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

摘要 拟议研究的目的是评估的可行性，可接受性，保真度 斯瓦希里语中的“增强妇女权能”， 采取干预措施，改善生殖健康（包括避孕药具的使用和控制）， 预防基于性别的暴力，促进经济自给自足， 肯尼亚城市的青少年女性（15-24岁）。在肯尼亚，近一半的孕妇是 无意的。性别暴力，特别是亲密伴侣暴力和生殖胁迫（RC;即男性） 阻碍妇女避孕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减少意外怀孕。 我们最近在美国和肯尼亚进行的研究表明， 和患有IPV和RC的女孩（ARCHES -解决健康环境中的生殖胁迫问题） 妇女和女孩离开虐待伴侣，减少意外怀孕。然而，我们也发现， 妇女和女孩经常在妇女集中储蓄的背景下讨论IPV和RC的经验 和小额贷款团体（a.k.a.，农村储蓄和贷款协会（VSLA））。VSLA旨在促进 经济自给自足，是整个肯尼亚越来越普遍的结构，在大多数低 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，减少少女怀孕和意外怀孕， 也降低了IPV的风险。因此，制定和测试干预措施，以解决IPV和RC在 VSLI背景下可能是减少意外妊娠的一种有前景的方法。我们的另一条线 最近在美国和尼日利亚对青春期女孩的研究导致了女孩投资的发展， 移动的健康应用程序（mHealth应用程序），旨在提高金融知识和经济自我， 充分性，证明在两国都是可行和可接受的。我们创造了层层叠达达 （斯瓦希里语为“赋予妇女权力”），方法是将与驻地协调员和土著人民志愿者有关的ARCHES组成部分纳入 在女童投资移动健康干预措施中，并调整这一措施，以在VSLA结构中提供 为肯尼亚的青少年和年轻女性提供服务。这种综合办法使社区一级的社会 支持青少年实现经济自立、生育自主， 没有暴力的关系当前提案的目的是1）完善和试点叠叠达达之间 参加内罗毕基贝拉社区VSLA团体的少女（15-24岁）， 肯尼亚; 2）评价叠游戏对中期生殖健康、性别暴力的影响， 通过随机分配12名现有受试者的整群随机对照试验（RCT）获得的经济结局 VSLA组接收Jenga Dada或标准VSLA编程。基线和6个月 将收集随访调查数据（N=144名参与者）。我们还将收集和分析过程 参与者和实施者之间的数据和程序后的定性数据。调查结果将告知 未来对Jenga Dada的长期结果进行全面评估（例如，IPV意外怀孕 经济自给自足）。

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).