Antiretroviral drugs taken during pregnancy, reduce the rates of mother-to-child transmission from 35 percent to as low as 1 to 2 percent (UNAIDS, 2009). In 2002, the Prevention of Mother-to-Child Transmission (PMTCT) programme was implemented in South Africa. Studies on the implementation of the PMTCT programme have shown that understaffed and under-developed health care facilities were key barriers to the provision of PMTCT services (Health Systems Trust, 2002: 6; Skinner et al., 2003). The aim of this study was to assess the challenges experienced by health care workers working in public sector facilities in the Nelson Mandela Metropole after implementation of the dual therapy PMTCT programme. Four areas were investigated: Infrastructure; Drug Supply Management; Clinic Procedures and Staffing. A quantitative descriptive study was conducted in August 2009 at nine public health care facilities in the Nelson Mandela Metropole, South Africa. Questionnaires were issued to 81 nurses and 41 pharmacy personnel (pharmacists and pharmacist assistants). Checklist audit forms were issued to the Facility Manager of each facility and completed with the researcher. The key findings for Infrastructure were lack of space at patient waiting rooms (9; 100 percent n=9), counselling area (5; 55.5 percent; n=9), nurse consultation rooms (6; 66.6 percent; n=9), storage areas (5; 55.5 percent; n=9) and filing areas (7; 77.7 percent; n=9). The key findings for Drug Supply Management were none of the dispensaries (0 percent; n=10) were fully compliant with Good Pharmacy Practice, pharmacy personnel indicated that there were no stock cards for medication (13; 31.7 percent; n=41); there was less than two weeks supply of buffer stock kept for zidovudine and nevirapine (13; 35.1percent; n=37) and medication orders were placed without any reference to minimum and maximum levels of medication (15; 36.5 percent; n=41) . The key findings for Clinic Procedures were only two facilities followed up on patients that had missed appointments (22.2 percent; n=9) and four facilities (44.4 percent; n=9) had a tracking system for patients that had defaulted. Of the nine facilities only three (33.3 percent; n=9) updated patient demographic details regularly. The key findings for Staffing were a shortage of doctors, nurses, counsellors and pharmacists at the facilities. One of the major challenges identified was the lack of training offered on new PMTCT protocols with 56.2 percent (45; n=80) of the nurses stating that no training was provided on the dual PMTCT protocol. Only 54.3 percent (44; n=81) of nurses stated that they knew the criteria to start the mother on dual PMTCT therapy. In conclusion there is an urgent need for barriers such as lack of staff, lack of space, lack of training on PMTCT and standard procedures for follow up of patients to be addressed in order to ensure the successful scaling up of PMTCT.

This study was an examination of an intervention called the baby think it over doll in a small sample of teenagers. The study attempted to ascertain the impact of the doll on attitudes and beliefs surrounding early parenthood and a teen's future hopes.

No description available.

Introduction: In recent year, the role of the pharmacist has evolved from product-focused to patient-focused activities. Following this evolution, new professional pharmacy services were simultaneously developed by researchers and started to be legally implemented and remunerated for community pharmacists around the world. Implementation, essential to ensure a good programme delivery and therefore its effectiveness, was seen as a passive process for which diffusion and dissemination were sufficient to translate research into practice. However, the transition from theory to practice is often difficult as different factors hinder or facilitate the implementation of such services. In consequence of that, implementation research started to be developed in the community pharmacy field to understand and fil the gap between theory and practice.Objectives of the thesis: Three projects were conducted in Belgium and Switzerland; (1) to understand the implementation of an existing programme in Belgium; the isotretinoin pregnancy prevention programme (PPP) (Chapter IV, point 4.1), and (2) to study the implementation of two new developed pharmaceutical services, which include an interview between the pharmacist and the patient and require interprofessional collaboration; the medication adherence program in Switzerland and the medication review in Belgium (Chapter IV, point 4.2). Methods: To understand the implementation of the isotretinoin PPP, two studies were conducted. The first study was a survey sent to health care professionals (pharmacists, general practitioners and dermatologists) and patients. The outcomes of the survey were the PPP awareness and compliance to safety recommendations related to the teratogenic risk of isotretinoin. The second study was cross-sectional and analysed the reimbursed prescription data of the Belgian population taking isotretinoin between January 2012 and August 2015. The outcomes were medication adherence to isotretinoin and to contraception, and the concomitant use of contraception and isotretinoin. Medication adherence was measured using the medication possession ratio (MPR), dividing the total days of medication supplied within the refill interval by the number of days in the refill interval. The concomitant use of isotretinoin and contraception was realised in combining prescription database of both isotretinoin and contraception of women between 12 and 21 years old, who received at least one prescription of isotretinoin during the study period.To study the implementation of the medication adherence program in Switzerland and the medication review service in Belgium, two prospective and observational studies were conducted with a mixed method approach (quantitative and qualitative outcomes). The defined outcomes, based on the RE-AIM model, were; reach of the target patients, adoption of the service by health care professionals providing the service, implementation (facilitators, barriers and fidelity or the extent to which the intervention is delivered as intended), and maintenance (the extent to which the intervention become institutionalized or part of the routine activity). Outcomes were collected through web platforms for quantitative data, and interviews and focus groups for qualitative data.Results and discussion: The study of the isotretinoin PPP implementation showed that two safety recommendations related to the teratogenic risk were particularly poorly applied by interviewed health care professionals. These two recommendations were the use of a second contraceptive method (like condoms) and the monthly pregnancy test. They considered these two recommendations as unnecessary for women taking an effective contraceptive method. Through the prescription refill data analysis, we observed that 46.1% of patients were adherent to isotretinoin (MPR ≥ 0.8) and 74.0% of women taking isotretinoin to their prescribed contraception (oral contraceptive, rings and patches). Lastly, 83.4% of women between 12 and 21 years taking isotretinoin did not receive an effective contraceptive method one month before, during and one month after isotretinoin treatment. However, the proportion of women receiving at least one prescription of contraception during (74.1%) and after (72.1%) isotretinoin treatment was higher than one month before isotretinoin treatment (35.7%). Regarding these results, less adopted recommendations should be reviewed by an expert committee and interventions focused on the improvement of the use of contraception during isotretinoin treatment could be developed.The two studies related to two new developed pharmaceutical services showed that their implementation was feasible in community pharmacy practice. Most of pharmacists participating in both projects had positive attitude regarding the implementation of these services in their daily practice. They considered it as professionally satisfying and important for patients and perceived the benefits of the programs. However, similar barriers were observed; difficulties to include patients and lack of interprofessional collaboration, and lack of time (related to lack of staff, administrative burden and lack of team adoption). According to participating health care professionals, the development of new strategies to overcome these barriers is necessary to anticipate the future implementation and the maintenance of these services at the national level. Following these results, the proposed strategies are for example the development of broad based media campaigns (for health care professionals and patients), or the development of specific trainings focusing on interprofessional collaboration, service-process, practice change management and leadership. Conclusion: The legal evolution of the pharmacists’ role is a positive progress but insufficient to ensure a full implementation in practice. Implementation strategies should be considered at different implementation stages (exploration, preparation, testing, operation and maintenance) and levels (individual, pharmacy, local setting, and system). The use of implementation science would allow a quicker and more effective implementation of these new professional pharmacy services. The anticipation of change and the selection of appropriate strategies would allow a higher fidelity level to the different components of the service by health care professionals and therefore a higher effectiveness, e.g. clinical and economic outcomes. Health care professionals, professional associations, academics and policy makers should be aware of implementation science and integrate it in the development of the new pharmacists’ role. As shown in our results, it should also be considered for existing programmes such as the isotretinoin PPP. / Doctorat en Sciences biomédicales et pharmaceutiques (Pharmacie) / info:eu-repo/semantics/nonPublished

In 2013, South Carolina implemented a multi-year program providing support services for pregnant and parenting teens. Local lead sites were responsible for coordinating service delivery in partnership with other multidisciplinary community-based organizations. We used social network theory and analyses (SNA) to examine changes in partnerships over time. Using two-stage purposeful sampling, we identified three lead sites and their self-reported community partners. We administered two web-based surveys grounded in social network theory that included questions about partnership relationships and organizational characteristics. We calculated selected whole-network measures (size, cohesion, equity, diversity). Following the Year 1 surveys, we reviewed our findings with the lead sites and suggested opportunities to strengthen their respective partnerships. Following the Year 3 surveys, we observed changes across the networks. Survey response rates were 91.5% (43/47) in Year 1 and 68.2% (45/66) in Year 3. By Year 3, the average network size increased from 15.6 to 20.3 organizations. By Year 3, one lead site doubled its measure of network cohesion (connectedness); another lead site doubled in size (capacity). A third lead site, highly dense in Year 1, increased in size but decreased in cohesion by Year 3. Innovative use of SNA findings can help community partnerships identify gaps in capacity or services and organizations needed to fulfill program aims. SNA findings can also improve partnership function by identifying opportunities to improve connectedness or reduce redundancies in program work. The ability of lead sites to strategically reconfigure partnerships can be important to program success and sustainability.

Every year, approximately 21 million girls aged 15 to 19 living in low- and middle-income countries (LMICs) become pregnant and over 12 million of these girls give birth. Complications from pregnancy are the leading cause of death for girls aged 15 to 19 in LMICs and adolescent mothers face an elevated risk of life-long morbidities due to pregnancy and childbirth. The risk of early childbearing and its associated consequences vary significantly depending on age, socioeconomic status, and place of residence. Adolescents affected by conflict or natural disasters are often recognized as one of the most vulnerable groups in this regard; among the countries with the highest adolescent birth rates globally, most are affected by conflict or fragility. This dissertation aimed to fill a critical gap in the literature on adolescent pregnancy in humanitarian settings. The three studies in this dissertation utilize qualitative and quantitative research to better understand the myriad drivers of adolescent pregnancy and, in the context of protracted conflict in Democratic Republic of the Congo (DRC), how exposure to armed conflict may or may not modify certain risk and protective factors. The findings of this dissertation confirm that risk and protective factors for adolescent pregnancy are numerous, interrelated, and complex; preventing early and unintended pregnancy requires multi-level interventions that build the protective assets of adolescents while also engaging with male partners, parents and caregivers, and community members. The research deepens this understanding by demonstrating the extent to which long-standing and deeply rooted sociocultural norms influence adolescents’ individual and inter-personal behaviors in diverse contexts, including settings affected by armed conflict. Thus, instead of considering how standalone risk and protective factors for adolescents differ depending on the context, the research highlights the importance of understanding linkages between environmental, inter-personal, and individual factors and the pathways through which these linkages influence reproductive health decision-making among adolescents. This dissertation also provides new evidence as to how the presence of armed conflict does not uniformly influence risk and protective factors for adolescent pregnancy. Instead, it finds that, in the case of DRC, underlying social norms and differences in social, demographic, and economic characteristics outweigh the effect of armed conflict on incidence of adolescent pregnancy. This finding does not mean that armed conflict does not have any impact on adolescent pregnancy; rather, it confirms the need for continued research in different humanitarian contexts and informs how to apply best practices from development settings to improve sexual and reproductive health (SRH) outcomes among adolescents affected by humanitarian crises. Meeting the SRH needs of adolescents requires going beyond service provision and understanding the numerous, interrelated risk and protective factors that exist at the individual, inter-personal, and community levels. Situations of conflict and displacement may present additional complexities for understanding and meeting the SRH needs of adolescents. However, this dissertation shows the feasibility of conducting research and utilizing existing data to understand some of the root causes of adolescent pregnancy in a conflict-affected setting. Moreover, the studies highlight how more robust evidence can challenge some of our longstanding assumptions about adolescents affected by humanitarian crises. Continued rigorous research and taking the time to listen to adolescents and their communities can lead to more responsive adolescent SRH programs and services that contribute to adolescents’ healthy transitions to adulthood.

No description available.

The United States teen birth rate has been declining since 1991, but the teen pregnancy rate remains one of the highest in the developed world outside the former Soviet Bloc. There is no current national strategy to implement comprehensive sexuality education in schools, and states have varying sex education and abortion policies. There are various effective programs designed to prevent teen pregnancies that share common characteristics of effective programs. Given the widespread reach and number of users, YouTube has the potential to be an education resource for teen pregnancy prevention. At the time of this study, there were no studies describing the content of videos that relate to teen pregnancy. This study is intended to fill this gap in the literature. YouTube was searched with the key words “teen pregnancy,” and the results were sorted by view count. The most widely viewed 100 videos meeting inclusion criteria were included in the study. The most widely viewed videos received 434,423,558 cumulative views. These videos were coded for their source, format, and the inclusion of content variables. The content variables were also organized to fit Kirby’s model of characteristics of effective programs. The majority of videos were sources and formats that depicted teens’ experience with pregnancy, including documentaries, reality TV programs, talk shows, and vlogs uploaded by consumers. Notably, there were no videos uploaded by professionals. The content most covered in the videos were the pregnancy outcome, how the teen mother found out she was pregnant, the teen mother’s reaction to the pregnancy, and the involvement of various family members. YouTube is an opportunity to reach a larger number of viewers, but the teen pregnancy videos in the study are missing key elements of teen pregnancy that are present in the literature, like the relationship between poverty and teen pregnancy, teen abortion rates, and repeat pregnancies. The videos were also lacking in elements of Kirby’s characteristics of effective programs. Recommendations for health education practice include the need for professionals to utilize the true stories of teen pregnancies and popular influencers to create engaging, accurate content.

Youth engage in high-risk sexual behaviors, placing them at risk for human immunodeficiency virus, sexually transmitted infections, unintended pregnancy, and other unwanted sexual and reproductive health (SRH) outcomes. Alarmingly, Black and Hispanic/Latinx adolescents who are houseless are more likely to engage in high-risk sexual behaviors and are disproportionately affected by these outcomes. Sex education can equip Black and Hispanic/Latinx adolescents who are houseless with the knowledge and skills to protect their SRH. Disturbingly, sex education is not mandated to be taught in all U.S. schools. Therefore, it is critical for parents to provide sex education to their teens. However, most parents do not possess the knowledge and skills to educate their teens about sex education. Specifically, parent-child communication about the topic may be lacking. Research shows that parent-child communication regarding sex and dating is associated with fewer risky sexual behaviors. Thus, parents must be armed with the knowledge and skills necessary to help them effectively communicate evidence-based sex education topics to their teens. Borrowing from the case study methodology, the overarching purpose of this dissertation was to elicit parental input for the design, feasibility, and content of a potential parent-based sex education program among parents living or who lived in homeless shelters and transitional housing in New York City (NYC). Specifically, this study aimed to (i) conduct a scoping review on parent-based sex education interventions that include parental involvement in the program and parental input in the planning or design process; (ii) administer needs assessment questionnaires to collect information on program input and parental attitudes, beliefs, and views about sex education and the program; and (iii) conduct semi-structured qualitative interviews to further collect specific information on program input and understand parental attitudes, beliefs, and views about sex education and the program. The scoping review of the literature confirmed the absence of parent-based sex education programs in homeless shelters and transitional housing in the country. From the needs assessment questionnaires and semi-structured interviews, participants highlighted the need for an accessible, convenient, and flexible parent-based sex education program. Furthermore, parents yearned for interactive and fun ways of learning sex education topics with various participants. Lastly, study participants endorsed comprehensive and inclusive information about life skills and sex education being included in the parent-based program.

Thesis (Ph. D. (Social Work)) -- University of Limpopo, 2018 / Teenage pregnancy is a social problem that affects and destroys the future of teenage girls, especially teenage learners. Its impact is not only felt by the teenage girls, but also by their families, schools, and the country in general. This study sought to develop an educational social group work model on teenage pregnancy for learners in schools in the North West province. To this effect, this study was anchored on five objectives, namely: to establish the extent of teenage pregnancy amongst learners in schools in the North West province; to assess factors that predispose learners to indulge in sexual activities despite the risk of pregnancy and sexually transmitted diseases; to describe the roles of parents in the prevention of teenage pregnancy amongst learners; to identify prevention measures used by the schools to prevent teenage pregnancy; and to develop, implement, and evaluate an educational social group work model on teenage pregnancy for learners. The study adopted a mixed methods approach by combining the qualitative and quantitative paradigms. The population of the study consisted of learners, while school principals, deputy principals, Life Orientation teachers, and parents/guardians were the key informants. The findings of this study confirm that teenage pregnancy is a serious problem that continues to affect schools. All grades from the secondary schools that participated in this study reported cases of learner pregnancies. The grades with high reported cases include Grades 10, 11, and 12, while Grades 8 and 9 appeared to be the least affected. Furthermore, the findings indicate that male learners are most likely to father children with female learners. The development of an educational social group work model on teenage pregnancy for learners was achieved via a literature review and the empirical findings from learners and the key informants. Group work as a method of the social work profession was chosen in this study because it is intensive in nature, and the follow-up sessions provided a platform for the evaluation of social worker interventions and the performance of individual members and the entire group. The developed model was implemented and evaluated. Different topics were discussed during a marathon of eight