Health service providers’ perspectives on the influence of modern health systems on adolescents’ sexual health practices in Umguza and Mberengwa districts of Zimbabwe

Background Health service providers play a significant role in crafting and implementing health policies and programs that manage adolescent sexual health-related issues at different health system levels. These influence adolescent sexual behaviours and practices. Aim This study explored the roles of health service providers in managing adolescent sexual issues and how this impacts their sexual behaviours and practices. The study further probed the health service providers on how the indigenous health system could be integrated into the modern health system for effective management of adolescent sexual health related issues. Methods A qualitative cross-sectional survey was conducted on purposively selected health service providers in health facilities in Mberengwa and Umguza districts. Data was collected using unstructured interviews that were recorded, transcribed verbatim, and thematically analysed. Findings were presented as clearly defined as superordinate and subordinate themes. Results A total of five superordinate themes and 19 subordinate themes emerged from the interrogated data. The superordinate themes were: overview of adolescent sexual health issues, role of modern health system in adolescent sexual health issues, challenges encountered, indigenous health system factors that could be factored into modern health systems, and strategies to foster the integration of indigenous health system and modern health system. The subordinate themes explored in-depth the findings of the key stakeholders under the five superordinate themes. Conclusions From the findings, it can be concluded that health service providers play an essential role in shaping and providing adolescent sexual health services that adolescents utilise despite challenges that have reduced demand for these services. Therefore, there is a need to point out that there is a window of opportunity to foster collaborations between the indigenous health system and the modern health system as they strive to serve the adolescents to the best of their ability though in different contextual settings.

Health System Strategies and Adolescent Sexual Health: A Systematic Review of the Literature using Rodgers Concept Analysis Framework

Background: Health Systems Strategies play a key role in determining Adolescent Sexual Health outcomes. This study aims to review the literature on the relationship between Health Systems Strategies and Adolescent Sexual Health issues guided by Rodger's evolutionary concept analysis framework. The study further develops a Conceptual Framework that would guide a study that seeks to “Develop strategies to facilitate safe sexual practices in adolescents through Integrated Health Systems in selected Districts in Zimbabwe.” Methods: Adolescents, Health Systems, Sexual Health, and Strategies were used to search for published literature (in English) on Google Scholar, PUBMED, EBSCO, Cochran Library, and Science Direct. A total of 142 Articles and 11 reports were obtained, and the content was screened for relevance. This led to 42 articles and 03 reports being found suitable and relevant, and thus, the content was reviewed. Thematic analysis was done to identify attributes, antecedents, and consequences of Health Systems Strategies on Adolescent Sexual Health. These findings were then used to inform the development of the Conceptual Framework. Results: Key attributes, antecedents and consequences of Health System Strategies on Adolescent Sexual Health were identified. Strategies to Improve Adolescent Sexual Health outcomes were also identified. Conclusions: Different contextual factors influence policy changes and the consequences are mixed, with both positive and negative outcomes.

Effects of telehealth interventions for adolescent sexual health: A systematic review and meta-analysis of randomized controlled studies

Introduction Telehealth interventions to advance adolescent sexual health have evolved and are being used to promote adolescent sexual health knowledge and healthy sexual behaviors. However, as this area of intervention modality expands, there is a need to pause and examine the effects of telehealth interventions on adolescent sexual health outcomes. Addressing this knowledge gap will inform researchers and practitioners on the current state of evidence of telehealth interventions and inform further intervention development and testing. This study aimed to explore the meta-effects of telehealth interventions on self-efficacy of using condoms, condom use practices, and sexually transmitted infection testing behaviors among adolescents. Methods A systematic review and meta-analysis of randomized controlled trials were conducted. Seven databases (Academic Search Complete, CINAHL, EMBASE, MEDLINE, PubMed, OVID (UpToDate), and Web of Science) were searched for relevant full-text articles from the inception to May 2021. The revised Cochrane risk-of-bias tool for randomized trials was used to assess the methodological quality of the included studies. A meta-analysis was performed using a random effects model to calculate the pooled effects of telehealth interventions for adolescents. Stata 16.0 was used for statistical analysis. Results A total of 15 studies ( N = 5499) that used telehealth interventions with adolescents were included in the analysis. Telehealth interventions were found to increase self-efficacy for condom use (standardized mean difference: 0.22; 95% confidence interval: 0.08–0.36), practice for condom use (standardized mean difference: 0.35; 95% confidence interval: 0.23–0.47), and being screened/tested for sexual transmitted infections (standardized mean difference: 0.61; 95% confidence interval: 0.31–0.92). Discussion Telehealth interventions show promise as effective intervention delivery solutions for improving self-efficacy and certain sexual health behaviors among adolescents. These telehealth strategies could be important alternatives to in-person visits to accessing sexual health information or services near where they live. Future research should consider testing telehealth strategies where there is evidence of impact to move the field forward.

Parenting with Unintended Pregnancy in East Java, Indonesia: A Qualitative Study

Teenage pregnancy is known to significantly impact the health of mothers and babies. Lack of preparations and poor knowledge might lead teenage mothers to have difficulties in practicing good parenting. Therefore, it is essential to assess parenting styles in adolescents with unwanted pregnancy (UP). This study aimed to analyse how teenage mothers with unwanted pregnancy nurture their babies. This research used a qualitative method with Rapid Assessment Procedure (RAP) study design. In-depth interviews, triangulations and observations were employed to obtain the data. Six informants participated in this study who were chosen purposively based on the inclusion criteria. The results showed that all informants took care of their babies by themselves. However, the majority of them showed inadequate exclusive breastfeeding (EBF), immunization and posyandu (Indonesian-integrated health post system) visit. Lack of informants’ understanding was found to be the leading factor of the inadequacies. Keywords: parenting, unintended pregnancy, adolescent, sexual health

Effects of a randomized controlled trial of a brief, student-nurse led, parent-based sexual health intervention on parental protective factors and HPV vaccination uptake

Background Parents play a pivotal role in adolescent sexual health and Human Papillomavirus (HPV) vaccination. Nurses are on the frontlines of healthcare and play a critical role in promoting HPV vaccination and parent-child sexual health communication. We enhanced the Families Talking Together (FTT) parent-based sexual health curriculum to include adolescent vaccinations herein, FTT + HPV, and trained student nurses to provide a strong HPV vaccination and parent-child sexual health communication endorsement. Methods Using a randomized attention-controlled trial design, we examined the efficacy of FTT + HPV among 519 parents and their 11–14 year old youth recruited from medically underserved communities between 2015 and 2018. Participants were recruited from 22 after-school programs (e.g., Boys and Girls Clubs) and 19 charter schools. For parents, we examined protective factors including parent-child sexual health communication and parental involvement. For youth, we examined sexual health knowledge, parent-child sexual health communication, and parent-child connectedness. To assess HPV vaccination initiation and completion, we searched IMMTRAC immunization registry records for 85% of youth and used parental report for youth without registry records. Group differences were calculated using the estimated mean difference at one- and six months post-intervention with significance set at the p < 0.05 level. Results Baseline rates of HPV vaccination were low at 55.7%. No significant difference between the groups was seen in vaccination initiation or completion rates by one-month post-intervention. However, by six-months post intervention, there was a significant difference between the groups with 70.3% of the intervention group initiating the HPV vaccination series vs. 60.6% for the control group (p = 0.02). No difference between the groups was found for HPV series completion at six-months. There were significant differences in condom knowledge (p = 0.04), parent-child connectedness (p = 0.04), and communication frequency (p = 0.001) with greater improvement in the intervention vs. the control group. Rates of sexual activity remained low in both groups throughout the six-month follow-up period. Conclusion A brief parent-based adolescent sexual health and HPV vaccination intervention delivered by student nurses can improve sexual health outcomes including protective parental factors, adolescent sexual health knowledge, and HPV vaccination initiation rates. Trial registration ClinicalTrials.gov Identifier: NCT02600884. Prospectively registered September 1, 2015.