Publications by authors named "Peter Decat"

26 Publications

  • Page 1 of 1

Family Physician Perceptions of Climate Change, Migration, Health, and Healthcare in Sub-Saharan Africa: An Exploratory Study.

Int J Environ Res Public Health 2021 06 11;18(12). Epub 2021 Jun 11.

Department of Economics-CESSMIR, Ghent University, UNU-CRIS, B-9000 Ghent, Belgium.

Although family physicians (FPs) are community-oriented primary care generalists and should be the entry point for the population's interaction with the health system, they are underrepresented in research on the climate change, migration, and health(care) nexus (hereafter referred to as the nexus). Similarly, FPs can provide valuable insights into building capacity through integrating health-determining sectors for climate-resilient and migration-inclusive health systems, especially in Sub-Saharan Africa (SSA). Here, we explore FPs' perceptions on the nexus in SSA and on intersectoral capacity building. Three focus groups conducted during the 2019 WONCA-Africa conference in Uganda were transcribed verbatim and analyzed using an inductive thematic approach. Participants' perceived interactions related to (1) migration and climate change, (2) migration for better health and healthcare, (3) health impacts of climate change and the role of healthcare, and (4) health impacts of migration and the role of healthcare were studied. We coined these complex and reinforcing interactions as continuous feedback loops intertwined with socio-economic, institutional, and demographic context. Participants identified five intersectoral capacity-building opportunities on micro, meso, macro, and supra (international) levels: multi-dimensional and multi-layered governance structures; improving FP training and primary healthcare working conditions; health advocacy in primary healthcare; collaboration between the health sector and civil society; and more responsibilities for high-income countries. This exploratory study presents a unique and novel perspective on the nexus in SSA which contributes to interdisciplinary research agendas and FP policy responses on national, regional, and global levels.
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http://dx.doi.org/10.3390/ijerph18126323DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296126PMC
June 2021

Community Health Workers as a Strategy to Tackle Psychosocial Suffering Due to Physical Distancing: A Randomized Controlled Trial.

Int J Environ Res Public Health 2021 03 17;18(6). Epub 2021 Mar 17.

Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium.

Background: During the COVID-19 pandemic, many primary care professionals were overburdened and experienced difficulties reaching vulnerable patients and meeting the increased need for psychosocial support. This randomized controlled trial (RCT) tested whether a primary healthcare (PHC) based community health worker (CHW) intervention could tackle psychosocial suffering due to physical distancing measures in patients with limited social networks.

Methods: CHWs provided 8 weeks of tailored psychosocial support to the intervention group. Control group patients received 'care as usual'. The impact on feelings of emotional support, social isolation, social participation, anxiety and fear of COVID-19 were measured longitudinally using a face-to-face survey to determine their mean change from baseline. Self-rated change in psychosocial health at 8 weeks was determined.

Results: We failed to find a significant effect of the intervention on the prespecified psychosocial health measures. However, the intervention did lead to significant improvement in self-rated change in psychosocial health.

Conclusions: This study confirms partially the existing evidence on the effectiveness of CHW interventions as a strategy to address mental health in PHC in a COVID context. Further research is needed to elaborate the implementation of CHWs in PHC to reach vulnerable populations during and after health crises.
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http://dx.doi.org/10.3390/ijerph18063097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8002631PMC
March 2021

Universal health coverage and primary health care: the 30 by 2030 campaign.

Bull World Health Organ 2020 Nov 5;98(11):812-814. Epub 2020 Oct 5.

Department of Public Health and Primary Care, Ghent University, U.Z.-Building 6 K3, Corneel Heymanslaan, 10, B-9000 Ghent, Belgium.

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http://dx.doi.org/10.2471/BLT.19.245670DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607468PMC
November 2020

Induced abortion: a cross-sectional study on knowledge of and attitudes toward the new abortion law in Maputo and Quelimane cities, Mozambique.

BMC Womens Health 2020 06 19;20(1):129. Epub 2020 Jun 19.

International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.

Background: Maternal mortality, of which 6.7% is attributable to abortion complications, remains high in Mozambique. The objective of this paper is to assess the level of induced abortion at the community, as well as to assess awareness of and attitudes towards the new abortion law among women of reproductive age in suburban areas of Maputo and Quelimane cities.

Methods: A cross-sectional household survey among women aged 15-49 years in Maputo and Quelimane cities was conducted using a multi-stage clustered sampling design. Data on sociodemographic characteristics, maternal outcomes, contraceptive use, knowledge and attitudes towards the new abortion law were collected. Bivariate and multiple logistic regression analysis using the complex samples procedure in SPSS were applied.

Results: A total of 1657 women (827 Maputo and 830 Quelimane) were interviewed between August 2016 and February 2017. The mean age was 27 years; 45.7% were married and 75.5% had ever been pregnant. 9.2% of the women reported having had an induced abortion, of which 20.0% (17) had unsafe abortion. Of the respondents, 28.8% knew the new legal status of abortion. 17% thought that the legalization of abortion was beneficial to women's health. Having ever been pregnant, being unmarried, student, Muslim, as well as residing in Maputo were associated with higher odds of having knowledge of the new abortion law.

Conclusion: Reports of abortion appear to be low compared to other studies from Sub-Saharan African countries. Furthermore, respondents demonstrated limited knowledge of the abortion law. Social factors such as education status, religion, residence in a large city as well as pregnancy history were associated with having knowledge of the abortion law. Only a small percentage of women perceived abortion as beneficial to women's health. There is a need for widespread sensitization about the new law and its benefits.
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http://dx.doi.org/10.1186/s12905-020-00988-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7304116PMC
June 2020

Teaching the health advocacy role in family medicine: Trial and error.

Eur J Gen Pract 2019 Oct 16;25(4):177-178. Epub 2019 Oct 16.

Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.

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http://dx.doi.org/10.1080/13814788.2019.1674048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6853227PMC
October 2019

Adult and young women communication on sexuality: a pilot intervention in Maputo-Mozambique.

Reprod Health 2019 Sep 18;16(1):144. Epub 2019 Sep 18.

Department of Public Health and Primary Care, C. Heymanslaan 10, 9000, Ghent, Belgium.

Background: Communication on sexuality within the family has been considered a determinant factor for the sexual behaviour of young women, contributing to delaying sexual initiation. Taking into account that young women are increasingly exposed to sexualized messages, they need clear, trustful and open communication on sexuality more than ever. However, in Mozambique, communication about sexuality is hampered by strict social norms. This paper evaluates the case of an intervention aimed at reducing the generational barrier for talking about sexuality and to contribute to better communication within the family context.

Methods: The intervention consisted of three weekly one-hour coached sessions in which female adults and young interacted about sexuality. Realist evaluation was used as a framework to assess context, mechanisms, and outcomes of the intervention. Interviews were conducted among 13 participants of the sessions.

Result: The interaction sessions were positively appreciated by the participants and contributed to change norms and attitudes towards communication on sexuality within families. Recognition of similarities and awareness of differences were key in the mechanisms leading to these outcomes. This was reinforced by the use of visual materials and the atmosphere of respect and freedom of speech that characterized the interactions. Limiting factors were related to the long-standing taboo on sexuality and existing misconceptions on sexuality education and talks about sex.

Conclusion: By elucidating mechanisms and contextual factors our study adds knowledge on strategies to improve transgenerational communication about sexuality.
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http://dx.doi.org/10.1186/s12978-019-0809-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751840PMC
September 2019

Inter-professional collaboration reduces the burden of caring for patients with mental illnesses in primary healthcare. A realist evaluation study.

Eur J Gen Pract 2019 Oct 2;25(4):236-242. Epub 2019 Aug 2.

Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.

The implementation of primary care for mental health is often insufficient, which leaves its mark on staff. A team-based approach of mental healthcare prevents poor staff morale. A community health centre (CHC), therefore, set up a project promoting interprofessional collaboration with a mental health team (MHT). This study aimed to understand how an MHT would influence staff morale in a primary care setting, aiming to formulate some recommendations for future projects. In 2017, interviews and a focus group discussion were conducted among the staff of a CHC. Using a qualitative approach, we aimed to unravel contextual factors and mechanisms that determine the effect of an MHT on staff morale. The project relieved the burden of the patient encounters and staff members felt more valuable to patients. Underlying mechanisms were recognition, altered attitudes towards patients and role clarity. Facilitating factors were intercultural care mediators and a positive team atmosphere, whereas inhibiting factors were inefficient time management and communicative issues. Our study elucidated mechanisms and the contextual factors by which an MHT in general practice improves staff morale.[Box: see text].
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http://dx.doi.org/10.1080/13814788.2019.1640209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6853250PMC
October 2019

"They Are After Quantity, Not Quality": Health Providers' Perceptions of Fee Exemption Policies in Morocco.

Int J Health Policy Manag 2018 12 1;7(12):1110-1119. Epub 2018 Dec 1.

Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.

Background: A free obstetric care policy (FOCP) has been implemented in Morocco in 2008 in order to further decrease maternal mortality.

Methods: Through in-depth interviews we explored the perceptions of health professionals in public Moroccan hospitals with regard to fee exemption policies. We tried to understand what drives health professionals to ignore, modify or apply a health policy as formulated.

Results: Respondents express significant influences of such policies on their work environment (higher workload and scarcity of resources) and on the patient/provider relationship, both of which may cause a negative effect on health workers' motivation. A mix of motivational determinants incites health workers in their turn to influence policy implementation.

Conclusion: Understanding the motivational determinants of health workers may optimize policy implementation at the point of service delivery.
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http://dx.doi.org/10.15171/ijhpm.2018.76DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6358657PMC
December 2018

Factors Influencing Abortion Decision-Making Processes among Young Women.

Int J Environ Res Public Health 2018 02 13;15(2). Epub 2018 Feb 13.

Department of Family Medicine and primary health care, Ghent University, 9000 Gent, Belgium.

Decision-making about if and how to terminate a pregnancy is a dilemma for young women experiencing an unwanted pregnancy. Those women are subject to sociocultural and economic barriers that limit their autonomy and make them vulnerable to pressures that influence or force decisions about abortion. : The objective of this study was to explore the individual, interpersonal and environmental factors behind the abortion decision-making process among young Mozambican women. : A qualitative study was conducted in Maputo and Quelimane. Participants were identified during a cross-sectional survey with women in the reproductive age (15-49). In total, 14 women aged 15 to 24 who had had an abortion participated in in-depth interviews. A thematic analysis was used. : The study found determinants at different levels, including the low degree of autonomy for women, the limited availability of health facilities providing abortion services and a lack of patient-centeredness of health services. : Based on the results of the study, the authors suggest strategies to increase knowledge of abortion rights and services and to improve the quality and accessibility of abortion services in Mozambique.
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http://dx.doi.org/10.3390/ijerph15020329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858398PMC
February 2018

Primary healthcare for refugees: The Ponton experience.

Eur J Gen Pract 2017 12;23(1):180-181

a General Practice and Primary Health Care , Gent University , Gent , Belgium.

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http://dx.doi.org/10.1080/13814788.2017.1331011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774268PMC
December 2017

Practical lessons for bringing policy-makers on board in sexual and reproductive health research.

BMC Health Serv Res 2016 11 11;16(1):649. Epub 2016 Nov 11.

International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP114, Ghent, 9000, Belgium.

Background: The need to translate research into policy, i.e. making research findings a driving force in agenda-setting and policy change, is increasingly acknowledged. However, little is known about translation mechanisms in the field of sexual and reproductive health (SRH) outside North American or European contexts. This paper seeks to give an overview of the existing knowledge on this topic as well as to document practical challenges and remedies from the perspectives of researchers involved in four SRH research consortium projects in Latin America, sub-Saharan Africa, China and India.

Methods: A literature review and relevant project documents were used to develop an interview guide through which researchers could reflect on their experiences in engaging with policy-makers, and particularly on the obstacles met and the strategies deployed by the four project consortia to circumvent them.

Results: Our findings confirm current recommendations on an early and steady involvement of policy-makers, however they also suggest that local barriers between researchers and policy-making spheres and individuals can represent major hindrances to the realization of translation objectives. Although many of the challenges might be common to different contexts, creating locally-adapted responses is deemed key to overcome them. Researchers' experiences also indicate that - although inevitable - recognizing and addressing these challenges is a difficult, time- and energy-consuming process for all partners involved. Despite a lack of existing knowledge on translation efforts in SRH research outside North American or European contexts, and more particularly in low and middle-income countries, it is clear that existing pressure on health and policy systems in these settings further complicates them.

Conclusions: This article brings together literature findings and researchers' own experiences in translating research results into policy and highlights the major challenges research conducted on sexual and reproductive health outside North American or European contexts can meet. Future SRH projects should be particularly attentive to these potential obstacles in order to tailor appropriate and consistent strategies within their existing resources.
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http://dx.doi.org/10.1186/s12913-016-1889-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5106764PMC
November 2016

Lessons learnt from the CERCA Project, a multicomponent intervention to promote adolescent sexual and reproductive health in three Latin America countries: a qualitative post-hoc evaluation.

Eval Program Plann 2016 10 13;58:98-105. Epub 2016 Jun 13.

International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 UZP 114, Ghent 9000, Belgium. Electronic address:

The Community-Embedded Reproductive Health Care for Adolescents (CERCA) Project was implemented in Bolivia, Ecuador and Nicaragua (2011-2014) to test the effectiveness of interventions preventing teenage pregnancies. As the outcome evaluation showed limited impact, a post-hoc process evaluation was carried out to determine if and how CERCA's design, implementation, monitoring and evaluation affected the results. We did a document analysis and conducted 18 in-depth interviews and 21 focus group discussions with stakeholders and beneficiaries. Transcripts were analyzed using directed content analysis. Data showed that CERCA sensitized stakeholders and encouraged the discussion on this sensitive issue. In terms of design, a strong point was the participatory approach; a weak point was that the detailed situation analysis was completed too late. In terms of implementation, a strong point was that multifaceted activities were implemented; a weak point was that the activities were not pilot tested for feasibility/acceptability and evolved substantially throughout the Project. In terms of monitoring, strong points were that regular monitoring kept the Project on track administratively/financially; a weak point was that monitoring indicators did not change as the intervention package changed. In terms of evaluation, weak points were the substantial attrition rate and narrow focus on adolescents. This study provides recommendations for future projects.
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http://dx.doi.org/10.1016/j.evalprogplan.2016.06.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987454PMC
October 2016

Reorienting adolescent sexual and reproductive health research: reflections from an international conference.

Reprod Health 2016 Jan 13;13. Epub 2016 Jan 13.

Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.

On December 4th 2014, the International Centre for Reproductive Health (ICRH) at Ghent University organized an international conference on adolescent sexual and reproductive health (ASRH) and well-being. This viewpoint highlights two key messages of the conference--(1) ASRH promotion is broadening on different levels and (2) this broadening has important implications for research and interventions--that can guide this research field into the next decade. Adolescent sexuality has long been equated with risk and danger. However, throughout the presentations, it became clear that ASRH and related promotion efforts are broadening on different levels: from risk to well-being, from targeted and individual to comprehensive and structural, from knowledge transfer to innovative tools. However, indicators to measure adolescent sexuality that should accompany this broadening trend, are lacking. While public health related indicators (HIV/STIs, pregnancies) and their behavioral proxies (e.g., condom use, number of partners) are well developed and documented, there is a lack of consensus on indicators for the broader construct of adolescent sexuality, including sexual well-being and aspects of positive sexuality. Furthermore, the debate during the conference clearly indicated that experimental designs may not be the only appropriate study design to measure effectiveness of comprehensive, context-specific and long-term ASRH programmes, and that alternatives need to be identified and applied. Presenters at the conference clearly expressed the need to develop validated tools to measure different sub-constructs of adolescent sexuality and environmental factors. There was a plea to combine (quasi-)experimental effectiveness studies with evaluations of the development and implementation of ASRH promotion initiatives.
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http://dx.doi.org/10.1186/s12978-016-0117-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4711048PMC
January 2016

Improving adolescent sexual and reproductive health in Latin America: reflections from an International Congress.

Reprod Health 2015 Jan 24;12:11. Epub 2015 Jan 24.

South Group, C, Ecuador O-138, Edificio Holanda, A-3A, Cochabamba, Bolivia.

In February 2014, an international congress on Promoting Adolescent Sexual and Reproductive Health (ASRH) took place in Cuenca, Ecuador. Its objective was to share evidence on effective ASRH intervention projects and programs in Latin America, and to link this evidence to ASRH policy and program development. Over 800 people participated in the three-day event and sixty-six presentations were presented.This paper summarizes the key points of the Congress and of the Community Embedded Reproductive Health Care for Adolescents (CERCA) project. It aims at guiding future ASRH research and policy in Latin America. 1. Context matters. Individual behaviors are strongly influenced by the social context in which they occur, through determinants at the individual, relational, family, community and societal levels. Gender norms/attitudes and ease of communication are two key determinants. 2. Innovative action. There is limited and patchy evidence of effective approaches to reach adolescents with the health interventions they need at scale. Yet, there exist several promising and innovative examples of providing comprehensive sexuality education through conventional approaches and using new media, improving access to health services, and reaching adolescents as well as families and community members using community-based interventions were presented at the Congress. 3. Better measurement. Evaluation designs and indicators chosen to measure the effect and impact of interventions are not always sensitive to subtle and incremental changes. This can create a gap between measured effectiveness and the impact perceived by the targeted populations. Thus, one conclusion is that we need more evidence to better determine the factors impeding progress in ASRH in Latin American, to innovate and respond flexibly to changing social dynamics and cultural practices, and to better measure the impact of existing intervention strategies. Yet, this Congress offered a starting point from which to build a multi-agency and multi-country effort to generate specific evidence on ASRH with the aim of guiding policy and program decision-making. In a region that contains substantial barriers of access to ASRH education and services, and some of the highest adolescent pregnancy rates in the world, the participants agreed that there is no time to lose.
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http://dx.doi.org/10.1186/1742-4755-12-11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4320614PMC
January 2015

Effect of improving the knowledge, attitude and practice of reproductive health among female migrant workers: a worksite-based intervention in Guangzhou, China.

Sex Health 2015 Mar;12(1):13-21

International Centre for Reproductive Health (ICRH), Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185 UZ P114, 9000 Ghent, VAT BE 248.015.142, Belgium.

Unlabelled: Background The sexual and reproductive health (SRH) knowledge and attitudes of female migrant workers are far from optimum in China. A worksite-based intervention program on SRH-related knowledge, attitude and practice (SRH KAP) modification may be an effective approach to improve the SRH status among migrant workers. This study aimed to identify better intervention approaches via the implementation and evaluation of two intervention packages.

Methods: A worksite-based cluster-randomised intervention study was conducted from June to December 2008 in eight factories in Guangzhou, China. There were 1346 female migrant workers who participated in this study. Factories were randomly allocated to the standard package of interventions group (SPIG) or the intensive package of interventions group (IPIG). Questionnaires were administered to evaluate the effect of two interventions.

Results: SRH knowledge scores were higher at follow up than at baseline for all participants of the SPIG; the knowledge scores increased from 6.50 (standard deviation (s.d.) 3.673) to 8.69 (s.d. 4.085), and from 5.98 (s.d. 3.581) to 11.14 (s.d. 3.855) for IPIG; SRH attitude scores increased among unmarried women: the attitude scores changed from 4.25 (s.d. 1.577) to 4.46 (s.d. 1.455) for SPIG, and from 3.99 (s.d. 1.620) to 4.64 (s.d. 1.690) for IPIG; most SRH-related practice was also modified (P<0.05). In addition, after intervention, the IPIG had a higher knowledge level than the SPIG; the scores were 11.14 (s.d. 3.855) versus 8.69 (s.d. 4.085), and unmarried women in the IPIG had higher condom use rate than the SPIG (86.4% versus 57.1%).

Conclusions: The interventions had positive influences on improvements in SRH knowledge, attitudes and behaviours. Additionally, IPIs were more effective than SPIs, indicating that a comprehensive intervention may achieve better results.
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http://dx.doi.org/10.1071/SH14061DOI Listing
March 2015

Sexual onset and contraceptive use among adolescents from poor neighbourhoods in Managua, Nicaragua.

Eur J Contracept Reprod Health Care 2015 Apr 20;20(2):88-100. Epub 2014 Oct 20.

* International Centre for Reproductive Health (ICRH), Ghent University , Belgium.

Background And Objectives: The prevalence of teenage pregnancies in Nicaragua is the highest in Latin-America. This study aimed to gain insight into factors which determine the sexual behaviours concerned.

Methods: From July until August 2011, a door-to-door survey was conducted among adolescents living in randomly selected poor neighbourhoods of Managua. Logistic regression was used to analyse factors related to sexual onset and contraceptive use.

Results: Data from 2803 adolescents were analysed. Of the 475 and 299 sexually active boys and girls, 43% and 54%, respectively, reported contraceptive use. Sexual onset was positively related to increasing age, male sex, alcohol consumption and not living with the parents. Catholic boys and boys never feeling peer pressure to have sexual intercourse were more likely to report consistent condom use. Having a partner and feeling comfortable talking about sexuality with the partner were associated with hormonal contraception.

Conclusions: Our data identified associates of adolescents' sexual behaviour related to personal characteristics (sex and alcohol use), to the interaction with significant others (parents, partners, peers) and to the environment (housing condition, religion). We interpreted those associates within the context of the rapidly changing society and the recently implemented health system reform in Nicaragua.
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http://dx.doi.org/10.3109/13625187.2014.955846DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4487549PMC
April 2015

A cross-sectional study on attitudes toward gender equality, sexual behavior, positive sexual experiences, and communication about sex among sexually active and non-sexually active adolescents in Bolivia and Ecuador.

Glob Health Action 2014 11;7:24089. Epub 2014 Jul 11.

International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium.

Background: It is widely agreed upon that gender is a key aspect of sexuality however, questions remain on how gender exactly influences adolescents' sexual health.

Objective: The aim of this research was to study correlations between gender equality attitudes and sexual behavior, sexual experiences and communication about sex among sexually active and non-sexually active adolescents in 2 Latin American countries.

Design: In 2011, a cross-sectional study was carried out among 5,913 adolescents aged 14-18 in 20 secondary schools in Cochabamba (Bolivia) and 6 secondary schools in Cuenca (Ecuador). Models were built using logistic regressions to assess the predictive value of attitudes toward gender equality on adolescents' sexual behavior, on experiences and on communication.

Results: The analysis shows that sexually active adolescents who consider gender equality as important report higher current use of contraceptives within the couple. They are more likely to describe their last sexual intercourse as a positive experience and consider it easier to talk with their partner about sexuality than sexually experienced adolescents who are less positively inclined toward gender equality. These correlations remained consistent whether the respondent was a boy or a girl. Non-sexually active adolescents, who consider gender equality to be important, are more likely to think that sexual intercourse is a positive experience. They consider it less necessary to have sexual intercourse to maintain a relationship and find it easier to communicate with their girlfriend or boyfriend than sexually non-active adolescents who consider gender equality to be less important. Comparable results were found for boys and girls.

Conclusions: Our results suggest that gender equality attitudes have a positive impact on adolescents' sexual and reproductive health (SRH) and wellbeing. Further research is necessary to better understand the relationship between gender attitudes and specific SRH outcomes such as unwanted teenage pregnancies and sexual pleasure among adolescents worldwide.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4095758PMC
http://dx.doi.org/10.3402/gha.v7.24089DOI Listing
February 2015

Factorial validation of the Attitudes toward Women Scale for Adolescents (AWSA) in assessing sexual behaviour patterns in Bolivian and Ecuadorian adolescents.

Glob Health Action 2014 23;7:23126. Epub 2014 Jan 23.

CHIP, WHO Collaborating Centre, Copenhagen University, Copenhagen, Denmark.

Background: Adolescents' health is greatly influenced by social determinants, including gender norms. Although research has shown that there is an association between gender attitudes and adolescents' sexual behaviour, few studies have assessed this relationship carefully. The Attitudes toward Women Scale for Adolescents (AWSA) is widely used to assess gender attitudes among adolescents; however, to our knowledge it has not been applied in Latin America.

Objective: To apply AWSA in Latin America for the first time, to perform a factorial validation of this scale and to assess the relationship of gender attitudes and sexual behaviour in Bolivian and Ecuadorian adolescents.

Design: This cross-sectional study was carried out in 2011 among 14-18 year olds in 20 high schools in Cochabamba (Bolivia) and six in Cuenca (Ecuador) as a part of a larger project. Schools were purposively selected. A Spanish version of the 12-item AWSA was employed for this study. The assessed aspects of adolescent sexual behaviour were: reported sexual intercourse, reported positive experience during last sexual intercourse and reported current use of contraception. The psychometric properties of AWSA were investigated, and both explanatory and confirmatory factorial analyses were performed.

Results: The number of questionnaires included in the analysis was 3,518 in Bolivia and 2,401 in Ecuador. A factorial analysis of AWSA resulted in three factors: power dimension (PD), equality dimension (ED) and behavioural dimension (BD). ED showed the highest correlates with adolescent sexual behaviour. Higher scores of this dimension were associated with a more positive experience of sexual relationships, a higher current use of modern contraception and greater sexual activity among girls.

Conclusions: This study revealed a three-factorial structure of AWSA and demonstrated that by employing factors, the sensitivity of AWSA increases as compared to using the scale as a whole to assess sexual behaviour. This could have important implications for future research on gender and the sexual experiences of adolescents.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901847PMC
http://dx.doi.org/10.3402/gha.v7.23126DOI Listing
October 2014

Primary healthcare providers' views on improving sexual and reproductive healthcare for adolescents in Bolivia, Ecuador, and Nicaragua.

Glob Health Action 2013 May 15;6:20444. Epub 2013 May 15.

Department of Family Medicine, Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania.

Objectives: To elicit the views of primary healthcare providers from Bolivia, Ecuador, and Nicaragua on how adolescent sexual and reproductive health (ASRH) care in their communities can be improved.

Methods: Overall, 126 healthcare providers (46 from Bolivia, 39 from Ecuador, and 41 from Nicaragua) took part in this qualitative study. During a series of moderated discussions, they provided written opinions about the accessibility and appropriateness of ASRH services and suggestions for its improvement. The data were analyzed by employing a content analysis methodology.

Results: Study participants emphasized managerial issues such as the prioritization of adolescents as a patient group and increased healthcare providers' awareness about adolescent-friendly approaches. They noted that such an approach needs to be extended beyond primary healthcare centers. Schools, parents, and the community in general should be encouraged to integrate issues related to ASRH in the everyday life of adolescents and become 'gate-openers' to ASRH services. To ensure the success of such measures, action at the policy level would be required. For example, decision-makers could call for developing clinical guidelines for this population group and coordinate multisectoral efforts.

Conclusions: To improve ASRH services within primary healthcare institutions in three Latin American countries, primary healthcare providers call for focusing on improving the youth-friendliness of health settings. To facilitate this, they suggested engaging with key stakeholders, such as parents, schools, and decision-makers at the policy level.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3656216PMC
http://dx.doi.org/10.3402/gha.v6i0.20444DOI Listing
May 2013

Community embedded reproductive health interventions for adolescents in Latin America: development and evaluation of a complex multi-centre intervention.

BMC Public Health 2013 Jan 14;13:31. Epub 2013 Jan 14.

International Centre for Reproductive Health, Ghent University, De Pintelaan 185 UZP 114, Gent 9000, Belgium.

Background: Adolescents in Latin America are at high risk for unwanted and unplanned pregnancies, which often result in unsafe abortions or poor maternal health outcomes. Both young men and women in the region face an increased risk of sexually transmitted infections due to inadequate sexual and reproductive health information, services and counselling. To date, many adolescent health programmes have targeted a single determinant of sexual and reproductive health. However, recent evidence suggests that the complexity of sexual and reproductive health issues demands an equally multi-layered and comprehensive approach.

Methods: This article describes the development, implementation and evaluation design of the community-embedded reproductive health care for adolescents (CERCA) study in three Latin American cities: Cochabamba (Bolivia), Cuenca (Ecuador) and Managua (Nicaragua). Project CERCA's research methodology builds on existing methodological frameworks, namely: action research, community based participatory research and intervention-mapping.The interventions in each country address distinct target groups (adolescents, parents, local authorities and health providers) and seek improvement of the following sexual health behaviours: communication about sexuality, sexual and reproductive health information-seeking, access to sexual and reproductive health care and safe sexual relationships.In Managua, we implemented a randomised controlled study, and in Cochabamba and Cuenca we adopted a non-randomised controlled study to evaluate the effectiveness of Project CERCA interventions, in addition to a process evaluation.

Discussion: This research will result in a methodological framework that will contribute to the improved design and implementation of future adolescent sexual and reproductive health interventions.

Trial Registration: ClinicalTrials.gov (NCT01722084).
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http://dx.doi.org/10.1186/1471-2458-13-31DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3599131PMC
January 2013

Promoting contraceptive use among female rural-to-urban migrants in Qingdao, China: a comparative impact study of worksite-based interventions.

Eur J Contracept Reprod Health Care 2012 Oct 30;17(5):363-72. Epub 2012 Jul 30.

International Centre for Reproductive Health (ICRH), Ghent University, Belgium.

Background: We conducted a comparative study in worksites to assess the impact of sexual health promoting interventions on contraceptive use among female rural-to-urban migrants.

Study Design: In Qingdao ten manufacturing worksites were randomly allocated to a standard package of interventions (SPI) and an intensive package of interventions (IPI). The interventions ran from July 2008 to January 2009. Cross-sectional surveys at baseline and end line assessed the sexual behaviour of young female migrants. To evaluate the impact of the interventions we assessed pre- and post-time trends.

Results: From the SPI group 721 (baseline) and 615 (end line) respondents were considered. Out of the IPI group we included 684 and 603 migrants. Among childless migrants, self-reported contraceptive use increased significantly after SPI and IPI (adjusted odds ratio [aOR] = 3.23; 95% confidence interval [CI] = 1.52-6.84; p < 0.01 and aOR = 5.81; 95% CI = 2.63-12.80; p < 0.001, respectively). Childless migrants older than 22 years reported a greater use after IPI than after SPI.

Conclusion: Implementing current Chinese sexual health promotion programmes at worksites is likely to have a positive impact on migrant women working in the manufacturing industry of Qingdao. More comprehensive interventions seem to have an added value if they are well targeted to specific groups.
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http://dx.doi.org/10.3109/13625187.2012.696752DOI Listing
October 2012

Study on sexual and reproductive health behaviors of unmarried female migrants in China.

J Obstet Gynaecol Res 2012 Apr 13;38(4):632-8. Epub 2012 Mar 13.

Graduate School of Peking Union Medical College, Beijing, China.

Aim: The purpose of this study was to broadly assess the level of knowledge, attitude and behaviors related to sexual and reproductive health (SRH) among unmarried female migrants in China.

Material And Methods: This cross-sectional study was conducted and a self-administered questionnaire was designed for collecting information on SRH including 15 items for knowledge, 8 items for attitude and some items for contraception and abortion related behaviors.

Results: A total of 1690 unmarried female migrants were interviewed. Most of the respondents had less knowledge of SRH. Only one-third of respondents was aware of emergency contraceptives and could freely talk about SRH with their friends. Over one-third of respondents were not willing to come into contact with someone with AIDS or STDs. In this study, 10.4% participants had an unwanted pregnancy and 95% of them had an abortion. Multivariate analysis showed that having a boyfriend, duration of employment in city, knowledge on SRH and freely discussing SRH with peer were associated with having premarital sex among these unmarried female migrants.

Conclusion: This study revealed that the unmarried female migrant was one of the most vulnerable groups concerning SRH. In some policy reforms, appropriate and cost-effective SRH services should be provided for these migrants.
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http://dx.doi.org/10.1111/j.1447-0756.2011.01753.xDOI Listing
April 2012

Sexual and reproductive health status and related knowledge among female migrant workers in Guangzhou, China: a cross-sectional survey.

Eur J Obstet Gynecol Reprod Biol 2012 Jan 8;160(1):60-5. Epub 2011 Nov 8.

School of Public Health, Sun Yat-sen University, Guangdong province, PR China.

Objective: The objective of this study was to investigate the current sexual and reproductive health (SRH) status including SRH-related knowledge and associated factors, self-reported symptoms of reproductive tract infection (RTI), medical assistance seeking behavior, sexual experience and contraceptive use, reproductive information approach and reproductive service utilization among female migrant workers in Huangpu district, Guangzhou city, China.

Study Design: A cross-sectional study was conducted in 2008 in eight factories, which were selected randomly from 32 eligible factories in the Huangpu district in Guangzhou. Descriptive statistics were used to describe the SRH status of migrant workers. Factors associated with the level of SRH knowledge were determined by a logistic regression model.

Results: Of 1346 female migrant workers, 831(61.7%) were unmarried and 515 (38.3%) were married. 27.2% of the unmarried respondents and 40.2% of the married respondents had suffered self-reported RTI symptoms. Among unmarried respondents, the median knowledge score was 5 points, compared to 8 points for the married. For unmarried migrant workers, factors associated with the knowledge level were age, education level, access to SRH information and service, sexual experiences and RTI symptoms. For married migrant workers, factors associated with the knowledge level were age, education level, access to SRH services and RTI symptoms.

Conclusions: A high prevalence of self-reported RTI symptoms and a low knowledge level were found among young female migrant workers. Unmarried migrant workers are more vulnerable to SRH problems. Those findings demand more specific interventions targeting female migrants and in particular the unmarried.
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http://dx.doi.org/10.1016/j.ejogrb.2011.10.001DOI Listing
January 2012

Promoting contraceptive use more effectively among unmarried male migrants in construction sites in China: a pilot intervention trial.

Asia Pac J Public Health 2012 Sep 28;24(5):806-15. Epub 2011 Apr 28.

Graduate School of Peking Union Medical College, Beijing, People's Republic of China.

Poor sexual and reproductive health status has been reported among rural-to-urban migrants in China. Therefore, some effective and feasible interventions are urgently needed. The authors developed a workplace-based intervention to compare 2 young labor migrant service packages (A and B) on the knowledge, attitude related to contraception, and contraceptive use among unmarried male migrants in Chengdu. Fourteen construction sites were randomly assigned to either of the 2 intervention packages. Interventions were completed in 3 months, and data were collected in 2 rounds independently (before and after interventions). After the intervention, the median scores for knowledge and attitude in migrants in package B were significantly higher than in migrants in package A. Although migrants in both packages increased use of condom, the increase was pronounced in migrants in package B, with odds ratio (OR) = 9.65 (95% confidence interval [CI] = 1.41-66.28). The rate of unwanted pregnancies was reduced more significantly in migrants in package B than in migrants in package A (OR = 0.16; 95%CI = 0.03-0.45). Unmarried male migrants who received the comprehensive intervention (package B) were more willing to use condoms and avoid unwanted pregnancies effectively.
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http://dx.doi.org/10.1177/1010539511406106DOI Listing
September 2012

Determinants of unmet need for contraception among Chinese migrants: a worksite-based survey.

Eur J Contracept Reprod Health Care 2011 Feb 15;16(1):26-35. Epub 2010 Dec 15.

International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Ghent University, Belgium.

Background: Considerable sexual and reproductive health (SRH) challenges have been reported among rural-to-urban migrants in China. Predictors thereof are urgently needed to develop targeted interventions.

Study Design: A cross-sectional study assessed determinants of unmet need for contraception using semi-structured interviews in two cities in China: Guangzhou and Qingdao.

Results: Between July and September 2008, 4867 female rural-to-urban migrants aged 18-29 years participated in the study. Of these, 2264 were married or cohabiting. Among sexually-active women (n = 2513), unmet need for contraception was reported by 36.8% and 51.2% of respondents in Qingdao and Guangzhou, respectively; it was associated with being unmarried, having no children, less schooling, poor SRH knowledge, working in non-food industry, and not being covered by health insurance. A substantial proportion of unmarried migrants reported they had sexual intercourse (16.6 % in Qingdao and 21.4% in Guangzhou) contrary to current sexual standards in China.

Conclusion: The study emphasises the importance of improving the response to the needs of rural-to-urban migrants and recommends strategies to address the unmet need for contraception. These should enhance open communication on sexuality, increase the availability of condoms, and improve health insurance coverage.
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http://dx.doi.org/10.3109/13625187.2010.536920DOI Listing
February 2011
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