Research Priorities for Adolescent Health in Low- and Middle-Income Countries: A Mixed-Methods Synthesis of Two Separate Exercises

Abstract

Research priorities for adolescent health in lowand middle-income countries: A mixed-methods synthesis of two separate exercises Background In order to clarify priorities and stimulate research in adolescent health in low-and middle-income countries (LMICs), the World Health Organization (WHO) conducted two priority-setting exercises based on the Child Health and Nutrition Research Initiative (CHNRI) methodology related to 1) adolescent sexual and reproductive health and 2) eight areas of adolescent health including communicable diseases prevention and management, injuries and violence, mental health, non-communicable diseases management, nutrition, physical activity, substance use, and health policy. Although the CHN-RI methodology has been utilized in over 50 separate research priority setting exercises, none have qualitatively synthesized the ultimate findings across studies. The purpose of this study was to conduct a mixed-method synthesis of two research priority-setting exercises for adolescent health in LMICs based on the CHNRI methodology and to situate the priority questions within the current global health agenda. Methods All of the 116 top-ranked questions presented in each exercise were analyzed by two independent reviewers. Word clouds were generated based on keywords from the top-ranked questions. Questions were coded and content analysis was conducted based on type of delivery platform, vulnerable populations, and the Survive, Thrive, and Transform framework from the United Nations Global Strategy for Women' s, Children' s, and Adolescents' Health, 2016-2030. Findings Within the 53 top-ranked intervention-related questions that specified a delivery platform, the platforms specified were schools (n = 17), primary care (n = 12), community (n = 11), parenting (n = 6), virtual media (n = 5), and peers (n = 2). Twenty questions specifically focused on vulnerable adolescents, including those living with HIV, tuberculosis, mental illness, or neurodevelopmental disorders; victims of gender-based violence; refugees; young persons who inject drugs; sex workers; slum dwellers; out-of-school youth; and youth in armed conflict. A majority of the top-ranked questions (108/116) aligned with one or a combination of the Survive (n = 39), Thrive (n = 67), and Transform (n = 28) agendas. Conclusions This study advances the CHNRI methodology by conducting the first mixed-methods synthesis of multiple research priority-setting exercises by analyzing keywords (using word clouds) and themes (using content analysis).

Risk Factors Related to Binge Drinking

“…For instance, in 2016, in America, 333,000 adolescents exhibited co-occurrence of mental health disorders and substance abuse (Substance Abuse and Mental Health Services Administration, 2017). The World Health Organization urges recognition of the need to address mental health and substance abuse issues in adolescents’ health and has set priority of place for adolescents’ health in schools, primary care settings, communities, parenting, virtual media, and among peers (Nagata et al, 2018). Therefore, the political will from governments and international agencies should be supported, as each sector has an important role in promoting mental health and contributing to prevention and early intervention for adolescents experiencing mental health problems and alcohol abuse (Whiteford, Degenhardt, Murray, Vos, & Lopez, 2014).…”

Global research priorities for social, behavioural and community engagement interventions for maternal, newborn and child health

“…Concurrent priority setting exercises were conducted for three health areas -(1) maternal, (2) newborn and (3) child health. Adolescent health was not included because a priority setting exercise had recently been conducted and the results included questions that pertained to SBCE interventions [10]. A mixed-methods approach Fig.…”

“…1 Conceptual framework for SBCE interventions for women, children's and adolescents' health [2] was used, which combined an adapted version of the Child Health and Nutrition Research Initiative (CHNRI) methodology [11] with a qualitative, consensus-building approach with experts. The CHNRI method features a metrics-based approach in which subject experts score a set of research priorities to determine their relative importance and has been used in over 50 health research prioritisation exercises [7][8][9][10][11][12].…”

“…Concerted effort is required to ensure research addresses these gaps. Global research priorities have recently been set for maternal and perinatal health [7], newborn health [8,9], and adolescent health [10]; some SBCE research priorities were identified within these exercises. However, a research agenda specifically for SBCE interventions for MNCH could better direct research towards the most important gaps in this field.…”

Minding the Gap: Setting Research Priorities Related to HIV Testing, Treatment, and Service Delivery Among Adolescents

“…The World Health Organization has recently supported priority setting exercises using the CHNRI method on adolescent health topics including sexual and reproductive health [10], communicable diseases, injuries and violence, mental health, non-communicable disease management, nutrition, physical activity, substance use, and health policy [11]. These exercises have produced a list of priority research questions for adolescent health in low- and middle-income countries, which have been further analyzed qualitatively [12] to identify platforms for the delivery of adolescent health interventions, vulnerable populations, and relation to the United Nations Global Strategy for Women’s, Children’s, and Adolescents’ Health, 2016–2030 [2]. Furthermore, the CHNRI methodology has been adapted to define adolescent health implementation research priorities at the national level in South Africa [13].…”