Health Policy Research Group, University of Nigeria Nsukka, Enugu, Nigeria.
Department of Sociology/Anthropology, University of Nigeria, Nsukka, Enugu, Nigeria.
BMC Health Serv Res. 2024 May 19;24(1):643. doi: 10.1186/s12913-024-11103-y.
School and Community-embedded reproductive health interventions have been implemented in developing countries, with evidence that they led to improved sexual and reproductive health among adolescents. However, this type of intervention is rarely evaluated for its potential adoption and use. This study evaluated the constraints and enablers of the adoption of a school and community-embedded intervention that used community engagement, capacity building, partnerships and collaborations to deliver sexual and reproductive health services to adolescents.
The intervention was implemented between 2019 and 2021 in six local government areas in Ebonyi State. The results on adoption presented here were collected four months into the mid-phase of the project, targeting adolescents, parents, adult family members, healthcare providers, local authorities, and community members. Sixteen in-depth interviews were conducted with policymakers, 14 with health service providers and 18 Focus Group Discussions (FGDs) with parents, community leaders and adolescents who were part of the implementation process. The coding reliability approach, a type of thematic data analysis was used, that involves early theme development and the identification of evidence for the themes.
The adoption of school and community-embedded reproductive health intervention was strong among stakeholders at the early stages of the implementation process. Multi-stakeholder involvement and its multi-component approach made the intervention appealing, thereby enabling its adoption. However, at the later stage, the adoption was constrained by beliefs and norms about sexual and reproductive health (SRH) and the non-incentivisation of stakeholders who acted as advocates at the community level. The sustainability of the intervention may be threatened by the non-incentivisation of stakeholders and the irregular supply of materials and tools to facilitate SRH advocacy at the community level.
The inclusive community-embedded reproductive health intervention was adopted by stakeholders because of the enablers which include timely stakeholder engagement. However, for it to be sustainable, implementers must address the non-incentivising of community-level advocates which serve as constraints.
学校和社区嵌入式生殖健康干预措施已在发展中国家实施，有证据表明，这些措施改善了青少年的性健康和生殖健康。然而，这种干预措施很少被评估其潜在的采用和使用。本研究评估了采用一种学校和社区嵌入式干预措施的限制因素和促进因素，该措施利用社区参与、能力建设、伙伴关系和合作，向青少年提供性健康和生殖健康服务。
该干预措施于 2019 年至 2021 年在埃邦伊州的六个地方政府区实施。此处呈现的关于采用的结果是在项目中期的四个月收集的，针对的是青少年、家长、成年家庭成员、医疗保健提供者、地方当局和社区成员。与政策制定者进行了 16 次深入访谈，与卫生服务提供者进行了 14 次访谈，并与参与实施过程的父母、社区领导和青少年进行了 18 次焦点小组讨论。采用了编码可靠性方法，这是一种主题数据分析类型，涉及早期主题开发和主题证据的识别。
在实施过程的早期阶段，利益相关者对学校和社区嵌入式生殖健康干预措施的采用非常强烈。多方利益相关者的参与及其多组件方法使干预措施具有吸引力，从而使其得到采用。然而，在后期，由于对性健康和生殖健康的信仰和规范以及对在社区层面充当倡导者的利益相关者没有激励，采用受到限制。由于没有激励社区层面的利益相关者，以及没有定期供应促进社区层面性健康倡导的材料和工具，该干预措施的可持续性可能受到威胁。
包容性社区嵌入式生殖健康干预措施得到了利益相关者的采用，因为其促进因素包括及时的利益相关者参与。然而，为了使其可持续，实施者必须解决社区层面倡导者缺乏激励的问题，这是其采用的限制因素。
