Crowdsourcing with adolescents in Senegal to address social norms limiting their access to sexual and reproductive health services

Adolescents make up 18% of the world population. They have unique health needs as they transition from children into adults. Despite their unique physical, social, cognitive and sexual health needs, until recently adolescent health has received little attention globally or nationally. This trend is changing, with adolescent health featuring prominently on the global health agenda. In particular, there is growing recognition of the need to invest in the sexual and reproductive health needs of adolescents, who are at higher risk of acquiring sexually transmitted infections and of having unwanted pregnancies. To increase coverage of these services among adolescents, sexual and reproductive health services need to be tailored to the their needs. In Senegal, the government is committed to providing sexual and reproductive health services to adolescents through the health system and through dedicated youth centres. Despite the availability of these services, adolescents, particularly those residing in poorer and more rural areas, have the lowest access to sexual and reproductive health of any age group, particularly family planning services. There is evidence that attitudes and beliefs (norms) towards adolescents' sexual activity, and the way in which services are provided in response to these norms, play a large role in limiting adolescents use of available services.

Through qualitative research and crowdsourcing, an innovative approach to intervention co-development, the proposed research aims to identify the key norms that limit service use in order to co-develop an intervention with adolescents aged 15 to 19 to address these norms. The research will take place in two regions of Senegal, one peri-urban area in the Dakar region and one rural area in Kedougou region in the South West of the country. Both regions are experiencing rapid increases in population due to urbanisation and gold mining, respectively. This increase in population means the number of adolescents living in these regions will increase, and that sexual practices may change as a result of increased migration and mining work. Adolescents who live in these regions therefore have a high need for sexual and reproductive services. The health systems of the two regions will also need to prepare for the increased need for services, and improve the manner in which services are delivered in order to better serve this population group.

Specifically, this research project will first of all examine the policies and programmes on sexual and reproductive health available to adolescents living in the two regions. This will be followed by interviews and focus group discussions with adolescents and the individuals providing sexual and reproductive health services to them to investigate barriers that stop adolescents from using the services intended for them. We will then select a panel of adolescents from each region to rank the barriers we identify and select the three barriers most important to them. The final stage of the research will be to run a crowdsourcing competition, where members of the public are asked to submit ideas or solutions to a proposed problem. In this study, adolescents will be invited to design an intervention to tackle the three barriers identified as most important to them. We will involve adolescents throughout the project and provide them with technical support they need to conduct the activities successfully.

The overall aim of this research project is to co-develop an intervention with adolescents aged 15 to 19 in order to address the social norms that limit their access to available sexual and reproductive health (SRH) services. The proposed research will take place in two regions of Senegal, one peri-urban area in Dakar region and one rural area in Kedougou region (South West Senegal). These regions are experiencing rapid population increases due to urbanisation and a thriving gold mining sector, respectively. In parallel with urbanisation and migration, there is likely to be an increase in sex work and other high-risk sexual behaviours. With SRH needs of adolescents already underserved, the health systems and health authorities of the two regions will need to plan an increase of service delivery and uptake to meet increased demand.

In this project we will use qualitative formative research and crowdsourcing, an innovative approach to intervention co-development. Specifically, we will examine sexual and reproductive health policies and programmes available to adolescents living in the two regions. We will conduct focus group discussions and semi-structured interviews with adolescents and SRH service providers to explore the norms underlying barriers to service use. We will collect stories of service use and through a panel of adolescents from each region will select the most important three barriers to access. We will then launch an open call for one-month to crowdsource ideas on interventions to address the selected social norms. Adolescents will be able to submit an intervention idea to one or all of the key barriers. The winners of this call, selected in collaboration with an established steering committee, will be supported in further developing an intervention to increase uptake of sexual and reproductive health services. The steering committee will rank the final interventions, with a winning entry selected based on established criteria

This project will accelerate progress towards improved adolescent sexual and reproductive health (SRH) in Senegal and provide a template for other countries to explore norms-based barriers to access, and to implement crowdsourcing as a strategy to co-design an intervention with adolescents. There are three main groups that will benefit from the proposed research.

First, this project intends to influence how adolescents perceive their access to SRH services. Adolescents will be involved at all stages of the programme through the adolescent community advisory board. They will contribute to the design of the study tools, help conduct the research and will inform the interpretation of the results.

Second, this research intends to inform policymakers and SRH service providers on how they can improve access to this key population. Senegalese policymakers and service providers will be provided with strategies that tackle the social norms underlying demand- and supply-side barriers to access. Policymakers and SHR providers, as well as other implementers such as UNICEF, will be included in the project from an early stage, and build on already-existing strong relationships IRESSEF already have with the Ministry of Health.

Third, the proposed research will advance the SRH, adolescent health and health systems literature by exploring the norms underlying barriers to access to service, the concept of adolescent-friendly health services and approaches to community involvement in community design. We will publish papers in high impact journals and present our results at academic conferences. All research team members will benefit from the project by developing research skills, learning about health systems in new contexts and forging south-south research partnerships.