Testing the Effectiveness of a Community-Based Peer Support Intervention to Mitigate Social Isolation and Stigma of Adolescent Motherhood in Zimbabwe

Maternal and Child Health Journal - Tập 28 Số 4 - Trang 657-666 - 2024
Chiwoneso B. Tinago1, Edward A. Frongillo2, Andrea Warren2, Vivian Chitiyo3, Terry Jackson4, Ashley K. Cifarelli1, Shannon Fyalkowski1, Victoria Pauline1
1Department of Public Health Sciences, West Chester University of Pennsylvania, 155 University Avenue, West Chester, PA, 19383, USA
2Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
3The Organization for Public Health Interventions and Development (OPHID), 20 Cork Road, Belgravia, Harare, Zimbabwe
4NORC at the University of Chicago, 4350 East-West Highway, 8th Floor, Bethesda, MD, USA

Tóm tắt

Abstract Objectives Social isolation and stigma contribute to poor mental health outcomes. Adolescent mothers in Zimbabwe often experience isolation and stigma, lacking social support and resources to navigate motherhood. The study tested the effectiveness of a community-based peer support intervention to mitigate social isolation and stigma of adolescent motherhood in Harare, Zimbabwe. Methods Community health workers (n = 12) and peer educators (n = 12) in the intervention arm were recruited and trained on co-facilitating peer support groups. Adolescent mothers aged 15–18 years from two low-income high-density communities in Harare were recruited, using a quasi-experimental design. The intervention arm (n = 104) participated in the peer support groups and both arms completed sociodemographic, base-, mid-, and end-line surveys (control arm n = 79). Peer support groups (12 groups with 6–12 participants in each) met in-person twice a month and completed 12 sessions from May to August 2019 addressing participant-identified topics such as income generation and depression. WhatsApp Messenger was used for training and implementation support. Key community stakeholders discussed project progress and recommendations to improve adolescent mothers’ health. Data were analyzed using Stata 15. Results The intervention arm reported lower depressive symptoms and common mental disorders and higher overall, family, friends, and significant-other support, compared to control. The intervention arm felt more engaged with peers, knew who and where to turn to for help, and had coping, parenting and communication strategies to manage life challenges. Conclusions for Practice The intervention mitigated social isolation and stigma and thereby improved mental health and social support among adolescent mothers in Harare. Trial Registration This trial is registered at Clinical Trials.gov, NCT05213182 https://clinicaltrials.gov/ct2/show/NCT05213182.

Từ khóa


Tài liệu tham khảo

Asheer, S., Berger, A., Meckstroth, A., Kisker, E., & Keating, B. (2014). Engaging pregnant and parenting teens: Early challenges and lessons learned from the evaluation of adolescent pregnancy prevention approaches. Journal of Adolescent Health, 54(3, Supplement), S84–S91. https://doi.org/10.1016/j.jadohealth.2013.11.019

Broström, S., Johansson, B. A., Verhey, R., & Landgren, K. (2021). “Seeing a Brighter Future”—Experiences of adolescents with common mental disorders receiving the problem-solving therapy “Youth Friendship Bench” in Zimbabwe. Issues in Mental Health Nursing, 42(11), 1019–1029. https://doi.org/10.1080/01612840.2021.1924323

Chibanda, D. (2017). Reducing the treatment gap for mental, neurological and substance use disorders in Africa: Lessons from the Friendship Bench in Zimbabwe. Epidemiology and Psychiatric Sciences, 26(4), 342–347. https://doi.org/10.1017/S2045796016001128

Chibanda, D., Bowers, T., Verhey, R., Rusakaniko, S., Abas, M., Weiss, H. A., & Araya, R. (2015). The Friendship Bench programme: A cluster randomised controlled trial of a brief psychological intervention for common mental disorders delivered by lay health workers in Zimbabwe. International Journal of Mental Health Systems, 9(1), 21. https://doi.org/10.1186/s13033-015-0013-y

Cluver, L. D., Gardner, F., & Operario, D. (2008). Effects of stigma on the mental health of adolescents orphaned by AIDS. Journal of Adolescent Health, 42(4), 410–417. https://doi.org/10.1016/j.jadohealth.2007.09.022

De La Rey, C., & Parekh, A. (1996). Community-based peer groups: An intervention programme for teenage mothers. Journal of Community & Applied Social Psychology, 6(5), 373–381. https://doi.org/10.1002/(SICI)1099-1298(199612)6:5%3c373::AID-CASP388%3e3.0.CO;2-O

Gertler, P. J., Martinez, S., Premand, P., Rawlings, L. B., & Vermeersch, C. M. J. (2016). Impact evaluation in practice (Second ed.). World Bank. https://openknowledge.worldbank.org/handle/10986/25030

Hall-Lande, J. A., Eisenberg, M. E., Christenson, S. L., & Neumark-Sztainer, D. (2007). Social isolation, psychological health, and protective factors in adolescence. Adolescence, 42(166), 265–286.

Kola, L., Bennett, I. M., Bhat, A., Ayinde, O. O., Oladeji, B. D., Abiona, D., Abdumalik, J., Faregh, N., Collins, P. Y., & Gureje, O. (2020). Stigma and utilization of treatment for adolescent perinatal depression in Ibadan Nigeria. BMC Pregnancy and Childbirth, 20(1), 294. https://doi.org/10.1186/s12884-020-02970-4

Kumar, M., Huang, K.-Y., Othieno, C., Wamalwa, D., Madeghe, B., Osok, J., Kahonge, S. N., Nato, J., & McKay, M. M. (2018). Adolescent pregnancy and challenges in Kenyan context: Perspectives from multiple community stakeholders. Global Social Welfare: Research, Policy & Practice, 5(1), 11–27. https://doi.org/10.1007/s40609-017-0102-8

Leigh-Hunt, N., Bagguley, D., Bash, K., Turner, V., Turnbull, S., Valtorta, N., & Caan, W. (2017). An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health, 152, 157–171. https://doi.org/10.1016/j.puhe.2017.07.035

Letourneau, N. L., Stewart, M. J., & Barnfather, A. K. (2004). Adolescent mothers: Support needs, resources, and support-education interventions. Journal of Adolescent Health, 35(6), 509–525. https://doi.org/10.1016/j.jadohealth.2004.01.007

Ministry of Health and Child Care. (2016). Zimbabwe National Adolescent Fertility Study, Harare: MoHCC technical report authored by Dr. Naomi N. Wekwete, Prof. https://zimbabwe.unfpa.org/sites/default/files/pub-pdf/UNFPA%20NAFS%20Main%20Report%20%202016%20For%20Web.pdf

Patel, V., Todd, C., Winston, M., Gwanzura, F., Simunyu, E., Acuda, W., & Mann, A. (1997). Common mental disorders in primary care in Harare, Zimbabwe: Associations and risk factors. The British Journal of Psychiatry: THe Journal of Mental Science, 171, 60–64.

Spitzer, R. L., Kroenke, K., Williams, J. B. W., the Patient Health Questionnaire Primary Care Study Group. (1999). Validation and utility of a self-report version of PRIME-MDThe PHQ primary care study. JAMA, 282(18), 1737–1744. https://doi.org/10.1001/jama.282.18.1737

Tinago, C. B., Frongillo, E. A., Warren, A. M., Chitiyo, V., Cifarelli, A. K., Fyalkowski, S., & Pauline, V. (2021). Development and assessment of feasibility of a community-based peer support intervention to mitigate social isolation and stigma of adolescent motherhood in Harare, Zimbabwe. Pilot and Feasibility Studies, 7(1), 110. https://doi.org/10.1186/s40814-021-00832-0

Wiemann, C. M., Rickert, V. I., Berenson, A. B., & Volk, R. J. (2005). Are pregnant adolescents stigmatized by pregnancy? Journal of Adolescent Health, 36(4), 352.e1-352.e7. https://doi.org/10.1016/j.jadohealth.2004.06.006

Willis, N., Milanzi, A., Mawodzeke, M., Dziwa, C., Armstrong, A., Yekeye, I., Mtshali, P., & James, V. (2019). Effectiveness of community adolescent treatment supporters (CATS) interventions in improving linkage and retention in care, adherence to ART and psychosocial well-being: A randomised trial among adolescents living with HIV in rural Zimbabwe. BMC Public Health, 19(1), 117. https://doi.org/10.1186/s12889-019-6447-4

World Health Organization. (2020). Adolescent pregnancy. https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy

Yardley, E. (2008). Teenage mothers’ experiences of stigma. Journal of Youth Studies, 11(6), 671–684. https://doi.org/10.1080/13676260802392940

Zimbabwe National Statistics Agency (ZIMSTAT). (2015). Zimbabwe—Multiple indicator cluster survey 2014. https://zimbabwe.savethechildren.net/sites/zimbabwe.savethechildren.net/files/library/Zimbabwe%20Multiple%20Indicator%20Cluster%20Survey%202014.pdf

Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 52(1), 30–41. https://doi.org/10.1207/s15327752jpa5201_2

ZIMSTAT. (2013). Zimbabwe population census 2012. http://www.zimstat.co.zw/dmdocuments/Census/CensusResults2012/National_Report.pdf

Thông tin
Thông tin xuất bản

Maternal and Child Health Journal

Tập 28 Số 4

657-666

Thông tin tác giả