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No other specific in- or exclusion criteria are formulated, not regarding sexual activity nor regarding adolescent pregnancy. The duration of the project is 3 years and is from January until December At the end of the first project year and during the second project year, the framework and accompanying script of the PEP will be developed, followed by the actual implementation and evaluation in the third project year. Taking into account the social context and complexity of adolescent pregnancy and SRH, input from local stakeholders and experts is considered necessary for succeeding of the project.
These events target experts and stakeholders in the field of health care and education, such as school teachers and directors, delegates of hospitals or medical centers, and delegates of local policies. Local network events are on the agenda at the start, halfway and at the end of the project. The aim of these events is to implement the research and the developed PEP maximally within daily life of young adolescents as well as ensuring that the PEP can be implemented smoothly next to the numerous educational programs and efforts in the context of SRH.
Five main topics are formulated for the events, being 1 different views on Rwandan prevention strategies for adolescents pregnancies, 2 learned lessons from previous experiences and projects, 3 strengths of and necessary conditions for the PEP, 4 expected barriers and how to tackle these, and 5 other opportunities and valorization options of the research project.
The first study phase comprises the quantitative part in which group 3 to 6 students from the three aforementioned schools are questioned regarding SRH. This survey is made available by the World Health Organization WHO and its purpose is to serve as a point of departure when examining the SRH of teenagers or young people who have reached puberty but have not yet married or entered stable cohabiting relationships. The survey is designed to document knowledge, beliefs and behavior in the domain of SRH and should be viewed as a tool to address the needs of teenagers and young people as cornerstone for interventions.
This is an important perspective as the outcome of this survey will be used as input for the development of the peer to peer PTP education program.
The instrument is constructed in such a manner that it should always be adapted to the local context, in this case to the Rwandan context. Second, the adapted version is being translated in Kinyarwanda and back translated into English. Only minor changes in answer options were needed to make sure that all questions and answers are clear for use in Kinyarwanda. A detailed description of these five topics is given below.
These topics seemed less relevant in view of the PTP education program and processing or removal of items led to a shortened survey of seven pages. Section two about sources of information on and knowledge of reproductive health questions the most important and the preferred source about puberty in general i.
The third section focusses on the knowledge and use of contraceptive methods. Six contraceptive methods are listed pill, injection, condom, emergency contraceptive pills, withdrawal and periodic abstinence with a short explanation e. In addition, it is questioned if respondents have heard of other methods.
Hereafter, respondents circle the methods they think are most suitable for young people and the methods they or their sexual partner have ever used in case of experienced sexual intercourse. Answers that can be circled are pill, injection, condom, emergency pill, withdrawal, periodic abstinence, other specify. The final section includes the use and perceptions of health services. This survey is taken at the beginning and the end of the project.
It is printed on paper and will be divided at each class room. In combination with the survey at the beginning of the project T1 , six focus group interviews are organized with Kirehe in-school students to explore their SRH knowledge and attitudes more in depth and to better understand their needs and the possible role of a PEP program in the prevention of adolescent pregnancies. Focus group interviews are led by a UR lectures assisted by a Belgian master student in Nursing. Interviews will be held in classrooms, located quiet and safe in the school area, and foreseen of a table with chairs.
The interviews will be mainly done in Kinyarwanda.
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A native speaking Rwandan lecturer is pointed out as first interviewer, while the Belgian student acts mainly as observer to take field notes of nonverbal communication and as back-up for substantive support. A semi-structured topic list is drawn up from the literature and matched with the main scope of the project. After a general introduction by the interviewer, name tags with letters A to H are given to participants in order to anonymize the obtained data as much as possible. The development of the actual PEP, consisting of a manual and two trainer modules, starts after retrieving insights from the preparatory quantitative and qualitative studies.
In an attempt to succeed in the empowerment of Kirehe adolescents in the context of SRH, it is of importance to increase the level of SRH knowledge and skills, since these are both necessary conditions for empowerment [ 14 ].
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This toolkit was developed to build the capacity of local non-governmental organisations to design, implement, supervise, monitor, and evaluate effective SRH PEPs. When the framework of the program is made, it is necessary that healthcare workers are sufficiently equipped with the necessary knowledge and skills to accurately facilitate peer exchange in the context of SRH. It is opted to focus on future health care workers last year Midwifery and Nursing students as they are already involved in SRH education from their learning programs — but in a lesser extent than pursued - so they need minimum substantive training.
Furthermore, these students are more closely related to the daily life of adolescents, since they are often still young adults.
And finally — and perhaps most importantly — by intervening in health care workers in training, we enhance the probability of evolving to a more sustainable and open professional climate regarding SRH. Next, the project steps forward to the peer education aspect. In order to maximally attract and motivate adolescents to become a peer, and to watch over the feasibility of the project, we will organize together with students Midwifery three times a two-day training in the first trimester on the most relevant SRH topics and communication skills.
Next to the training of peers, UR students Midwifery will be involved in peer selection and recruitment. Trained UR students Midwifery will be instructed to apply their knowledge and skills to class- and schoolmates. After a period of approximately 6 months following the second train-the-trainer module, focus group interviews with the trained peers will be executed together with students Midwifery.
We want to understand what barriers and opportunities emanate from the program, so that we can optimally fit the program to the local context. In this manner, built-up partnerships can be nourished and maintained, resulting into a more sustainable prevention strategy in the battle against adolescent pregnancies. The mixed study design allows different types of data analyses; several analytical procedures will be considered for the quantitative part, while more in-depth analyses are foreseen for the qualitative part.
Analytical procedures will include descriptive and cohort study analyses, performed in SPSS software. A specific P -value of significance will be determined based on the number of tests that will be performed for a specific research question. Interviews will be audio-recorded and saved safely by the researchers. Following at-verbatim transcription, recorded interviews will be deleted from the dictaphones.
Transcriptions will be coded in NVivo 12 according to the principles of thematic analysis. The obtained data will be triangulated by peer debriefing and main findings will be schematically conceptualized for increasing transferability. No power calculation has been performed for the quantitative study. The three participating schools are chosen with respect to the practical feasibility of the project. Besides, the choice for these three schools in the three most challenging regions in Kirehe district is based on the number of pregnancies in in-school adolescents see introduction.
However, in comparison with similar studies, the number of included adolescents seems acceptable in order to obtain reliable data outcomes. This project started in January In the first project year and the first half of the second project year, a network event took place, six focus group interviews were done, the baseline measurement was taken and the PEP program has been developed.
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First research papers on these data are expected to be published by the end of and in Research data from the PEP program, the pre versus post-measurement and the focus group interview with adolescents being pregnant or having one or more children will probably be published in the second half of and This paper presents the emergence and development of a school-based PEP uncovering and tackling important determinants in the prevention of adolescent pregnancies in Kirehe district, Rwanda.
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