Community-embedded Reproductive Health Care for Adolescents in Latin America.
Condition: Sexual and Reproductive Health Problems
Study type: Interventional

Summary: 
      Adolescents in Latin America are at major risk for unwanted pregnancies leading to unsafe
      abortions and maternal health risks. Mostly, adolescent health programmes tend to focus on
      unidirectional interventions aiming at a single determinant of adolescents´ sexual and
      reproductive health. However, evidence exists that a complex health problem should be
      addressed by an equally nuanced and multipronged response. Knowledge is lacking on how to
      develop a comprehensive approach to promote adolescents' sexual health.

      The CERCA study will conduct an implementation based on the hypothesis that a comprehensive
      strategy of community-embedded interventions helps to improve the sexual health of
      adolescents. We will test this hypothesis and describe the development, implementation and
      testing of interventions in three Latin American cities: Cochabamba (Bolivia), Cuenca
      (Ecuador) and Managua (Nicaragua).

      The research methodology has been designed based on the methodological frameworks of action
      research, community based participatory research and intervention mapping.

      The interventions are complex addressing different target groups (adolescents, parents,
      authorities and health providers) and focussing on various behaviours that are related to
      communication about sexuality, information seeking, access to health care and safe sexual
      intercourse.

      For the evaluation of effectiveness a randomised and non-randomised controlled study was
      developed for respectively Managua and the two other cities. Furthermore a process evaluation
      is conducted.

      This research will result in a framework that will contribute to the planning of
      interventions that are effective and responsive to adolescents' sexual health needs.
    


Intervention name(s): Theory of planned behaviour (TPB) and social cognitive theory (SCT).
Intervention type(s): Behavioral
Intervention description(s): TPB is appropriate to influence adolescents' behaviour related to the use of contraceptive methods and their health/information seeking behaviour. The SCT helped to find out strategies to improve communication about sexuality, to promote openness towards adolescents' sexuality among parents, community members and health providers and for health providers to adopt a more adolescent friendly attitude.The development of the strategies in the different countries is a dynamic process that is continuously being adapted. The target groups were "driving" the process of identifying, selecting and implementing interventions. Therefore, local institutions were involved in the intervention. Attention was paid to ensure that the interventions were in line with the existing local structures/policies and reinforce the local health system.Primary health care services had a key role in the interventions. Gender was a transversal topic throughout the intervention process.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention