Kigongo Eustes, Ekungu Emmanuel, Edmonton Acheka, Auma Anna Grace, Ongom Morris Chris, Samson Udho, Anyolitho Maxson Kenneth, Kabunga Amir, Murara Odette, Akello Judith Abal, Omech Bernard
Department of Environment Health and Disease Control, Lira University, Lira, Uganda.
Department of Nursing, Lira University, Lira, Uganda.
Open Access J Contracept. 2025 Sep 3;16:81-96. doi: 10.2147/OAJC.S550132. eCollection 2025.
Conventional top-down health interventions often exclude adolescents and community stakeholders from service design and implementation, resulting in low uptake and a mismatch with young people's needs. The CAFFP-PAC initiative in Northern Uganda sought to explore how a community-led, adolescent-centered inception process could support integration of adolescent-friendly family planning and post-abortion care into primary healthcare services.
A participatory qualitative design was employed during an inception meeting in Lira City on April 1, 2025, guided by principles of community-based participatory research and citizen science. A total of 110 purposively selected stakeholders including adolescents, youth mentors, parents, educators, health professionals, and cultural and religious leaders engaged in dialogue circles, breakout sessions, simulations, and visual storytelling to co-develop integration strategies. Data were collected through audio recordings, field notes, and participatory tools, and analyzed using Braun and Clarke's thematic analysis framework.
Six themes emerged: (1) meaningful participation of adolescents and stakeholders; (2) adolescent-friendly and confidential service environments; (3) health system readiness and provider attitudes; (4) addressing socio-cultural and gender norms; (5) integration strategies for CAFFP-PAC in primary care; and (6) sustained engagement and feedback mechanisms. Adolescents emphasized safe, private, and respectful care environments, while stakeholders stressed community ownership, trust-building, and reliance on local structures. Youth mentors, cultural leaders, and school clubs were identified as key enablers for service uptake.
A community-led inception process centered on adolescents and local voices is feasible and essential for successful CAFFP-PAC integration in Northern Uganda. Findings highlight the need to shift from provider-centered models to inclusive, participatory approaches that leverage community assets, foster adolescent agency, and ensure sustained engagement. Such approaches are vital for enhancing service accessibility, responsiveness, and sustainability in resource-constrained settings.
传统的自上而下的健康干预措施往往在服务设计和实施过程中将青少年及社区利益相关者排除在外，导致接受度低且与年轻人的需求不匹配。乌干达北部的CAFFP - PAC倡议旨在探索以社区为主导、以青少年为中心的启动过程如何支持将青少年友好型计划生育和堕胎后护理纳入初级卫生保健服务。
2025年4月1日在利拉市举行的启动会议期间采用了参与式定性设计，以基于社区的参与式研究和公民科学原则为指导。总共110名经过有目的挑选的利益相关者，包括青少年、青年导师、家长、教育工作者、卫生专业人员以及文化和宗教领袖，参与了对话圈、分组讨论、模拟和视觉叙事活动，以共同制定整合策略。通过录音、实地笔记和参与式工具收集数据，并使用布劳恩和克拉克的主题分析框架进行分析。
出现了六个主题：（1）青少年和利益相关者的有意义参与；（2）青少年友好且保密的服务环境；（3）卫生系统的准备情况和提供者态度；（4）应对社会文化和性别规范；（5）CAFFP - PAC在初级保健中的整合策略；（6）持续参与和反馈机制。青少年强调安全、私密和尊重的护理环境，而利益相关者则强调社区所有权、建立信任和对当地结构的依赖。青年导师、文化领袖和学校俱乐部被确定为服务接受的关键推动者。
以青少年和当地声音为中心的社区主导启动过程对于在乌干达北部成功整合CAFFP - PAC是可行且必不可少的。研究结果强调需要从以提供者为中心的模式转向包容性的、参与式的方法，这些方法利用社区资产、促进青少年的能动性并确保持续参与。这种方法对于在资源有限的环境中提高服务的可及性、响应性和可持续性至关重要。
