Interviewing adolescent girls about sexual and reproductive health: a qualitative study exploring how best to ask questions in structured follow-up interviews in a randomized controlled trial in Zambia

Abstract Background Numerous studies have documented inconsistent reporting of sexual behaviour by adolescents. The validity and reliability of self-reported data on issues considered sensitive, incriminating or embarrassing, is prone to social-desirability bias. Some studies have found that Audio Computer-Assisted Self Interviewing (ACASI) that removes the personal interaction involved in face-to-face interviews, decreases item non-response and increases reporting of sensitive behaviours, but others have found inconsistent or contradictory results. To reduce social desirability bias in the reporting of sensitive behaviours, face-to-face interviews were combined with ACASI in a cluster randomized trial involving adolescents in Zambia. Methods To explore adolescent girls’ experiences and opinions of being interviewed about sexual and reproductive health, we combined Focus Group Discussions with girl participants and individual semi-structured interviews with teachers. This study was done after the participants had been interviewed for the 6th time since recruitment. Young, female research assistants who had conducted interviews for the trial were also interviewed for this study. Results Respondents explained often feeling shy, embarrassed or uncomfortable when asked questions about sex, pregnancy and abortion face-to-face. Questions on sexual activity elicited feelings of shame, and teachers, research assistants and girls alike noted that direct questions about sexual activities limit what the participant girls may be willing to share. Responding to more indirect questions in relation to the context of a romantic relationship was slightly easier. Efforts by interviewers to signal that they did not judge the participants for their behavior and increased familiarity with the interviewer reduced discomfort over time. Although some appreciated the opportunity to respond to questions on their own, the privacy offered by ACASI also provided an opportunity to give false answers. Answering on tablets could be challenging, but participants were reluctant to ask for assistance for fear of being judged as not conversant with technology. Conclusion Strategies to avoid using overly direct language and descriptive words, asking questions within the context of a romantic relationship and a focus on establishing familiarity and trust can reduce reporting bias. For the use of ACASI, considerations must be given to the context and characteristics of the study population.

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Tax compliance and social desirability bias of taxpayers: experimental evidence from Indonesia

Journal of Public Policy ◽

10.1017/s0143814x21000040 ◽

2021 ◽

pp. 1-18

Author(s):

Endra Iraman ◽

Yoshikuni Ono ◽

Makoto Kakinaka

Keyword(s):

Experimental Evidence ◽

Social Desirability ◽

Tax Evasion ◽

Tax Compliance ◽

Computer Assisted ◽

Social Desirability Bias ◽

Lower Income ◽

Tax Returns ◽

List Experiment ◽

Experiment Technique

Abstract Identifying taxpayers who engage in noncompliant behaviour is crucial for tax authorities to determine appropriate taxation schemes. However, because taxpayers have an incentive to conceal their true income, it is difficult for tax authorities to uncover such behaviour (social desirability bias). Our study mitigates the bias in responses to sensitive questions by employing the list experiment technique, which allows us to identify the characteristics of taxpayers who engage in tax evasion. Using a dataset obtained from a tax office in Jakarta, Indonesia, we conducted a computer-assisted telephone interviewing survey in 2019. Our results revealed that 13% of the taxpayers, old, male, corporate employees, and members of a certain ethnic group had reported lower income than their true income on their tax returns. These findings suggest that our research design can be a useful tool for understanding tax evasion and for developing effective taxation schemes that promote tax compliance.

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Sexual and reproductive health of Syrian refugee adolescent girls: a qualitative study using focus group discussions in an urban setting in Lebanon

Reproductive Health ◽

10.1186/s12978-021-01178-9 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Rayan Korri ◽

Sabine Hess ◽

Guenter Froeschl ◽

Olena Ivanova

Keyword(s):

Focus Group ◽

Reproductive Health ◽

Sexual Harassment ◽

Qualitative Study ◽

Adolescent Girls ◽

Sexual And Reproductive Health ◽

Urban Setting ◽

Focus Group Discussions ◽

Group Discussions ◽

To Receive

Abstract Background The war in Syria caused the forced displacement of millions of Syrians to neighboring countries. Lebanon is the host country with the largest overall number of Syrian refugees per capita. Adolescent refugee girls experience a unique level of vulnerability during human emergencies and are at increased risk of suffering from poor sexual and reproductive health (SRH) outcomes. We conducted an exploratory qualitative study to learn about the SRH perceptions and experiences of refugee adolescent girls living in Bourj Hammoud, an urban setting in Lebanon. Methods We employed a qualitative design with eight focus group discussions (FGDs) conducted with 40 Syrian Arab and Syrian Kurdish adolescent girls between January and March 2020. Every FGD consisted of five participants aged 13 to 17 years. A semi-structured guide was used covering multiple themes: menstruation, puberty, SRH awareness, and sexual harassment. FGDs were transcribed and analyzed using thematic analysis. Findings The participants discussed adolescent girls’ health and named six elements of good health, such as healthy activities and self-protection. The majority of the FGD participants reported a lack of awareness about menstruation when they experienced it for the first time and the social stigma associated with menstruation. When defining puberty, they indicated its social link to a girl’s readiness for marriage and her need to become cautious about sexual harassment. Most FGD participants had very poor knowledge of the female reproductive system. Mothers were the most approached persons to receive information on SRH issues; however, the girls indicated a wish to receive advice from specialists in a comfortable and private atmosphere. All the girls reported that either they themselves, or an acquaintance, had experienced some type of sexual harassment. The girls rarely reported those incidents due to fear of being blamed or subjected to mobility restrictions, or forced to drop out of school. Conclusions The findings show the refugee girls need for satisfactory knowledge on SRH issues and interventions to prevent sexual and gender-based violence that take into consideration the complexity of urban settings.

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Sexual and Reproductive Health Information and Experiences Among Syrian Refugee Adolescent Girls in Lebanon

Qualitative Health Research ◽

10.1177/1049732321989685 ◽

2021 ◽

Vol 31 (5) ◽

pp. 983-998

Author(s):

L’Emira Lama El Ayoubi ◽

Sawsan Abdulrahim ◽

Maia Sieverding

Keyword(s):

Reproductive Health ◽

Adolescent Girls ◽

Sexual And Reproductive Health ◽

Well Being ◽

Focus Group Discussions ◽

Group Discussions ◽

Syrian Refugee ◽

Entry Points ◽

Depth Interviews ◽

Source Of Information

Providing adolescent girls with sexual and reproductive health (SRH) information protects them from risks and improves their well-being. This qualitative study, conducted in Lebanon, examined Syrian refugee adolescent girls’ access to SRH information about and experiences with puberty and menarche, sex, marriage, contraception, and pregnancy. We gathered data through three focus group discussions (FGDs) with unmarried adolescent girls, 11 in-depth interviews with early-married adolescents, and two FGDs with mothers. Our findings highlighted that adolescent participants received inadequate SRH information shortly before or at the time of menarche and sexual initiation, resulting in experiences characterized by anxiety and fear. They also revealed discordance between girls’ views of mothers as a preferred source of information and mothers’ reluctance to communicate with their daughters about SRH. We advance that mothers are important entry points for future interventions in this refugee population and offer recommendations aimed to improve adolescent girls’ SRH and rights.

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Situation analysis for delivering integrated comprehensive sexual and reproductive health services for displaced population of Kasaï, Democratic Republic of Congo: Protocol for a mixed method study

PLoS ONE ◽

10.1371/journal.pone.0242046 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0242046

Author(s):

Jacques B. O. Emina ◽

Parfait Gahungu ◽

Francis Iyese ◽

Rinelle Etinkum ◽

Brigitte Kini ◽

...

Keyword(s):

Reproductive Health ◽

Service Delivery ◽

Adolescent Girls ◽

Sexual And Reproductive Health ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

Reproductive Age ◽

Gender Based Violence ◽

Reproductive Health Services ◽

Republic Of Congo

Introduction Delivering integrated sexual and reproductive health services (SRHS) in emergencies is important in order to save lives of the most vulnerable as well as to combat poverty, reduce inequities and social injustice. More than 60% of preventable maternal deaths occur in conflict areas and especially among the internally displaced persons (IDP). Between 2016 and 2018, unprecedented violence erupted in the Kasaï’s region, in the Democratic Republic of Congo (DRC), called the Kamuina Nsapu Insurgency. During that period, an estimated three million of adolescent girls and women were forced to flee; and have faced growing threat to their health, safety, security, and well-being including significant sexual and reproductive health challenges. Between August 2016 and May 2017, the “Sous-Cluster sur les violences basées sur le genre (SC-VBG)” in DRC (2017) reported 1,429 Gender Based Violence (GBV) incidents in the 49 service delivery points in the provinces of Kasaï, Kasaï Central and Kasaï Oriental. Rape cases represented 79% of reported incidents whereas sexual assault and forced marriage accounted for respectively 11% and 4% of Gender Based Violence (GBV) among women and adolescent girls. This study aims to assess the availability of SRHS in the displaced camps in Kasaï; to evaluate the SRHS needs of young girls and women in the reproductive age (12–49). Studies of sexual and reproductive health (SRH) in the Democratic Republic of Congo (DRC) have often included adolescent girls under the age of 15 because of high prevalence of child marriage and early onset of childbearing, especially in the humanitarian context. According to the 2013 Demographic and Health Survey (DHS), about 16% of surveyed women got married by age 14 while the prevalence of early child marriage (marriage by 15) was estimated at 30%; to assess the use of SRHS services and identify barriers as well as challenges for SRH service delivery and use. Findings from this study will help provide evidence to inform towards more needs-based and responsive SRH service delivery. This is hoped for ultimately improve the quality and effectiveness of services, when considering service delivery and response in humanitarian settings. Data and methods We will conduct a mixed-methods study design, which will combine quantitative and qualitative approaches. Based on the estimation of the sample size, quantitative data will be drawn from the community-based survey (500 women of reproductive age per site) and health facility assessments will include assessments of 45 health facilities and 135 health providers’ interviews. Qualitative data will comprise materials from 30 Key Informant Interviews (KII) and 24 Focus Group Discussions (FGDs), which are believed to achieve the needed saturation levels. Data analysis will include thematic and content analysis for the KIIs and FGDs using ATLAS.ti software for the qualitative arm. For the quantitative arm, data analysis will combine frequency and bivariate chi-square analysis, coupled with multi-level regression models, using Stata 15 software. Statistic differences will be established at the significance level of 0.05. We submitted this protocol to the national ethical committee of the ministry of health in September 2019 and it was approved in January 2020. It needs further approval from the Scientific Oversee Committee (SOC) and the Provincial Ministry of Health. Prior to data collection, informed consents will be obtained from all respondents.

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Knowledge, Attitude and Practice of Sexual and Reproductive Health Among Older Adolescent Girls in Bangladesh: An Institution-Based Cross-Sectional Study

10.21203/rs.3.rs-64357/v1 ◽

2020 ◽

Author(s):

Muhammad Zakaria ◽

Junfang Xu ◽

Farzana Karim ◽

Subarna Mazumder ◽

Feng Cheng

Keyword(s):

Reproductive Health ◽

Linear Regression ◽

Mass Media ◽

Adolescent Girls ◽

Sexual And Reproductive Health ◽

Cross Sectional Study ◽

Regression Analyses ◽

Sectional Study ◽

Cross Sectional ◽

Attitudes And Practices

Abstract Background: Improving the sexual and reproductive health (SRH) of adolescent girls is one of the primary agenda of the Sustainable Development Goals (SDGs). Adequate and accurate knowledge, favorable attitude, safe behavior, and regular practice contribute to the adolescent girls’ SRH, maternal, and child health. In the background, this study aims to explore the level of knowledge, attitudes, and practices (KAP) of SRH among college-going older adolescent girls in Chittagong district, Bangladesh. Methods: An institution-based cross-sectional study was conducted in four colleges among the older adolescent girls age group of 16-17 (N = 792) attending a higher secondary grade in Chittagong district. Data were collected using a structured and self-administered questionnaire. Descriptive statistics and multiple linear regression analyses were used to summarize the SRH-related KAP and identify the associated factors, respectively. Results: 62% of study participants had the awareness that both physical and psychological changes occur in the adolescence period, while only 36% knew that menstruation is not a disease. Besides, only 30% of adolescent girls were informed about taking birth control has no adverse effect on the sexual relationship of a couple. Moreover, only 40% of students were learned that HIV could not be spread through the mosquito and flea, whereas only 25% knew that transmission of HIV is unlikely from an infected person’s coughing and sneezing. Of older adolescent girls, 35% disagreed perfectly whether sexual education can lead to more sexual activity. Besides, more or less 20% of participants opined that adolescent girls should refrain from going outside even to the school, entering into the kitchen, touching anyone, brushing hair, and see in the mirror. Moreover, 52% of adolescent girls wanted to learn more details about SRH, while 48% felt timid and afraid of their puberty changes. Besides, 62.5% of adolescent girls reported their using cloth during the menstrual cycle instead of the sanitary pad. Standardized coefficients beta (β) and p value < .05 in linear regression analyses explored that adolescent girls’ study of science, urban residence, reading or watching SRH contents on the mass media appeared as the more significant predictors for outcome variables. Conclusion: Many problems related to SRH exist among older adolescent girls in Bangladesh, such as behaviors and social constraints associated with menstruation, myths, and assumptions, recognition of the value of awareness and knowledge of reproductive health. Therefore, strengthening SRH-related comprehensive education programs incorporating into the curriculum, effective use of mass media, and supplying behavioral change communication materials are essential.

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Correction to: Mobile Link – a theory-based messaging intervention for improving sexual and reproductive health of female entertainment workers in Cambodia: study protocol of a randomized controlled trial

Trials ◽

10.1186/s13063-019-3941-z ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Carinne Brody ◽

Sovannary Tuot ◽

Pheak Chhoun ◽

Dallas Swendeman ◽

Kathryn C. Kaplan ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Reproductive Health ◽

Study Protocol ◽

Sexual And Reproductive Health ◽

Controlled Trial ◽

Randomized Controlled ◽

Female Entertainment Workers ◽

Mobile Link

After publication of our article [1] we became aware that several sections of text in our Methods section were copied from a previously published article [2]. We would like to formally apologize and give credit to the authors of that article [2]: Chris Smith, Uk Vannak, Ly Sokhey, Thoai D Ngo, Judy Gold, Khemrin Khut, Phil Edwards, Tung Rathavy and Caroline Free.

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