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Table 4 Characteristics of research studies (N=12)

From: Measuring adolescent friendly health services in India: A scoping review of evaluations

ID LOCATION (State:District-Block or villages) YEAR ORGANIZATION(S) PERFORMING (“BY”) AND REQUESTING (“FOR”) STUDY OBJECTIVE OF STUDY PROGRAMME MESTUDIED STUDY DESIGN STUDY METHODS FACILITY TYPE STUDIED SCOPE OF STUDY
1 [59] Maharashtra: Dhamari village, Pune 2006 BY: International NGO (ICRW) and academic institution/university (KEM Hospital)
FOR: International NGO (ICRW)
To test feasibility in rural context to provide married youth with integrated package of reproductive health care and counselling Providing integrated package of:
(1) Reproductive health information
(2) Clinical referrals
(3) Reproductive and sexual health couples counselling
Multiple designs:
(1) Feasibility assessment: Observations on implementation of package of reproductive health education, care and counselling for rural married youth.
(2) Descriptive: Post-intervention cross-sectional study of attendance levels of participants, focus group discussions and interviews with participants
(3) Quasi-experimental: Pre- and post-test of couples’ RSH knowledge
(1) Methods not specified
(2) Analysis of attendance records and referrals made, and follow-up visits that occurred, evaluations (self and external) of community level educators, group discussions and individual interviews with participants
(3) Pre- and post-implementation surveys to test couples’ RSH knowledge
Type of health facilities within intervention not specified Number of facilities and adolescent clients using those facilities not specified
2 [60] Maharashtra: Urban Mumbai 2006 BY: academic institution/university (National Institute for Research in Reproductive Health (NIRRH))
FOR: Not specified
To assess the reproductive health problems and help-seeking behaviour among urban school-going adolescents [in context of ongoing intervention in schools in urban Mumbai during 2003-04 aimed at creating model for school-based adolescent friendly services through Adolescent Friendly Center (AFC)] Providing school-based adolescent friendly services through AFC (established on school premises, function 2 days/week for 2 hours/day; services include information provision, counselling, free medical exams, anonymous letterbox) Descriptive: post-intervention cross-sectional study of students using adolescent friendly center and of clinic attendance trends (1) Self-administered questionnaire and collection of biologic health data during camp
(2) Focus group discussions with male and female students
(3) Monitoring of attendance data from clinic
Outpatient clinic on a school premises 300 urban school-going adolescents participated (11-14 year olds) from a single outpatient clinic on a school premises. A separate evaluation (not included) was done for 300 15-19 year olds
Details of school population from which this group was sampled not specified
3 [61] Maharashtra: 2 unspecified blocks in Ahmednagar 2006 BY: Indigenous NGO (Foundation for Research in Health Systems (FRHS)) and international NGO (International Center for Research on Women (ICRW))
FOR: Indigenous NGO (FRHS) and international NGO (ICRW)
To assess the effectiveness of social mobilization and health services strengthening to improve married adolescents’ reproductive and sexual health knowledge and to increase their access to and use of health services. (1) Social mobilization strategy implemented through indigenous, community-based women’s and youth organizations to provide structured, interaction and recurrent health education sessions on select reproductive health topics.
(2) Strengthening health services was done by working with state government to address specific gaps in training local health officials
Multiple designs:
(1) Experimental: Communities were randomly assigned to social mobilization, strengthening of health services, both or neither and knowledge and utilization of services were compared between 4 arms
(2) Descriptive: Post-implementation cross-sectional study of husbands in one study arm
(3) Quasi-experimental: pre- and post-implementation qualitative comparison of mothers-in-law in one study arm
(1) Pre- and post-surveys of young married women assessing knowledge and reported utilization of services
(2) Post-implementation survey of husbands of young married women in social mobilization arm involvement and awareness in womens’ reproductive health
(3) Pre- and post- interviews of mothers-in-law in social mobilization arm assessing involvement and awareness in womens’ reproductive health
Type of health facilities within intervention not specified
(Social mobilization activities involved indigenous, community-based women’s and youth organizations with some district health staff, and health service strengthening involved training of local health officials)
Number of facilities and adolescent clients using those facilities not specified
4 [62] Haryana/Punjab: Sectors 19 and 38 of Chandigarh City 2008 BY: academic institution/university (Post Graduate Institute of Medical Education and
Research)
FOR: Not specified
(1) To assess perceived health problems and help seeking behaviour of adolescents
(2) To measure utilization of adolescent health clinics by adolescents
Establishing adolescent
health clinics in two diverse settings; a school-based clinic and a dispensary-based clinic
Descriptive: post-implementation cross-sectional study of self-reported health problems and help-seeking behaviours and of pattern of service utilization of clinic over preceding year Semi-structured questionnaire and analysis of clinic utilization records School-based clinic and dispensary-based clinic, both described as “adolescent health clinics”) 360 adolescents using 2 facilities (1 school-based clinic and 1 dispensary-based clinic) were selected by stratified random sampling from a population of 3000 adolescents (2100 from sector 19 in 2 schools and 900 from sector 19 in 1 school)
5 [63] Bihar: Nalanda, Nawada, Patna 2008 BY: International NGO (Pathfinder International)
FOR: International NGO (Pathfinder International)
To assess effect of PRACHAR intervention on:
(1) contraceptive demand and use and (2) related attitudes and knowledge
PRACHAR intervention:
(1) Social environment building
(2) Providing info on RH and services
(3) Improving access to RH services: training formal and informal rural health service providers on RH issues and contraception, encouraging vulnerable populations to seek services, motivating chemists and village convenience shops to keep regular stocks of condoms and pills
Quasi-experimental: Pre- and post-implementation comparison of participants’ contraception attitudes, knowledge, demand, and use Pre- and post-implementation questionnaire Type of health facilities within intervention not specified Health facilities in intervention communities and number of adolescent participants using facilities not assessed
6 [64] Delhi, West Bengal, and Chandigarh: South West Delhi District, Chandigarh- Sector 32, Kolkata District of West Bengal state 2009 BY: Academic institution/university (India Council of Medical Research (ICMR))
FOR: National government agency (Ministry of Health and Family Welfare (MHFW) and multilateral agency (World Health Organization)
To examine whether adolescent friendly health centres (AFC) have increased the quality and access to health services as per the client’s perception Delivering health services based on Government of India’s ARSH Programme Quasi-experimental design: Comparison of quality and utilization of ARSH with corresponding “control” outpatient clinics (1) Interviews with key stakeholders (staff members, adolescents, parents)
(2) Review of relevant documents (not clear if a facility assessment was performed)
ARSH in government health facilities and corresponding “control” outpatient clinics (e.g. obstetrics, skin care) in government facilities 3 intervention sites in tertiary care hospitals located in medical colleges, all run outreach programme in schools as well
Each site evaluation included 4 staff member, 25 adolescent, and 25 parent interviews
7 [65] Maharashtra: Mumbai 2010 BY:
Academic institution/university (National Institute for Research in Reproductive Health (NIRRH) and state government agency (Municipal Corporation of Greater Mumbai)
FOR: Not specified
To test the feasibility of delivering ARSH services within public sector of Mumbai and to evaluate scaled up ARSH services at other health facilities Delivering health services based on Government of India’s ARSH Programme (1) Feasibility assessment: Observations on implementation of ARSH services within public sectors
(2) Quasi-experimental: Pre- and post-scale up comparison of participants’ SRH knowledge help-seeking behaviours and time series comparison of health service utilization
(1) Focus group discussions with adolescents, teachers, parents, and other stakeholders
(2) Pre- and post-scale up questionnaire
(3) Monitoring of attendance data from clinic
Government primary care health posts with subsequent scale-up to include secondary care level hospitals Research phase questionnaire participants N =
1326 adolescents interviewed of 1565 total adolescents using services at 2 health posts)
Scale up phase questionnaire participants N = 2164 of 3250 adolescents using services at 3 health posts)
8 [66] Bihar: Nalanda, Nawada, Patna 2010 By: International NGO (Pathfinder International)
FOR:
International NGO (Pathfinder International)
To estimate the impact of implementing the PRACHAR model in the reproductive health and FP programs in Bihar and Uttar Pradesh PRACHAR intervention (see above) Quasi-experimental: Comparison of projected population growth between intervention and non-intervention communities Population projection using computer programme SPECTRUM to evaluate change in two fertility parameters (total fertility rate and age-pattern of fertility) over period under projection 2005 and 2025 Type of health facilities within intervention not specified Health facilities in intervention communities and number of adolescent participants using facilities not assessed
9 [67] Bihar: Gaya, Nalanda, Nawada, and Patna 2011 BY: International NGO (Pathfinder International) and consulting agency (India Institute of Health Management Research (IHMR))
FOR: Foreign government agency (USAID)
To conduct retrospective analysis of PRACHAR phase I and II data to develop a better understanding of the impact of FP/SRH outcomes and analyse possible trends in gender norms, attitudes, practices related to SRH that may have changed over time as result of PRACHAR
-To conduct qualitative research (thru FGDs) to explore possible linkages between intended SRH behavioural outcomes, multisectoral elements (e.g. education) and PRACHAR’s gender accommodating and transformative elements and how gender inputs could be made stronger to enhance gender outcomes
PRACHAR intervention (see above) Multiple designs:
(1) Quasi-experimental: Comparison of attitudes and health behaviours between intervention community participants and comparison community participants
(2) Descriptive: post-implementation qualitative study
(1) Post-implementation structured interview to assess history of marriage, reproductive health knowledge, attitudes, and behaviours, and pregnancy outcomes
(2) Focus group discussions exploring gender and multisectoral factors, family relations and communication, education, work, support
Type of health facilities within intervention not specified Health facilities in intervention communities and number of adolescent participants using facilities not assessed
Evaluation sample = 23,400 intervention participants, 3900 baseline comparison participants, 7200 endline participants.
Adolescent Follow-Up Study sample: 1224 participants who had been exposed to PRACHAR (306 M, 306 F, baseline and endline)
21 FGDs with 196 participants (varied from young women and men, mothers, fathers, community influences, trainers, field workers)
10 [68] Gujarat: Ahmedabad 2012 BY: Academic institution/university (Department of Community Medicine, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat)
FOR: Not specified
To evaluate knowledge regarding AFHS among Anganwadi workers (AWWs)
To evaluate improvement in knowledge and skills of AWWs at appropriate intervals after skill-based training
To assess health status and knowledge, attitudes, and practices (KAP) of adolescent girls of Anganwadis
Provision of a didactic education session with power point presentation, uterus model and chalkboard on importance of adolescent health to 111 AWWs in order to improve health services based on Government of India’s Adolescent Reproductive and Sexual Health Programme Multiple designs:
Quasi-experimental: Pre- and post-intervention comparison of knowledge of Anganwadi workers
Descriptive: Cross-sectional assessment of health status and KAP of adolescent girls
Questionnaire measuring knowledge of Anganwadi workers
Assessment tool to measure health status and KAP of adolescent girls not described
Type of health facilities within intervention not specified Health facilities in intervention communities and number of adolescent participants using facilities not assessed
Convenience sample of 111 AWWs for didactic education and questionnaire
142 adolescent girls were assessed for health status and KAP (target population unknown)
11 [69] Bihar: Nalanda, Nawada, Patna 2012 By: International NGO (Pathfinder International/Daniel et al)
FOR: International NGO (Pathfinder International)
To assess the effect of intervention on age at marriage, contraceptive use before and after first birth, age at first birth PRACHAR intervention (see above) Quasi-experimental: post-implementation comparison of behavioural and health outcomes between participants in intervention communities versus those in non-intervention communities Post-implementation structured interview using questionnaire to assess history of marriage, reproductive health knowledge, attitudes, and behaviours, and pregnancy outcomes Type of health facilities within intervention not specified Health facilities in intervention communities and number of adolescent participants using facilities not assessed
12 [70] Uttar Pradesh: Arajiline block of Varanasi district and Hosakote block of Bangalore district 2013 BY: Indigenous NGO (Research Unit at MAMTA-Health Institute for Mother and Child, Delhi)
FOR: Not specified
To describe features of the intervention and to investigate (1) the impact on improving awareness and utilization of services by adolescents and (2) the quality of ARSH services in the intervention districts Delivering health services based on Government of India’s ARSH Programme Descriptive: post-implementation cross-sectional study of quality of services comparing two intervention districts Community-based survey of adolescents
Exit interviews questionnaire of adolescent clients
-Structured facility questionnaire to measure staffing, training, infrastructure, supplies, and services
-Measurement of health service utilization
Youth friendly health facilities not further specified 17/217 villages in Arajliine and 17/333 villages in Hosakote with 12 girls and 12 boys selected from each → total sample = 737 adolescents (383 M, 354 F)
Consecutive sample of 120 clients from 4 selected clinics for exit interviews