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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2016

Open Access 01-12-2016 | Research article

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

Authors: Joanna M. Charles, Jo Rycroft-Malone, Rabeea’h Aslam, Maggie Hendry, Diana Pasterfield, Rhiannon Whitaker

Published in: BMC Pregnancy and Childbirth | Issue 1/2016

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Abstract

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.

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Literature
1.
2.
3.
Koniak-Griffin D, Turner-Pluta C. Health risks and psychosocial outcomes of early childbearing: a review of the literature. J Perinat Neonatal Nurs. 2001;15(2):1–17.CrossRefPubMed
4.
Rigsby DC, Macones GA, Driscoll DA. Risk factors for rapid repeat pregnancy among adolescent mothers: a review of the literature. J Pediatr Adolesc Gynecol. 1998;11(3):115–26.CrossRefPubMed
5.
Nelson PB. Repeat pregnancy among adolescent mothers: a review of the literature. J Natl Black Nurses Assoc. 1990;4(1):28–34.PubMed
6.
7.
8.
Swann C, Bowe K, McCormick G, Kosmin M. Teenage pregnancy and parenthood: a review of reviews. NICE Evidence Briefing 2003. London: Health Development Agency
9.
Black M, Bentley M, Papas M, Oberlander S, Teti L, McNary S, et al. Delaying second births among adolescent mothers: a randomized, controlled trial of a home-based mentoring program. Pediatrics. 2006;118(4):e1087–99.CrossRefPubMed
10.
Erikson EH. Childhood and Society. New York: WW Norton & Company; 1993.
11.
Rosenstock IM, Strecher VJ, Becker MH. Social learning theory and the health belief model. Health Educ Q. 1988;15(2):175–83.CrossRefPubMed
12.
Ramos C. Interventions for preventing unintended pregnancies among adolescents: The WHO Reproductive Health Library. Geneva: World Health Organization; 2011.
13.
14.
DiCenso A, Guyatt G, Willan A, Griffith L. Interventions to reduce unintended pregnancies among adolescents: systematic review of randomised controlled trials. BMJ. 2002;15(324):1426.CrossRef
15.
Whitaker R, Hendry M, Aslam R, Booth A, Carter B, Charles JM, Craine N, Tudor-Edwards R, Noyes J, Ntambwe LI, Pasterfield D, Rycroft-Malone J, Williams N. Intervention Now to Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness and qualitative and realist synthesis of implementation factors and user engagement. Health Technol Assess. 2016; 20(16).
16.
Charles JM, Rycroft-Malone J, Aslam R, Hendry M, Pasterfield D. An embedded realist review of what works, for whom, how, and in what circumstances to reduce repeat pregnancies in adolescence: a systematic mixed-methods review. Lancet (conference abstract). 2015;386:S28.CrossRef
17.
Pawson R. Evidence-based policy: a realist perspective. London: Sage; 2006.CrossRef
18.
19.
20.
Kane SS, Gerretsen B, Scherpbier R, Dal Poz M, Dieleman M. A realist synthesis of randomised control trials involving use of community health workers for delivering child health interventions in low and middle income countries. BMC Health Serv Res. 2010;10:28.CrossRef
21.
Hewitt G, Sims S, Harris R. Using realist synthesis to understand the mechanisms of interprofessional teamwork in health and social care. J Interprof Care. 2014;28(6):501–206.CrossRefPubMed
22.
Higgins J, Deeks J, Altman D. Section 16.2, Chapter 16: Special topics in statistics. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011): The Cochrane Collaboration; 2011. http://​handbook.​cochrane.​org/​. Accessed 11 Apr 2014.
23.
Pace R, Pluye P, Bartlett G, Macaulay A, Salsberg J, Jagosh J, et al. Testing the reliability and efficiency of the pilot Mixed Methods Appraisal Tool (MMAT) for systematic mixed studies review. Int J Nurs Stud. 2012;49:47–53.CrossRefPubMed
24.
Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. 4th ed. Oxford, UK: Oxford University Press; 2015.
25.
Guyatt GH, Oxman AD, Schunemann HJ, Tugwell P, Knottnerus A. GRADE Guidelines: a new series of articles in the Journal of Clinical Epidemiology. J Clin Epidemiol. 2011;64(4):380–2.CrossRefPubMed
26.
Glenton C, Colvin C, Carlsen B, Swartz A, Lewin S, Noyes J, et al. Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child heath: qualitative evidence synthesis (Protocol). Cochrane Database Syst Rev. 2013;2.
27.
28.
Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist review - a new method of systematic review designed for complex policy interventions. J Health Serv Res Policy. 2005;10(S1):21–34.CrossRefPubMed
29.
Paukku M, Quan J, Darney P, Raine T. Adolescents’ contraceptive use and pregnancy history: is there a pattern? Obstet Gynecol. 2003;101(3):534–8.PubMed
30.
Clarke J. Repeat teenage pregnancy in two cultures - the meanings ascribed by teenagers. Child Soc. 2010;24(3):188–99.
31.
Stevens-Simon C, Kelly L, Singer D, Nelligan D. Reasons for first teen pregnancies predict the rate of subsequent teen conceptions. Pediatrics. 1998;101:e8.CrossRefPubMed
32.
Barnet B, Liu J, DeVoe M. Double jeopardy - depressive symptoms and rapid subsequent pregnancy in adolescent mothers. Arch Pediatr Adolesc Med. 2008;162(3):246–52.CrossRefPubMed
33.
Raneri LG, Wiemann CM. Social ecological predictors of repeat adolescent pregnancy. Perspect Sex Reprod Health. 2007;39(1):39–47.CrossRefPubMed
34.
Sims K, Luster T. Factors related to early subsequent pregnancies and second births among adolescent mothers in a family support program. J Fam Issues. 2002;23(8):1006–31.CrossRef
35.
Kershaw TS, Niccolai LM, Ickovics JR, Lewis JB, Meade CS, Ethier KA. Short and long-term impact of adolescent pregnancy on postpartum contraceptive use: implications for prevention of repeat pregnancy. J Adolesc Health. 2003;33(5):359–68.CrossRefPubMed
36.
Weston MRS, Martins L, Neustadt AB MLG. Factors influencing uptake of intrauterine devices among postpartum adolescents: a qualitative study. Am J Obstet Gynecol. 2012;206(40):e1–7.
37.
Bull S, Hogue C. Exploratory analysis of factors associated with teens’ repeated childbearing. J Health Care Poor Underserved. 1998;9(1):42–61.CrossRefPubMed
38.
Crittenden CP, Boris NW, Rice JC, Taylor CA, Olds DL. The role of mental health factors, behavioral factors, and past experiences in the prediction of rapid repeat pregnancy in adolescence. J Adolesc Health. 2009;44(1):25–32.CrossRefPubMed
39.
Herrman JW. Repeat pregnancy in adolescence: intentions and decision making. MCN Am J Matern Child Nurs. 2007;32(2):89–94.CrossRefPubMed
40.
Mbambo DE, Ehlers VJ, Monareng LV. Factors influencing adolescent mothers’ non-utilisation of contraceptives in the Mkhondo area. Health SA Gesondheid. 2006;11(4):22–31.CrossRef
41.
Clarke J. Repeated Teenage Pregnancies –The meanings ascribed by teenagers-a comparison between London and two Caribbean islands. Faculty of Life Sciences Department of Health & Social Care, Brunel University (Doctoral Thesis) 2002.
42.
Collins ME, Stevens JW, Lane TS. Teenage parents and welfare reform: findings from a survey of teenagers affected by living requirements. Soc Work. 2000;45(4):327–38.CrossRefPubMed
43.
Seamark C. Design or accident? The natural history of teenage pregnancy. JRSM Open. 2001;94(6):282–5.
44.
Haamid F, Wiemann C. You’re pregnant again?! Which adolescent mothers experience multiple repeat pregnancies? J Adolesc Health. 2010;46(2):S32.CrossRef
45.
Carvajal D, Burrell L, Duggan A, Barnet B. Repeat pregnancy prevention self-efficacy in adolescents: associations with provider communication, provider type, and depression. South Med J. 2012;105(11):591–7.CrossRefPubMed
46.
Sant’Anna MJC, Carvalho KAM, Melhado A, Coates V, Omar HA. Teenage pregnancy: Impact of the integral attention given to the pregnant teenager and adolescent mother as a protective factor for repeat pregnancy. Sci World J. 2007;7:187–94.CrossRef
47.
Key JD, Barbosa GA, Owens VJ. The Second Chance Club: repeat adolescent pregnancy prevention with a school-based intervention. J Adolesc Health. 2001;28(3):167–69.CrossRefPubMed
48.
Sangalang BB, Barth RP, Painter JS. First-birth outcomes and timing of second births: a statewide case management program for adolescent mothers. Health Soc Work. 2006;31(1):54–63.CrossRefPubMed
49.
Hellerstedt WL, Story M. Adolescent satisfaction with postpartum contraception and body weight concerns. J Adolesc Health. 1998;22(6):446–52.CrossRefPubMed
50.
Williams EG, Sadler LS. Effects of an urban high school-based child care center on self-selected adolescent parents and their children. J Sch Health. 2001;71(2):47–52.CrossRefPubMed
51.
Wilson EK, Samandari G, Koo HP, Tucker C. Adolescent mothers’ postpartum contraceptive use: a qualitative study. Perspect Sex Reprod Health. 2011;43(4):230–7.CrossRefPubMed
52.
Swedish KA, Rothenberg A, Fuchs K, Rosenberg G. Successful life navigation by former participants in a group for pregnant and parenting teens. Vulnerable Child Youth Stud. 2010;5(4):310–21.CrossRef
53.
Berenson A, Wiemann C. Contraceptive use among adolescent mothers at 6 months postpartum. Obstet Gynecol. 1997;89(6):999–1005.CrossRefPubMed
54.
Havens KK, Wagstaff DA, Mercer PA, Longeway K, Gutman M. Lessons learned from a mentoring program for teenage mothers. Wis Med J. 1997;96(9):38–43.
55.
Keown K, Van Eerd D, Irvin E. Stakeholder engagement opportunities in systematic reviews: knowledge transfer for policy and practice. J Contin Educ Health Prof. 2008;28(2):67–72.CrossRefPubMed
56.
Metadata
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
Authors
Joanna M. Charles
Jo Rycroft-Malone
Rabeea’h Aslam
Maggie Hendry
Diana Pasterfield
Rhiannon Whitaker
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2016
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-016-1066-x

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