Health Policy Research Group, University of Nigeria Nsukka, Enugu, Nigeria.
Department of Community Medicine, Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria.
Reprod Health. 2024 Jan 11;21(1):5. doi: 10.1186/s12978-024-01738-9.
Adolescents 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.
This 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.
The 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.
The 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.
尼日利亚埃邦伊州的青少年及其社区对青少年性与生殖健康（SRH）持有不良态度和观念。本文报告了一项社区嵌入式干预的效果，该干预侧重于改变青少年和社区成员的态度和观念，以增强青少年获取 SRH 信息和服务的机会。
本研究采用定性影响评估方法，从社区嵌入式干预的受益者（即青少年、父母、学校教师和社区领袖）的角度评估青少年对 SRH 的态度和观念的变化。该干预在尼日利亚东南部埃邦伊州的六个地方政府区实施，评估是在干预实施四个月后进行的。对 82 名干预受益人的 18 次访谈包括：（i）对六名学校教师进行了六次深入访谈；（ii）对父母进行了两次按性别分组的焦点小组讨论；（iii）对社区领袖进行了两次按性别分组的焦点小组讨论；（iv）对在校和校外青少年进行了八次按性别分组的焦点小组讨论。使用 NVivo 软件版本 12 对数据进行了主题分析。
社区嵌入式干预导致了个体态度和观念的变化，以及社区对青少年 SRH 的规范和价值观的变化。青少年报告说，在社区嵌入式 SRH 干预之后，他们更愿意与同龄人公开讨论 SRH 问题，并且更容易与父母接触并发起 SRH 讨论。青少年的父母报告说，在干预之后，他们更愿意与青少年讨论敏感的 SRH 问题，并且经常抽出时间这样做。也有人报告说，父母不再使用委婉语来描述性身体部位，社区领袖现在认为与青少年讨论 SRH 是可以的。因此，与青少年进行或发起 SRH 讨论不再被误解为鼓励性行为，未婚青少年的月经也不再被视为淫乱的迹象。受访者还强调了社区规范的变化，（i）父母在性别方面对 SRH 问题的沟通，因为父母双方都开始与他们的青少年男孩和女孩讨论 SRH 问题；（ii）对怀孕少女的公开羞辱和纪律处分正在减少。
基于社区的干预对青少年 SRH 的个人态度和观念以及社区和社会的价值观和规范产生了积极影响。应该优先考虑考虑到青少年 SRH 相关社区规范和价值观的干预措施，以实现可持续发展目标 3 中的与 SRH 相关的目标。
