Karen Austrian

Real Men Do…Real Men Don’t: Young Latino and African American Men’s Discourses Regarding Sexual Health Care Utilization:

There is growing recognition that men as well as women need sexual health care (SHC) services. Despite this, male friendly sexual health services are not readily available in the United States, and men are underutilizing the services that are available. This situation needs to be rectified to improve sexual health outcomes for men and women. In this study we conducted 10 focus groups with young adult Latino and African American men to examine their perceptions of the factors influencing SHC utilization among the men they know, with an emphasis on how notions of what it means to be a man affects health care seeking. The findings both amplify and complicate the relationship between masculinity and SHC seeking. They suggest new directions for public health efforts to enhance men’s SHC utilization.

Barriers and Facilitators to Health Behaviour Change and Economic Activity among Slum-Dwelling Adolescent Girls and Young Women in Nairobi, Kenya: The Role of Social, Health and Economic Assets.

Adolescent girls and young women in urban slum areas in developing countries face a myriad of challenges regarding education, sexual health, livelihoods and gender-based violence. One way of understanding how these challenges interact with each other is through the Asset Building Framework, which posits that girls need a combination of social, health and economic assets in order to make a healthy transition from childhood to adulthood. This study sought to examine barriers and facilitators to health behaviour change and economic activity for girls within the context of this framework. It involved a combination of focus group discussions and in-depth interviews with 128 young women who were in the age range of 18–25 years, living in various slums in Nairobi, Kenya. We found that economic assets reduce young womens dependence on others (especially parents and relationships with men) so that they are able to make positive changes in health behaviour. Social networks, self-esteem and financial literacy all played important roles in positively positioning girls to make the transition to economic activity safely and successfully. We suggest that programmes that seek to improve girls’ and young womens health behaviour or economic activity include elements of asset building within all three categories of assets.

Cluster randomized evaluation of Adolescent Girls Empowerment Programme (AGEP): study protocol

BackgroundAdolescents in less developed countries such as Zambia often face multi-faceted challenges for achieving successful transitions through adolescence to early adulthood. The literature has noted the need to introduce interventions during this period, particularly for adolescent girls, with the perspective that such investments have significant economic, social and health returns to society. The Adolescent Girls Empowerment Programme (AGEP) was an intervention designed as a catalyst for change for adolescent girls through themselves, to their family and community. Methods/designAGEP was a multi-sectoral intervention targeting over 10,000 vulnerable adolescent girls ages 10–19 in rural and urban areas, in four of the ten provinces of Zambia. At the core of AGEP were mentor-led, weekly girls’ group meetings of 20 to 30 adolescent girls participating over two years. Three curricula ― sexual and reproductive health and lifeskills, financial literacy, and nutrition ― guided the meetings. An engaging and participatory pedagogical approach was used. Two additional program components, a health voucher and a bank account, were offered to some girls to provide direct mechanisms to improve access to health and financial services. Embedded within AGEP was a rigorous multi-arm randomised cluster trial with randomization to different combinations of programme arms. The study was powered to assess the impact across a set of key longer-term outcomes, including early marriage and first birth, contraceptive use, educational attainment and acquisition of HIV and HSV-2. Baseline behavioural surveys and biological specimen collection were initiated in 2013. Impact was evaluated immediately after the program ended in 2015 and will be evaluated again after two additional years of follow-up in 2017. The primary analysis is intent-to-treat. Qualitative data are being collected in 2013, 2015 and 2017 to inform the programme implementation and the quantitative findings. An economic evaluation will evaluate the incremental cost-effectiveness of each component of the intervention.DiscussionThe AGEP program and embedded evaluation will provide detailed information regarding interventions for adolescent girls in developing country settings. It will provide a rich information and data source on adolescent girls and its related findings will inform policy-makers, health professionals, donors and other stakeholders.Trial registrationISRCTN29322231. March 04 2016; retrospectively registered.

Transitioning Customized ACASI Windows .NET Solution to Android Java on Lower-Priced Devices and Technical Lessons Learned

Research‐based organizations are continuing to find ways to leverage newer technologies in projects, specifically using lower cost hardware solutions if at all possible. There exist many electronic data collection solutions for purchase, as well as free open‐source options to assist researchers and investigators, particularly those engaged in international public health. Sometimes, however, these solutions may not meet the specific needs of the research project. In this case, organizations may opt to architect and develop a custom product. Android devices, both smartphone and tablet‐based, continue to expand into many markets globally, particularly in the developing world. These devices can be found in most major cities and local technology support for them, as well as an understanding of their operation is growing along‐side this expansion in use. Recently Google chose India to introduce the first of a series of affordable smartphones under its Android One initiative, a bid by the company to win over the “next billion” users in emerging economies (Rai, Saritha 2014). Software developers may be required to transfer existing developed applications and programs to operate on the new Android‐based devices. In our case we had a working Microsoft.NET program developed in the C# programming language that works well on Windows‐based laptops and tablets, but it could not be used on the lower priced Android units. Converting the.NET application or at least the heavier programming logic in the application, to the Java language may be possible and the details of performing this task are discussed in this paper.

Is Working Risky or Protective for Married Adolescent Girls in Urban Slums in Kenya? Understanding the Association between Working Status, Savings and Intimate-Partner Violence.

Introduction Previous studies have shown that women’s empowerment, though beneficial in many aspects, can also increase the risk of intimate-partner violence (IPV). This study seeks to examine the association between work and experience of physical violence among married adolescents, and to understand the impact of access to independent financial resources on this risk. Authors draw on the asset-building framework and the ecological model. Methods The data is from a baseline survey of girls aged 15–19 residing in urban slums in four cities and towns in Kenya (Nairobi, Thika, Nakuru and Kisumu). The analytic sample is 452 married girls. Logistic regression is used to examine associations between working status, savings and experience of IPV in the previous six months, controlling for other factors. This is complemented by content analysis of in-depth interviews with 32 adolescent girls and 16 young men. Results Compared to girls who did not work, working with no regular savings was significantly associated with greater odds (OR = 1.96, p<0.01) of experiencing IPV. There was no difference between girls who did not work and those who worked but had regular savings. Qualitative findings indicate savings decrease girls’ dependency on men and allow them to leave abusive partners. Discussion Findings imply that in these communities with patriarchal gender norms and high levels of poverty, female employment and financial conflicts can be triggers of violence in marriages. On the other hand, girls’ management of and access to independent financial resources through savings can potentially help to reduce this risk.

Mothers’ Education and Girls’ Achievement in Kibera: The Link With Self-Efficacy:

Research evidence has established the importance of mothers’ education and their children’s educational achievement. However, little has been done to establish the association between mothers’ education with girls’ literacy and numeracy scores, while linking it with self-efficacy. Using baseline data collected in Kibera informal settlement in 2015 as part of the Adolescent Girls Initiative–Kenya (AGI-K), this article tests the mother–child education achievement hypothesis while taking into account girls’ self-efficacy. Results show a significant association between parental education and numeracy and cognitive scores at the bivariate level. In addition, interaction effects of mother’s and father’s education showed that girls whose mothers had at least some secondary education significantly performed better in numeracy, while the performance increased even more with increased father’s level of education. Findings also show that on average, girls’ numeracy and cognitive scores significantly increased by half of a standard deviation for a unit increment in self-efficacy. One policy implication is that investments into the secondary education of mothers in support of their daughter’s education need to strengthen individual attributes of girls in self-efficacy.

The Case for a Multi-Sectoral Approach to Preventing Child Marriage and Early Childbearing in Sub-Saharan Africa

In sub-Saharan Africa and other developing countries, millions of girls are married before the age of 18, and child marriage often leads to early childbearing. The drivers of early marriage and early childbearing are complex, and interrelated, including contextual factors, factors related to one’s background and upbringing, and access to education. Consequences of early marriage and childbearing include adverse health effects, reduced education and earnings, and decreased economic power in relationships. Three theories, human capital theory, the theory of gender stratification, and the human capabilities approach, are used to provide an understanding of these effects. This chapter makes the argument for a multi-sectoral approach to preventing child marriage and early childbearing. The Adolescent Girls Initiative-Kenya (AGI-K) is provided as an example of a multidimensional program including interventions across four sectors (violence prevention, education, health, and wealth creation) aimed at delaying the age of marriage and childbearing by building girls’ education and social, health, and economic assets while improving community norms and the value of girls in society.