Cargando…
Reducing repeat pregnancies in adolescence: applying realist principles as part of a mixed-methods systematic review to explore what works, for whom, how and under what circumstances
BACKGROUND: Previous research has demonstrated emotional, psychological and educational harm to young mothers following unintended conceptions. The UK has one of the highest rates of pregnancies in adolescence in Western Europe with a high proportion of these being repeat pregnancies, making it a to...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2016
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5029024/ https://www.ncbi.nlm.nih.gov/pubmed/27644695 http://dx.doi.org/10.1186/s12884-016-1066-x |
_version_ | 1782454447735046144 |
---|---|
author | Charles, Joanna M. Rycroft-Malone, Jo Aslam, Rabeea’h Hendry, Maggie Pasterfield, Diana Whitaker, Rhiannon |
author_facet | Charles, Joanna M. Rycroft-Malone, Jo Aslam, Rabeea’h Hendry, Maggie Pasterfield, Diana Whitaker, Rhiannon |
author_sort | Charles, Joanna M. |
collection | PubMed |
description | BACKGROUND: Previous research has demonstrated emotional, psychological and educational harm to young mothers following unintended conceptions. The UK has one of the highest rates of pregnancies in adolescence in Western Europe with a high proportion of these being repeat pregnancies, making it a topic of interest for public health policy makers, and health and social care practitioners. As part of a wider mixed-methods systematic review, realist principles were applied to synthesise evidence about interventions aiming to reduce repeat pregnancies in adolescence. METHODS: A multi-streamed, mixed-methods systematic review was conducted searching 11 major electronic databases and 9 additional databases from 1995 onwards, using key terms such as pregnancy, teen or adolescent. The principles of realist synthesis were applied to all included literature to uncover theories about what works, for whom, how and in what context. Initial theory areas were developed through evidence scoping, group discussion by the authors and stakeholder engagement to uncover context + mechanism = outcome (CMO) configurations and related narratives. RESULTS: The searches identified 8,664 documents initially, and 403 in repeat searches, filtering to 81 included studies, including qualitative studies, randomised controlled trials, quantitative studies and grey literature. Three CMO configurations were developed. The individual experiences of young mothers’ triggered self-efficacy, notions of perceived risks, susceptibility and benefits of pregnancy, resulting in the adolescent taking control of their fertility and sexual encounters. The choice between motherhood and other goals triggered notions of motivations, resulting in the adolescent managing their expectations of motherhood and controlling their fertility and sexual encounters. Barriers and facilitators to accessing services triggered notions of connectedness and self-determination; resulting in interventions that are tailored so they are relevant to young persons, and improve access to services and engagement with the issue of pregnancy in adolescence. CONCLUSIONS: Pregnancy in adolescence is a complex issue with many factors to consider. The conceptual platform described here could help guide policy makers and professionals towards a number of areas that need to be attended to in order to increase the likelihood of an intervention working to prevent rapid repeat pregnancy in adolescence. TRIAL REGISTRATION: PROSPERO CRD42012003168 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12884-016-1066-x) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5029024 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-50290242016-09-22 Reducing repeat pregnancies in adolescence: applying realist principles as part of a mixed-methods systematic review to explore what works, for whom, how and under what circumstances Charles, Joanna M. Rycroft-Malone, Jo Aslam, Rabeea’h Hendry, Maggie Pasterfield, Diana Whitaker, Rhiannon BMC Pregnancy Childbirth Research Article BACKGROUND: Previous research has demonstrated emotional, psychological and educational harm to young mothers following unintended conceptions. The UK has one of the highest rates of pregnancies in adolescence in Western Europe with a high proportion of these being repeat pregnancies, making it a topic of interest for public health policy makers, and health and social care practitioners. As part of a wider mixed-methods systematic review, realist principles were applied to synthesise evidence about interventions aiming to reduce repeat pregnancies in adolescence. METHODS: A multi-streamed, mixed-methods systematic review was conducted searching 11 major electronic databases and 9 additional databases from 1995 onwards, using key terms such as pregnancy, teen or adolescent. The principles of realist synthesis were applied to all included literature to uncover theories about what works, for whom, how and in what context. Initial theory areas were developed through evidence scoping, group discussion by the authors and stakeholder engagement to uncover context + mechanism = outcome (CMO) configurations and related narratives. RESULTS: The searches identified 8,664 documents initially, and 403 in repeat searches, filtering to 81 included studies, including qualitative studies, randomised controlled trials, quantitative studies and grey literature. Three CMO configurations were developed. The individual experiences of young mothers’ triggered self-efficacy, notions of perceived risks, susceptibility and benefits of pregnancy, resulting in the adolescent taking control of their fertility and sexual encounters. The choice between motherhood and other goals triggered notions of motivations, resulting in the adolescent managing their expectations of motherhood and controlling their fertility and sexual encounters. Barriers and facilitators to accessing services triggered notions of connectedness and self-determination; resulting in interventions that are tailored so they are relevant to young persons, and improve access to services and engagement with the issue of pregnancy in adolescence. CONCLUSIONS: Pregnancy in adolescence is a complex issue with many factors to consider. The conceptual platform described here could help guide policy makers and professionals towards a number of areas that need to be attended to in order to increase the likelihood of an intervention working to prevent rapid repeat pregnancy in adolescence. TRIAL REGISTRATION: PROSPERO CRD42012003168 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12884-016-1066-x) contains supplementary material, which is available to authorized users. BioMed Central 2016-09-20 /pmc/articles/PMC5029024/ /pubmed/27644695 http://dx.doi.org/10.1186/s12884-016-1066-x Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Charles, Joanna M. Rycroft-Malone, Jo Aslam, Rabeea’h Hendry, Maggie Pasterfield, Diana Whitaker, Rhiannon Reducing repeat pregnancies in adolescence: applying realist principles as part of a mixed-methods systematic review to explore what works, for whom, how and under what circumstances |
title | Reducing repeat pregnancies in adolescence: applying realist principles as part of a mixed-methods systematic review to explore what works, for whom, how and under what circumstances |
title_full | Reducing repeat pregnancies in adolescence: applying realist principles as part of a mixed-methods systematic review to explore what works, for whom, how and under what circumstances |
title_fullStr | Reducing repeat pregnancies in adolescence: applying realist principles as part of a mixed-methods systematic review to explore what works, for whom, how and under what circumstances |
title_full_unstemmed | Reducing repeat pregnancies in adolescence: applying realist principles as part of a mixed-methods systematic review to explore what works, for whom, how and under what circumstances |
title_short | Reducing repeat pregnancies in adolescence: applying realist principles as part of a mixed-methods systematic review to explore what works, for whom, how and under what circumstances |
title_sort | reducing repeat pregnancies in adolescence: applying realist principles as part of a mixed-methods systematic review to explore what works, for whom, how and under what circumstances |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5029024/ https://www.ncbi.nlm.nih.gov/pubmed/27644695 http://dx.doi.org/10.1186/s12884-016-1066-x |
work_keys_str_mv | AT charlesjoannam reducingrepeatpregnanciesinadolescenceapplyingrealistprinciplesaspartofamixedmethodssystematicreviewtoexplorewhatworksforwhomhowandunderwhatcircumstances AT rycroftmalonejo reducingrepeatpregnanciesinadolescenceapplyingrealistprinciplesaspartofamixedmethodssystematicreviewtoexplorewhatworksforwhomhowandunderwhatcircumstances AT aslamrabeeah reducingrepeatpregnanciesinadolescenceapplyingrealistprinciplesaspartofamixedmethodssystematicreviewtoexplorewhatworksforwhomhowandunderwhatcircumstances AT hendrymaggie reducingrepeatpregnanciesinadolescenceapplyingrealistprinciplesaspartofamixedmethodssystematicreviewtoexplorewhatworksforwhomhowandunderwhatcircumstances AT pasterfielddiana reducingrepeatpregnanciesinadolescenceapplyingrealistprinciplesaspartofamixedmethodssystematicreviewtoexplorewhatworksforwhomhowandunderwhatcircumstances AT whitakerrhiannon reducingrepeatpregnanciesinadolescenceapplyingrealistprinciplesaspartofamixedmethodssystematicreviewtoexplorewhatworksforwhomhowandunderwhatcircumstances |