Adolescent condom use in Southern Africa: narrative systematic review and conceptual model of multilevel barriers and facilitators

BMC Public Health

Lynne Lohfeld¹  G. J. Melendez-Torres²  Sarah Skeen³  Christina Laurenzi³  Sarah Gordon³  Jackie Stewart³  Yeukai Chideya³  Stephan Rabie⁴  Moroesi Makhetha⁵  Allen Thurston⁶  Maria Lohan⁷  Áine Aventin⁷  Mark Tomlinson⁸ 

[1] Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland;College of Medicine and Health, University of Exeter, Exeter, England, UK;Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa;Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa;Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Cape Town, South Africa;Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa;World Vision, Maseru, Lesotho;School of Education, Social Sciences, Education and Social Work, Queen’s University Belfast, Belfast, Northern Ireland;School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland, UK;School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland, UK;Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa;

关键词: Systematic review;    Condom use;    Sexual and reproductive health;    Adolescents;    Adolescent health;    Southern Africa;   

DOI  :  10.1186/s12889-021-11306-6

来源: Springer

【 摘 要 】

BackgroundAdolescent HIV and pregnancy rates in Southern Africa are amongst the highest in the world. Despite decades of sexual and reproductive health (SRH) programming targeting adolescents, recent trends suggest there is a continued need for interventions targeting condom use for this age group.MethodsThis review synthesises evidence from qualitative studies that describe the determinants of condom use among adolescents in Southern Africa. We conducted systematic searches in four databases. Data were extracted, appraised for quality and analysed using a ‘best-fit’ framework synthesis approach.ResultsWe coded deductively findings from 23 original studies using an a priori framework and subsequently conducted thematic analysis. Synthesised findings produced six key themes relating to: 1) pervasive unequal gender norms and restrictive masculinities favouring male sexual decision-making and stigmatising condom use in committed relationships; 2) other social norms reflecting negative constructions of adolescent sexuality and non-traditional family planning; 3) economic and political barriers including poverty and a lack of policy support for condom use; 4) service-level barriers including a lack of youth-friendly SRH services and comprehensive sex education in schools; 5) interpersonal barriers and facilitators including unequal power dynamics in sexual partnerships, peer influences and encouraging condoning condom use, and inadequate communication about SRH from parents/caregivers; and 6) negative attitudes and beliefs about condoms and condom use among adolescents. A conceptual model was generated to describe determinants of condom use, illustrating individual-, interpersonal- and structural-level barriers and facilitating factors.ConclusionSRH programming targeting barriers and facilitators of condom use at multiple levels is recommended in Southern Africa. We present a multilevel integrated model of barriers and facilitators to guide adolescent SRH decision-making, programme planning and evaluation. Given the existence of multilevel barriers and facilitators, interventions should, likewise, take a multilevel approach that incorporates locally relevant understanding of the individual-, interpersonal- and structural-level barriers and facilitators to condom use among adolescents in the region.

【 授权许可】

CC BY