Crowdsourcing with adolescents in Senegal to address social norms limiting their access to sexual and reproductive health services

青少年占世界人口的18%。他们在从儿童过渡到成年人的过程中有独特的健康需求。尽管青少年在身体、社会、认知和性健康方面有独特的需求，但直到最近，青少年健康在全球或全国范围内几乎没有受到关注。这一趋势正在改变，青少年健康在全球健康议程上占据突出地位。特别是，人们日益认识到有必要对青少年的性健康和生殖健康需求进行投资，因为青少年获得性传播感染和意外怀孕的风险更高。为了扩大这些服务在青少年中的覆盖面，性健康和生殖健康服务需要根据他们的需要量身定做。在塞内加尔，政府致力于通过保健系统和专门的青年中心向青少年提供性健康和生殖健康服务。尽管提供了这些服务，但青少年，特别是生活在较贫穷和较农村地区的青少年，在所有年龄段中获得性健康和生殖健康的机会最少，特别是计划生育服务。有证据表明，对青少年性行为的态度和信念(规范)，以及根据这些规范提供服务的方式，在限制青少年使用现有服务方面发挥了很大作用。通过定性研究和众包，这是一种干预共同发展的创新方法，拟议的研究旨在确定限制服务使用的关键规范，以便与15至19岁的青少年共同制定干预措施，以解决这些规范。这项研究将在塞内加尔的两个地区进行，一个在达喀尔地区的城市周边地区，一个在该国西南部的基杜古地区的农村地区。由于城市化和金矿开采，这两个地区的人口都在快速增长。人口的这种增长意味着生活在这些地区的青少年数量将会增加，性行为可能会因为移民和采矿工作的增加而改变。因此，生活在这些地区的青少年对性服务和生殖服务的需求度很高。这两个区域的卫生系统还需要为日益增长的服务需求做好准备，并改进提供服务的方式，以便更好地为这一人口群体提供服务。具体地说，这一研究项目将首先审查这两个区域的青少年可获得的性健康和生殖健康政策和方案。随后将与青少年和向他们提供性健康和生殖健康服务的个人进行访谈和重点小组讨论，以调查阻碍青少年使用为他们提供的服务的障碍。然后，我们将从每个地区选择一个由青少年组成的小组，对我们确定的障碍进行排名，并选择对他们最重要的三个障碍。这项研究的最后阶段将是举办众包竞赛，要求公众就提出的问题提交想法或解决方案。在这项研究中，青少年将被邀请设计一项干预措施，以解决对他们来说最重要的三个障碍。我们将让青少年参与整个项目，并为他们提供成功开展活动所需的技术支持。

Adolescents make up 18% of the world population. They have unique health needs as they transition from children into adults. Despite their unique physical, social, cognitive and sexual health needs, until recently adolescent health has received little attention globally or nationally. This trend is changing, with adolescent health featuring prominently on the global health agenda. In particular, there is growing recognition of the need to invest in the sexual and reproductive health needs of adolescents, who are at higher risk of acquiring sexually transmitted infections and of having unwanted pregnancies. To increase coverage of these services among adolescents, sexual and reproductive health services need to be tailored to the their needs. In Senegal, the government is committed to providing sexual and reproductive health services to adolescents through the health system and through dedicated youth centres. Despite the availability of these services, adolescents, particularly those residing in poorer and more rural areas, have the lowest access to sexual and reproductive health of any age group, particularly family planning services. There is evidence that attitudes and beliefs (norms) towards adolescents' sexual activity, and the way in which services are provided in response to these norms, play a large role in limiting adolescents use of available services. Through qualitative research and crowdsourcing, an innovative approach to intervention co-development, the proposed research aims to identify the key norms that limit service use in order to co-develop an intervention with adolescents aged 15 to 19 to address these norms. The research will take place in two regions of Senegal, one peri-urban area in the Dakar region and one rural area in Kedougou region in the South West of the country. Both regions are experiencing rapid increases in population due to urbanisation and gold mining, respectively. This increase in population means the number of adolescents living in these regions will increase, and that sexual practices may change as a result of increased migration and mining work. Adolescents who live in these regions therefore have a high need for sexual and reproductive services. The health systems of the two regions will also need to prepare for the increased need for services, and improve the manner in which services are delivered in order to better serve this population group. Specifically, this research project will first of all examine the policies and programmes on sexual and reproductive health available to adolescents living in the two regions. This will be followed by interviews and focus group discussions with adolescents and the individuals providing sexual and reproductive health services to them to investigate barriers that stop adolescents from using the services intended for them. We will then select a panel of adolescents from each region to rank the barriers we identify and select the three barriers most important to them. The final stage of the research will be to run a crowdsourcing competition, where members of the public are asked to submit ideas or solutions to a proposed problem. In this study, adolescents will be invited to design an intervention to tackle the three barriers identified as most important to them. We will involve adolescents throughout the project and provide them with technical support they need to conduct the activities successfully.