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

该项目将确定南非高危青少年母亲及其子女利用医疗保健的障碍和促进者。研究问题和方法由南北研究小组、政策制定者、非政府组织和青少年家长咨询小组共同制定。我们将在南非的早期学者、博士生和政府官员中建设青少年健康研究的当地能力。我们共同拥有关于弱势青少年和高影响方案参与的道德研究的可靠记录。世卫组织指南将青少年保健利用置于社会生态框架内。但在非洲，每三个青少年母亲中就有一个生活在那里，对于青少年母亲和她们的孩子来说，存在重大的证据差距。关于医疗保健、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背景下，人们知之甚少。关于青春期父亲的证据有限：他们参与产前和儿童早期护理的潜在优点。这项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。研究结果将直接有助于区域政策和规划。阶段1(2017-18年)共同创建和试点。这项研究是与政策制定者、青少年和医护人员共同创建的。我们与青少年家长、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稿。从2018年4月开始，我们将以初步的定性实地考察补充这一点。在联合国儿童基金会的共同资助下，我们目前正在试行针对青少年母婴的问卷调查和发展评估工具。第二阶段(2018-19年)实地考察。我们将进行初步研究，以确定在南非高危青少年中使用孕产妇保健的预测因素。这项新的研究将利用2015-2017年间1589名青少年的现有队列数据，这些青少年的艾滋病毒、结核病和贫困率较高。到2019年，这一群体将包括450名青少年母亲，其中450名儿童在72家医疗机构接受护理。这提供了一个前所未有的机会来测试医疗保健利用率的先前和当前预测因素，以及它对母婴健康的影响。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育评估)；ii)来自所有医疗机构的详细服务提供数据；iii)自我报告的青少年医疗保健经历、暴力接触、酒精使用、支持、学校教育、育儿、父亲参与、贫困和社会保障机会；以及iv)青少年母亲和父亲的深入定性和人种学数据。我们将把这项新的研究与先前的纵向青少年数据合并，并使用倾向-分数匹配、多层次结构方程建模和边际效应建模等技术来检查医疗保健利用的障碍和促进者。调查结果将确定在政府和非政府组织提供的卫生和社会服务中可行的解决方案。我们将与政府合作伙伴一起，通过成本效益分析来确定“最佳购买”，以组合有效的条款，从而对健康结果产生最佳影响。STAGE 4(2021-22)共同创建基于证据的解决方案。我们将与我们的政策和青少年合作伙伴共同创建高影响力的宣传材料。通过我们的编程合作伙伴培训论坛，我们将为具有区域覆盖范围的前线工作人员进行技能培训。我们将与国际机构、捐助者和各国政府一起实施广泛的影响战略。该项目将创新的伙伴关系与严格的证据相结合，以促进青少年母亲及其子女的生存和茁壮成长。

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.