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Adolescents are currently becoming sexually active before their 18th birthday during which they have to battle with unsafe sexual behaviours, teenage pregnancies, sexually transmitted infections (STIs), and school dropouts. The trend is linked with low soft skills (self-esteem and assertiveness skills) for them to make informed, reasoned, and responsible decisions over sexual activities. This study designed and tested the effect of integrated reproductive health (RH) lesson materials in a problem-based pedagogy (PBP) to enhance soft skills for safe sexual behaviour among adolescents in Tanzania. A double-blinded clustered randomized controlled trial was conducted between September 2019 and September 2020 among 660 randomly selected adolescents. A Sexual-risk Behaviour Beliefs and Self-esteem Scale adopted from previous studies measured soft skills for safe sexual behaviour. A descriptive statistical analysis was performed by using the statistical analysis software programme version 9.4. The effect of the intervention was determined using Linear Mixed Model set at α error probability = 5% significance level (95% confidence interval) and a β error probability = 0.80. Adolescents' mean age was 15±1.869 with 57.5% females. The end-line findings indicated that the coefficient of soft skills was significantly higher among adolescents in the hybrid PBP (β=9.0986, p<0.01; 95%CI: 4.7772, 14.2311) and pure PBP (β =8.7114, p<0.01; 95%CI: 3.9990, 10.1208) than in the control group. The retention rate of soft skills was still significantly higher at 3-months follow-up (β=2.0044; p<0.01; 95%CI: 1.0234, 4.1182) and at 6-months follow-up (β=1.9803; p<0.01; 95%CI: 0.8399, 3.1099) compared to the baseline and immediate post-intervention assessments. The intervention substantially enhanced soft skills for safe sexual behaviour among adolescents of both sex. Despite the fact that scores for soft skills varied across the study timelines, adolescents demonstrated significant intentions to abstain from sexual intercourse, delay sexual relationships, negotiate condom use, and withstand sexual coercions. The PBP may need to be incorporated in ordinary level secondary school curricula as a formal guide to teachers and or health workers to optimally prepare adolescents for their healthy adulthood.

Adolescent pregnancy constitutes a critical public health issue worldwide. Young mothers face substantial physical and psychological changes as they transition to motherhood, while limited knowledge, experience, and maturity may impair parenting and increase stress. The study aimed to evaluate the effects of the parental enhancing program with mobile application on parental stress and competence among Thai adolescent postpartum women. A quasi-experimental study using a matched control design was conducted among sixty adolescent postpartum women, aged 15-19. Participants were sequentially allocated to an intervention group (n = 30) receiving a parental enhancing program with mobile application, and a control group (n = 30) receiving standard postpartum care. Adolescent postpartum women in the intervention group received two sessions from the parental enhancing program before discharge with weekly follow-up through the Line Official Account™. Data were collected using questionnaires, including the Edinburgh Postnatal Depression Scale (EPDS), Parenting Stress Index (PSI-4-SF), and Parenting Sense of Competence Scale (PSOC). Evaluations were conducted during the 6-week postpartum. ANCOVA was used to compare post-intervention mean scores of parental stress and competence between groups. All enrolled participants completed the study (Intervention: 30; Control: 30). At 6-weeks postpartum, after controlling baseline EPDS scores, the results revealed that adolescent postpartum women in the intervention group demonstrated significantly lower parental stress (F(1,57) = 14.40, partial η² = 0.20, 95% CI [-14.05, -4.34], p < .001) and higher parental competence (F(1,57) = 8.79, partial η² = 0.13, 95% CI [1.90, 9.80], p < .01) compared to the control group. The parental enhancing program with mobile application demonstrates promise for evidence of reducing parental stress and improving parental competence in postpartum adolescent mothers. However, further studies in randomized controlled trials are warranted to confirm its effectiveness and generalizability. Thai clinical trials registry (TCTR20250309010).

Adolescent pregnancy is associated with elevated stress, anxiety, and depression, often exacerbated by limited social support. Despite the recognized risks faced by pregnant adolescents, there is a paucity of research evaluating the effectiveness of psychoeducational interventions specifically integrated into antenatal care for this population. Midwife-led care is widely recognized for its holistic and personalized approach, which is particularly valuable for adolescent mothers. Psychoeducational interventions, enhancements have shown promise in reducing psychological distress and improving well-being among pregnant adolescents. However, evidence remains limited, with few randomized controlled trials evaluating the impact of these interventions when delivered as part of routine childbirth preparation classes. This study aimed to assess the effect of a midwife-led psychoeducational life skills intervention, incorporated into routine childbirth preparation classes, on pregnancy-related anxiety, stress, depression, and perceived social support in pregnant adolescents. This randomized controlled trial involved 90 pregnant adolescents recruited from health centers, with 45 participants assigned to the intervention group and 45 to the control group. The intervention group received ten structured psychoeducational sessions focusing on life skills, delivered by a trained instructor alongside standard childbirth preparation classes. The control group received only routine prenatal education. The control group received routine care only. Outcome assessors were blinded to group allocation. Primary outcomes were pregnancy-related anxiety, perceived stress, and depression; the secondary outcome was perceived social support. Data were collected using validated self-report measures at three time points: baseline (pre-intervention), immediately post-intervention, and one month after the intervention. Statistical analyses were performed using SPSS version 22, including repeated-measures analysis of variance (ANOVA), independent t-tests, and chi-square tests. Ethical approval: IR.AJUMS.REC.1402.140. Trial registration: IRCT20190129042544N1 (26 June 2023). Compared with controls, the intervention group demonstrated significant reductions in anxiety (η² = 0.32, p  < 0.001), perceived stress (η² = 0.29, p  < 0.001), and depression (η² = 0.31, p  < 0.001). Perceived social support increased within both groups, but between-group differences were not significant ( p  = 0.238). The group × time interaction was statistically significant for anxiety, stress, and depression, compared with the control group, and this effect was maintained at both the 1-month and 3-month follow-up assessments, indicating the sustained efficacy of the midwife-led psychoeducational life skills program. The integration of a psychoeducational life skills program into routine midwife-led antenatal education proved effective in improving the psychological well-being of pregnant adolescents, as evidenced by significant reductions in anxiety, stress, and depression. These findings support the inclusion of structured psychoeducational interventions in adolescent maternity care services to promote mental health during pregnancy. While both the intervention and control groups experienced increased perceived social support, the lack of a significant between-group difference suggests that additional or alternative strategies may be needed to further enhance social support outcomes in this population. Trial registration : The study protocol was prospectively registered in the Iranian Registry for Randomized Controlled Trials on 26 June 2023 (registration number: IRCT20190129042544N1), and participant recruitment began on October 1, 2024.

The purpose of this explanatory sequential mixed methods study was to examine parenting outcomes and experiences over time among marginalized adolescent mothers enrolled in randomized clinical trials (RCT) between 2002 and 2016 testing Minding the Baby® (MTB), an early home visiting program. The quantitative phase examined associations between measures of maternal experiences and parenting outcomes from 71 participants 2–8 years since RCT completion. MTB mothers reported less hostile parenting and fewer child behavior problems. The sequential qualitative phase involved interviews with a subsample ( n = 31) and revealed six themes about their personal and parenting maturation. Through integration of quantitative and qualitative data, we generated metainferences, revealing a nuanced understanding of participants’ experiences. Integrated findings revealed the complex personal and parenting experiences among former adolescent mothers during their developmental phases of emerging and early adulthood. Findings inform clinical and research approaches to promote personal growth and positive parenting outcomes over time among women who began childbearing in adolescence.

Health care providers are a trusted and accurate source of sexual health information for most adolescents, and clinical guidelines recommend that all youth receive comprehensive, confidential sexual health information and services. However, these guidelines are followed inconsistently. Providers often lack the time, comfort, and skills to provide patient-centered comprehensive contraceptive counseling and services. There are significant disparities in the provision of sexual health services for Latino adolescents, which contribute to disproportionately higher rates of teenage pregnancy. To address this, we developed Health-E You or Salud iTu in Spanish, an evidence-informed mobile health (mHealth) app, to provide interactive, individually tailored sexual health information and contraception decision support for English and Spanish speakers. It is designed to be used in conjunction with a clinical encounter to increase access to patient-centered contraceptive information and services for adolescents at risk of pregnancy. Based on user input, the app provides tailored contraceptive recommendations and asks the youth to indicate what methods they are most interested in. This information is shared with the provider before the in-person visit. The app is designed to prepare youth for the visit and acts as a clinician extender to support the delivery of health education and enhance the quality of patient-centered sexual health care. Despite the promise of this app, there is limited research on the integration of such interventions into clinical practice. This study described efforts used to support the successful adoption and implementation of the Health-E You app in clinical settings and described facilitators and barriers encountered to inform future efforts aimed at integrating mHealth interventions into clinical settings. This study was part of a larger, cluster randomized control trial to evaluate the effectiveness of Health-E You on its ability to reduce health disparities in contraceptive knowledge, access to contraceptive services, and unintended pregnancies among sexually active Latina adolescents at 18 school-based health centers (SBHCs) across Los Angeles County, California. App development and implementation were informed by the theory of diffusion of innovation, the Patient-Centered Outcomes Research Institute's principles of engagement, and iterative pilot testing with adolescents and clinicians. Implementation facilitators and barriers were identified through monthly conference calls, site visits, and quarterly in-person collaborative meetings. Implementation approaches enhanced the development, adoption, and integration of Health-E You into SBHCs. Implementation challenges were also identified to improve the integration of mHealth interventions into clinical settings. This study provides important insights that can inform and improve the implementation efforts for future mHealth interventions. In particular, an implementation approach founded in a strong theoretical framework and active engagement with patient and community partners can enhance the development, adoption, and integration of mHealth technologies into clinical practice. ClinicalTrials.gov NCT02847858; https://clinicaltrials.gov/ct2/show/NCT02847858 (Archived by WebCite at http://www.webcitation.org/761yVIRTp).

Background Depression is a common and severe disorder among low-income adolescent mothers in low-and middle-income countries where resources for treatment are limited. We wished to identify factors influencing health service utilization for adolescent perinatal depression, in Nigeria to inform new strategies of care delivery. Methods Focus Group Discussions (FGDs) were conducted among purposively selected low-income young mothers (with medical histories of adolescent perinatal depression), and separately with primary care clinicians treating this condition in Ibadan, Nigeria. Participants from this community-based study were from the database of respondents who participated in a previous randomized control trial (RCT) conducted between 2014 and 2016 in 28 primary health care facilities in the 11 Local government areas in Ibadan. Semi-structured interview guides, framed by themes of the Behavioral Model for Vulnerable Populations, was developed to obtain views of participants on the factors that promote or hinder help-seeking and engagement (see additional files 1 & 2). FGDs were conducted, and saturation of themes was achieved after discussions with six groups. Transcripts were analyzed using content analysis. Results A total of 42 participants, 17 mothers (who were adolescents at the time of the RCT), and 25 care providers participated in 6 FGDs. The availability of care for perinatal depression at the primary care level was an important enabling factor in healthcare utilization for the adolescents. Perceived health benefits of treatment received for perinatal depression were strong motivation for service use. Significant stigma and negative stereotypes expressed by care providers towards adolescent pregnancy and perinatal depression were obstacles to care. However, individual patient resilience was a major enabling factor, facilitating service engagement. Providers trained in the management of perinatal depression were perceived to deliver more tolerant and supportive care that adolescent mothers valued. Conclusions Participants identified unsupportive and stigmatizing clinic environments towards pregnant and parenting adolescents as significant barriers to accessing available care. Interventions to reduce stigma among healthcare providers may improve services for this vulnerable population.

Background Pregnancy and childbirth at an early age are associated with potential risks and complications for adolescent mothers. Health practices are behaviors that can positively affect maternal and fetal health. This study aimed to investigate the effects of self-care counseling on health practices (main outcome), attitudes towards motherhood and pregnancy, and pregnancy symptoms (secondary outcomes) in adolescent pregnant women. Methods In this randomized controlled trial, 54 adolescent pregnant women admitted to the health centers of Bukan, Iran in 2020 were enrolled. Using randomized block design, the participants were randomly assigned to the counseling ( n =27) and control ( n =27) groups. Those in the intervention group attended 6 self-care group counseling sessions. The Health Practices Questionnaire-II (HPQ-II), Attitudes towards Motherhood and Pregnancy Questionnaire (PRE-MAMA), and Pregnancy Symptoms Inventory (PSI) were completed before and 4 weeks after the intervention. Results Based on the results of ANCOVA with controlled baseline values, after the intervention the mean health practices score of the participants in the intervention group was significantly higher than those in the control group (adjusted mean difference (AMD): 36.34; 95% CI: 34.69 to 37.98; P <0.001). The mean attitude towards motherhood score of the participants in the intervention group was significantly higher than those in the control group (AMD: 1.01; 95% CI: 0.06 to 1.96; P = 0.038). However, the mean pregnancy symptoms score of the participants in the intervention group was partially lower than those in the control group (AMD: -1.37; 95% CI: -4.32 to 1.58; P = 0.354). Conclusion Self-care counseling sessions can improve the health practices of adolescent pregnant women and enhance their attitudes towards maternal role and pregnancy. Therefore, planners are recommended to organize self-care counseling programs for all pregnant women, especially for adolescent pregnant women. Trial registration Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N54 . Date of registration: 2/3/2020. URL: https://en.irct.ir/user/trial/42571/view ; Date of first registration: February 3, 2020.

ObjectivesOne of Africa's most important challenges is to improve maternal and neonatal health. The identification of groups at highest risk for adverse pregnancy outcomes is important for developing and implementing targeted prevention programmes. This study assessed whether young adolescent girls constitute a group at increased risk for adverse birth outcomes among pregnant women in sub-Saharan Africa.SettingData were collected prospectively as part of a large randomised controlled clinical trial evaluating intermittent preventive treatment of malaria in pregnancy (NCT00811421—Clinical Trials.gov), conducted between September 2009 and December 2013 in Benin, Gabon, Mozambique and Tanzania.ParticipantsOf 4749 participants, pregnancy outcomes were collected for 4388 deliveries with 4183 live births including 83 multiple gestations. Of 4100 mothers with a singleton live birth delivery, 24% (975/4100) were adolescents (≤19 years of age) and 6% (248/4100) were aged ≤16 years.Primary and secondary outcome measuresPrimary outcomes of this predefined analysis were preterm delivery and low birth weight.ResultsThe overall prevalence of low birthweight infants and preterm delivery was 10% (371/3851) and 4% (159/3862), respectively. Mothers aged ≤16 years showed higher risk for the delivery of a low birthweight infant (OR: 1.96; 95% CI 1.35 to 2.83). Similarly, preterm delivery was associated with young maternal age (≤16 years; OR: 2.62; 95% CI 1.59 to 4.30). In a subanalysis restricted to primiparous women: preterm delivery, OR 4.28; 95% CI 2.05 to 8.93; low birth weight, OR: 1.29; 95% CI 0.82 to 2.01.ConclusionsYoung maternal age increases the risk for adverse pregnancy outcomes and it is a stronger predictor for low birth weight and preterm delivery than other established risk factors in sub-Saharan Africa. This finding highlights the need to improve adolescent reproductive health in sub-Saharan Africa.Trial registration numberNCT00811421; Post-results.

Background Adolescent pregnancy remains a critical global health issue, with the World Health Organization reporting a prevalence of 10.3%. Pregnant adolescents aged 10 to 19 face elevated risks of mental health challenges, including depression, anxiety, and stress. Despite these vulnerabilities, there is a notable lack of effective psychosocial interventions, particularly in low- and middle-income countries. This study aims to develop and evaluate a culturally tailored psychosocial support intervention to improve mental health outcomes among pregnant adolescents in Iran. Methods This mixed-methods study comprises three sequential phases. First, a qualitative study will explore the experiences and perceptions of pregnant adolescents regarding psychosocial support. Second, insights from the qualitative phase will inform the development of a targeted intervention, guided by expert consensus using the Nominal Group Technique. Third, a quantitative phase will assess the intervention’s effectiveness through a randomized controlled trial involving 84 pregnant adolescents. Key outcomes will include levels of social support, anxiety, depression, and stress, measured using validated instruments. Data collection will involve semi-structured interviews, expert panels, and pre- and post-intervention assessments. Discussion The study is expected to advance understanding of the psychosocial needs of pregnant adolescents and provide evidence for culturally sensitive interventions. The findings aim to inform clinical practice and health policy, contributing to improved mental health and overall well-being among this high-risk population. Trial registration This study has been approved by the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences (IR.AJUMS.REC.1402.140) and registered with the Iranian Registry of Clinical Trials on June 26, 2023 (IRCT20190129042544N1).

The study assessed the relationship between postpartum intimate partner violence (IPV) and postpartum health risks among young mothers over time. Data were collected from 2001 to 2005 on young women aged 14–25 attending obstetrics and gynecology clinics in two US cities. Postpartum IPV (i.e., emotional, physical, sexual) was assessed at 6 and 12 months after childbirth (n = 734). Four types of postpartum IPV patterns were examined: emerged IPV, dissipated IPV, repeated IPV, and no IPV. Emerged IPV occurred at 12 months postpartum, not 6 months postpartum. Dissipated IPV occurred at 6 months postpartum, not 12 months postpartum. Repeated IPV was reported at 6 months and 12 months postpartum. Postpartum health risks studied at both time points were perceived stress, depression, fear of condom negotiation, condom use, infant sleeping problems, and parental stress. Repeated measures analysis of covariance was used. The proportion of young mothers reporting IPV after childbirth increased from 17.9 % at 6 months postpartum to 25.3 % at 12 months postpartum ( P  < 0.001). Emerged and/or repeated postpartum IPV were associated with increased perceived stress, depression, fear of condom negotiation, and infant sleeping problems as well as decreased condom use ( P  < 0.05). Dissipated postpartum IPV was associated with decreased depression ( P  < 0.05). IPV screening and prevention programs for young mothers may reduce health risks observed in this group during the postpartum period.