“It is judgment by the people that have meant something to me that hurts the most”: Inter-discursive evidence synthesis incorporates the lived experience of adolescent mothers
Bibliographic record
Abstract
Abstract Background Evidence synthesis without meaningful stakeholder engagement can overlook factors considered relevant and influential by stakeholders. This paper presents an inter-discursive approach to grounding conventional mixed methods evidence synthesis in stakeholder views of adolescent perinatal health in Canada. Methods A parallel-results convergent mixed review identified studies reporting on perinatal outcomes and experiences of adolescents during pregnancy to 12 months post-partum, in French or English, published in Canada after 2000. We summarized findings using thematic synthesis and descriptive statistics. We then extracted data from a provincial database of maternal and newborn outcomes and calculated relative risks for common perinatal risk factors and outcomes for adolescents compared to adult population within a local health region and across Ontario from 2012-2017. Two trained peer researchers contributed to our evidence syntheses. We shared syntheses with four service providers and 13 marginalized adolescent mothers, who identified and prioritized their areas of concern. A second literature review refocused around the priority issues identified by the women and was then expanded through semi-structured interviews. Results Adolescent mothers face more poverty, higher rates of abuse, anxiety and depression than adult mothers. They also report experiencing negative judgments when accessing services, highlighting the need for more youth-friendly services. Adolescent women prioritized the experience of judgment in perinatal health and social services, and more specifically how they felt judgment contributed to them being identified as a child protection risk. Other priorities included inadequate housing, judgment around breastfeeding, loss of social support and inaccessibility of community resources. Judgment in the adolescent perinatal health literature was summarized around three themes: being invisible, incapable and at risk. Adolescent mothers adapted and added onto these categories, emphasizing organizational and social challenges, with important consequences for their mental health and accessing appropriate care. Conclusions Incorporating young women’s voices changed the focus of our research. Women’s priorities highlighted the way motherhood norms are embedded in social and institutional structures. Adolescent women’s experiences of care have important implications for ensuring the effectiveness of more targeted interventions to maximize benefit to women and newborns.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.266 | 0.360 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.014 | 0.013 |
| Science and technology studies | 0.008 | 0.017 |
| Scholarly communication | 0.022 | 0.012 |
| Open science | 0.004 | 0.011 |
| Research integrity | 0.004 | 0.004 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; the direct Gemma label and the distilled Codex classifier agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".