On September 9, Knowledge SUCCESS & FP2020 hosted the fifth and final session in the first module of the Connecting Conversations series. Missed this session? The presentation slides are available to download at the end of this recap. Due to a computer error, only the French recording is available. Registration is now open for the second module, which focuses on critical and influential messenger’s in young people’s lives.
The fifth and final session in the first module of our “Connecting Conversations” series addressed key considerations for conducting needs assessments related to adolescent and youth reproductive health. Our featured speakers included Dr. Bill Brieger, DrPH, MPH, a Public Health Education Specialist from the Johns Hopkins University Bloomberg School of Public Health and Jhpiego, and George Mwinnya, MHS, Research Fellow at the National Institute of Allergy and Infectious Diseases (NIAID). Needs assessments are often challenging, and it can be especially challenging to include and meaningfully engage youth in these exercises. Dr. Brieger and Mr. Mwinnya offered practical recommendations and examined a fundamental framework that can help ensure a needs assessment is useful and holistic.
Dr. Brieger provided a look at the PRECEDE-PROCEED framework that can be used to guide needs assessments. He emphasized that effective strategies to address youth health needs must be based not only on behaviors, but on other influencing factors.
The framework starts with understanding the community and client contexts, as well as behavioral contexts and antecedents, before moving to the final step and matching strategies to behavioral antecedents. PRECEDE stands for Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation and involves assessing community factors. PROCEED stands for Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development and involves identification of desired outcomes and program implementation. Using the PRECEDE-PROCEED framework can help adolescent and youth reproductive health program implementers understand what is happening in a particular area or within a particular community.
Both Dr. Brieger and Mr. Mwinnya emphasized the need to include community members and youth voices in all the steps of the framework, and especially ensure their perspectives are documented during the needs assessment process. They discussed the usefulness of embracing qualitative data to understand variables in quantitative data and tell the whole story of what is happening in a community. Youth offer unique perspectives and have their own ideas about the reproductive health behaviors that they or their peers engage in, and how to create innovative solutions to effectively meet the reproductive health needs and desires of young people.
Drawing on his experience working as a community health worker (CHW) in Ghana, Mr. Mwinnya discussed the importance of considering power dynamics when determining how to practically incorporate young people in the needs assessment process. He mentioned that when program implementers or those collecting data interact with young people, there is a subtle but palpable power dynamic. This can make it difficult for young people to feel comfortable. An adolescent in this situation might be more apprehensive about discussing reproductive health care topics; as a result, the program data collected during those interviews may not accurately reflect the true needs, desires, and perspectives of young people. He urged participants to consider making these relationships as informal as possible, and to make needs assessment interviews friendlier and more comfortable for young people, so that participants don’t feel like they are in an inferior or subordinate position.
During the discussion, Dr. Brieger and Mr. Mwinnya answered questions on a wide range of topics. They spoke about practical considerations when including young people in needs assessments, how to understand context and factors that contribute to behaviors, considerations around gender, the importance of being thorough and inclusive when doing a needs assessment, and considerations for hard-to-reach populations and for conducting assessments during pandemics, such as COVID-19.
Dr. Brieger reminded us of the importance of looking at not only the intended audience when developing program activities, but also the groups that influence and affect the intended audience. These groups may be diverse and have varying levels of influences, and examining these nuances and layers is critical to understanding a particular health behavior or perspective on reproductive health care. For example, perhaps you are intending to reach young women and girls in a particular community. A strong needs assessment would not only include and meaningfully engage female youth in the needs assessment process, but also incorporate the perspectives of those individuals who influence young women and girls in the community, which might include their mothers, partners, or religious groups. Rarely do behaviors occur in a silo, and despite the challenge to understanding all the layers of influence, taking the time to do this will help to create a more holistic picture of the context in which a young person lives and their reproductive health behaviors, needs, and desires.
In response to a question on gender, Dr. Brieger mentioned that in doing a needs assessment, it is essential to understand how groups are defined and how to better tailor strategies to specific groups within a community. He emphasized that it is crucial to understand gender-related issues in order to understand how a community functions. Mr. Mwinnya mentioned that although gender considerations are important pieces of a needs assessment, in his work as a CHW, he found that the questions that concern young women are often quite important for young men as well. He also mentioned that sometimes, the unequal power dynamics between an older man and his much younger female partner are more important than gender considerations or power dynamics among young people of the same age.
Throughout the conversation, Dr. Brieger and Mr. Mwinnya both emphasized the value of getting out in the community and involving young people and different groups. Quantitative data can only tell you so much, and listening to the opinions, perspectives, and beliefs of young people is crucial to planning successful AYRH programs. They recognized that this might be challenging for hard-to-reach populations, such as those youth who are out of school or who live in conflict settings. But it is essential to incorporate their voices to obtain a holistic view of the community and young people’s perspectives. In addition–especially now during the COVID-19 pandemic, when in-person gatherings are not always possible–Dr. Brieger and Mr. Mwinnya underlined how technology, such as social media, can be used to engage with young people in a virtual setting. It works both ways: Technology can not only help you understand their perspectives and incorporate them into a needs assessment, but also lets you provide them with reproductive health care and information.
Want to make sure you have this overview of a needs assessment handy? Download Dr. Brieger’s presentation slides!
“Connecting Conversations” is a series of discussions on adolescent and youth reproductive health—hosted by FP2020 and Knowledge SUCCESS. Over the next year, we will be co-hosting these sessions every two weeks or so on a variety of topics. We’re using a more conversational style, encouraging open dialogue and allowing plenty of time for questions. We guarantee you will be coming back for more!
The series will be divided into five modules. Our first module, which started on July 15 and ran through September 9, focused on a foundational understanding of adolescent development and health. Presenters—including experts from organizations such as the World Health Organization, Johns Hopkins University, and Georgetown University—offered a framework for understanding adolescent and youth reproductive health, and implementing stronger programs with and for young people. Subsequent modules will touch on themes of improving young people’s knowledge and skills, providing care, creating supportive environments, and addressing the diversity of young people.
Be on the lookout for more on our second module coming soon!