Background
Realist synthesis
Methods
Search strategy
Inclusion/exclusion criteria
Quality appraisal
Involving stakeholders
Theory development
Data extraction
Data synthesis
Results
Context | + | Mechanism | = | Outcome |
---|---|---|---|---|
Individual Experiences
Age, Culture, Past Experiences Family, peer and community influences, Personal circumstances and Past/current relationships | Taking control triggered through self-efficacy & perceived risks, susceptibility and benefits of pregnancy | If the adolescent views pregnancy as a likely negative outcome, with severe consequences and little benefit, they will take control of perceived barriers overcoming them to protect themselves against pregnancy. | ||
Barriers and Facilitators
Developmental stage and age, Knowledge of services, contraception availability Contraception preferences, Issues of access, Incentives, crèche facilities, and transport | Tailoring triggered through connectedness, support and self-determination | Tailoring interventions so they are relevant to a young person may result in a greater potential for connectedness with the intervention and the issue of teenage pregnancy itself, providing a notion of support and triggering self-determination. Feeling connected and supported can help an adolescent feel their life choices are being encouraged. A supportive professional delivering the intervention, the group itself or family members can help to verbalise and confirm a mother’s skills, and help them to develop strategies and plans to change their attitudes and behaviour. | ||
Motherhood versus Other Goals
Thoughts and feelings about motherhood, Emphasis placed on motherhood, How do adolescents plan or view the future, Engagement with school or a vocation | Motivations triggered by self-esteem, self-efficacy & empowerment | Motivations (conscious or unconscious) could lead the adolescent to manage their expectations of motherhood and take control of sexual encounters resulting in consistent use of contraception, if they feel there are other goals or opportunities available outside of motherhood to achieve success. |
Conceptualising the issue of pregnancy in adolescence
CMO 1: Taking control of the issue of adolescent pregnancy
Actionable implications
CMO 1 - Individual experiences of young mothers trigger self-efficacy, perceived risks, susceptibility and benefits of pregnancy, resulting in the adolescent taking control of their fertility and sexual encounters.
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Paukku et al [29] “Adolescents’ contraceptive practice differed remarkably by pregnancy history.” |
Barnet et al [32] “Similar to findings of previous studies, our findings show an increased subsequent pregnancy risk for an adolescent mother who reports a romantic relationship with the baby’s father.” |
Black et al [9] “Finally in some communities, rapid second births among adolescent mothers may be valued and regarded as desirable, thereby undermining many intervention programs…” |
Herrman [39] “In low-income communities there may be contextual rewards for bearing children, where the norms might not discourage adolescent childbearing.” |
Bull & Hogue [37] “....in school all the girls either got babies or is expecting…it’s got to the point where it’s normal in a group of girls; if you haven’t been pregnant, then you don’t fit in” |
Clarke [41] “…a purely mechanical approach to contraceptive provision is very unlikely to work for many young people…Therefore, contraceptive providers…need to widen their approach to ensure that there are opportunities for the many emotional and psychological barriers to contraceptive use…” |
Stakeholders involved in the research stated “If their first pregnancy resulted in termination, still birth or the child was taken into care, they want to replace a baby…these young women do not receive any bereavement counselling.” |
CMO 2: The adolescent’s motivation to engage with the issue of adolescent pregnancy
Actionable implications
CMO 2 – Choice between motherhood and other goals, triggers notions of motivations (conscious or unconscious) could lead the adolescent to manage their expectations of motherhood and take control of sexual encounters.
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Raneri & Wiemann [33] “Nevertheless, medical and social service providers should help young mothers to think about how potential age, financial or relationship imbalances may affect decisions regarding childbearing and other life plans.” |
Herrman [39] “when asked about decision making before unprotected sexual activity, the mothers claimed that either they did not weigh the consequences or that the consequences were not powerful enough to alter behaviours.” |
Raneri & Wiemann [33] “…Some teenage mothers may be ambivalent about using contraceptives to prevent additional pregnancies. Others feel they have limited educational and occupational options, and that early motherhood is not tragic or even problematic choice.” |
Barnet et al [32] “Motivational interviewing is a counselling style that emphasizes an individual’s personal goals and self-efficacy in relation to complex health behaviours…Motivational interviewing aims to highlight discrepancies between current behaviors and personal goals, thereby promoting an intention and optimism for change.” |
Carvajal et al [45] “Positive provider communication is associated with pregnancy prevention self-esteem.” |
Clarke [30] “…commitment to their maternal identities, provided a buffer against the potential threats to self-esteem.” |
Stakeholders involved in the research stated “Teenagers may be getting pregnant as there are no jobs, no prospects. Girls sometimes “drift”, thus they just continue the pregnancies because they do not know there are other options.” |
Stakeholders involved in the research stated “…there is a need for increased self-esteem, life skills and empowerment of teenage girls.” |
Stakeholders involved in the research stated “Need to empower the girls to make choices, this message needs to be given by all services consistently.” |
CMO 3: Tailoring so interventions work with the adolescent and their circumstances
Actionable implications
CMO 3 - Barriers and facilitators to accessing services, trigger notions of connectedness, support and self-determination; resulting in the tailoring of interventions so they are relevant to young persons and improve access to services and engagement with the issue of pregnancy in adolescence.
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Clarke [41] “…a purely mechanical approach to contraceptive provision is very unlikely to work for many young people…Therefore, contraceptive providers…need to widen their approach to ensure that there are opportunities for the many emotional and psychological to contraceptive use…” |
Haamid & Wiemann [44] “There was a lack of intention associated with repeat pregnancy…The adult who expects young people to engage in premeditated sex after deliberating the costs and rewards of an unintended pregnancy is not looking at sex and pregnancy from an adolescent viewpoint…interventions must be created that take the nature of this sexual activity into account.” |
Key et al [47] “Adolescent mothers face a difficult course navigating obstacles such as school failure and repeat pregnancy.” |
Stakeholders involved in the research stated “Schemes that involve home visits are likely to be more successful than involving people getting to clinics using public transport.” |
Stakeholders involved in the research stated “Childcare to support young mothers going back into education should be more supported and facilitated”. |
Stakeholders involved in the research stated “Interventions need to be tailored to the individual according to circumstances at the time – girls complain that they are not listened to by professionals”. |
Stakeholders involved in the research stated “We really need to find out what they really need and want and understand what they are asking for – there is too much generalisation, and perceptions of what girls want are not accurate”. |
Young mothers in a service user feedback group stated they would like services/interventions to have; “Positive discussion about contraception choices, teen centred groups and flexible services that allow for travel issues, difficulties in getting children ready to leave the house and absences due to child sickness.” |
Young mothers in a service user feedback group stated “In a group, we can see everyone, hear everyone’s opinion and if I feel something I am not alone.” |