Integration of a menstrual health intervention in a community-based sexual and reproductive health service for young people in Zimbabwe: a qualitative acceptability study

Abstract

Background Despite being fundamental to the health and well-being of women, menstrual health is often overlooked as a health priority and access to menstrual health education, products, and support is limited. Consequently, many young women are unprepared for menarche and face challenges in accessing menstrual health products and support and in managing menstruation in a healthy and dignified way. In this paper, we examine the acceptability of a comprehensive menstrual health and hygiene (MHH) intervention integrated within a community-based sexual and reproductive health (SRH) service for young people aged 16–24 years in Zimbabwe called CHIEDZA. Methods We conducted focus group discussions, that included participatory drawings, with CHIEDZA healthcare service providers (N = 3) and with young women who had attended CHIEDZA (N = 6) between June to August 2020. Translated transcripts were read for familiarisation and thematic analysis was used to explore acceptability. We applied Sekhon’s thematic framework of acceptability that looks at seven key constructs (affective attitudes, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy). Data from FGDs and meeting minutes taken during the study time period were used to triangulate a comprehensive understanding of MHH intervention acceptability. Results The MHH intervention was acceptable to participants as it addressed the severe prevailing lack of access to menstrual health education, products, and support in the communities, and facilitated access to other SRH services on site. In addition to the constructs defined by Sekhon’s thematic framework, acceptability was also informed by external contextual factors such as sociocultural norms and the economic environment. Providers highlighted the increased burden in their workload due to demand for MHH products, and how sociocultural beliefs around insertable menstrual products compromising virginity can negatively affect acceptability among young people and community members. Conclusions MHH interventions are acceptable to young women in community-based settings in Zimbabwe as there is great unmet need for comprehensive MHH support. The integration of MHH in SRH services can serve as a facilitator to female engagement with SRH services. However, it is important to note that contextual external factors can affect the implementation and acceptability of integrated SRH and MHH services within communities. Trial registration Registry: Clinicaltrials.gov, Registration Number: NCT03719521, Registration Date: October 25, 2018.

Acceptability of a community-embedded intervention for improving adolescent sexual and reproductive health in south-east Nigeria: A qualitative study

“…Concerning the healthcare service providers, the SRH intervention was welcomed as it was perceived as "a hook" to attract adolescents, both in and out of school, and expose them to quality SRH information and services using varied formats. Our study's acceptance of the intervention corroborates earlier studies on the acceptability of SRH products in Zimbabwe [17] and Malawi [22], where similar acceptance was reported. Given the acceptability of the strategies, SRH interventions should be designed to be context-specific, adaptable to the users' needs and preferences, and SRH education prioritised for informed sexual choice.…”

“…The intervention was accepted in the community because it helped address the conflicts between personal beliefs and societal norms and expectations. This is in contrast to a study in Zimbabwe [17], where despite implementing PLOS ONE a community-based SRH intervention for healthcare providers and product sensitization, there were still challenges to overcoming the sociocultural barriers to SRH product acceptability. Concerning the healthcare service providers, the SRH intervention was welcomed as it was perceived as "a hook" to attract adolescents, both in and out of school, and expose them to quality SRH information and services using varied formats.…”

High uptake of menstrual health information, products and analgesics within an integrated sexual reproductive health service for young people in Zimbabwe

“…The high MH service uptake at first visit and the popularity of the MH service overall suggests that the MH service may have had a particularly strong influence on bringing young women to CHIEDZA. This finding is further supported by a qualitative study we conducted to explore the acceptability of the MH service within CHIEDZA [ 44 ]. Here, particularly during the COVID-19 pandemic, when markets were closed, less money was available in the household, and social activities and games within CHIEDZA were suspended, the MH service became the sole “ pull factor ” framing CHIEDZA as a “women’s service” and encouraging young women to visit CHIEDZA [ 44 , 47 ].…”

“…The reluctance to opt for and/or use the menstrual cup may be due to an unwillingness to try a novel menstrual product or unwillingness to use an insertable product that may affect their “virginity” [ 28 , 30 , 43 ]. These barriers persisted despite MH and menstrual cup sensitization and education provided through group talks, educational materials, and “menstrual cup champions” on site [ 44 ].…”

High uptake of menstrual health information, products and analgesics within an integrated sexual reproductive health service for young people in Zimbabwe

“…Overall, the study results showed high uptake of the MH service among young women as part of a multicomponent SRH service package. The provision of MH education, analgesics, and a choice of MH products through comprehensive MH interventions may serve as a pathway to increase female engagement with other important SRH services such as family planning and HIV testing (17,19,41,50).…”