Seminar

Effectiveness of peer led education interventions on contraceptive demand and use among secondary school adolescents in Gedeo Zone, South Ethiopia. A cluster randomized controlled trial.

Ethiopian Health Education and Promotion Professionals Association (EHEPA)

Virtual

Background: Contraception is defined as a sharp avoidance of birth via numerous methods. Its name could be family planning, which allows users to decide the number of children and when to have them, but in the case of adolescents, more focus is given on preventing pregnancy. Given that most adolescent girls are in schools where they often spend a significant amount of their time with their peers, a school based peer education intervention to promote contraceptive use would be a potential strategy. Objective: To assess contraceptive utilization barrier, use and effectiveness of peer-led education interventions in increasing modern contraceptive methods use, reducing unmet needs and increasing demand for modern contraceptive methods among senior secondary school adolescents girl (aged 15-19) in Gedeo Zone, South Ethiopia. Methods: For the qualitative part, the study's data were obtained from in-depth interviews and key informant interviews. This study involved 24 in-depth interviews with secondary school adolescents and 28 key informants’ interviews. ATLAS. ti V.7.1.4 aided in the coding and further analysis of the data. The findings were organized into themes, categories, and subcategories based on important quotes. For a formative quantitative study, a cross-sectional study was conducted. Study participants were selected using a stratified sampling technique. For an interventional study, a single-blinded cluster randomized controlled trial study was performed in six randomly selected secondary schools in the Gedeo Zone. For the interventional study Pre- and post-intervention differences within the intervention and control groups were measured in the beginning, then after, to measure the net effect or effect size of the intervention, the Difference in difference (DID) between the intervention and control group was measured once again, in addition to the Difference in difference (DID) net of the intervention also measured using odd ratio using generalized estimating equation (GEE) model with a binary logit function to compare differences in outcome change between the intervention and control groups. Result: Formative qualitative study findings were organized into four major themes influencing contraceptive use. These include (1) Individual-related barriers such as Knowledge, fear, and psychosocial development. (2) Community-related barriers encompass fear of rumors, family pressure, social and cultural norms, economic vulnerability, and religious beliefs. (3) Health service-related barriers include the lack of adolescent-responsive health services, health workers' behavior, and fear of health workers. Furthermore, (4) the school and service integration barrier was identified. The effect size of peer education intervention after six months was measured using the Difference-in difference effect size measure and generalized estimating equation (GEE) with a binary logit function using the odds ratio (OR) accordingly; the Difference-in differences (DID) in contraceptive use, unmet need, and contraceptive demand between the intervention and control groups were 25.1%, -7.4%, and 17.7%, respectively. The generalized estimating equation (GEE) with a binary logit function model showed that there was a statistically significant difference in contraceptive use [OR = 8.7, 95% CI: (3.66, 20.83), unmet need for contraceptives [OR = 6.2, 95% CI: (1.61, 24.36)] and contraceptive demand [OR = 6.1, 95% CI: (2.43, 15.11)] between the intervention and control groups. Conclusions and Recommendations: The baseline findings of the qualitative and quantitative studies showed that students note various barriers to using contraception and that, without contraception, sexual activity can lead to an increased risk for unintended pregnancy and its associated health risks; thus, the current interventional study of this dissertation concludes that peer-led education intervention was effective in improving contraceptive use, unmet needs, and creating contraceptive demand/intention among sexually active adolescent girls. Similar programs should be implemented in areas where coverage of contraception use and demand is low.