Narratives of most significant change to explore experiences of caregivers in a caregiver-young adolescent sexual and reproductive health communication intervention in rural south-western Uganda

Background This paper presents findings from a qualitative effectiveness evaluation of an intervention aimed at improving caregiver-young adolescent sexual and reproductive health (SRH) communication including training modules for caregivers on parent-child SRH communication. Methods Data was collected (October 2021-November 2021) using a narrative interviewing technique with thirty caregivers (8 males and 22 females), who received the parent-child communication intervention in Mbarara district, south-western Uganda. We explored caregivers’ experiences with the intervention based on four domains of change: caregiver-young adolescent communication on SRH issues, knowledge and attitudes towards adolescent SRH, parenting skills, and personal life and family. Thematic analysis was used to code and analyse the data, with attention to gender differences. Results Findings highlight positive parenting as a key attribute of SRH communication, along with a transformation of knowledge and attitudes towards the SRH of young adolescents leading to an overall improvement in SRH communication. However, communication is still limited to comfortable topics. Conclusion Our findings indicate improved caregiver–adolescent SRH communication practices following a community intervention. Programming for adolescent health on broader sexuality topics, comfortability and attitude change among caregivers could promote behaviour change on a long term. Future studies may focus on the long term impacts of interventions of this nature and test interventions aimed at addressing comfortability with discussingSRH issues.

[1]  K. Michielsen,et al.  Level and comfort of caregiver–young adolescent communication on sexual and reproductive health: a cross-sectional survey in south-western Uganda , 2022, BMC Public Health.

[2]  K. Michielsen,et al.  Gendered Experiences of Parent–Child Communication on Sexual and Reproductive Health Issues: A Qualitative Study Employing Community-Based Participatory Methods among Primary Caregivers and Community Stakeholders in Rural South-Western Uganda , 2022, International journal of environmental research and public health.

[3]  K. Wyka,et al.  The development of adolescent agency and implications for reproductive choice among girls in Zambia , 2021, SSM - population health.

[4]  N. Andersson,et al.  How beneficiaries see complex health interventions: a practice review of the Most Significant Change in ten countries , 2021, Archives of Public Health.

[5]  Wubet Taklual,et al.  Parent-adolescent communication on sexual and reproductive health issues and its associated factors in Ethiopia: a systematic review and meta-analysis , 2020, Italian Journal of Pediatrics.

[6]  C. Bylund,et al.  International barriers to parent-child communication about sexual and reproductive health topics: a qualitative systematic review , 2020 .

[7]  B. Ushie,et al.  Parent-child sexual and reproductive health communication among very young adolescents in Korogocho informal settlement in Nairobi, Kenya , 2020, Reproductive Health.

[8]  J. Kinsman,et al.  Obstacles to intergenerational communication in caregivers’ narratives regarding young people’s sexual and reproductive health and lifestyle in rural South Africa , 2020, BMC Public Health.

[9]  K. Michielsen,et al.  Institutional and contextual obstacles to sexuality education policy implementation in Uganda , 2020, Sex Education.

[10]  Mohannad A. Aldiqs,et al.  Parent–child communication about sexual and reproductive health: perspectives of Jordanian and Syrian parents , 2020, Sexual and reproductive health matters.

[11]  K. Michielsen,et al.  Evaluation of a school based comprehensive sexuality education program among very young adolescents in rural Uganda , 2019, BMC Public Health.

[12]  M. Makoae,et al.  'They tell you about the risks':Exploring sources of sexuality education among very young adolescents in rural Mpumalanga. , 2018, South African Journal of Child Health.

[13]  Sudirman Nasir,et al.  Use of most significant change (MSC) technique to evaluate health promotion training of maternal community health workers in Cianjur district, Indonesia. , 2018, Evaluation and program planning.

[14]  T. Kohi,et al.  Caretaker-adolescent communication on sexual and reproductive health: a cross-sectional study in Unguja-Tanzania Zanzibar , 2017, BMC Public Health.

[15]  A. A. Kamangu,et al.  Barriers to parent-child communication on sexual and reproductive health issues in East Africa: A review of qualitative research in four countries , 2017 .

[16]  T. Kohi,et al.  Caretaker’s Perceptions on Caretaker-Adolescent Communication on Sexual and Reproductive Health in Unguja-Zanzibar: Implication for Intervention , 2016 .

[17]  Dan J Stein,et al.  Developing family interventions for adolescent HIV prevention in South Africa , 2016, AIDS care.

[18]  V. Guilamo-Ramos,et al.  Parental Monitoring and Its Associations With Adolescent Sexual Risk Behavior: A Meta-analysis , 2015, Pediatrics.

[19]  C. Currie,et al.  Adolescent health in the 21st century , 2015, The journal of the Royal College of Physicians of Edinburgh.

[20]  K. Klepp,et al.  Perceptions and experiences of adolescents, parents and school administrators regarding adolescent-parent communication on sexual and reproductive health issues in urban and rural Uganda , 2015, Reproductive Health.

[21]  D. Béguy,et al.  Influence of parental factors on adolescents’ transition to first sexual intercourse in Nairobi, Kenya: a longitudinal study , 2015, Reproductive Health.

[22]  A. Worku,et al.  Parent-Adolescent Sexual and Reproductive Health Communication Is Very Limited and Associated with Adolescent Poor Behavioral Beliefs and Subjective Norms: Evidence from a Community Based Cross-Sectional Study in Eastern Ethiopia , 2015, PloS one.

[23]  R. Jewkes,et al.  Early adolescent pregnancy increases risk of incident HIV infection in the Eastern Cape, South Africa: a longitudinal study , 2014, Journal of the International AIDS Society.

[24]  S. Bastien,et al.  A review of studies of parent-child communication about sexuality and HIV/AIDS in sub-Saharan Africa , 2011, Reproductive health.

[25]  W. Stones,et al.  Parent-child communication about sexual and reproductive health in rural Tanzania: Implications for young people's sexual health interventions , 2010, Reproductive health.

[26]  R. Forehand,et al.  Why Parents Matter!: The Conceptual Basis for a Community-Based HIV Prevention Program for the Parents of African American Youth , 2004 .

[27]  M. Magadi,et al.  Parental presence and adolescent reproductive health among the Nairobi urban poor. , 2003, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[28]  B. Miller,et al.  Interventions designed to promote parent-teen communication about sexuality. , 2002, New directions for child and adolescent development.

[29]  E. S. Lefkowitz,et al.  Beyond the yes-no question: measuring parent-adolescent communication about sex. , 2002, New directions for child and adolescent development.

[30]  M. Greene,et al.  Creating an enabling environment for adolescent sexual and reproductive health: a framework and promising approaches. , 2015, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[31]  Frank Stowell,et al.  The Appreciative Inquiry Method—A Suitable Candidate for Action Research? , 2013 .