An mHealth-enabled intervention to prevent partner violence and pregnancy among adolescents and young women

基于移动医疗的干预措施可预防青少年和年轻女性的伴侣暴力和怀孕

• 批准号: 10373736
• 负责人: Elizabeth Ann Reed
• 金额: $ 20.18万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10373736
• 关键词: Address; Adolescent; Africa; Age; Behavior; Clinic; Communities; Contraceptive Agents; Contraceptive Usage; Country; Data; Development; Economics; Ensure; Evaluation; Female Adolescents; Future; Generations; Health; Income; Intervention; Kenya; Mobile Health Application; Modeling; Nigeria; Outcome; Participant; Pregnancy; Pregnancy in Adolescence; Process; Randomized Controlled Trials; Recommendation; Reporting; Reproductive Health; Research; Risk; Savings; Security; Self Efficacy; Slum; Social support; Structure; Surveys; Testing; Violence; Woman; Work; base; design; economic outcome; empowerment; experience; financial literacy; follow-up; gender-based violence; girls; implementation fidelity; improved; innovation; intimate partner violence; low and middle-income countries; mHealth; male; member; mobile computing; partner violence; peer support; prevent; programs; reproductive; reproductive coercion; rural area; scale up; unintended pregnancy; vulnerable adolescent; working group; young woman

ABSTRACT The objective of the proposed study is to assess the feasibility, acceptability, fidelity of implementation, and preliminary efficacy of Jenga Dada (“women’s empowerment” in Kiswahili), an intervention to improve reproductive health (including contraceptive use and control), reduce gender- based violence (GBV) and promote economic self-sufficiency to prevent unintended pregnancy among adolescent females (ages 15-24 years) in urban Kenya. Nearly half of all pregnancies in Kenya are unintended. GBV, specifically intimate partner violence (IPV) and reproductive coercion (RC; i.e. male partner behaviors that block women’s contraceptive use or pregnancy decisions), contributes to unintended pregnancy by reducing girls’ and women’s control over sexual and reproductive decisions. Our recent research in both the U.S. and Kenya indicates that a clinic-based program to assist women and girls with IPV and RC (ARCHES – Addressing Reproductive Coercion in Health Settings) empowers woman and girls to leave abusive partners and reduces incident pregnancy. However, we also found that women and girls frequently discuss experiences of IPV and RC in the context of women’s pooled savings and microloan groups (a.k.a., village savings and loan associations [VSLAs]). VSLAs aim to promote economic self-sufficiency and are an increasingly prevalent structure throughout Kenya and in most low and middle-income countries. Notably, economic self-sufficiency has also been identified as important in reducing adolescent and unintended pregnancy by decreasing financial reliance on male partners, which also reduces risk for IPV. Thus, development and testing of interventions to address IPV and RC in the context of VSLAs may be a promising approach to reduce unintended pregnancy. Another line of our recent research with adolescent girls in the U.S. and Nigeria has led to development of Girls Invest, an mobile health application (mHealth app) designed to increase financial literacy and economic self- sufficiency, demonstrated to be feasible and acceptable in both countries. We have created Jenga Dada (“women’s empowerment” in Kiswahili), by integrating ARCHES components related to RC and IPV within the Girls Invest mHealth intervention, and adapting this to be delivered within the VSLA structure for adolescent and young women in Kenya. This integrated approach enables community-level social support for adolescents as they move towards economic self-sufficiency, reproductive autonomy, and violence-free relationships. The aims of the current proposal are 1) to refine and pilot Jenga Dada among adolescent girls (ages 15-24 years) participating in VSLA groups in the Kibera community of Nairobi, Kenya; and 2) to evaluate the effects of Jenga Dada on intermediate reproductive health, GBV, and economic outcomes via cluster randomized controlled trial (RCT) with random assignment of 12 existing VSLA groups to receive either Jenga Dada or standard VSLA programming. Baseline and 6-month follow-up survey data will be collected (N=144 participants). We will also collect and analyze process data and post-program qualitative data among participants and implementers. Findings will inform a future full-scale evaluation of Jenga Dada on long-term outcomes (e.g., IPV, unintended pregnancy, economic self-sufficiency).

抽象的 拟议研究的目的是评估可行性、可接受性和保真度 Jenga Dada（斯瓦希里语“妇女赋权”）的实施和初步成效 改善生殖健康（包括避孕药具的使用和控制）、减少性别歧视的干预措施 基于暴力（GBV）并促进经济自给自足，以防止意外怀孕 肯尼亚城市的青春期女性（15-24 岁）。肯尼亚近一半的怀孕是 无意的。 GBV，特别是亲密伴侣暴力 (IPV) 和生殖胁迫 (RC；即男性 阻碍女性避孕药具使用或怀孕决定的伴侣行为），有助于 通过减少女孩和妇女对性和生殖决定的控制来防止意外怀孕。 我们最近在美国和肯尼亚进行的研究表明，以临床为基础的项目可以帮助女性 以及患有 IPV 和 RC 的女孩（ARCHES – 解决健康环境中的生殖强制问题） 妇女和女孩离开施虐伴侣并减少怀孕事件。然而我们也发现 妇女和女孩经常在妇女集合储蓄的背景下讨论 IPV 和 RC 的经验 和小额贷款团体（又称乡村储蓄贷款协会 [VSLA]）。 VSLA 旨在促进 经济自给自足，并且是整个肯尼亚和大多数低收入国家日益普遍的结构 和中等收入国家。值得注意的是，经济自给自足也被认为是重要的 通过减少对男性伴侣的经济依赖来减少青少年和意外怀孕，这 还可以降低 IPV 风险。因此，开发和测试解决 IPV 和 RC 的干预措施 VSLA 的背景可能是减少意外怀孕的一种有前途的方法。我们的另一条线 最近对美国和尼日利亚少女的研究促成了 Girls Invest 的发展， 移动健康应用程序（mHealth应用程序）旨在提高金融知识和经济自我 充分性，被证明在两国都是可行和可接受的。我们创造了 Jenga Dada （斯瓦希里语中的“妇女赋权”），通过集成与 RC 和 IPV 相关的 ARCHES 组件 在 Girls Invest mHealth 干预措施中，并对其进行调整以在 VSLA 结构内提供 针对肯尼亚的青少年和年轻女性。这种综合方法使社区层面的社会 支持青少年走向经济自给自足、生殖自主和 无暴力的关系。当前提案的目标是 1) 完善和试点 Jenga Dada 参加内罗毕基贝拉社区 VSLA 团体的少女（15-24 岁）， 肯尼亚; 2) 评估 Jenga Dada 对中期生殖健康、GBV 和 GBV 的影响 通过整群随机对照试验 (RCT) 随机分配 12 个现有的经济结果 VSLA 分组接收 Jenga Dada 或标准 VSLA 编程。基线和 6 个月 将收集后续调查数据（N=144 名参与者）。我们还将收集并分析过程 参与者和实施者之间的数据和项目后定性数据。调查结果将告知 未来对 Jenga Dada 对长期结果的全面评估（例如 IPV、意外怀孕、 经济自给自足）。