicability in a global context. Furthermore, we provide recommendations for areas of improvement to encourage adolescents' agency in their SRH education.

A scoping review of strategies for adolescents' sexual and reproductive health role modelling.

Individuals strive to maintain their sexual and reproductive health (SRH) by being exposed to correct information, having access to contraceptives, and promoting safe sex practices. Adolescent SRH promotion efforts should consider the influence of role models. This review explored the availability and nature of strategies and programmes on adolescents' SRH role modelling and described them using a scoping review. Studies were retrieved from four databases and grey literature through a search of 223 studies. The databases included EBSCO-host, Medline, Sabinet, and Pubmed. Data extraction was guided by a data-extraction tool adapted from the JBI Manual for Evidence Synthesis. The characteristics of the selected studies were recorded in a Microsoft spreadsheet. Eleven studies published between 2014 and 2022 were included for the final review and analysed using thematic analysis. Selected articles focused on adolescents' SRH; however, only two studies focused particularly on role modelling. Nonetheless, some aspects of the findings and recommendations presented could be extrapolated to adolescents' SRH role modelling. This includes adolescent-parent communication on SRH, community engagement, mentoring, positive role modelling, and information sharing through media campaigns. There is a lack of literature on SRH role modelling because most studies did not focus on role modelling as an aspect of SRH. Therefore, research needs to be conducted on strategies and programmes focusing on SRH modelling.Contribution:The findings of this scoping review may encourage the development and implementation of strategies and programmes targeting adolescents' SRH throughout diverse communities to promote adolescent SRH.

An Overview Review of Understanding the Need for Adolescents Sexual and Reproductive Health Interventions

Adolescents are the most vulnerable group, who are denied to access information and guidance related to sexual and reproductive health needs because of the social taboos that lead them to encumbrances. This review study helps to understand the different perspectives of sexual and reproductive health based on cultural, sociological, physiological, and economical aspects. The paper explains sexuality from the theoretical perspectives. Adolescence is the transitional stage where physiological, biological, and psychological changes occur, at the same time proper knowledge about sexual and reproductive health should be provided with importance of sexual and reproductive health interventions. It intricates the availability and effectiveness of adolescent sexual and reproductive health (ASRH). The methodology is a systematic review with PRISMA guidelines sourced from various databases of PubMed databases, Research Gate, Science Direct, BMC Public Health, Web of Science, SAGE, Scopus, WHO library, and other websites relevant to this study. The recent literature highlighted the importance of sexual and reproductive health interventions among adolescents. The study has concluded with the findings impact of Adolescent Sexual and Reproductive Health (ASRH) intervention programmes and to develop an increase in effective ASRH programmes, which will help the adolescents to know the importance of sexual hygiene and reproductive hygiene.

Effects of an intervention to improve sexual and reproductive health on level and predictors of awareness and knowledge of condoms and dual protection amongst adolescents in Nigeria

BackgroundAdolescents need both information about sexual behaviours and potential risks in order to make the right choices. This study compared adolescents’ level of awareness and predictors of knowledge of condoms and dual protection where a multi-component sexual and reproductive health (SRH) intervention was implemented and in communities where the intervention was not implemented, so as to understand the effect of the intervention on awareness and knowledge and also identify predictors of knowledge of contraception methods.MethodsThe study was an intervention study that was undertaken in six local government areas (three rural and three urban LGAs) in Ebonyi state, southeast Nigeria. Data were collected from 855 adolescent boys and girls, using a pre-tested interviewer administered questionnaire. Systematic random sampling technique was used to select eligible households from which adolescents were interviewed Analysis of data was carried out using bivariate and multivariate linear regression analyses. The level of statistical significance was determined by a p value of < 0.05.ResultsThe level of awareness of condoms and dual protection was similar in the intervention and non-intervention communities. However, the predictors of knowledge about condoms and dual protection were different between the intervention and non-intervention groups. The multivariate linear regression showed that the higher the level of education, the higher the level of awareness of contraception methods among adolescents (p < 0.05). Likewise, increasing age by one year and working for pay increased the awareness of condoms and dual protection(p < 0.05).ConclusionThere was no difference in the level of awareness of pregnancy prevention methods, knowledge of condoms and dual protection in both arms of the study. Higher level of education, increasing age, and working for pay are factors associated with awareness of condom and dual protection. These factors should be prioritized for effective Adolescent sexual and reproductive health (ASRH) programming.

Female adolescent sexual reproductive health service utilization concerns: A qualitative enquiry in the Tema metropolis of Ghana.

Evidence globally indicates that female adolescents face numerous sexual and reproductive health (SRH) risks. Utilization of sexual reproductive health services among adolescents is of global health importance and plays a crucial role in adolescent sexual reproductive health outcomes and their quality of life. The current study explored sexual reproductive health service utilization concerns among female adolescents in the Tema Metropolis in Southern Ghana using the Anderson and Newman Behavioural model of Health Service Utilization as a guiding framework. The study utilized a qualitative exploratory descriptive design. Purposive sampling was used to recruit female adolescents. In-depth face-to-face interviews were conducted using a semi-structured interview guide. In all, 12 interviews were conducted. Each interview lasted between 45 and 60 minutes. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic content analysis. Thematic analysis was guided by the constructs of the Anderson and Newman Behavioural model of health service utilization. Utilization of sexual reproductive health services among female adolescents is low in the Tema metropolis. Factors such as unprotected non-consensual sexual activity or an unwanted pregnancy sometimes triggered the use of these services. Barriers to utilization identified include lack of awareness on sexual reproductive health services, unreliable sources of SRH information, underestimation of the severity of sexual reproductive health problems faced, unmet expectations and poor experiences with service providers. The current study identified poor utilization of sexual reproductive health services among female adolescents within the Tema metropolis of Ghana. There is the need to increase the number of adolescent health corners, increase awareness about SRH services among adolescents, improve parent-child SRH communication and provide adequate training for healthcare providers to improve provider attitude towards adolescent SRH service delivery in order to increase utilization of sexual reproductive health services among female adolescents in the Metropolis.

Digital Knowledge Translation Tools for Disseminating Sexual and Reproductive Health Information to Adolescents: Protocol for an Evidence Gap Map Review.

Digital or eHealth knowledge translation (KT) interventions have been identified as useful public health tools, particularly to advance sexual and reproductive health (SRH) among adolescents. Existing literature reviews on digital health interventions for adolescents' SRH demonstrate limitations, including shortcomings in reporting and comprehensiveness that limit the utility and trustworthiness of findings. However, there is a lack of evidence synthesis on the effectiveness of available digital or mobile health KT tools to promote SRH interventions for adolescents. We aim to identify, map, and describe existing empirical evidence on the digital KT tools developed to improve adolescent SRH outcomes globally. This study will be conducted using an evidence gap map (EGM) approach to address the objectives, including reviewing relevant literature and a landscape analysis of the outcomes of interest. The following electronic databases will be searched for retrieval of literature: MEDLINE (1946-present), Embase (1974-present), and Global Health (1910-present) via OVID; CINAHL (1936-present) via EBSCOhost; Scopus (1976-present); and Cochrane Library (1993-present) via Wiley. We will include only those studies that focused on adolescents aged 10-19 years and addressed SRH outcomes. We will include experimental studies (randomized or cluster randomized and nonrandomized controlled trials, including quasi-randomized, controlled before-after, and interruptive time series) and observational studies, that is, including prospective cohort and case-control studies. The experimental and observational studies will only be included in the presence of control or comparison arms. Studies with a historical control arm will be excluded. The systematic review software, Covidence (Ventas Health Innovation), will be used to screen and select the studies. Further, 2 independent reviewers will complete the first and second levels of screening of studies and any conflicts arising will be resolved by consensus between the 2 reviewers or by involving the third reviewer. We will conduct the quality assessment of all included studies using the Risk of Bias tool for randomized controlled trials and nonrandomized controlled trials, and AMSTAR2 for systematic reviews. Papers screening, data extraction, and synthesis will be completed by March 2024. We will use EPPI-Mapper (The International Public Policy Observatory) software to generate an online evidence map and to produce the tables and figures for the descriptive report. This EGM review will identify areas with high-quality, evidence-based digital KT tools (for immediate scale and spread) and areas where few or no KT tools exist (for targeted KT tool development and research or policy prioritization). This protocol focused on mapping eHealth KT tools that have been used in the literature to address SRH among adolescents. This will be the first EGM exercise to map digital KT tools to promote adolescents' SRH and will incorporate a range of published sources. DERR1-10.2196/55081.

Assessment of Structural and Process Factors in Delivering Quality Adolescent Sexual and Reproductive Health Services in Ghana.

Sexual and reproductive health services are often underserved to adolescents in many societies. For many of these sexually active adolescents, reproductive health services such as the provision of contraception and treatment for sexually transmitted infections, either are not available or are provided in a way that makes adolescents feel unwelcome and embarrassed. This study assessed the structural and process factors available in delivering quality adolescent sexual and reproductive health (ASRH) services in health facilities across three regions in Ghana. A facility-based descriptive cross-sectional study assessed the structural and process factors available for delivering quality adolescent sexual reproductive health services in 158 selected health facilities across three regions (Oti, Eastern, and Volta) of Ghana. A simple random sampling by balloting was used to select the health facilities and a total of 158 adolescents who used ASRH services in the selected facilities were sampled for an existing interview. The Donabedian model of quality assessment was adopted and modified into an assessment tool and a questionnaire to assess the selected health facilities and respondents. The Statistical Package for the Social Sciences (SPSS) version 20.0 was used to analyze the data collected and the findings presented in the tables. The study found some structural and process barriers that affected the delivery of quality ASRH services in Ghana. A proportion of 85 (53.50%) of the facilities assessed did not have separate spaces for delivering services for adolescents. All 158 health facilities had the National Health Insurance Scheme (NHIS) covering contraceptive/family planning services for adolescents. Most (128, 81.01%) facilities had available educational materials on ASRH but were not made available for take home by adolescents. The findings indicated that most respondents did not require parental, spouse, or guardian consent before using ASRH services. The average waiting time for adolescents to be attended to by service providers was ≤30 minutes. The study found some structural and process barriers that affected the delivery of quality ASRH services in Ghana. ASRH services, particularly contraceptive/family planning services, were well integrated into NHIS to improve access and utilization by adolescents.

A qualitative assessment of the impact of a community-embedded intervention on beneficiaries' attitudes and beliefs about adolescent sexual reproductive health in Ebonyi State, Southeast, Nigeria

BackgroundAdolescents and their communities in Ebonyi State, Nigeria have poor attitudes and beliefs towards adolescent sexual and reproductive health (SRH). This paper reports on the effects of a community-embedded intervention that focused on creating positive changes in the attitudes and beliefs of adolescents and community members to enhance adolescents’ access to SRH information and services. MethodsThis study adopted the Qualitative Impact Assessment approach to evaluate the changes in attitudes and beliefs about the SRH of adolescents from the perspectives of the beneficiaries of a community-embedded intervention namely, adolescents, parents, school teachers, and community leaders. The intervention was implemented in six local government areas in Ebonyi State, southeast Nigeria and the evaluation was undertaken four months after the implementation of the interventions commenced. Eighteen (18) interviews were conducted with 82 intervention beneficiaries including: (i) six in-depth interviews with school teachers; (ii) two sex-disaggregated FGDs with parents; (iii) two sex-disaggregated FGDs with community leaders; and (iv) eight sex-disaggregated FGDs with in school and out of school adolescents. A thematic analysis of data was performed with the aid of NVivo software, version 12.ResultsThe community-embedded intervention led to changes in individual attitudes and beliefs, as well as changes in community norms and values concerning adolescent SRH. Adolescents reported that following the community-embedded SRH intervention, they have become more comfortable discussing openly SRH issues with their peers, and they could more easily approach their parents and initiate SRH discussions. The parents of adolescents reported that following the intervention, they have become more willing to discuss sensitive SRH issues with adolescents, and frequently make out time to do so. It was also reported that parents no longer use euphemisms to describe sexual body parts, and community leaders now believe that it is all right to discuss SRH with adolescents. Hence, initiating or having SRH discussions with adolescents is no longer misconceived as encouraging sex, and menstruation in unmarried adolescents is no longer viewed as a sign of promiscuity. Respondents also highlighted changes in community norms of, (i) gendered parental communication of SRH matters, as both mothers and fathers have started discussing SRH issues with their adolescent boys and girls; and (ii) public shaming and discipline of pregnant teenage girls are on the decline.ConclusionThe community-based intervention had a positive impact on individual attitudes and beliefs, as well as community and societal values and norms about adolescent SRH. Interventions that take into account community norms and values regarding adolescent SRH should be prioritized to enable the achievement of the SRH-related target of SDG 3.

Adolescents Knowledge and Attitude towards Sexual and Reproductive Health in Bhopal (Madhya Pradesh)

With a staggering adolescent population of 253 million, India stands as the world's epicenter of youth. Adolescence, a distinctive phase marked by active physical and psychological growth, often initiates the exploration of romantic and sexual realms. Adolescents are particularly susceptible to various reproductive and sexual health vulnerabilities such as unintended pregnancies, sexually transmitted infections, reproductive tract infections, and the heightened risk of maternal and infant mortality. This susceptibility is accentuated in regions where healthcare services are constrained and knowledge regarding health matters is limited. A descriptive cross-sectional survey was conducted in the year 2022, with due ethical considerations, among students in the 9th to 12th grades (n=322) in Bhopal District, Madhya Pradesh, a region where utilisation of Adolescent Reproductive and Sexual Health (ARSH) services remains notably modest. The objectives were to assess the knowledge and attitudes of adolescents regarding SRH and to find the relationship between the knowledge and attitude. Data was collected in schools from adolescents aged 14 to 18 years, using researcher-developed structured questionnaires. The findings revealed that the majority (50.9%) of participants had poor knowledge, 34.5 percent showed moderate knowledge and 14.6 percent exhibited good knowledge. About 60 percent of the participants expressed a favorable attitude towards sexual and reproductive health (SRH). The relationship between knowledge and attitude was positive but weak. These outcomes collectively underscore the need for improving adolescents' SRH knowledge and attitudes in the region. Focusing efforts towards comprehensive SRH education and promoting well-informed attitudes may help reduce the adolescents’ susceptibility to SRH vulnerabilities.

Acceptability of a community-embedded intervention for improving adolescent sexual and reproductive health in south-east Nigeria: A qualitative study

Introduction Adolescents have limited access to quality sexual and reproductive health (SRH) services that are key to healthy sexual lives in many low and middle-income countries such as Nigeria. Hence, context-specific interventions are required to increase adolescents’ access to and utilisation of SRH. This paper provides new knowledge on the acceptability of a community-embedded intervention to improve access to SRH information and services for adolescents in Ebonyi state, southeast Nigeria. Methods A community-embedded intervention was implemented for six months in selected communities. Thereafter the intervention was assessed for its acceptability using a total of 30 in-depth interviews and 18 focus group discussions conducted with policymakers, health service providers, school teachers, community gatekeepers, parents and adolescents who were purposively selected as relevant stakeholders on adolescent SRH. The interview transcripts were coded in NVivo 12 using a coding framework structured according to four key constructs of the theoretical framework for acceptability (TFA): affective attitude, intervention coherence, perceived effectiveness, and self-efficacy. The outputs of the coded transcripts were analysed, and the emergent themes from each of the four constructs of the TFA were identified. Results The intervention was acceptable to the stakeholders, from the findings of its positive effects, appropriateness, and positive impact on sexual behaviour. Policymakers were happy to be included in collaborating with multiple stakeholders to co-create multi-faceted interventions relevant to their work (positive affective attitude). The stakeholders understood how the interventions work and perceived them as appropriate at individual and community levels, with adequate and non-complex tools adaptable to different levels of stakeholders (intervention coherence). The intervention promoted mutualistic relations across stakeholders and sectors, including creating multiple platforms to reach the target audience, positive change in sexual behaviour, and cross-learning among policymakers, community gatekeepers, service providers, and adolescents (intervention effectiveness), which empowered them to have the confidence to provide and access SRH information and services (self-efficacy). Conclusions Community-embedded interventions were acceptable as strong mechanisms for improving adolescents’ access to SRH in the communities. Policymakers should promote the community-embedded strategy for holistic health promotion of adolescents.

Impact of the COVID-19 pandemic on the sexual and reproductive health of adolescents in Alberta, Canada

PurposeThe COVID-19 pandemic led to major service disruptions in the healthcare sector, especially regarding sexual and reproductive health services. However, the impact of the pandemic on Canadian adolescents is relatively unknown. This study aimed to investigate the impacts of the COVID-19 pandemic and associated public health measures on the sexual and reproductive health (SRH) of adolescents in Alberta, Canada.MethodsA qualitative study using an interpretive description (ID) approach and community-based participatory research principles was conducted to capture the subjective experience and perceptions of adolescents and service providers. With the collaboration of the Adolescent Advisory Group and community partners, 18 adolescents and 15 service providers were recruited for the study through purposive sampling. Findings from the qualitative interviews were analyzed using thematic analysis.ResultsThree major themes emerged from the analysis: (1) COVID-19 SRH experience, (2) barriers to SRH, and (3) adolescent SRH strategies. Our findings highlight numerous barriers and challenges that prevented adolescents from accessing SRH education, products, and services.ConclusionThe COVID-19 pandemic had a profound impact on the SRH and the well-being of adolescents. Our study reflects the need for diverse SRH strategies to maintain continued access to SRH resources during disruptive events, such as the pandemic.

Exploring the culturally sensitive sexual and reproductive health information communication skill needs of parents in Ghana.

Parents play a vital role in the sexual and reproductive health (SRH) of adolescents. Parents' communication with their adolescents regarding SRH is considered an important part of adolescent development, as this contributes to optimising safe SRH. This phase of the study explored the culturally sensitive SRH information communication skill needs of parents, based on their personal and social motivation, within the Ghanaian context. The study was conducted at the Asante Akyem North Municipality of Ghana. This article describes the second phase of an explanatory, sequential, mixed-method study. Following on from the first phase systematic review, this second phase comprised a qualitative descriptive study where 10 purposively sampled parents of adolescents participated in semi-structured interviews to elicit data. Braun and Clarke's thematic data analysis process was applied. Data were saved and managed in Atlas.ti (version 23.0.7). Four themes emerged on communication skills: SRH information, parent and adolescent factors, contextual factors and communication skill needs. Parent and adolescent communication on SRH takes place occasionally. Parents lack the skills to communicate with adolescents regarding SRH. Parents in this context require skills to communicate SRH information with their adolescent children. A culturally appropriate intervention that supports SRH information communication between parents and adolescents may have value in guiding this communication process.Contribution: The findings of this study can contribute to the adaptation of a culturally sensitive SRH information communication intervention in Ghana which will promote adolescent SRH.

Effect of Adolescent Health Policies on Health Outcomes in India

Adolescence is a crucial phase marked by significant physical, psychological, emotional, and social changes. India has the world’s largest adolescent population. Understanding and addressing their health needs is vital for the nation’s social, political, and economic progress. The primary aim of this study was to evaluate the main adolescent health policies and strategies implemented from 2006 to 2020 and analyze the outcomes for adolescent health in India. To achieve this objective, the research adopted a mixed-method approach, combining qualitative and quantitative analyses of health policies, strategies, and programs implemented since 2005. Additionally, data from the most recent three Demographic Health Surveys (DHSs) were analyzed and compared to assess changes in adolescent health indicators after implementing these policies/strategies. The findings focused on India’s major adolescent health policies, namely the Adolescent Reproductive and Sexual Health (ARSH) Strategy2005, Rashtriya Kishor Swasthya Karyakram (RKSK) 2014, and the School Health Program 2020. All the strategies and programs aim to provide a comprehensive framework for sexual and reproductive health services, expand the scope of adolescent health programming, and address various health aspects. The analysis highlighted strengths in targeted interventions, monitoring, and promotion but weaknesses in awareness, societal barriers, and healthcare worker participation. Opportunities include female-friendly clinics and education about early pregnancy, while addressing substance abuse and training volunteers remain challenges. Family planning has improved with higher contraception usage and a decline in unmet needs. The incidence of violence decreased, and positive health behaviors increased, such as condom use. However, challenges remain, including limited access to health services, concerns about female providers, and low health insurance coverage. Nutrition indicators showed a slight increase in overweight/obesity and anemia rates. In conclusion, progress has been made, but certain adolescent health aspects still require attention. Further efforts are needed to achieve universal health coverage and improve adolescent health outcomes. Conducting targeted awareness campaigns, strengthening health worker and NGO engagement, and combating the increasing prevalence of overweight and obesity among adolescents are recommended.

The effectiveness of combined approaches towards improving utilisation of adolescent sexual and reproductive health services in Kenya: a quasi-experimental evaluation

Adolescent sexual and reproductive health (ASRH) services are key to improving the health of adolescents. This study aimed to establish the effectiveness of an intervention that combined activities in health facilities and communities in Kenya to increase utilisation of ASRH services. A quasi-experimental evaluation design was used to assess the effectiveness of the intervention. Using a stratified cluster sampling approach, two cross-sectional household surveys targeting girls aged 15–19 were conducted at baseline (September 2019) and endline (December 2020) in intervention and comparison. We combined the difference-in-difference approach to analyse the net change in outcomes between intervention and comparison arms of the study at baseline and endline and coarsened exact matching for variables that were significantly different to address the imbalance. There were a total of 1011 participants in the intervention arm and 880 in the comparison arm. Descriptive results showed a net increase of 12.7% in intervention sites in the knowledge of misconceptions about sex, pregnancy, and contraception, compared to 10.4% in the control site. In the multivariate regression analysis, two outcomes remained significant: decreases in adolescents’ discomfort when seeking ASRH services because of either fear of parents (aPR = 0.58, 95% CI = 0.42–0.79, P = 0.001) or a lack of support from their partner (aPR = 0.25, 95% CI = 0.08–0.82, P = 0.023). The intervention combining a facility and community approach was not effective in increasing the use of ASRH information and services. Possible reasons for this are explored.

Findings from the Tushirikiane mobile health (mHealth) HIV self-testing pragmatic trial with refugee adolescents and youth living in informal settlements in Kampala, Uganda.

Urban refugee youth remain underserved by current HIV prevention strategies, including HIV self-testing (HIVST). Examining HIVST feasibility with refugees can inform tailored HIV testing strategies. We examined if HIVST and mobile health (mHealth) delivery approaches could increase HIV testing uptake and HIV status knowledge among refugee youth in Kampala, Uganda. We conducted a three-arm pragmatic controlled trial across five informal settlements grouped into three sites in Kampala from 2020 to 2021 with peer-recruited refugee youth aged 16-24 years. The intervention was HIVST and HIVST + mHealth (HIVST with bidirectional SMS), compared with standard of care (SOC). Primary outcomes were self-reported HIV testing uptake and correct status knowledge verified by point-of-care testing. Some secondary outcomes included: depression, HIV-related stigma, and adolescent sexual and reproductive health (SRH) stigma at three time points (baseline [T0], 8 months [T1] and 12 months [T2]). We used generalized estimating equation regression models to estimate crude and adjusted odds ratios comparing arms over time, adjusting for age, gender and baseline imbalances. We assessed study pragmatism across PRECIS-2 dimensions. We enrolled 450 participants (50.7% cisgender men, 48.7% cisgender women, 0.7% transgender women; mean age: 20.0, standard deviation: 2.4) across three sites. Self-reported HIV testing uptake increased significantly from T0 to T1 in intervention arms: HIVST arm: (27.6% [n = 43] at T0 vs. 91.2% [n = 135] at T1; HIVST + mHealth: 30.9% [n = 47] at T0 vs. 94.2% [n = 113] at T1]) compared with SOC (35.5% [n = 50] at T0 vs. 24.8% [ = 27] at T1) and remained significantly higher than SOC at T2 (p<0.001). HIV status knowledge in intervention arms (HIVST arm: 100% [n = 121], HIVST + mHealth arm: 97.9% [n = 95]) was significantly higher than SOC (61.5% [n = 59]) at T2. There were modest changes in secondary outcomes in intervention arms, including decreased depression alongside increased HIV-related stigma and adolescent SRH stigma. The trial employed both pragmatic (eligibility criteria, setting, organization, outcome, analysis) and explanatory approaches (recruitment path, flexibility of delivery flexibility, adherence flexibility, follow-up). Offering HIVST is a promising approach to increase HIV testing uptake among urban refugee youth in Kampala. We share lessons learned to inform future youth-focused HIVST trials in urban humanitarian settings.

A systematic review of effective parent-adolescent sexual and reproductive health information communication in lower- and middle-income countries

Background: Parents play an important role in the sexual and reproductive health (SRH) of their adolescents. Parent–adolescent SRH information communication is cardinal and is expected to improve SRH outcomes of adolescents.Aim: The aim of this systematic review was to search for effective SRH information communication interventions in lower- and middle-income countries (LMICs) to inform the adaptation of parent–adolescent SRH information communication intervention.Method: This is the first phase of an explanatory sequential mixed method study. The systematic review was carried out by employing Joanna Briggs Institute software for reviews. Search sources included Cochrane Reviews Library, EMBASE, CINAHL, PubMed, OVID, Scopus, Web of Science and Science Direct. A systematic search strategy was formulated, making use of the key terms: adolescent, teenager, youth, parent, mother, father, caregiver, reproductive, sexual, health, information, communication and intervention.Results: Five articles met the inclusion criteria for full-text screening. The interventions included addressed sociodemographic covariates; parent–adolescent general communication; parental monitoring; parent–adolescent communication about sex-related topics; parent’s sexual communication skills; parent’s self-efficacy in sexual communication; parent’s responsiveness to sexual communication; communication frequency; quality of sex‑related communication and information-motivational-behavioural skills.Conclusion: Findings suggest that evidence-based SRH information communication interventions are effective in improving parent–adolescent SRH information communication to optimise safe SRH behaviour in LMICs.Contribution: This systematic review identified effective SRH information communication interventions in LMICs, which can form the basis of further qualitative exploration for adaptation of a culturally sensitive intervention in Ghana.

The effect of the anglophone crisis on youth sexual and reproductive health in the Northwest region of Cameroon: a qualitative study

Background The ongoing armed conflict in the two English-speaking regions of Cameroon, named the “Anglophone crisis”, has had a deleterious impact on the health and wellbeing of the populations inhabiting these regions, especially adolescents and youth, but there is sparse evidence on the effect of the crisis on adolescent and youth sexual and reproductive health (SRH). This study aimed to describe the effects of the crisis on adolescent SRH and identify stakeholder recommendations for strategies to address the SRH of youth in their crisis-impacted communities. Methods This was a secondary analysis of qualitative data collected during discussion forums with 316 community stakeholders, including parents (n=63), youths (n=81), religious leaders (29), neighborhood leaders (n=23), secondary school teachers (n=28), health professionals (n=37), pharmacists (n=5), local drug vendors (n=13), media representatives (n=12), and non-governmental organization representatives (n=29), in Bamenda, northwest region, Cameroon. A total of 12 homogenous discussion groups of 5 to 41 participants in each were conducted between May and July 2020. Session recordings were transcribed and then analyzed using Dedoose qualitative data management software and a text analysis approach. Results The results indicate that the crisis led to internal displacements and idleness among adolescent and youth, which increased their social and economic vulnerabilities, including to sexual violence and transactional sex. Resulting SRH effects were unplanned pregnancies, sexually transmitted Infections, unsafe abortions, maternal mortality, and psychosocial distress. Community stakeholders recommended that strategies to improve adolescent and youth SRH outcomes in these conflict-hit regions focus on spreading information about SRH, providing SRH services, and addressing issues of idleness. Conclusions The armed conflict in the Northwest region of Cameroon has had consequences on adolescent and youth’s adverse SRH outcomes, such as unintended pregnancies, transactional sex, rapes, unsafe abortions, and maternal death. The findings of this study highlight the importance of raising awareness on SRH risks of adolescents and youth and the necessity of adopting a community approach in developing interventions and policies to improve adolescent and youth SRH in regions affected by armed conflicts.

Validation of the Adolescent Health Quality of Care (AHQOC) index for mystery client studies.

The Adolescent Health Quality of Care (AHQOC) index is a tool designed to evaluate the quality of facility-based adolescent sexual and reproductive health (ASRH) services. This descriptive cross-sectional study aimed to validate the AHQOC index in 27 primary and secondary public health facilities located in a rural and an urban local government area (LGA) of Ogun State, Nigeria. To conduct the study, 12 mystery clients (MCs) were recruited and performed 144 visits to the health facilities. The MCs were young males and females who were seeking information on premarital sex, pregnancy prevention, sexually transmitted infections (STIs), and contraception. The validity, and reliability of the AHQOC index were evaluated using exploratory factor analysis, Cronbach's Alpha, and intra-class correlation coefficient tests. The Kaiser-Meyer-Olkin test result for the initial 37-item pool was 0.7169, and the final tool retained 27 items with a Cronbach's Alpha of 0.80. Two subscales of the index had Cronbach's Alpha of 0.76 and 0.85. The intra-rater consistency assessed by the intra-class correlation coefficient was 0.66 (0.10-0.92) p = 0.001 for the urban LGA and 0.72 (0.37-0.91) p = 0.001 for the rural LGA. Positive and statistically significant relationships were observed between the full scales and subscales and the validity item (MC ranking of health worker on proficiency from 1 to 10). The results of this study demonstrate that the validated AHQOC index is a valuable tool for assessing the quality of ASRH services in public health facilities.

Narratives of most significant change to explore experiences of caregivers in a caregiver-young adolescent sexual and reproductive health communication intervention in rural south-western Uganda.

This paper presents findings from a qualitative effectiveness evaluation of an intervention aimed at improving caregiver-young adolescent sexual and reproductive health (SRH) communication including training modules for caregivers on parent-child SRH communication. Data was collected (October 2021-November 2021) using a narrative interviewing technique with thirty caregivers (8 males and 22 females), who received the parent-child communication intervention in Mbarara district, south-western Uganda. We explored caregivers' experiences with the intervention based on four domains of change: caregiver-young adolescent communication on SRH issues, knowledge and attitudes towards adolescent SRH, parenting skills, and personal life and family. Thematic analysis was used to code and analyse the data, with attention to gender differences. Findings highlight positive parenting as a key attribute of SRH communication, along with a transformation of knowledge and attitudes towards the SRH of young adolescents leading to an overall improvement in SRH communication. However, communication is still limited to comfortable topics. Our findings indicate improved caregiver-adolescent SRH communication practices following a community intervention. Programming for adolescent health on broader sexuality topics, comfortability and attitude change among caregivers could promote behaviour change on a long term. Future studies may focus on the long term impacts of interventions of this nature and test interventions aimed at addressing comfortability with discussingSRH issues.

A cross-sectional study of knowledge and practices related to sexual and reproductive health among adolescents in 'unrestricted environments' in Ghana: A policy implementation context view

Background: Sexual and reproductive health (SRH) is key to the growth and development of adolescents. Inadequate information exposes adolescents to some challenges. This becomes more pronounced as they move from restricted unrestricted environments such as pertains universities where there is virtually no control. It is importantto assess their knowledge of issues related to adolescent sexual and reproductive health (ASRH) needs and how that knowledge influences their sexual practices. Objective: To assess the knowledge and practice of adolescents in public universities across Ghana on their SRH needs. Study Participants: 672 adolescents from the three selected public institutions who met the inclusion criteria and consented to the study. Study Setting: The Study Setting was the University of Professional Studies Accra (UPSA); Kwame Nkrumah University of Science and Technology (KNUST), Kumasi; and the University for Development Studies (UDS) in Tamale, all in Ghana. Study Design: A cross-sectional study of adolescents in public universities across Ghana. Results: The study found that over 80% of university respondentshad high knowledge of ASRH issues. However, more than two-thirds (67%) of the respondents indicated that they had no knowledge that sexually transmitted infections (STIs) could be transmitted through unprotected sex. Regarding their sexual practices, the study found that 70% of the respondents were sexually active however, the prevalence of contraceptive use among them was extremely low (7%). Conclusion: A high level of knowledge on SRH issues among a large proportion of sexually active adolescents does not correspond to levels of practising safe sex making themsusceptible to STIsand unplanned pregnancies. Knowledge was thus disproportionally associated with safe sexual practices among adolescents in the unrestricted environments surveyed. Implementing behavioural change interventions through sexual education and improved access to ASRH services could improve the situation. These findings are thus relevant for SRH policy reforms and implementation programmes.