Parent-adolescent sexual and reproductive health information communication in Ghana | Reproductive Health

Summary of quantitative results

Following a thorough search of databases, 1,706 studies were retrieved. Thirteen studies were included, following title and abstract screening. Five studies were included when full text screening and narrative synthesis were done because of the heterogenous nature of the studies. Four studies were RCTs and one used quasi-experimental design. Two of the studies that were included were from Iran and one each from Tanzania, South Africa, and Uganda. On average, the studies focused on adolescents between 13 and 16 years of age. One of the studies delivered the intervention to both parents and their adolescents. In the other four studies, interventions were delivered only to parents. The method of intervention delivery included role plays, lectures, group discussions, posters, games, and take-home assignments. Intervention delivery was done by experts such as a SRH education and adolescent counsellor, a consultant midwifery student with certificate in sexual training of children and adolescents, teachers, and HIV peer educators. The various interventions were delivered in health centers, community, worksite, and school settings. Some of the studies had components other than SRH communication, such as normal sexual development and condom use behaviour. SRH communication was found to be influenced by SRH information, motivation, or attitudes towards SRH information communication, and SRH communication skills.

Summary of qualitative findings

Ten parent-adolescent pairs were selected to participate in the study. Four of the parents were males and six were females based. Nine of the participants were married and the other was divorced. Two of them had no formal education, whilst the rest had received formal education, with one ending at the primary level and the rest at the tertiary level. Eight of the participants were Christians and two were Muslims.

Five themes emerged from the study in the first theme, SRH topics that were discussed by parents as well as the sources of information for the discussion were labelled as SRH information communicated. The second theme related to the elements that either encouraged or discouraged parents from discussing SRH issues with their adolescents. This was labelled individual parent and adolescent factors. The third theme was about the perception of the parents regarding support from significant others and the behaviour of the community towards SRH communication with adolescents. This was labelled contextual factors influencing SRH information communication. The fourth theme was on how parents share SRH information with their adolescents. This was labelled SRH communication skill needs of parents. The last theme was on how parents would want SRH intervention to be packaged to meet their needs which considers the method of delivery, experts to deliver and venue for delivery of intervention and this was labelled Context specific Information Communication Intervention.

In the second qualitative phase, 10 adolescents of the parents interviewed in the first qualitative phase were selected. Their ages ranged from 13 to 16 years, based on the Systematic Review participant population. There were six females and four males. Seven of the participants were at the Junior High School level and the other three were at the Senior High School level. Eight of the participants were Christians and two were Muslims.

Five themes emerged from the study. The adolescent and parent factors that influenced the SRH communication between adolescents and their parents were labelled adolescent and parent concerns that influence SRH communication skills. Adolescents’ perception of the support from significant others, and cultural norms that influence their SRH communication with their parents, were labelled sociocultural issues influencing communication skills. The process by which adolescents share SRH information with their parents was labelled SRH information communication that influences communication skills. The question of the skills that are needed by the adolescents for communicating SRH information with their parents was labelled SRH information communication skill needs. The last theme was on how the adolescents would want SRH intervention to be packaged to meet their needs which considers the method of delivery, experts to deliver and venue for delivery of intervention and this was labelled Context specific Information Communication Intervention.

Mixed method findings

The findings from the Systematic Review and qualitative study revealed seven areas of focus which are, method of intervention delivery, experts involved in the delivery of intervention, venue or place of intervention delivery, SRH information, motivation, SRH information skills and SRH information communication (Fig. 2).

Regarding the method of delivery, the qualitative findings explained the quantitative findings in the Systematic Review in that, what emerged in the qualitative data were methods that had been used in the studies identified in the systematic review. Various methods were used across the identified interventions in the delivery. The methods included lectures, games, group discussions, role-plays and brainstorming [1]; workshop, classroom teaching (which included role plays, debates and writing exercises), homework assignments [27]; lectures, posters, group discussions, exercises, role-plays and creating scenarios [13]; workshop making use of group sessions [15]; group Counseling [9]. Parents in the qualitative study mentioned that they would prefer workshop with lectures, role plays, group discussions, role plays, discussion and brainstorming (Table 1). Adolescents preferred classroom teaching with homework and games (Table 1). The illustrative quotes have been given on Table 1. It is likely that the delivery method employed by Seif and colleagues [1] would be accepted in the Ghanaian context.

Regarding the experts used to deliver the interventions (Table 2), the qualitative findings explained the quantitative findings in the Systematic Review in that, what emerged in the qualitative data were experts with similar background that had been used in the studies identified in the systematic review. Teachers [14]; expert in sexuality health education, adolescent counsellor [13]; peer HIV educators, clinical psychologists [15]; and consultant midwifery student [9] were found in the systematic review (Table 2). In the qualitative study, nurses and midwives also emerged as experts that would be preferred (Table 2). Parents only wanted that their children to be taught by someone who holds their culture in high esteem so that adolescents would receive a culturally appropriate SRH information.

In respect of the setting for the study (Table 3), the qualitative findings explained the findings in the systematic review. In the systematic review, school setting [14]; worksite [15]; community [1, 13]; health centre [9]. In the qualitative study, it emerged that parents mentioned that they would want to receive the training at a community centre. Adolescents preferred their school environment. Illustrative quotes have been given on Table 3.

With respect to the SRH information, only two studies [1, 15] measured the SRH information communicated by parents and adolescents. Various SRH information had been communicated by parents and adolescents as identified across the studies. These included the range of SRH topics. However, it was noted that in some studies, few topics were in discussed, why in others, most topics had been discussed. No single study had discussed all SRH topics. This has been well presented in article 1. In the qualitative study, parents and adolescents had discussed about pregnancy, STIs, pregnancy and STIs prevention, abortion, abstinence, sex, changes in adolescence, personal hygiene. These had been discussed across parents and adolescents. Contraceptives was not really discussed among majority of parents and adolescents. Most parents mentioned that they will not talk about it because of the age of the adolescents and others because it is not culturally appropriate. Information sources for parents included relatives, books, church, mosque, the media, personal experiences whilst parents, books, school, relatives, peers, church, mosque and the media. Illustration quotes have been given on Table 4.

On account of what motivated parents and adolescents to communicate, the qualitative findings explained the quantitative findings. This was measured by Seif and colleagues [1] and [14] in their studies. Personal and social motivation emerged in the qualitative study to be factors that influence SRH information communication skills and the search for SRH information Table 5).

Regarding the SRH information communication skills, the qualitative findings explained the quantitative findings. Those who were trained in the various interventions identified in the systematic review had improved SRH information communication skills as compared to those in the control group. In the qualitative study, because no intervention had been delivered, it was found that parents and adolescents lacked SRH information communication skills (Table 6). This explains the need for a culturally sensitive SRH information communication intervention to be used to train parents and adolescents on SRH information communication.

Lastly SRH information communication was also identified as a theme (Table 7). Regarding this, the qualitative findings explained the quantitative findings from the systematic review. After the various interventions, frequency of communication improved. In the qualitative study, it emerged that parents and adolescents do not frequently communicate SRH information communication. It is believed that, when there is an intervention, it could assist in training them to have the skills that will translate into frequent SRH information communication.