An mHealth-enabled intervention to prevent partner violence and pregnancy among adolescents and young women

摘要 拟议研究的目的是评估该系统的可行性、可接受性、保真度 Jenga Dada(斯瓦希里语“妇女赋权”)的实施和初步成效，以及 改善生殖健康的干预措施(包括避孕措施的使用和控制)，减少性别-- 以暴力(GBV)为基础，促进经济自给自足，以防止意外怀孕 肯尼亚城市的青春期女性(15-24岁)。肯尼亚近一半的孕妇是 不是故意的。GBV，特别是亲密伴侣暴力(IPV)和生殖胁迫(RC；即男性 阻碍女性使用避孕药或决定怀孕的伴侣行为)，有助于 意外怀孕，减少女孩和妇女对性和生殖决定的控制。 我们最近在美国和肯尼亚的研究表明，一个以诊所为基础的帮助妇女的计划 患有IPV和RC的女孩(ARES--解决健康环境中的生殖强迫问题)增强了 妇女和女孩离开虐待伴侣，减少意外怀孕。但是我们也发现， 妇女和女孩经常在妇女集合储蓄的背景下讨论IPV和RC的经验 和小额贷款团体(也称为村级储蓄和贷款协会[VSLA])。VSLA旨在促进 经济自给自足，是整个肯尼亚和大多数低收入国家日益普遍的结构 和中等收入国家。值得注意的是，经济自给自足在#年也被认为是重要的。 通过减少对男性伴侣的经济依赖来减少青少年和意外怀孕，这 也降低了IPV的风险。因此，开发和测试干预措施以解决IPV和RC在 VSLA的背景可能是一种有前途的减少意外怀孕的方法。我们的另一条线路 最近对美国和尼日利亚青春期女孩的研究导致了Girls Invest的发展，这是一种 旨在提高金融知识和经济自我意识的移动健康应用程序(MHealth App) 充足，这在两国都被证明是可行和可接受的。我们已经创建了Jenga Dada (斯瓦希里语中的“妇女赋权”)，通过整合与RC和IPV有关的ARCES组成部分 在女孩投资移动健康干预中，并将其调整为在VSLA结构中提供 为肯尼亚的青春期和年轻妇女提供服务。这种集成的方法使社区级别的社会 支持青少年实现经济自给自足、生殖自主和 没有暴力的关系。当前提案的目标是1)完善和试点Jenga Dada 参加内罗毕基贝拉社区VSLA团体的少女(15-24岁)， 肯尼亚；以及2)评估Jenga Dada对中等生殖健康、GBV和 通过12个现有随机分配的整群随机对照试验(RCT)获得的经济结果 VSLA组接收Jenga Dada或标准VSLA编程。基准和6个月 将收集跟踪调查数据(N=144名参与者)。我们还将收集和分析流程 参与者和实施者之间的数据和计划后质量数据。调查结果将向 未来对Jenga Dada的长期结果进行全面评估(例如，IPV、意外怀孕、 经济自给自足)。

ABSTRACT The objective of the proposed study is to assess the feasibility, acceptability, fidelity of implementation, and preliminary efficacy of Jenga Dada (“women’s empowerment” in Kiswahili), an intervention to improve reproductive health (including contraceptive use and control), reduce gender- based violence (GBV) and promote economic self-sufficiency to prevent unintended pregnancy among adolescent females (ages 15-24 years) in urban Kenya. Nearly half of all pregnancies in Kenya are unintended. GBV, specifically intimate partner violence (IPV) and reproductive coercion (RC; i.e. male partner behaviors that block women’s contraceptive use or pregnancy decisions), contributes to unintended pregnancy by reducing girls’ and women’s control over sexual and reproductive decisions. Our recent research in both the U.S. and Kenya indicates that a clinic-based program to assist women and girls with IPV and RC (ARCHES – Addressing Reproductive Coercion in Health Settings) empowers woman and girls to leave abusive partners and reduces incident pregnancy. However, we also found that women and girls frequently discuss experiences of IPV and RC in the context of women’s pooled savings and microloan groups (a.k.a., village savings and loan associations [VSLAs]). VSLAs aim to promote economic self-sufficiency and are an increasingly prevalent structure throughout Kenya and in most low and middle-income countries. Notably, economic self-sufficiency has also been identified as important in reducing adolescent and unintended pregnancy by decreasing financial reliance on male partners, which also reduces risk for IPV. Thus, development and testing of interventions to address IPV and RC in the context of VSLAs may be a promising approach to reduce unintended pregnancy. Another line of our recent research with adolescent girls in the U.S. and Nigeria has led to development of Girls Invest, an mobile health application (mHealth app) designed to increase financial literacy and economic self- sufficiency, demonstrated to be feasible and acceptable in both countries. We have created Jenga Dada (“women’s empowerment” in Kiswahili), by integrating ARCHES components related to RC and IPV within the Girls Invest mHealth intervention, and adapting this to be delivered within the VSLA structure for adolescent and young women in Kenya. This integrated approach enables community-level social support for adolescents as they move towards economic self-sufficiency, reproductive autonomy, and violence-free relationships. The aims of the current proposal are 1) to refine and pilot Jenga Dada among adolescent girls (ages 15-24 years) participating in VSLA groups in the Kibera community of Nairobi, Kenya; and 2) to evaluate the effects of Jenga Dada on intermediate reproductive health, GBV, and economic outcomes via cluster randomized controlled trial (RCT) with random assignment of 12 existing VSLA groups to receive either Jenga Dada or standard VSLA programming. Baseline and 6-month follow-up survey data will be collected (N=144 participants). We will also collect and analyze process data and post-program qualitative data among participants and implementers. Findings will inform a future full-scale evaluation of Jenga Dada on long-term outcomes (e.g., IPV, unintended pregnancy, economic self-sufficiency).