Engaging providers, community members, and young women to adapt and pilot a youth-friendly sexual and reproductive health package in low-income communities in India

让服务提供者、社区成员和年轻女性参与，在印度低收入社区调整和试点适合青年的性健康和生殖健康一揽子计划

• 批准号: 10454501
• 负责人: Marie Amanda Brault
• 金额: $ 7.85万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-04 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10454501
• 关键词: Adolescent; Adolescent Health Services; Age; Anthropology; Area; Caring; Clinic; Communication; Communities; Competence; Consensus; Contraceptive Usage; Control Groups; Data; Development; Education; Educational Curriculum; Effectiveness; Evaluation; Face; Feedback; Female Adolescents; Fright; Gender; Generations; HIV risk; HIV/STD; Health; Health Club; Health Personnel; Health education; Healthcare; Healthcare Systems; Hybrids; Improve Access; India; International; Intervention; K-Series Research Career Programs; Knowledge; Legal; Low income; Marriage; Maternal Mortality; Maternal and Child Health; Measurement; Medical; Mental Health; Mentored Research Scientist Development Award; Mentors; Methods; Modeling; Outcome; Participant; Pattern; Personal Satisfaction; Pilot Projects; Population; Poverty; Pre-Post Tests; Privatization; Process; Provider; Published Comment; Reproductive Health; Reproductive Rights; Research; Research Personnel; Research Project Grants; Research Training; Resources; SECTM1 gene; Schools; Services; Sexual Health; Social support; Surveys; Training; Translating; United States; Unmarried; Violence; Waiting Lists; Woman; Work; Youth; adolescent health; adolescent sexual health; age group; behavioral health; behavioral outcome; community based care; complex data; design; disorder control; experience; gender-based violence; global health; health care availability; health care quality; health knowledge; healthcare community; high risk; implementation framework; implementation outcomes; implementation science; implementation study; improved; improved outcome; intervention participants; low and middle-income countries; maternal morbidity; member; multidisciplinary; neglect; peer; physical conditioning; post intervention; post-doctoral training; preference; programs; psychological trauma; service uptake; social stigma; success; training opportunity; uptake; young woman

Project summary/abstract Impoverished adolescent girls and young women (ages 15-25 years) in low- and middle-income countries (LMICs) face inequitable gender norms that limit their educational opportunities, social support, and healthcare access. These inequities also place them at higher risk for maternal morbidity and mortality, psychological trauma, violence, and STIs/HIV. Consistent with these patterns, many young women in India marry early and face similar sexual and reproductive health and rights (SRHR) challenges. Adolescent services in India are unequally distributed leaving marginalized adolescents, including those not in school, without services or access. In 2013, India launched the “Rashtriya Kishor Swasthya Karyakam” (National Adolescent Health Program) framework for improved adolescent health services and education to be provided in the healthcare system and community through adolescent health clubs and adolescent-friendly health clinics. However, implementation of the framework has been uneven, with poor fidelity in the adaptation of programs to make them youth-centered. In this proposal, I will adapt and pilot an integrated community and facility intervention to improve uptake of adolescent-friendly services for married and unmarried AGYW (ages 15-25) in a low-income area with a population of 600,000 in Mumbai, India. Formative research will characterize the SRHR landscape in the study area and adapt the intervention using the systematic ADAPT-ITT approach. The community component will adapt a health curriculum for the peer adolescent health clubs to incorporate participatory activities to build AGYW’s resources and agency, promote use of newly available adolescent services, and obtain participants’ viewpoints and preferences. The facility component consists of adapted sensitization training on adolescent- friendly care for health providers and staff at both public and private clinics in the study area. This hybrid pilot study will assess both implementation outcomes and a pilot set of health/behavioral outcomes including clinic service uptake, contraceptive use, mental health, gender norms/agency, and health knowledge. My longstanding commitment to global health research with adolescent girls and young women has led me to pursue training opportunities to gain experience in international collaborative research projects. This K award builds on my doctoral and post-doctoral training in medical anthropology and adolescent SRHR, and the relationships I have developed with multidisciplinary mentors and organizations in the United States and Mumbai, India. This proposal extends my previous training and K12 work on youth-centered approaches to SRHR communication in the U.S. by providing training in adolescent health quality improvement, implementation science, and advanced quantitative methods in an international context. This K01 award also facilitates my development into an independent global health researcher focused on improving adolescent girls’ health and well-being in low-income communities.

项目概要/摘要 低收入和中等收入的贫困少女和年轻妇女（15-25岁） 低收入国家面临不公平的性别规范，限制了他们的教育机会，社会支持， 获得医疗服务。这些不平等还使她们面临更高的孕产妇发病率和死亡率风险， 心理创伤、暴力和性传播感染/艾滋病毒。与这些模式相一致的是，印度的许多年轻女性 早婚和面临类似的性健康和生殖健康及权利挑战。 印度的青少年服务分布不均，致使处于社会边缘的青少年， 不是在学校，没有服务或访问。2013年，印度推出了“Rashtriya Kishor Swasthya Karyakam” （国家青少年健康方案）改善青少年健康服务和教育的框架， 在保健系统和社区通过青少年健康俱乐部和方便青少年的 健康诊所。然而，该框架的执行情况并不均衡，在调整方面的忠实度很差 让他们以年轻人为中心 在本提案中，我将调整和试行一项综合社区和设施干预措施， 在低收入地区为已婚和未婚的年龄在15-25岁之间的青少年妇女提供方便妇女的服务 人口60万的印度孟买。形成性研究将描述2010 - 2011年性健康和生殖健康及权利的状况。 研究区域，并采用系统性ADAPT-ITT方法调整干预措施。社区部分 将为同龄青少年健康俱乐部调整健康课程，纳入参与性活动， 青少年妇女协会的资源和机构，促进使用新提供的青少年服务，并获得参与者的 观点和偏好。设施部分包括针对青少年的适应性宣传培训， 为研究地区的公共和私人诊所的医疗服务提供者和工作人员提供友好的护理。这个混合动力飞行员 这项研究将评估实施结果和一组试点健康/行为结果，包括诊所 服务接受、避孕药具使用、心理健康、性别规范/机构和健康知识。 我长期致力于对青春期女孩和年轻女性的全球健康研究， 我希望能寻求培训机会，以获得国际合作研究项目的经验。这个K 这个奖项建立在我在医学人类学和青少年SRHR方面的博士和博士后培训基础上， 我与美国的多学科导师和组织建立了关系， 印度，孟买。这个建议扩展了我以前的培训和K12工作，以青年为中心的方法， 在美国，通过提供青少年健康质量改善方面的培训， 实施科学和国际范围内的先进定量方法。K 01奖也 帮助我发展成为一名独立的全球健康研究人员，专注于改善青春期女孩的健康状况。 低收入社区的健康和福祉。