Nursing and midwifery research priorities for Kenya: Results from a national Delphi survey.

BACKGROUND: The International Council of Nurses and the World Health Organization have prioritized evidence-based nursing and midwifery practice derived from nurse-led research. However, in a low-resource country like Kenya, there is a need to identify research priorities to optimize utilization of limited existing research infrastructure and funding. Kenya lacks a nursing and midwifery research strategy to guide research prioritization. INTRODUCTION: The goal of this study was to identify and describe nursing and midwifery research priorities for Kenya. METHODS: A cross-sectional Delphi survey using two iterative rounds of electronic data collection was used to reach a consensus about priorities for nursing and midwifery research in Kenya. NVivo-12 was used to analyze the qualitative data to identify categories, sub-themes, and themes; descriptive statistics were used to analyze quantitative data. RESULTS: Participants included 159 nurse managers, administrators, and educators representing regional, county, and national referral, private, and faith-based hospitals, nurse training schools, research institutions, and nursing organizations in Kenya. Staffing challenges, motivation, remuneration, and funding for higher education were ranked as the top critically important issues using a cutoff point of ≥ 70% agreement. CONCLUSION: There is a need for the development of a National Framework for Nursing and Midwifery Research Priorities in Kenya to guide research that builds excellence in meeting nursing and midwifery human resource concerns and ultimately improves patient care practices and outcomes. IMPLICATIONS FOR NURSING AND NURSING POLICY: The objective of Kenya's health goals delineated within three key national health documents cannot be attained without adequate numbers of nursing and midwifery professionals and policies that address nursing and midwifery staffing challenges, remuneration for employment, and improved funding for higher education.

Nurses' and midwives' participation and utilization of health-related research in Kenya: Implications for evidence-based practice.

Objective: To assess the level of participation of nurses and midwives in health-related research, determine the status of utilization of research to inform nursing and midwifery practice in Kenya, and explore perspectives of nurses and midwives about strategies to empower nurses/midwives to engage in health research in Kenya. Methods: Data were extracted from online survey responses of 156 nurse and midwife educators, practitioners, and managers/administrators. SPSS version 26 was used to analyze quantitative data; qualitative data were analyzed using Excel to organize data into categories. Results: Over one-third of participants reported ever publishing research (37.2%, 58/156). Participants reported using knowledge gained in nursing school to guide practice most frequently (n = 148). Utilization of research findings to guide practice was reported by 80.3% (110/137) of participants. Strategies to enhance participation in the research included research training, research forums, policy reforms, and emphasis on research in curricula. Conclusions: There is need to intensify and prioritize proposed strategies to empower nurses/midwives to engage in health research.

Menstruation Experiences of Middle and High School Students in the Midwest: A Pilot Study.

The purpose of this pilot study was to expand understanding of the experience of menstruation for girls in the United States and its impact in the school setting. A qualitative approach was used to gather data from focus group interviews. Descriptive content analysis was used to categorize the range and types of menstruation experiences described by 12 participants aged 12-16 years. Findings revealed four main themes: (1) learning about menstruation, (2) experiencing menstruation, (3) managing menstruation, and (4) social norms and meaning of menstruation. Participants described multiple challenges faced learning about and experiencing menstruation, especially in the school setting. Participants described the limited understanding of menstruation experiences and confusion about the use of menstrual hygiene products. Challenges experienced at school included not having adequate access to menstrual hygiene products, limited time for changing products, fear of leaking menstrual blood, and impacts on school attendance. School nurses are well-positioned to contribute to creating school environments that are supportive of menstruation.

Teacher Perceptions of and Experiences with Student Menstruation in the School Setting.

BACKGROUND: Menstrual hygiene management is an important public health issue for adolescents. The objective of this study was to explore teacher perceptions and experiences addressing adolescent menstruation experiences at school and examine their perception of the impact of menstruation on student learning. METHODS: Teachers in a Midwest school district participated in an online survey about their perceptions of adolescent school-based menstruation experiences, including: experience and comfort-level with providing menstruation assistance, presence of menstrual products in classroom/office for students, perceptions about adolescent school-based menstruation experiences, and perceptions on the impact of menstruation on student learning. RESULTS: Two hundred and nine teachers participated in this study. Teachers perceived students' school-based menstruation experiences to be mostly negative, stressful, embarrassing, and focused on concealment. Teachers described school-based menstruation events as a distraction to learning and responded by offering emotional support and menstrual products, typically purchased by teachers. CONCLUSION: Teachers' negative perception of about menstruation and distractions in the classroom are amplified by social norms associated with overall menstruation-related stigma. Findings emphasize the importance of educating teachers on how to more positively address student menstruation experiences to foster a more supportive environment conducive to learning for these students.

Associations between oil development and sexually transmitted infections: Public health nurse perspectives.

BACKGROUND: Oil development (OD) has been associated with increased sexually transmitted infection (STI) rates, with limited focus on the North Dakota (ND) oil boom. Public health (PH) nurse experiences can provide context related to health challenges during OD-related population booms. OBJECTIVE: To compare reported STI rates in ND oil-producing (OP) and non-oil-producing (NOP) counties before, during, and after the oil boom and describe PH nurse experiences during this time. DESIGN: We conducted secondary data analysis of oil production data and reported rates for chlamydia and gonorrhea, and conducted interviews with ND PH nurses. SAMPLE: PH nurses within ND counties geographically located in or near OD in the state. MEASUREMENTS: ND county-level OD data trends were compared to similarly timed reported rates of chlamydia and gonorrhea in OP and NOP counties. PH nurse interviews were conducted addressing their STI-related experiences working in PH during the oil boom. RESULTS: Significant findings include a correlation between OD and gonorrhea rates. PH nurses described a limited PH infrastructure to meet the health needs of a transient, increasing population. CONCLUSIONS: Expanding the role of PH nurses in ND to implement STI screening and treatment would improve access to STI testing allowing for comprehensive reporting of STIs.

Improving the Sexual Health of Young People With Mobility Impairments: Challenges and Recommendations.

INTRODUCTION: This mixed-method study (a) describes challenges to providing sexual health services to youth with mobility impairments from the perspective of health care providers and experts and (b) describes and compares sexual health-related experiences of youth with mobility impairments. METHOD: Secondary data analysis of My Path, a study focused on the transition to adulthood for youth with mobility impairments. Using an exploratory sequential design, qualitative data (n = 10) were analyzed using systematic content analysis followed by quantitative analysis of survey data (N = 337). RESULTS: Challenges included not talking about sex, managing sexual development, adaptation and instruction, parent roles, and safety. Survey data showed that youth with mobility impairments are diverse in their experiences with sexual behavior and sources of sexual health information. Although connected with primary care providers, few received information about sexual health. DISCUSSION: Interventions to improve youths' well-being should include comprehensive care and education that promotes and supports healthy sexual development.

Adolescent Experience of Menstruation in Rural Kenya.

BACKGROUND: Although menstruation is a universal experience, girls in resource-poor areas face unique challenges related to menstruation management. In Kenya, girls miss nearly 3.5 million learning days per month because of limited access to sanitary products and lack of adequate sanitation. Global priorities to address gender inequality-especially related to education-often do not consider the impact of poverty on gendered experiences, such as menstruation. OBJECTIVE: The aim of the study was to describe the experiences of menstruation from the perspective of adolescent girls living in rural Kenya. METHODS: Data for this qualitative study were collected through 29 individual interviews with adolescent girls and separate field observations. Descriptive content analysis was used to identify themes reflective of the data from the individual interviews and field notes. RESULTS: Four themes were developed to summarize the data: (a) receiving information about menstruation, (b) experiences of menstruation, (c) menstrual hygiene practices, and (d) social norms and the meaning of menstruation. CONCLUSIONS: Findings from this study describe the impact of menstruation on the lives of adolescent girls in rural Kenya. Menstrual hygiene management and its associated challenges may impact girls' academic continuity. Experiences of menstruation also reinforce gender inequality and further marginalize girls in low-income, rural areas of Kenya. Consideration of menstruation is critical to promote health and academic continuity for girls in rural Kenya.

Associations Between Sleep and Health-Risk Behaviors in a Rural Adolescent Population.

INTRODUCTION: Insufficient sleep has been associated with engagement in a number of health-risk behaviors in adolescents, including substance use and sexual activity. Associations between sleep and health-risk behaviors in adolescents living in rural areas of the United States are not well investigated. In rural settings, adolescents' sleep patterns, lifestyle factors, and health-risk opportunities may differ from those of urban adolescents, making the independent study of sleep and health behavior associations necessary. METHOD: This study examined data from the Rural Adolescent Health Survey (N = 322) administered in rural North Dakota. RESULTS: Rural adolescents who reported engaging in smoking, alcohol use, or drug use slept significantly less than adolescents who did not report engaging in these activities. DISCUSSION: Sleep was not associated with chewing tobacco use or risky sexual activity, which may reflect an effect of rural cultural values on sleep and health-risk behavior associations.

Barriers and Facilitators of Adolescent Health in Rural Kenya.

PURPOSE: The purpose of this research was to identify perceived barriers and facilitators of health from the perspective of rural Kenyan adolescents and to characterize the cultural context that shapes these barriers and facilitators. DESIGN: Following a semistructured interview guide, qualitative focus group interviews were conducted at day schools with 64 upper-primary and secondary students in rural central Kenya. Participants provided written parental consent and individual assent for study participation. RESULTS: Findings were organized into seven categories (individual, family, peer, school, community, institutional, and cultural) according to a social-ecological framework to highlight the multiple social and environmental contexts that shape health the experiences rural Kenyan youth. CONCLUSIONS: The prevalence and complexity of factors that shape the health experiences of young people in rural Kenya displayed in these findings adds context to the importance of utilizing multipronged approaches to improving adolescent health by focusing on the social contextual determinants of health behaviors and outcomes.

Doulas' Perspectives about Providing Support to Incarcerated Women: A Feasibility Study.

OBJECTIVE: To document the logistical feasibility of a doula program for pregnant incarcerated women and to assess doulas' perceptions of their achievements. DESIGN AND SAMPLE: Six doulas provided written case notes ("birth stories") about their experiences with 18 pregnant women in one Midwestern state prison. MEASURES: The birth stories were analyzed by two coders to identify major themes related to doulas' perceptions about providing support to incarcerated women. Analyses involved coder consensus about major themes and doula affirmation of findings. RESULTS: All doulas reported that they met key objectives for a successful relationship with each of their clients. Key themes were their ability to empower clients, establish a trusting relationship, normalize the delivery, and support women as they were separated from their newborns. CONCLUSIONS: The intervention was logistically feasible, suggesting that doulas can adapt their practice for incarcerated women. Doulas may need specific training to prepare themselves for institutional restrictions that may conflict with the traditional roles of doula care. It may be important for doulas to understand the level of personal and professional resources they may have to expend to support incarcerated women if they are separated from their infants soon after delivery.

Rural adolescents' access to adolescent friendly health services.

INTRODUCTION: The purpose of this study was to assess rural North Dakota adolescents' experiences in accessing adolescent-friendly health services and to examine the relationship between rural adolescents' communication with health care providers and risk behaviors. METHODS: Data are from the Rural Adolescent Health Survey (RAHS), an anonymous survey of 14- to 19-year-olds (n = 322) attending secondary schools in four frontier counties of North Dakota. Descriptive statistics were used to assess participants' access to adolescent-friendly health services characterized as accessible, acceptable, and appropriate. Logistic regressions were used to examine whether participant-reported risk behaviors predicted communication with health care providers about individual health risk behaviors. RESULTS: Rural adolescents reported high access to acceptable primary health care services but low levels of effective health care services. Participant report of engaging in high-risk behaviors was associated with having received information from health care providers about the leading causes of morbidity and mortality. DISCUSSIONS: These findings reveal missed opportunities for primary care providers in rural settings to provide fundamental health promotion to adolescents.

Homeless health needs: shelter and health service provider perspective.

The effects of homelessness on health are well documented, although less is known about the challenges of health care delivery from the perspective of service providers. Using data from a larger health needs assessment, the purpose of this study was to describe homeless health care needs and barriers to access utilizing qualitative data collected from shelter staff (n = 10) and health service staff (n = 14). Shelter staff members described many unmet health needs and barriers to health care access, and discussed needs for other supportive services in the area. Health service providers also described multiple health and service needs, and the need for a recuperative care setting for this population. Although a variety of resources are currently available for homeless health service delivery, barriers to access and gaps in care still exist. Recommendations for program planning are discussed and examined in the context of contributing factors and health care reform.

Prime Time: long-term sexual health outcomes of a clinic-linked intervention.

CONTEXT: Evidence about long-term effects of preventive health services for youth with complex needs is lacking. Prime Time, a youth development intervention, aims to reduce pregnancy risk among vulnerable adolescent females seeking clinic services. METHODS: In a randomized trial, 253 sexually active females aged 13-17 who were at high risk for pregnancy were assigned to the Prime Time intervention or usual clinic services. The 18-month intervention, initiated in 2007-2008, comprised regular meetings with case managers and participation in youth leadership groups. Trial participants completed surveys at baseline and 30 months. Regression analyses were used to evaluate differences between groups in sexual and psychosocial outcomes at follow-up. RESULTS: At 30 months, the intervention group reported more months of consistent condom use (adjusted means, 1.8 vs. 1.1) and dual contraceptive use (0.9 vs. 0.3) in the past seven months than did controls. The intervention was most effective in promoting consistent use among participants with relatively high levels of connectedness to family or school. Fifteen percent of intervention participants, but only 6% of controls, reported having abstained from sex in the past six months (adjusted odds ratio, 2.9). Moreover, among high school graduates, those in the intervention group were more likely than those in the control group to have enrolled in college or technical school (72% vs. 37%; odds ratio, 4.5). CONCLUSION: Health services grounded in a youth development framework can lead to reductions in sexual risk among vulnerable youth that are evident one year following conclusion of services.

Prime time: 18-month violence outcomes of a clinic-linked intervention.

Prime Time, a youth development intervention, aims to reduce multiple risk behaviors among adolescent girls seeking clinic services who are at high risk for pregnancy. The purpose of the current study was to examine whether Prime Time involvement produced changes in relational aggression, physical violence, and related psychosocial and behavioral outcomes. Qualitative case exemplars illustrated social contexts of intervention participants with differing longitudinal patterns of relational aggression and physical violence. Data were from a randomized efficacy trial with 13-17 year-old girls (n = 253) meeting specified risk criteria. Intervention participants were involved in Prime Time and usual clinic services for 18 months, control participants received usual clinic services. Participants in the current study completed self-report surveys at baseline and 18 months following enrollment. Outcomes analyses revealed significantly lower levels of relational aggression perpetration in the intervention group versus controls. In contrast, Prime Time involvement did not result in significant reductions in physical violence. Exploratory dose-response analyses indicated that reductions in relational aggression may have been most pronounced among girls actively involved in Prime Time case management and peer leadership activities. Qualitative findings suggested that the intervention's emphasis on modeling and building supportive relationships contributed to reductions in relational aggression. This study contributes to what has been a very limited evidence base regarding effective approaches to preventing violence among high-risk adolescent girls. Findings suggest that offering youth development interventions through clinic settings hold promise in reducing violence risk among vulnerable youth.

Characteristics of violence among high-risk adolescent girls.

INTRODUCTION: Recent evidence demonstrates increasing rates of involvement with violence among adolescent girls. The objective of this study was to describe the types and sources of violence experienced within social contexts of adolescent girls at high risk for pregnancy. METHOD: Qualitative data for this analysis are drawn from intervention summary reports of 116 girls participating in Prime Time, a youth development intervention for adolescent girls. Descriptive content analysis techniques were used to identify types and sources of violence experienced by girls within their daily contexts. RESULTS: Types of violence included physical fighting, witnessing violence, physical abuse, gang-related violence, verbal fighting, verbal abuse, and sexual abuse. Sources of violence included family, peers and friends, romantic partners, community violence, and self-perpetrated violence. Many girls in this study experienced violence in multiple contexts. DISCUSSION: It is imperative that efforts to assess and prevent violence among adolescent girls include paying attention to the social contexts in which these adolescents live.

Life experiences of instability and sexual risk behaviors among high-risk adolescent females.

CONTEXT: Understanding the interplay of multiple contexts of adolescents' sexual risk behaviors is essential to helping them avoid pregnancy and STDs. Although a body of research has identified multiple individual- and family-level variables associated with adolescents' sexual risk behaviors, relatively few studies have examined relationships between these behaviors and latent indicators of unstable, chaotic environments. METHODS: In 2007-2008, a sample of 241 sexually active adolescent females who were at high risk for pregnancy and STDs were recruited through two school-based clinics and two community clinics in Minneapolis and St. Paul. Confirmatory factor analysis was used with baseline data to specify latent constructs of individual risk and family disengagement. Structural equation models examined longitudinal relationships between baseline measures of these constructs and sexual risk behaviors assessed six months later. RESULTS: The latent construct of individual risk encompassed substance use, violence perpetration, violence victimization and having witnessed violence; that of family disengagement included family disconnection, poor family communication and perceived lack of safety at home. Baseline level of individual risk was positively associated with number of male sex partners six months later (path coefficient, 0.2); it was not associated with consistent condom use at follow-up. Level of family disengagement was negatively associated with condom use consistency six months later (-0.3), but was not associated with number of male sex partners. CONCLUSIONS: To meet the health needs of vulnerable adolescents, health systems should incorporate coordinated and interdisciplinary services that acknowledge adolescents' relevant familial and social contexts.

Prime time: sexual health outcomes at 24 months for a clinic-linked intervention to prevent pregnancy risk behaviors.

IMPORTANCE: Preventing early pregnancy among vulnerable adolescents requires innovative and sustained approaches. Prime Time, a youth development intervention, aims to reduce pregnancy risk among adolescent girls seeking clinic services who are at high risk for pregnancy. OBJECTIVE: To evaluate sexual risk behaviors and related outcomes with a 24-month postbaseline survey, 6 months after the conclusion of the Prime Time intervention. DESIGN: Randomized controlled trial. SETTING: Community and school-based primary care clinics. PARTICIPANTS: Of 253 sexually active 13- to 17-year-old girls meeting specified risk criteria, 236 (93.3%) completed the 24-month follow-up survey. INTERVENTION: Offered during an 18-month period, Prime Time includes case management and youth leadership programs. MAIN OUTCOME MEASURES: Self-reported consistency of condom, hormonal, and dual-method contraceptive use with most recent male sex partner and number of male sex partners in the past 6 months. RESULTS: At 24-month follow-up, the intervention group reported significantly more consistent use of condoms, hormonal contraception, and dual-method contraception than the control group. Intervention participants also reported improvements in family connectedness and self-efficacy to refuse unwanted sex, and reductions in the perceived importance of having sex. No between-group differences were found in the number of recent male sex partners. CONCLUSIONS AND RELEVANCE: This study contributes to what has been a dearth of evidence regarding youth development interventions offered through clinic settings, where access to high-risk adolescents is plentiful but few efforts have emphasized a dual approach of strengthening sexual and nonsexual protective factors while addressing risk. Findings suggest that health services grounded in a youth development framework can lead to long-term reductions in sexual risk among vulnerable youth.

Engaging vulnerable adolescents in a pregnancy prevention program: perspectives of Prime Time staff.

INTRODUCTION: Evaluating interventions for reducing unintended adolescent pregnancy is necessary to ensure quality and efficacy. The purpose of this study was to examine core case management practices and processes for engaging high-risk girls in Prime Time, an intensive multi-component intervention from the perspectives of intervention program staff. METHOD: Structured individual interviews were conducted with the entire Prime Time program staff (N = 7) to assess successes and challenges in engaging adolescent girls at high risk for early pregnancy. The girls were recruited from school and community clinics. RESULTS: Program staff described different capacities of adolescents to engage with the program (those who connected easily, those in the middle range of connecting, and those who had difficulty connecting) and provided specific recommendations for working with the different types of connectors. DISCUSSION: Findings from this study support the supposition that persons engaging in preventive interventions with vulnerable groups of adolescents must pay careful attention to strategies for establishing trusting youth-adult relationships. The ability of staff (e.g., case managers and nurses) to engage with adolescents is a crucial step in improving health outcomes. The identified strategies are useful in helping adolescents build skills, motivations, and supports needed for healthy behavior change.

Living with juvenile arthritis: adolescents' challenges and experiences.

INTRODUCTION: The objective of this study was to identify challenges that teens experience while living with juvenile arthritis (JA) from the perspective of youth and young adults with JA. METHOD: Focus group interviews were conducted with youth (aged 14-21 years) and young adults (aged 22-29 years) with JA using a semi-structured interview protocol that included questions about the challenges adolescents experience while living with arthritis. RESULTS: Challenges of living with JA were identified in the areas of (a) health care, (b) relationships, (c) school, (d) physical, and (e) individual. However, distinct perspectives emerged between youth and young adult participants. For youth, challenges were situated in present time and focused heavily on interpersonal situations. Alternatively, young adults reported challenges that illuminated their experiences of movement from adolescence into young adulthood (e.g., independently managing their JA and disclosure to dating partners). DISCUSSION: Findings from this study display complex and multifaceted experiences that teens face while living with arthritis. Experiences associated with arthritis were not limited to being described as health care-related challenges; rather, arthritis permeates multiple contexts in adolescents' lives.

Prime Time: 12-month sexual health outcomes of a clinic-based intervention to prevent pregnancy risk behaviors.

PURPOSE: Prime Time, a youth development intervention, aims to reduce pregnancy risk among adolescent girls seeking clinic service who are at high risk for pregnancy. This article examines sexual risk behaviors and hypothesized psychosocial mediators after 12 months of the Prime Time intervention. METHODS: This study was a randomized controlled trial with 253 girls aged 13-17 years meeting specified risk criteria. Intervention participants were involved in Prime Time programming plus usual clinic services for 18 months, control participants received usual clinic services. The intervention used a combination of case management and peer leadership programs. Participants in this interim outcomes study completed self-report surveys at baseline and 12 months after enrollment. Surveys assessed sexual risk behaviors and psychosocial factors targeted for change by Prime Time. RESULTS: At the 12-month interim, the intervention group reported more consistent use of condoms, hormonal contraception, and dual contraceptive methods with their most recent partner as compared with the control group. The intervention group also reported greater stress management skills with trends toward higher levels of prosocial connectedness at school and with family. No between-group differences were noted in psychosocial measures specific to sex and contraceptive use. CONCLUSION: Preventing early pregnancy among high-risk adolescents requires multifaceted, sustained approaches. An important research focus involves testing youth development interventions offered through clinic settings, where access to high-risk adolescents is plentiful and few efforts have emphasized a dual approach of building protective factors while addressing risk. Findings suggest that youth development interventions through clinic settings hold promise in reducing pregnancy risk among high-risk youth.