1. From silos to synchronicity
Creating a transdisciplinary model to enhance AYSRH program design
Claire Cole, Implementation Science & Learning Advisor | Adolescents 360 | PSI
The Smart Start intervention (Ethiopia) targets newly married couples by situating contraception into the couple’s new social identity – presenting it in the context of financial planning. Adolescent Developmental Science, anthropology, and HCD merged to help identify opportunities for contraceptive uptake that linked to existing concepts and norms in agrarian communities regarding the need for planning to achieve stability. The Smart Start counseling approach helps providers bring couples through the cognitive and emotional journey to state their life goals, and begin acting for their achievement, positioning contraceptives as a critical tool in that process.
1. BACKGROUND
Recent systematic reviews of adolescent and youth sexual and reproductive health (AYSRH) programming in low and middle -income countries have helped to assess the spectrum of AYSRH interventions and effectiveness. The most promising AYSRH interventions combine training and facility modifications to enable youth-friendly service provision with community engagement and demand generation. However, even the most promising interventions most efficaciously change attitudes, beliefs and intentions rather than behavior. As such, further research is needed to understand the “mechanisms of action” that lead to effective behavior change. As the global reproductive health community strives to improve health outcomes of the most vulnerable youth, putting the beneficiaries at the center of the intervention design process will facilitate a better understanding of the pathways to behavior change. A transdisciplinary approach integrating the fields of public health, adolescent developmental science, cultural anthropology, youth engagement, social marketing, and human-centered design offers meaningful insights into the mechanisms informing effective AYSRH interventions. Launched in 2016, Adolescents360 (A360)– a project aiming to increase contraceptive uptake among young women ages in Ethiopia, Nigeria, and Tanzania – offers an exemplar of how an integrated, user-centered approach provides insights that enhance the precision – in both developmental timing and message targeting – of effective AYSRH interventions.
A360 interventions map to girls’ developmental & life trajectories, and their reproductive life stages. In Tanzania, the transdisciplinary approach showed that meaningful distinction in girls’ trajectories were based on sexual experience and independence from parents rather than marital status or parity. Concerns over future stability factored for all. As a result, Kuwa Mjanja aligns contraceptive use with girls’ belief in the future, positive identity, self-efficacy, prosocial norms, and self-determination. Girls with less sexual experience and independence receive the “Know Your Body” message linking to consideration of contraceptives. Girls with more experience and independence receive the “Know Your Path” message. Opt-out moments with providers enable on-demand method provision.
9ja Girls (Nigeria) aims to leverage girls’ desire for autonomy and financial independence by coupling trade skills with contraception. Girls participate in life, love, and health sessions in which they are provided a safe space to gain skills, hear information, and ask anonymously about questions ranging from AYSRH to sex, relationships, and life overall. During sessions, girls transition to opt-out confidential counseling and method provision on-site, in public health facilities.
2. METHODS
Since January 2016, A360 has engaged a diverse disciplinary consortium toward key aims:
Develop a framework for design and implementation of AYSRH interventions that motivate contraceptive uptake with girls at scale and which moves AYSRH programming from youth as targets and sources, to youth as co-designers and co-analysts
Develop, test, and implement effective interventions to reach young married girls in seven regions of Ethiopia, and unmarried and married girls in nine states of Nigeria and nine regions of Tanzania
Using HCD methodologies and integrating the project’s additional foundational disciplines, adults, girls and young women worked in partnership in a systematic and cyclical process of reviewing existing evidence, collecting data, designing and testing prototypes, and vetting and refining intervention approaches in each of the three countries.
By close of 2017, this design process yielded one intervention in each of the three countries and a vetted transdisciplinary framework for intervention design and iterative adaptation. With respect to service delivery performance monitoring, results of the interventions’ effectiveness are derived through district monitoring (DHIS2).
FIG 1. A360 INTERVENTION SERVICE DELIVERY PERFORMANCE July September 2018
Modern Contraceptive Adopters
% Adopters of Total Girls Reached
% LARC
ETHIOPIA- Smart Start
8,975
51%
25%
TANZANIA- Kuwa Mjanja
50,913
62%
64%
NIGERIA- 9jaGirls!
13,918
42%
15%
NIGERIA- Arewa* (xxx months implementation)
1,864
69%
28%
TOTAL
73,806
56%
50%
3. RESULTS
4. PROGRAM IMPLICATIONS | LESSONS
A360 has resulted in the development of a novel transdisciplinary evidence-base, theoretical language, and integrated set of design and implementation standards to support the sustained resonance of AYSRH interventions with girls and young women. The project resulted in an integrated, youth-engaged, transdisciplinary, human-centered design methodology uniquely positioned to address the gap between interventions and effective behavior change in contraceptive uptake.
Youth and expert-led insights resulted in a carefully curated combination of youth friendly service delivery and life planning tools that respond to and are found to resonate with specific moments in girls’ life trajectory.
T he A360 approach offers lessons about how to effectively develop an integrated, transdisciplinary approach and about how that approach can improve the understanding of behavioral mechanisms in ways that refine the precision and resonance of resulting AYSRH interventions. Recognizing challenges and barriers (e.g. funding; geography; sector specific values, language, and methods) associated with developing transdisciplinary teams, A360 offers a spectrum of lessons learned spanning from practices for effective disciplinary integration to critical principles to improve the precision of the AYSRH interventions that result. Through analyzing the mixed methods findings of the A360 interventions’ design to implementation phases, key insights may prove salient to future efforts to enhance understanding of the mechanisms of effective contraceptive AYSRH interventions. Further, opportunities and challenges associated with taking both the A360 model and interventions to scale provide rich ground for productively problematizing the future of AYSRH implementation. In particular the field of public health and HCD have recognized the critical importance of community/beneficiary involvement, and bridging the evidence to action gap. A360 offers critical insights about how to transition youth and expert insights into meaningful practice.
A360LearningHub.org
Adolescents 360
@Adolescents360

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