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Abstract：
Adolescents in low-and-middle-income countries like Zambia face a high burden of sexual, reproductive, health and rights problems including coerced sex, teenage pregnancies, and early marriages. The Zambia government through Ministry of Education has integrated comprehensive sexuality education (CSE) in the education and school system to contribute towards addressing Adolescents sexual, reproductive, health and rights (ASRHR) problems. This paper sought to explore teachers and community based health workers (CBHWs)\' experiences in addressing ASRHR problems in in rural health systems in Zambia.
The study was conducted under Research Initiative to Support the Empowerment of Girls (RISE) community randomized trial that aims to measure the effectiveness of economic and community interventions in reducing early marriages, teenage pregnancies, and school dropout in Zambia. We conducted qualitative 21 in-depth interviews with teachers and CBHWs involved in the implementation of CSE in communities. Thematic analysis was used to analyse teachers and CBHWs´ roles, challenges, and opportunities in promoting ASRHR services.
The study identified teachers and CBHWs roles, and challenges experienced in promoting ASRHR and suggested strategies to enhance delivery of the intervention. The role of teachers and CBHWs in addressing ASRHR problems included mobilizing and sensitizing the community for meetings, providing SRHR counseling services to both adolescents and guardians, and strengthening referral to SRHR services if needed. The challenges experienced included stigmatization associated with difficult experiences such as sexual abuse and pregnancy, shyness among girls to participate when discussing SRHR in the presence of the boys and myths about contraception. The suggested strategies for addressing the challenges included creating safe spaces for adolescents to discuss SRHR issues and engaging adolescents in coming up with the solution.
This study provides significant insight on the important roles that teachers CBHWs can play in addressing adolescents SRHR related problems. Overall, the study emphasizes the need to fully engage adolescents in addressing adolescents SRHR problems.
Comprehensive sexuality education programmes are often not implemented properly because facilitators are not adequately prepared, and the community usually resist such programs. Similarly, in Zambia, the teachers and CBHWs implementing sexual and reproductive health activities often felt uncomfortable discussing sensitive sexuality topics with adolescents. This study was conducted within a bigger research project exploring whether teachers and community-based health workers together can effectively deliver sexual and reproductive health information at school and community levels. Discussions on the delivery of ASRHR services were held with teachers and CBHWs to identify their roles, and challenges that they experienced, and find solutions to problems. The interviews showed that the teachers and CBHWs provided sexual reproductive health and rights (SRHR) counselling to adolescents and parents. They were also involved in mobilising communities to attend SRHR meetings, sensitise, and refer them to SRHR services. However, teachers and CBHWs encountered several challenges. These include late reporting and hiding of sexual abuse cases, myths about contraceptives, and stigmatisation of girls with history of sexual abuse, and pregnancy. Further, girls felt shy to participate in SRHR discussions due to customary norms and values regarding marriage. More community engagement opportunities are needed to break the barriers of communication, and shift cultural norms to help enhance adolescent uptake of SRHR services in order to prevent pregnancy and other related challenges.
The study was conducted under Research Initiative to Support the Empowerment of Girls (RISE) community randomized trial that aims to measure the effectiveness of economic and community interventions in reducing early marriages, teenage pregnancies, and school dropout in Zambia. We conducted qualitative 21 in-depth interviews with teachers and CBHWs involved in the implementation of CSE in communities. Thematic analysis was used to analyse teachers and CBHWs´ roles, challenges, and opportunities in promoting ASRHR services.
The study identified teachers and CBHWs roles, and challenges experienced in promoting ASRHR and suggested strategies to enhance delivery of the intervention. The role of teachers and CBHWs in addressing ASRHR problems included mobilizing and sensitizing the community for meetings, providing SRHR counseling services to both adolescents and guardians, and strengthening referral to SRHR services if needed. The challenges experienced included stigmatization associated with difficult experiences such as sexual abuse and pregnancy, shyness among girls to participate when discussing SRHR in the presence of the boys and myths about contraception. The suggested strategies for addressing the challenges included creating safe spaces for adolescents to discuss SRHR issues and engaging adolescents in coming up with the solution.
This study provides significant insight on the important roles that teachers CBHWs can play in addressing adolescents SRHR related problems. Overall, the study emphasizes the need to fully engage adolescents in addressing adolescents SRHR problems.
Comprehensive sexuality education programmes are often not implemented properly because facilitators are not adequately prepared, and the community usually resist such programs. Similarly, in Zambia, the teachers and CBHWs implementing sexual and reproductive health activities often felt uncomfortable discussing sensitive sexuality topics with adolescents. This study was conducted within a bigger research project exploring whether teachers and community-based health workers together can effectively deliver sexual and reproductive health information at school and community levels. Discussions on the delivery of ASRHR services were held with teachers and CBHWs to identify their roles, and challenges that they experienced, and find solutions to problems. The interviews showed that the teachers and CBHWs provided sexual reproductive health and rights (SRHR) counselling to adolescents and parents. They were also involved in mobilising communities to attend SRHR meetings, sensitise, and refer them to SRHR services. However, teachers and CBHWs encountered several challenges. These include late reporting and hiding of sexual abuse cases, myths about contraceptives, and stigmatisation of girls with history of sexual abuse, and pregnancy. Further, girls felt shy to participate in SRHR discussions due to customary norms and values regarding marriage. More community engagement opportunities are needed to break the barriers of communication, and shift cultural norms to help enhance adolescent uptake of SRHR services in order to prevent pregnancy and other related challenges.
摘要：
背景：赞比亚等中低收入国家的青少年面临着很高的性负担，生殖,健康和权利问题，包括强迫性行为，少女怀孕,和早婚。赞比亚政府通过教育部将全面的性教育(CSE)纳入教育和学校系统，为解决青少年性、生殖,健康与权利(ASRHR)问题。本文旨在探索教师和社区卫生工作者（CBHW）在解决赞比亚农村卫生系统中的ASRHR问题方面的经验。
方法：该研究是在支持女孩赋权的研究倡议（RISE）社区随机试验中进行的，该试验旨在衡量经济和社区干预措施在减少早婚方面的有效性。少女怀孕,在赞比亚辍学。我们对参与社区实施CSE的教师和CBHW进行了21次定性深入访谈。主题分析用于分析教师和CBHW的角色，挑战,以及促进ASRHR服务的机会。
结果：该研究确定了教师和CBHW的角色，以及在促进ASRHR方面遇到的挑战，并提出了加强干预措施实施的策略。教师和CBHW在解决ASRHR问题方面的作用包括动员和宣传社区参加会议，向青少年和监护人提供SRHR咨询服务，并在必要时加强向SRHR服务的推荐。经历的挑战包括与性虐待和怀孕等艰难经历相关的污名化，在男孩在场的情况下讨论SRHR时，女孩羞怯地参与其中，还有关于避孕的神话。建议的应对挑战的战略包括为青少年创造安全的空间来讨论SRHR问题，并让青少年参与提出解决方案。
结论：这项研究为教师CBHW在解决青少年SRHR相关问题中发挥的重要作用提供了重要见解。总的来说,该研究强调有必要让青少年充分参与解决青少年SRHR问题。
全面的性教育计划往往没有得到适当的实施，因为促进者没有做好充分的准备，社区通常抵制此类计划。同样，在赞比亚,实施性健康和生殖健康活动的教师和CBWH经常感到不舒服，与青少年讨论敏感的性话题。这项研究是在一个更大的研究项目中进行的，旨在探索教师和社区卫生工作者是否可以在学校和社区层面有效地提供性健康和生殖健康信息。与教师和CBHW举行了关于提供ASRHR服务的讨论，以确定他们的角色，和他们经历的挑战，并找到解决问题的方法。访谈显示，教师和CBHW向青少年和父母提供了性生殖健康和权利（SRHR）咨询。他们还参与动员社区参加SRHR会议，敏感，并将其转给SRHR服务。然而,教师和CBHW遇到了一些挑战。这些包括迟报和隐瞒性虐待案件，关于避孕药的神话，以及对有性虐待史的女孩的污名化，和怀孕。因此，由于有关婚姻的习惯规范和价值观，女孩感到害羞参加SRHR讨论。需要更多的社区参与机会来打破沟通障碍，转变文化规范，以帮助提高青少年对SRHR服务的吸收，以防止怀孕和其他相关挑战。
方法：该研究是在支持女孩赋权的研究倡议（RISE）社区随机试验中进行的，该试验旨在衡量经济和社区干预措施在减少早婚方面的有效性。
结果：该研究确定了教师和CBHW的角色，
结论：这项研究为教师CBHW在解决青少年SRHR相关问题中发挥的重要作用提供了重要见解。
全面的性教育计划往往没有得到适当的实施，因为促进者没有做好充分的准备，
