83 Understanding complex community structures to improve sexual reproductive health for adolescents in Uganda
Bibliographic record
Abstract
Abstract Primary Subject area Global Child and Youth Health Background Based on the 2014 census, 35% of Uganda’s population is between 10-24 years old. Health indicators show concerning sexual and reproductive health (SRH) trends such as high teen pregnancy, unsafe abortions, limited contraceptive use, and access to antenatal and postnatal care. However, the barriers to adolescents seeking and receiving care are complicated due to pre-existing social structures in smaller, closely linked communities. Objectives To understand the social structures and motivation of communities in western Ugandan districts that impact SRH in adolescents to better implement Healthy Adolescent and Young people (HAY!). Design/Methods In September 2020, a qualitative study was conducted in 2 districts, in southwestern Uganda. Fourteen focus group discussions and 3 key informant interviews consisted of 94 participants were carried out with a purposive sample of adolescents, parents, community health workers (CHWs), community leaders, health facility staff, and district health officers. Ethics approval was obtained and COVID-19 prevention guidelines were strictly followed. Data was audio-recorded, transcribed, and thematically analyzed. Results Based on our qualitative inquiry, participants recognized that adolescents face numerous SRH challenges and expressed their tension for change and motivation to support interventions that may positively impact SRH behavior and outcomes in adolescents. However, participants who were mothers highlighted that their motivation was due to better marriage prospects for their daughters, which is determined by respect and social standing in the community. In situations of unwanted pregnancies, participants shared that because of the fear of shame, and desire to keep adolescents in school, mothers often supported unsafe abortion to maintain community standing. This is an unusual and interesting finding. Similarly, aunties and uncles were traditionally regarded as champions for protecting and guiding adolescents, but participants highlighted a negative shift in this dynamic; aunties and uncles put female adolescents at risk by connecting them with interested men in exchange for gifts and money. Consequently, they are no longer trusted. Despite these gaps, volunteer CHWs who work closely within their communities by conducting home visits, educating, and providing referrals, emerged as a trusted resource by adolescent participants in accessing SRH related information. CHW participants also shared that adolescents often confided in them when unable to speak openly with their parents. Conclusion Although participant groups were motivated towards supporting adolescents, interventions must first understand and navigate complex community structures to deliver a comprehensive and targeted intervention to improve SRH outcomes in adolescents.
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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 | 0.003 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.005 | 0.003 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.001 | 0.006 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 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; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
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".