If I Were Thabo: Optimisation and feasibility trial of a gender transformative sexual and reproductive health intervention in South Africa and Lesotho

如果我是塔博：南非和莱索托性别变革性健康和生殖健康干预措施的优化和可行性试验

• 批准号: MR/T040246/1
• 负责人: Sarah Skeen
• 金额: $ 81.3万
• 依托单位: Stellenbosch University
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2021
• 资助国家: 英国
• 起止时间: 2021 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FT040246%2F1
• 关键词: Were; Thabo; Optimisation; feasibility; trial

Research on adolescent sexual and reproductive health (SRH) in sub-Saharan Africa is heavily focused on preventing unintended pregnancies and preventing HIV infection. However, very little of this work focuses on, and actively targets, boys and young men. Gender-transformative approaches, or approaches that seek to shift gender norms and power relations, have been hailed as one way to disrupt underlying factors that can lead to poor health outcomes and drive HIV infection and adolescent pregnancy. Applying a gender-transformative approach in South Africa and Lesotho, across two low-resource settings with very high rates of both HIV and adolescent pregnancy, our research aims to meet an urgent need for localised solutions and do so in an innovative and inclusive way. The aim of this study is to address the evidence gap by adapting the If I Were Jack programme for use in South Africa and Lesotho, under the name If I Were Thabo. The original programme, developed in the UK, is a group-based intervention delivered to adolescents in educational settings, which includes a culturally sensitive interactive film about an adolescent who discovers that his girlfriend is unexpectedly pregnant, and a guided discussion about how participants would feel and react in his position. The programme is accompanied by educational materials and sessions for adolescents' caregivers, and has been shown to be acceptable and cost-effective in its current form. We propose to adapt the programme in two LMICs, South Africa and Lesotho, in partnership with adolescents, parents, teachers, community members and local experts. We will target adolescents aged 13-14, an age range where there is still potential to prevent sexual risk-taking before the majority of adolescents are sexually active, and before the increase in pregnancy and STIs reported in later adolescence. To develop and test the intervention, the proposed study will involve two phases. First, we will work with adolescents, their parents and caregivers, teachers, health professionals and other key community members to adapt and optimise the programme materials from the UK for use in South Africa and Lesotho. This will involve co-producing locally relevant and appropriate intervention materials in each site. Adolescents will work with researchers and filmmakers to write, cast and develop new films in each site, and advise on the acceptability of text-based material, and their caregivers will be consulted on caregiver-targeted information. Teachers, community group facilitators and healthcare professionals will provide feedback on materials designed for programme facilitators. In addition, we will ask adolescents and their caregivers to give feedback on some of the research tools that will be used in the next phase. Next, we will run a pilot of the programme within a feasibility cluster randomised trial to assess if the intervention implementation and evaluation design is feasible in both countries. As a part of this phase we will survey adolescents in schools and community groups, half of whom will be randomly chosen to receive the intervention and the other half of whom will continue with 'normal practice'. We will assess whether the questionnaires capture the necessary information on SRH outcomes for this group, including intentions relating to adolescent pregnancy, and HIV and STI infection. We will also evaluate whether the processes needed to implement the programme work well. After programme completion, we will interview adolescents and other stakeholders about their opinions of the programme and whether it is feasible to deliver in schools and community groups, and what will hinder or help the implementation in the two settings. Based on these results, we will decide if it will be feasible to do a larger trial of the intervention in both sites to see if the programme is effective in improving SRH for adolescents in these countries.

关于撒哈拉以南非洲青少年性健康和生殖健康的研究主要侧重于预防意外怀孕和预防艾滋病毒感染。然而，这项工作很少关注和积极针对男孩和青年男子。性别转变方法，或寻求改变性别规范和权力关系的方法，被誉为破坏可能导致健康状况不佳和推动艾滋病毒感染和少女怀孕的根本因素的一种方法。在南非和莱索托应用性别变革方法，跨越两个艾滋病毒和青少年怀孕率非常高的低资源环境，我们的研究旨在满足对本地化解决方案的迫切需求，并以创新和包容的方式这样做。这项研究的目的是通过调整“如果我是杰克”方案，以“如果我是塔博”的名义在南非和莱索托使用，来解决证据差距问题。最初的方案是在英国开发的，是在教育环境中向青少年提供的一种基于小组的干预措施，其中包括一部具有文化敏感性的互动电影，讲述一名青少年发现他的女朋友意外怀孕的故事，并指导讨论参与者在他的位置上会有什么感受和反应。该方案还为青少年照料者提供教育材料和课程，目前的形式已被证明是可以接受的，具有成本效益。我们建议与青少年、家长、教师、社区成员和当地专家合作，在南非和莱索托这两个中低收入国家调整该方案。我们将针对13-14岁的青少年，在大多数青少年性活跃之前，在青春期后期报告的怀孕和性传播感染增加之前，这个年龄段仍然有可能防止性冒险。为了开发和测试干预措施，拟议的研究将包括两个阶段。首先，我们将与青少年、他们的父母和照顾者、教师、卫生专业人员和其他主要社区成员合作，调整和优化联合王国的方案材料，供南非和莱索托使用。这将涉及在每个地点共同制作与当地有关的适当干预材料。青少年将与研究人员和电影制片人合作，在每个地点编写、放映和制作新电影，并就文字材料的可接受性提供咨询意见，将就针对青少年的信息征求其照顾者的意见。教师、社区小组协调员和医疗保健专业人员将对为方案协调员设计的材料提供反馈。此外，我们将要求青少年及其照顾者对下一阶段将使用的一些研究工具提供反馈。接下来，我们将在可行性集群随机试验中进行该计划的试点，以评估干预措施的实施和评估设计在这两个国家是否可行。作为这一阶段的一部分，我们将对学校和社区团体的青少年进行调查，其中一半将被随机选择接受干预，另一半将继续进行“正常实践”。我们将评估调查问卷是否收集了关于这一群体性健康和生殖健康结果的必要信息，包括与少女怀孕、艾滋病毒和性传播感染有关的意图。我们还将评估执行方案所需的程序是否运作良好。在计划完成后，我们会与青少年及其他持份者会面，了解他们对计划的意见，以及在学校和社区团体推行计划是否可行，以及在这两种环境下推行计划会有什么阻碍或帮助。根据这些结果，我们将决定是否可以在这两个地点进行更大规模的干预试验，看看该计划是否能有效改善这些国家青少年的性健康和生殖健康。

项目成果

PROTOCOL: Involving men and boys in family planning: A systematic review of the effective components and characteristics of complex interventions in low- and middle-income countries.

• DOI: 10.1002/cl2.1140
• 发表时间: 2021-03
• 期刊: Campbell systematic reviews
• 影响因子: 3.2
• 作者: Aventin Á;Robinson M;Hanratty J;Ruane-McAteer E;Tomlinson M;Clarke M;Okonofua F;Bonell C;Lohan M
• 通讯作者: Lohan M

Psychosocial interventions for improving engagement in care and health and behavioural outcomes for adolescents and young people living with HIV: a systematic review and meta-analysis.

• DOI: 10.1002/jia2.25741
• 发表时间: 2021-08
• 期刊: Journal of the International AIDS Society
• 影响因子: 6
• 作者: Laurenzi CA;du Toit S;Ameyan W;Melendez-Torres GJ;Kara T;Brand A;Chideya Y;Abrahams N;Bradshaw M;Page DT;Ford N;Sam-Agudu NA;Mark D;Vitoria M;Penazzato M;Willis N;Armstrong A;Skeen S
• 通讯作者: Skeen S

Protocol for a systematic review of economic evaluations conducted on gender-transformative interventions aimed at preventing unintended pregnancy and promoting sexual health in adolescents.

• DOI: 10.1136/bmjopen-2021-056553
• 发表时间: 2022-05-24
• 期刊: BMJ OPEN
• 影响因子: 2.9
• 作者: Ncube, Janet;Adom, Theodosia;Nkonki, Lungiswa
• 通讯作者: Nkonki, Lungiswa

Adaptation of a gender-transformative sexual and reproductive health intervention for adolescent boys in South Africa and Lesotho using intervention mapping.

• DOI: 10.1080/16549716.2021.1927329
• 发表时间: 2021-01-01
• 期刊: Global health action
• 影响因子: 2.6
• 作者: Aventin Á;Rabie S;Skeen S;Tomlinson M;Makhetha M;Siqabatiso Z;Lohan M;Clarke M;Lohfeld L;Thurston A;Stewart J
• 通讯作者: Stewart J

Nothing so practical as theory: a rapid review of the use of behaviour change theory in family planning interventions involving men and boys.

• DOI: 10.1186/s12978-021-01173-0
• 发表时间: 2021-06-13
• 期刊: Reproductive health
• 影响因子: 3.4
• 作者: Robinson M;Aventin Á;Hanratty J;Ruane-McAteer E;Tomlinson M;Clarke M;Okonofua F;Lohan M
• 通讯作者: Lohan M