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How Do Jordanian and Syrian Youth Living in Jordan Envision Their Sexual and Reproductive Health Needs? a Concept Mapping Study Protocol

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How Do Jordanian and Syrian Youth Living in Jordan Envision Their Sexual and Reproductive Health Needs? a Concept Mapping Study Protocol Open access Protocol BMJ Open: first published as 10.1136/bmjopen-2018-027266 on 28 January 2019. Downloaded from How do Jordanian and Syrian youth living in Jordan envision their sexual and reproductive health needs? A concept mapping study protocol Jewel Gausman,1 Areej Othman,2 Iqbal Lutfi Hamad,3 Maysoon Dabobe,3 Insaf Daas,4 Ana Langer1 To cite: Gausman J, Othman A, ABSTRACT Strengths and limitations of this study Hamad IL, et al. How do Introduction Youth in Jordan constitute 20.4% of the Jordanian and Syrian youth population, and many face considerable challenges ► The use of concept mapping, an iterative and inter- living in Jordan envision their in addressing their sexual and reproductive health sexual and reproductive health active qualitative data collection and analysis tech- (SRH) needs, such as those related to the prevention of needs? A concept mapping nique, encourages participants to open up about unintended pregnancy and sexually transmitted infections, study protocol. BMJ Open sensitive topics—especially younger youth. early marriage and sexual coercion and violence. The 2019;9:e027266. doi:10.1136/ ► This study includes young men; a population that is findings of previous studies indicate that Jordanian youth bmjopen-2018-027266 commonly overlooked in studies on sexual and re- require reproductive health-related support, information productive health. ► Prepublication history for and services; however, there remains very limited data this paper is available online. ► The sample size is robust (n=288) for concept map- as to how youth envision their SRH challenges and To view these files, please visit ping in order to obtain a rich data set. needs. This protocol outlines the design of a qualitative the journal online (http:// dx. doi. ► While a strength of this study lies in the fact that study using a participatory research methodology called org/ 10. 1136/ bmjopen- 2018- sexual and reproductive health issues in this popu- concept mapping. This methodology enables participants 027266). lation are understudied, the cultural sensitivity of the to develop a conceptual framework for how they envision topics discussed may influence the results in that Received 16 October 2018 their sexual and reproductive health needs. participants may not be comfortable sharing their Revised 29 October 2018 Methods and analysis This study will use concept ideas. Accepted 30 October 2018 mapping, which consists of a structured and iterative ► Because this study is qualitative in nature, re- participatory research process that engages participants sults may not be generalisable outside the study http://bmjopen.bmj.com/ over three data collection sessions in order to generate population. the information needed to create a visual display of their ideas pertaining their SRH needs, issues and concerns, and how these ideas relate to each other. Each data (15–24 years).1 During these years, individ- collection session focuses on a different activity, including brainstorming, pile sorting and interpretation of the results. uals undergo fundamental physiological © Author(s) (or their Data will be analysed using hierarchical cluster analysis and psychosocial changes, often with limited employer(s)) 2019. Re-use reproductive health information.2 3 In less permitted under CC BY-NC. No and multidimensional scaling. Transcriptions of group developed countries, the obstacles that stand commercial re-use. See rights discussions will be coded and analysed to add depth to on 28 January 2019 by guest. Protected copyright. and permissions. Published by the study results. Two hundred and eighty-eight males and in the way of a healthy transition to adult- BMJ. females of Jordanian or Syrian descent living in Jordan will hood are the highest.4 The world’s youth are 1Women and Health Initiative; be recruited from four communities across Jordan. at a higher risk of sexual and reproductive Department of Global Health and Ethics and dissemination This study meets the morbidity and mortality due to a variety of Population, Harvard T.H. Chan requirements of the Declaration of Helsinki and has been School of Public Health, Boston, factors including early marriage, early preg- approved by the Institutional Review Boards at the Harvard nancy, unsafe abortion, sexually transmitted Massachusetts, USA T.H. Chan School of Public Health and the University of 2School of Nursing, University of infections (STIs), harmful traditional prac- Jordan. Study findings will be presented in peer-reviewed, Jordan, Amman, Jordan tices and sexual coercion.5–7 Conservative 3 international journals and made available to local Jordanian Hashemite sociocultural norms, such as those found Foundation for Human programme managers, policy-makers and stakeholders Development (JOHUD), Amman, through local dissemination efforts. in many areas throughout the Middle East, Jordan create barriers to youth obtaining specific, 4Center for Women’s Studies, timely and high-quality sexual and reproduc- University of Jordan, Amman, tive health (SRH) information and services.8 9 Jordan INTRODUCTION Youth in Jordan constitute 20.4% of the 10 Correspondence to The United Nations defines young people population, many of whom face consid- Dr Jewel Gausman; as those aged between 10 and 24 years; this erable challenges in addressing their SRH jmg923@ mail. harvard. edu includes adolescents (10–19 years) and youth needs,2 3 11 including those related to the Gausman J, et al. BMJ Open 2019;9:e027266. doi:10.1136/bmjopen-2018-027266 1 Open access BMJ Open: first published as 10.1136/bmjopen-2018-027266 on 28 January 2019. Downloaded from prevention of unintended pregnancy and STIs,11–15 early governance that ultimately manifests in further limiting marriage,16 17 and sexual coercion and violence.18 19 The access to SRH services.29 findings of previous studies indicate that Jordanian youth Syrian men and women living in Jordan face unprec- need reproductive health-related support, information edented challenges with regard to their SRH. The and services. The National Youth Survey conducted in humanitarian crisis has caused young girls to become 2001 included 2142 Jordanians aged 15–24.11 The survey increasingly vulnerable to poor SRH outcomes, such as found that 29% of women and 44% of men aged 15–24 early pregnancy, child marriage, gender-based violence did not know the meaning of the term reproductive and sexual assault as a result of changing economic health, and healthcare providers and media were the pressures, community dynamics and social norms.29–32 preferred sources of family planning (FP) and SRH infor- Previous qualitative research has highlighted that many mation, compared with peers or parents. A recent quali- young women fear negative repercussions, such as stig- tative study of 60 Jordanian adolescent men and women matisation and discrimination from service providers and between the ages of 12 and 18 indicated that there is their communities, should they seek SRH services, while significant demand for reproductive health information, others report poor treatment by healthcare workers.33 counselling and accessible, youth-friendly services near Additionally, many Syrian refugee youth do not have where they live or study.3 basic knowledge related to reproductive health or know A few qualitative studies conducted among Jordanians where to find a provider.34–37 A study conducted in 2013 and Syrians have documented that youth perceive avail- among Syrian refugees in camps found evidence of both able FP services to be unpleasant, unprofessional and of severe supply and demand side barriers, such as provider poor quality.3 20 Additionally, youth cite concerns that bias in offering women contraception and limited knowl- providers do not take them seriously, treat them like chil- edge among women of where to obtain SRH services, dren, do not know what information youth need and view resulting in reports of provider refusal to provide emer- youth’s questions as inappropriate.21 An evaluation of gency contraception postrape and women reporting services offered at selected public and private clinics in self-induced abortion because of the lack of contraceptive Jordan noted a lack of private rooms at Ministry of Health availability.38 Women living outside of camps often faced (MOH) clinics,22 which is a concern that has been echoed increased challenges with regard to SRH than those in by youth.3 Another study found that providers often give camps, given that they tend to be younger, poorer and incorrect information to youth regarding reproductive less educated.34–37 39 health, such as instructing them not to use contraception As Jordan’s health system tries to respond to the because of fears over the relationship between FP use and changing needs in these communities, more research infertility.23 Because of these and other challenges, util- is needed that examines how youth envision their SRH isation rates among adolescents of public sector health concerns, as well as the challenges that they encounter services are extremely low. The Jordanian MOH estimates related to meeting their reproductive health needs. In http://bmjopen.bmj.com/ a primary healthcare utilisation rate among adolescents Jordan, the SRH health needs of youth are largely under- of 1% or less.24 studied due to concerns over the sensitive nature of Jordanian society is fairly conservative with regard to discussing such topics with youth, and assumptions that norms relating to sexuality, and the discussion of sex-re- conflate the silence
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