Om Dalal, Lauren Maldonado, Gertrude Anusu, Laura Ruhl, Maureen Chepkoech, Anjellah Jumah, Joan Keter, Justus Elung’at, Michael Scanlon, Astrid Chrisoffersen-Deb, Edith Apondi, Julia Songok, Julie Thorne

Assessing a Community-based, Group Care Program Adapted for Pregnant and Parenting Adolescents in Western Kenya: An Acceptability and Feasibility Study

Introduction

Assessing a community-based, group care program adapted for pregnant and parenting adolescents in western kenya: an acceptability and feasibility study. This study evaluates a community-based group care program for pregnant & parenting adolescents in Western Kenya. Findings show high acceptability, feasibility, improved health literacy, peer support, and scale-up potential.

Abstract

Background: An estimated 21 million adolescent pregnancies occur worldwide, predominantly in low- and middle-income countries (LMICs). These pregnancies often result in poor health outcomes due to low health literacy and limited healthcare interaction. Furthermore, many adolescent parents face disproportionate stigma and are unable to complete their education or seek employment due to parenting obligations. The Chamas for Change program, an existing community-based group care program in Kenya targeted to adult mothers, shows promise in improving maternal, newborn, and child health (MNCH) outcomes in adolescents. This study evaluates the acceptability and feasibility of an adapted Chamas model tailored for pregnant and parenting adolescents. Methods: This mixed-methods study investigated the acceptability and feasibility of an adapted Chamas program for pregnant adolescents in rural Western Kenya. Likert scale surveys (ranging 1-5, 5 = “completely agree”) were conducted at baseline and endline to quantitively assess acceptability of the program. Program attendance, barriers to attendance, and intention to re-enroll were used to assess feasibility. Two Focus Group Discussions (FGDs) conducted at endline were analyzed through a thematic framework to qualitatively assess acceptability and feasibility. Results: Over the course of the study, 85% of participants had attended at least half of the adapted program sessions. At endline, 99% of adolescents reported the program is acceptable and 95% reported it is feasible (score ≥ 4 on the Likert scale). Additionally, 99% indicated they would re-enroll in the program for another cycle and 71% would attend even if no transportation and snacks are offered. Through thematic analysis of FGDs, strong themes of greater peer support and health literacy were noted. Conclusion and Potential Impact: The adolescent Chamas pilot demonstrated strong acceptability and feasibility, with MNCH outcomes being equivalent or better with the intervention. As such, there is potential to scale-up and expand the adapted Chamas program.

Review

This timely study addresses the critical global challenge of adolescent pregnancies, particularly in low- and middle-income countries, where poor health literacy and limited healthcare access often lead to adverse outcomes for both mother and child. By adapting the well-regarded Chamas for Change group care program, previously successful with adult mothers, to specifically cater to pregnant and parenting adolescents in Western Kenya, the researchers explore a promising, community-based intervention. The central objective of assessing the acceptability and feasibility of this adapted model is highly relevant, offering potential pathways to mitigate the socio-economic and health disadvantages faced by this vulnerable demographic. The research employs a robust mixed-methods design, which is a significant strength in evaluating such community-based interventions. Quantitative data, gathered through Likert scale surveys at baseline and endline, alongside program attendance and re-enrollment intentions, provides clear metrics of acceptability and feasibility. These are complemented by qualitative insights from endline Focus Group Discussions, which delve deeper into participants' experiences. The results are overwhelmingly positive: a high attendance rate of 85%, near-universal agreement on acceptability (99%) and feasibility (95%) at endline, and a strong intent to re-enroll (99%). Crucially, the finding that 71% would attend even without transportation and snacks underscores the program's inherent value to participants. The qualitative data further reinforces these findings, highlighting the significant benefits of enhanced peer support and improved health literacy. In conclusion, this pilot study compellingly demonstrates the strong acceptability and feasibility of the adapted Chamas program for pregnant and parenting adolescents. The consistent positive feedback across both quantitative and qualitative measures, coupled with the high attendance and re-enrollment intentions, strongly supports the program's potential for impact. While the observation that MNCH outcomes were "equivalent or better" is very encouraging, future studies with designs specifically powered to measure health outcomes would be beneficial to conclusively establish efficacy. Nevertheless, the successful demonstration of acceptability and feasibility in this context provides a solid foundation for the proposed scale-up and expansion of the adapted Chamas program, offering a promising model for improving the lives of adolescent mothers and their children.

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