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

基于移动医疗的干预措施可预防青少年和年轻女性的伴侣暴力和怀孕

• 批准号: 10654543
• 负责人: Elizabeth Ann Reed
• 金额: $ 23.37万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10654543
• 关键词: Address; Adolescent; Africa; Age; Behavior; Clinic; Communities; Contraceptive Agents; Contraceptive Usage; Country; Data; Development; Economics; Ensure; Evaluation; Female Adolescents; Future; Generations; Health; Income; Intervention; Investments; Kenya; Mobile Health Application; Modeling; Nigeria; Outcome; Participant; Pregnancy; Pregnancy in Adolescence; Process; Random Allocation; Randomized; Randomized, Controlled Trials; Recommendation; Reporting; Reproductive Health; Research; Risk; Risk Reduction; Savings; Security; Self Efficacy; Self Management; Slum; Social support; Structure; Surveys; Testing; Violence; Woman; Work; acceptability and feasibility; design; economic outcome; empowerment; experience; financial literacy; follow-up; gender-based violence; girls; implementation fidelity; improved; innovation; intimate partner violence; low and middle-income countries; mHealth; male; member; mobile computing; partner violence; peer support; prevent; programs; reproductive; reproductive coercion; rural area; scale up; unintended pregnancy; vulnerable adolescent; working group; young woman

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).

抽象的 拟议的研究的目的是评估可行性，可接受性，忠诚度 Jenga Dada的实施和初步效率（Skiswahili的“妇女赋权”） 干预措施以改善复制品健康（包括避孕药使用和控制），减少性别 基于暴力（GBV）并促进经济自给自足，以防止意外怀孕 肯尼亚城市的青少年女性（15-24岁）。肯尼亚的所有怀孕近一半是 意外。 GBV，特别是亲密伴侣暴力（IPV）和复制胁迫（RC；即男性 阻止妇女避孕药或怀孕决定的伴侣行为，有助于 意外怀孕，通过减少女孩和妇女对性和繁殖决定的控制。 我们最近在美国和肯尼亚的研究表明，一项基于诊所的计划，以帮助女性 以及具有IPV和RC的女孩（拱门 - 在健康环境中解决生殖胁迫） 女人和女孩离开虐待伴侣并减少事件的怀孕。但是，我们还发现 妇女和女孩经常在妇女储蓄的背景下讨论IPV和RC的经历 和Microloan团体（又称村庄储蓄和贷款协会[VSLAS]）。 VSLA旨在促进 经济自给自足，在整个肯尼亚，大多数人中都是越来越普遍的结构 和中等收入国家。值得注意的是，经济自给自足也已被确定为重要 通过减少男性伴侣的财务责任来减少青少年和意外怀孕，这 还降低了IPV的风险。那是解决干预措施以解决IPV和RC的开发和测试 VSLAS的背景可能是减少意外怀孕的一种承诺方法。我们的另一行 在美国和尼日利亚的青春期女孩的最新研究导致了女孩投资的发展，这是 移动健康应用程序（MHealth应用程序）旨在提高金融素养和经济自我 充分性，在这两个国家都可以可行且可接受。我们创建了Jenga Dada （基斯瓦希里（Kiswahili）的“女性赋权”），通过整合与RC和IPV相关的拱门组件 在女孩中投资MHealth干预措施，并将其适应以在VSLA结构中提供 适用于肯尼亚的青少年和年轻妇女。这种综合方法使社区级的社会 支持青少年在经济自给自足，生殖自治和 无暴力关系。当前建议的目的是1）在 青春期女孩（15-24岁）参加了内罗毕基贝拉社区的VSLA团体， 肯尼亚; 2）评估Jenga Dada对中级生殖健康的影响，GBV和 通过群集随机对照试验（RCT）进行经济成果，并随机分配12个现有 VSLA组接收Jenga Dada或Standard VSLA编程。基线和6个月 将收集后续调查数据（n = 144名参与者）。我们还将收集和分析过程 参与者和实施者之间的数据和程序后定性数据。调查结果将告知 未来对Jenga Dada对长期结果的全面评估（例如IPV，意外怀孕， 经济自给自足）。