From Stop to Go! Overcoming barriers to healthcare utilisation for high-risk adolescent mothers and their children in Southern Africa.

该项目将查明南非高危少女母亲及其子女利用保健服务的障碍和促进因素。研究问题和方法由一个南北研究小组、政策制定者、非政府组织和一个青少年父母咨询小组共同制定。我们将在南非的早期职业学者、博士生和政府官员中建立青少年健康研究的地方能力。我们在针对弱势青少年的伦理研究和高影响力的项目参与方面有着良好的记录。世卫组织准则从社会生态的角度看待青少年保健利用问题。但在非洲，青少年母亲及其子女的证据存在重大差距，三分之一的青少年母亲生活在非洲。对于保健、家庭、学校和经济因素如何阻碍或促进产前、孕产妇和儿童保健服务的使用，特别是在艾滋病毒的情况下，知之甚少。关于青少年父亲的证据有限：他们参与产前和幼儿保育的潜在优点。本研究将准实验队列数据与定性参与性研究相结合，以解决这一紧迫的证据差距。调查结果将直接有助于区域政策和方案编制。第一阶段（2017-18）共同创造和引导。这项研究是与政策制定者、青少年和卫生保健工作者共同创建的。我们与青少年父母、联合国、政府合作伙伴和一线工作人员进行了磋商并审查了问卷草案。从2018年4月起，我们将进行初步定性的实地调查。在联合国儿童基金会的共同资助下，我们目前正在对青少年母子进行问卷调查和发展评估工具的试点。第二阶段（2018-19）实地考察。我们将进行初步研究，以确定南非高危青少年中孕产妇保健使用的预测因素。这项新研究将利用2015-2017年1589名青少年的现有队列数据，这些青少年的艾滋病毒、结核病和贫困率都很高。到2019年，这一队列将包括450名少女母亲及其450名子女，她们将在72家卫生保健机构接受护理。这提供了一个前所未有的机会来测试以前和目前的医疗保健利用预测指标及其对孕产妇和儿童健康的影响。我们将收集i)青少年母亲及其子女的医疗记录（包括标准化的儿童发展评估）；Ii)所有医疗机构提供的详细服务数据；自我报告的青少年保健经历、暴力暴露、酒精使用、支持、上学、养育子女、父亲参与、贫困和获得社会保护；4)来自青少年父母的深入的定性和人种学数据。第三阶段（2019- 2020年）数据分析和配置效率模型。我们将把这项新研究与先前的纵向青少年数据合并，并使用倾向得分匹配、多层次结构方程模型和边际效应模型等技术来检查医疗保健利用的障碍和促进因素。调查结果将确定在政府和非政府组织提供的保健和社会服务范围内可行的解决办法。我们将与政府合作伙伴一起，通过成本效益分析确定对健康结果产生最佳影响的有效措施组合，从而确定“最合买”。第四阶段（2021- 2022）共同创造基于证据的解决方案。我们将与政策伙伴和青少年伙伴共同制作具有高影响力的宣传材料。通过我们的项目合作伙伴的培训论坛，我们将对具有区域影响力的一线工人进行技能培训。我们将与国际机构、捐助者和各国政府共同制定广泛的影响战略。该项目将创新的伙伴关系与严谨的证据相结合，以促进青少年母亲及其子女的生存和发展。

This project will identify barriers and facilitators of healthcare utilization among high-risk adolescent mothers and their children in South Africa. Research questions and methods were co-developed by a South-North research team, policymakers, NGOs and an adolescent parents Advisory Group. We will build local capacity in adolescent health research among South Africa-based early-career academics, doctoral students and government officials. Together we have a proven track-record of ethical research with vulnerable adolescents and high-impact programmatic engagement.WHO guidelines view adolescent healthcare utilization within a socio-ecological framework. But there are major evidence gaps for adolescent mothers and their children in Africa, where one in three adolescent mothers live. Little is known about how healthcare, family, school and economic factors block or promote use of antenatal, maternal and child health services, especially in the context of HIV. There is limited evidence on adolescent fathers: the potential merits of their involvement in antenatal and early childhood care. This study combines quasi-experimental cohort data with qualitative participatory research to address this pressing evidence gap. The findings will directly contribute to regional policy and programming.Stage 1 (2017-18) CO-CREATION AND PILOTING. The study was co-created with policymakers, adolescents and healthcare workers. We conducted consultations and reviewed draft questionnaires with adolescent parents, UN, government partners and frontline workers. From April 2018, we will supplement this with preliminary qualitative fieldwork. With co-funding from UNICEF, we are currently piloting questionnaires and developmental assessment tools with adolescent mother-child dyads. Stage 2 (2018-19) FIELDWORK. We will conduct primary research to determine predictors of maternal healthcare use amongst high-risk adolescents in South Africa. This new research will capitalise on existing cohort data from 1589 adolescents followed from 2015-2017, with high rates of HIV, TB and poverty. By 2019 this cohort will include 450 adolescent mothers, and 450 of their children receiving care in 72 healthcare facilities. This provides an unprecedented opportunity to test prior and current predictors of healthcare utilisation, and its impacts on maternal and child health. We will collect i) medical records for adolescent mothers and their children (including standardised child development assessments); ii) detailed service provision data from all healthcare facilities; iii) self-reported adolescent healthcare experiences, violence exposure, alcohol use, support, schooling, parenting, father involvement, poverty and social protection access; and iv) in-depth qualitative and ethnographic data from adolescent mothers and fathers.STAGE 3 (2019-20) DATA ANALYSIS AND ALLOCATIVE EFFICIENCY MODELS. We will merge this new study with prior longitudinal adolescent data, and use techniques such as propensity-score matching, multi-level structural equation modelling and marginal effects modelling to examine barriers and facilitators to healthcare utilisation. Findings will identify solutions that are feasible within government and NGO-provided health and social services. With government partners, we will identify 'best buys' through cost-effectiveness analyses for combinations of effective provisions for optimal impact on health outcomes.STAGE 4 (2021-22) CO-CREATION OF EVIDENCE-BASED SOLUTIONS. We will co-create high-impact dissemination materials with our policy and adolescent partners. Through our programming partner's training fora, we will conduct skills training with frontline workers with regional reach. We will engage in extensive impact strategies with international agencies, donors and national governments. This project combines innovative partnership with rigorous evidence to promote survival and thriving for adolescent mothers and their children.