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Evaluating the effectiveness of a combined approach to improve utilization of adolescent sexual reproductive health services in Kenya : a quasi-experimental design study protocol

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Abstract
Background: Access to and utilization of adolescent sexual and reproductive health (ASRH) services remains poor. ASRH services in Kenya are primarily offered in health facilities and include counselling, information, and services on family planning, sexually transmitted infections, and HIV and basic life skills. The Ministry of Education also provides age-appropriate sexual and reproductive health information in schools. This paper presents a study protocol that will evaluate the effectiveness of a combined approach toward improving utilization of ASRH services. Methods: This will be a quasi-experimental study utilizing qualitative and quantitative methods. During the formative phase, data will be collected through focus group discussions, in-depth interviews, and key informant interviews to explore the barriers and facilitators of provision and utilization of ASRH services. A quantitative design will be used to obtain baseline and endline data through household surveys and client exit interviews. Following the formative and baseline household and client exit assessments, an intervention focusing on provision of ASRH service package targeting boys and girls will be implemented for 18 months. The package will include contextualized ASRH services, including counselling and age-appropriate, comprehensive sexual education for behavior change with an aim to increase utilization of ASRH services. An analysis of the primary outcome (utilization of ASRH services) will be undertaken to establish the difference in difference between the control and intervention arm, before the intervention (using the baseline survey data) and after the intervention (using the endline survey data). Discussion: Adolescents have now been included in the World Health Organization's Global strategy for women's, children's and adolescents' health (2016-2030), acknowledging the unique health challenges facing young people and their pivotal role as drivers of change in the post-2015 era. This study will generate evidence on whether a combined school, facility, and community approach works toward improving utilization of ASRH services. The information generated from the study will be beneficial for programming as it will identify underlying reasons for low utilization of ASRH services. Results will help to shape ASRH programs and reduce teenage pregnancy within Kenya and other similar low middle-income countries.
Keywords
Adolescent, Sexual and reproductive health, Contraception, Family planning, Approach

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MLA
Mutea, Lilian, et al. “Evaluating the Effectiveness of a Combined Approach to Improve Utilization of Adolescent Sexual Reproductive Health Services in Kenya : A Quasi-Experimental Design Study Protocol.” REPRODUCTIVE HEALTH, vol. 16, 2019, doi:10.1186/s12978-019-0825-3.
APA
Mutea, L., Ontiri, S., Macharia, S., Tzobotaro, M., Ajema, C., Odiara, V., … Gichangi, P. (2019). Evaluating the effectiveness of a combined approach to improve utilization of adolescent sexual reproductive health services in Kenya : a quasi-experimental design study protocol. REPRODUCTIVE HEALTH, 16. https://doi.org/10.1186/s12978-019-0825-3
Chicago author-date
Mutea, Lilian, Susan Ontiri, Sheila Macharia, Meital Tzobotaro, Carolyne Ajema, Vincent Odiara, Francis Kadiri, et al. 2019. “Evaluating the Effectiveness of a Combined Approach to Improve Utilization of Adolescent Sexual Reproductive Health Services in Kenya : A Quasi-Experimental Design Study Protocol.” REPRODUCTIVE HEALTH 16. https://doi.org/10.1186/s12978-019-0825-3.
Chicago author-date (all authors)
Mutea, Lilian, Susan Ontiri, Sheila Macharia, Meital Tzobotaro, Carolyne Ajema, Vincent Odiara, Francis Kadiri, Solomon Orero, Mark Kabue, Kristien Michielsen, and Peter Gichangi. 2019. “Evaluating the Effectiveness of a Combined Approach to Improve Utilization of Adolescent Sexual Reproductive Health Services in Kenya : A Quasi-Experimental Design Study Protocol.” REPRODUCTIVE HEALTH 16. doi:10.1186/s12978-019-0825-3.
Vancouver
1.
Mutea L, Ontiri S, Macharia S, Tzobotaro M, Ajema C, Odiara V, et al. Evaluating the effectiveness of a combined approach to improve utilization of adolescent sexual reproductive health services in Kenya : a quasi-experimental design study protocol. REPRODUCTIVE HEALTH. 2019;16.
IEEE
[1]
L. Mutea et al., “Evaluating the effectiveness of a combined approach to improve utilization of adolescent sexual reproductive health services in Kenya : a quasi-experimental design study protocol,” REPRODUCTIVE HEALTH, vol. 16, 2019.
@article{8634670,
  abstract     = {{Background: Access to and utilization of adolescent sexual and reproductive health (ASRH) services remains poor. ASRH services in Kenya are primarily offered in health facilities and include counselling, information, and services on family planning, sexually transmitted infections, and HIV and basic life skills. The Ministry of Education also provides age-appropriate sexual and reproductive health information in schools. This paper presents a study protocol that will evaluate the effectiveness of a combined approach toward improving utilization of ASRH services. 
Methods: This will be a quasi-experimental study utilizing qualitative and quantitative methods. During the formative phase, data will be collected through focus group discussions, in-depth interviews, and key informant interviews to explore the barriers and facilitators of provision and utilization of ASRH services. A quantitative design will be used to obtain baseline and endline data through household surveys and client exit interviews. Following the formative and baseline household and client exit assessments, an intervention focusing on provision of ASRH service package targeting boys and girls will be implemented for 18 months. The package will include contextualized ASRH services, including counselling and age-appropriate, comprehensive sexual education for behavior change with an aim to increase utilization of ASRH services. An analysis of the primary outcome (utilization of ASRH services) will be undertaken to establish the difference in difference between the control and intervention arm, before the intervention (using the baseline survey data) and after the intervention (using the endline survey data). 
Discussion: Adolescents have now been included in the World Health Organization's Global strategy for women's, children's and adolescents' health (2016-2030), acknowledging the unique health challenges facing young people and their pivotal role as drivers of change in the post-2015 era. This study will generate evidence on whether a combined school, facility, and community approach works toward improving utilization of ASRH services. The information generated from the study will be beneficial for programming as it will identify underlying reasons for low utilization of ASRH services. Results will help to shape ASRH programs and reduce teenage pregnancy within Kenya and other similar low middle-income countries.}},
  articleno    = {{153}},
  author       = {{Mutea, Lilian and Ontiri, Susan and Macharia, Sheila and Tzobotaro, Meital and Ajema, Carolyne and Odiara, Vincent and Kadiri, Francis and Orero, Solomon and Kabue, Mark and Michielsen, Kristien and Gichangi, Peter}},
  issn         = {{1742-4755}},
  journal      = {{REPRODUCTIVE HEALTH}},
  keywords     = {{Adolescent,Sexual and reproductive health,Contraception,Family planning,Approach}},
  language     = {{eng}},
  pages        = {{9}},
  title        = {{Evaluating the effectiveness of a combined approach to improve utilization of adolescent sexual reproductive health services in Kenya : a quasi-experimental design study protocol}},
  url          = {{http://dx.doi.org/10.1186/s12978-019-0825-3}},
  volume       = {{16}},
  year         = {{2019}},
}

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