Community based interventions for strengthening adolescent sexual reproductive health and rights: how can they be integrated and sustained? A realist ... View Full Text


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Article Info

DATE

2018-12

AUTHORS

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

ABSTRACT

BACKGROUND: Research that explores how community-based interventions for strengthening adolescent sexual reproductive health and rights (SRHR) can be integrated and sustained in community health systems, is, to the best of our knowledge, very scarce, if not absent. It is important to document mechanisms that shape integration process in order to improve health systems' responsiveness towards adolescents' SRHR. This realist evaluation protocol will contribute to this knowledge in Zambia where there is increased attention towards promoting maternal, neonatal and child health as a means of addressing the current high early pregnancy and marriage rates. The protocol will ascertain: why, how, and under what conditions the integration of SRHR interventions into Zambian community health systems will optimise (or not) acceptability and adoption of SRHR services. This study is embedded within a randomized controlled trial - "Research Initiative to Support the Empowerment of Girls (RISE)"- which aims to reduce adolescent girl pregnancies and marriages through a package of interventions including economic support to families, payment of school fees to keep girls in school, pocket money for girls, as well as youth club and community meetings on reproductive health. METHODS: This is a multiple-case study design. Data will be collected from schools, health facilities and communities through individual and group interviews, photovoice, documentary review, and observations. The study process will involve 1) developing an initial causal theory that proposes an explanation of how the integration of a community-based intervention that aimed to integrate adolescent SRHR into the community health system may lead to adolescent-friendly services; 2) refining the causal theory through case studies; 3) identifying contextual conditions and mechanisms that shape the integration process; and 4) finally proposing a refined causal theory and set of recommendations to guide policy makers, steer further research, and inform teaching programmes. DISCUSSION: The study will document relevant values as well as less formal and horizontal mechanisms which shape the integration process of SRHR interventions at community level. Knowledge on mechanisms is essential for guiding development of strategies for effectively facilitating the integration process, scaling up processes and sustainability of interventions aimed at reducing SRH problems and health inequalities among adolescents. More... »

PAGES

145

References to SciGraph publications

  • 2013-12. Studying complex interventions: reflections from the FEMHealth project on evaluating fee exemption policies in West Africa and Morocco in BMC HEALTH SERVICES RESEARCH
  • 2013-12. How do primary health care teams learn to integrate intimate partner violence (IPV) management? A realist evaluation protocol in IMPLEMENTATION SCIENCE
  • 2010-12. A realist evaluation of the management of a well- performing regional hospital in Ghana in BMC HEALTH SERVICES RESEARCH
  • 2013-12. Resources, attitudes and culture: an understanding of the factors that influence the functioning of accountability mechanisms in primary health care settings in BMC HEALTH SERVICES RESEARCH
  • 2016-12. Effectiveness of a girls’ empowerment programme on early childbearing, marriage and school dropout among adolescent girls in rural Zambia: study protocol for a cluster randomized trial in TRIALS
  • 2011-12. A realist evaluation of the role of communities of practice in changing healthcare practice in IMPLEMENTATION SCIENCE
  • 2011-12. Implementing accountability for reasonableness framework at district level in Tanzania: a realist evaluation in IMPLEMENTATION SCIENCE
  • 2010-12. How to develop a theory-driven evaluation design? Lessons learned from an adolescent sexual and reproductive health programme in West Africa in BMC PUBLIC HEALTH
  • 2010-12. A realist synthesis of randomised control trials involving use of community health workers for delivering child health interventions in low and middle income countries in BMC HEALTH SERVICES RESEARCH
  • 2015-12. Research priorities on ending child marriage and supporting married girls in REPRODUCTIVE HEALTH
  • 2017-12. A new resource for developing and strengthening large-scale community health worker programs in HUMAN RESOURCES FOR HEALTH
  • 2015-12. Supporting close-to-community providers through a community health system approach: case examples from Ethiopia and Tanzania in HUMAN RESOURCES FOR HEALTH
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    http://scigraph.springernature.com/pub.10.1186/s12978-018-0590-8

    DOI

    http://dx.doi.org/10.1186/s12978-018-0590-8

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1106387767

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/30153839


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