A qualitative study to explore the barriers and enablers for young people with disabilities to access sexual and reproductive health services in Senegal, Reproductive Health Matters, 25:50,[43][44][45][46][47][48][49][50][51][52][53][54]

BackgroundThis paper describes the systematic development of an intervention for the prevention of obesity among overweight adults. Its development was guided by the six steps of Intervention Mapping (IM), in which the establishment of program needs, objectives and methods is followed by development of the intervention and an implementation and evaluation plan.MethodsWeight gain prevention can be achieved by making small changes in dietary intake (DI) or physical activity (PA). The intervention objectives, derived from self-regulation theory, were to establish goal-oriented behaviour. They were translated into a computer-tailored Internet-delivered intervention consisting of four modules. The intervention includes strategies to target the main determinants of self-regulation, such as feedback and action planning.The first module is intended to ensure adults' commitment to preventing weight gain, choosing behaviour change and action initiation. The second and third modules are intended to evaluate behaviour change, and to adapt action and coping plans. The fourth module is intended to maintain self-regulation of body weight without use of the program.The intervention is being evaluated for its efficacy in an RCT, whose protocol is described in this paper. Primary outcomes are weight, waist circumference and skin-fold thickness. Other outcomes are DI, PA, cognitive mediators and self-regulation skills.DiscussionThe IM protocol helped us integrating insights from various theories. The performance objectives and methods were guided by self-regulation theory but empirical evidence with regard to the effectiveness of theoretical methods was limited. Sometimes, feasibility issues made it necessary to deviate from the original, theory-based plans. With this paper, we provide transparency with regard to intervention development and evaluation.Trial registrationNTR1862

BackgroundStudies have shown that, compared to native counterparts, preschoolers from ethnic minorities are at an increased risk of problem behaviour. Socio-economic factors only partly explain this increased risk. This study aimed to further unravel the differences in problem behaviour among ethnic minority and native preschoolers by examining the mediating role of family functioning and parenting factors.MethodsWe included 4,282 preschoolers participating in the Generation R Study, an ethnically-diverse cohort study with inclusion in early pregnancy. At child age 3 years, parents completed the Child Behavior Checklist (CBCL/1,5-5); information on demographics, socio-economic status and measures of family functioning (maternal psychopathology; general family functioning) and parenting (parenting stress; harsh parenting) were retrieved from questionnaires. CBCL Total Problems scores in each ethnic subgroup were compared with scores in the Dutch reference population. Mediation was evaluated using multivariate regression models.ResultsAfter adjustment for confounders, preschoolers from ethnic minorities were more likely to present problem behaviour than the Dutch subgroup (e.g. CBCL Total Problems Turkish subgroup (OR 7.0 (95% CI 4.9; 10.1)). When considering generational status, children of first generation immigrants were worse off than the second generation (P<0.01). Adjustment for socio-economic factors mediated the association between the ethnic minority status and child problem behaviour (e.g. attenuation in OR by 54.4% (P<0.05) from OR 5.1 (95% CI 2.8; 9.4) to OR 2.9 (95% CI 1.5; 5.6) in Cape Verdean subgroup). However, associations remained significant in most ethnic subgroups. A final adjustment for family functioning and parenting factors further attenuated the association (e.g. attenuation in OR by 55.5% (P<0.05) from OR 2.2 (95% CI 1.3; 4.4) to OR 1.5 (95% CI 1.0; 2.4) in European other subgroup).ConclusionsThis study showed that preschoolers from ethnic minorities and particularly children of first generation immigrants are at an increased risk of problem behaviour compared to children born to a Dutch mother. Although socio-economic factors were found to partly explain the association between the ethnic minority status and child problem behaviour, a similar part was explained by family functioning and parenting factors. Considering these findings, it is important for health care workers to also be attentive to symptoms of parental psychopathology (e.g. depression), poor family functioning, high levels of parenting stress or harsh parenting in first and second generation immigrants with young children.

The ‘insider’ status of peer researchers can increase access to study informants, enhance data quality and empower them, but comes with challenges related to their ability to collect and analyse quality data and ethical challenges. We piloted a peer research methodology in Senegal as part of a qualitative study on access to sexual and reproductive health services for young people with disabilities (YPWD) to assess how working with YPWD as peer researchers influences the quality of data and data analysis alongside understanding the experiences of being a peer researcher. Our study reveals that peer researchers facilitated building rapport with study informants, but they lacked experience in effectively probing. Some demonstrated potential to be involved in data analysis, but further research is needed to explore their contribution to the analysis and quality of data. We recommend considering peers throughout the whole research cycle, beyond data collection, and providing the necessary training and tools to allow them to effectively participate in the process, especially regarding exploration of sensitive research topics. Reflexivity tools can provide insights into the experiences of peer researchers, as well as monitor their well-being during the process, and contribute to data quality, but must be accompanied by clear guidance.

Recently in Sex Education authors have raised concern with regards to Comprehensive Sexuality Education (CSE) in resourcepoor countries as part of Western European development aid policy. It has been argued that the agency-focused and rightsbased nature of 'northern' sexuality education puts too much responsibility on young people's shoulders and disregards their insecurity and shame, as well as local culture more generally. By promoting a rights-based approach to CSE in countries in the South, European development organisations would risk being insensitive to local collective concerns, networks, sensitivities and affects, not least those based in religion. In addition to concerns related to CSE content, concern has been expressed about the unequal relationships between stakeholders from the global north versus the global south in the shaping of youth sexuality education. The issues raised are important and call for further elaboration and discussion, which is what we intend to initiate here. The viewpoints we present relate, among others, to the balance between structure and agency focused perspectives in CSE; the multiplicity of needs with regard to sexual agency; the precariousness of international partnerships; ongoing national and international controversies over sexual rights; and the absolute necessity for multicomponent approaches and careful community building as part of CSE implementation and scale-up.