Community-embedded Reproductive Health Care for Adolescents in Latin America. (CERCA)

Community-embedded Reproductive Health Care for Adolescents in Latin America (CERCA).

Adolescents in Latin America are at major risk for unwanted pregnancies leading to unsafe abortions and maternal health risks. Mostly, adolescent health programmes tend to focus on unidirectional interventions aiming at a single determinant of adolescents´ sexual and reproductive health. However, evidence exists that a complex health problem should be addressed by an equally nuanced and multipronged response. Knowledge is lacking on how to develop a comprehensive approach to promote adolescents' sexual health.

The CERCA study will conduct an implementation based on the hypothesis that a comprehensive strategy of community-embedded interventions helps to improve the sexual health of adolescents. We will test this hypothesis and describe the development, implementation and testing of interventions in three Latin American cities: Cochabamba (Bolivia), Cuenca (Ecuador) and Managua (Nicaragua).

The research methodology has been designed based on the methodological frameworks of action research, community based participatory research and intervention mapping.

The interventions are complex addressing different target groups (adolescents, parents, authorities and health providers) and focussing on various behaviours that are related to communication about sexuality, information seeking, access to health care and safe sexual intercourse.

For the evaluation of effectiveness a randomised and non-randomised controlled study was developed for respectively Managua and the two other cities. Furthermore a process evaluation is conducted.

This research will result in a framework that will contribute to the planning of interventions that are effective and responsive to adolescents' sexual health needs.

Study Overview

• Status: Completed
• Conditions: Sexual and Reproductive Health Problems
• Intervention / Treatment: Behavioral: Theory of planned behaviour (TPB) and social cognitive theory (SCT).

• Study Type: Interventional
• Enrollment (Actual): 9625
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Bolivia
  • Cochabamba, Bolivia
    • South Group
• Ecuador
  • Cuenca, Ecuador
    • Universidad de Cuenca
• Nicaragua
  • Managua, Nicaragua
    • Centro de investigaciones y estudios de salud
  • Managua, Nicaragua
    • Instituto Centro Americano de la Salud

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 13 years to 18 years (Child, Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

Nicaragua - adolescents aged 13-18 living in the 33 town districts of Managua with a population number that varies between 1400 and 4500 inhabitants and with more than 50 % poor people.

Bolivia and Ecuador: Students from conveniently selected secondary schools in Cochabamba (Bolivia) and Cuenca (Ecuador).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Community-eùbedded reproductive health interventions; Members of communities that belonged to the intervention arm were exposed to complex interventions addressing different target groups (adolescents, parents, authorities and health providers) and focusing on various behaviours that were related to communication about sexuality, information seeking, access to health care and safe sexual intercourse.	Behavioral: Theory of planned behaviour (TPB) and social cognitive theory (SCT).; TPB is appropriate to influence adolescents' behaviour related to the use of contraceptive methods and their health/information seeking behaviour. The SCT helped to find out strategies to improve communication about sexuality, to promote openness towards adolescents' sexuality among parents, community members and health providers and for health providers to adopt a more adolescent friendly attitude.The development of the strategies in the different countries is a dynamic process that is continuously being adapted. The target groups were "driving" the process of identifying, selecting and implementing interventions. Therefore, local institutions were involved in the intervention. Attention was paid to ensure that the interventions were in line with the existing local structures/policies and reinforce the local health system.Primary health care services had a key role in the interventions. Gender was a transversal topic throughout the intervention process.
No Intervention: Community members without intervention

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Self-reported use of modern contraceptives at 18 months of interventions.	Self-reported exposure to intervention activities and registered participation at intervention activities.	At 18 months of intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Self-reported ease to communicate about sexuality with parents, partner, friends.	Self-reported exposure to intervention activities, registered participation at intervention activities and registered access of adolescents to health services.	At 18 months of intervention
Self-reported access health services for sexual and reproductive health.	Self-reported exposure to intervention activities, registered participation at intervention activities and registered access of adolescents to health services.	At 18 months of intervention
Self-reported information seeking behaviour.	Self-reported exposure to intervention activities, registered participation at intervention activities and registered access of adolescents to health services.	At 18 months of intervention
Self-reported pregnancy.	Self-reported exposure to intervention activities, registered participation at intervention activities and registered access of adolescents to health services.	At 18 months of intervention

Collaborators and Investigators

• Sponsor: University Ghent
• Collaborators: Lithuanian University of Health Sciences; VU University of Amsterdam
• Investigators: Principal Investigator: Marleen Temmerman, MD, PhD, University Ghent

Publications and helpful links

General Publications

• Decat P, Nelson E, De Meyer S, Jaruseviciene L, Orozco M, Segura Z, Gorter A, Vega B, Cordova K, Maes L, Temmerman M, Leye E, Degomme O. Community embedded reproductive health interventions for adolescents in Latin America: development and evaluation of a complex multi-centre intervention. BMC Public Health. 2013 Jan 14;13:31. doi: 10.1186/1471-2458-13-31.

Study record dates

Study Major Dates

• Study Start: July 1, 2011
• Primary Completion (Actual): October 1, 2013
• Study Completion (Actual): December 1, 2013

Study Registration Dates

• First Submitted: October 29, 2012
• First Submitted That Met QC Criteria: November 2, 2012
• First Posted (Estimate): November 6, 2012

Study Record Updates

• Last Update Posted (Estimate): December 5, 2014
• Last Update Submitted That Met QC Criteria: December 4, 2014
• Last Verified: December 1, 2014

More Information

Terms related to this study

• Other Study ID Numbers: 2011/380; FP7-health-241615