Engaging Key Stakeholders

Adolescent development takes place within a complex web of family, peer, school, community, media, and broader cultural influences as well as within legislation and regulation frameworks.

Adolescents are in a rapid developmental transition period from childhood to adulthood, are particularly sensitive to their social environments. These social environment determinants are the conditions within which people are born, grow, develop, live, work, and age and determine an individual’s health seeking behaviour.

Adolescent families, peer groups, schools, and communities can either support or threaten young people’s health and well-being. Societal policies and cues, such as structural racism and media messages, can do the same. Adolescents, who are supported by their families, peers, schools and communities, are able to experience positive development during the child to adult transition, facilitating their adoption of healthy behaviours and assist to ensure a healthy and productive adult life.

Family

Families provide the primary structure within which children are born, grow, and develop, and from which adolescents transition to adult lives.

  • Adolescents who have good communication and are bonded with a caring adult (parental support) are less likely to engage in risky behaviours (7).
  • Parents who supervise and are involved with their adolescents’ activities are promoting a safe environment for them to explore opportunities.
  • The children of families living in poverty are more likely to have health conditions and poorer health status, as well as lower access to and use of health care services.
  • Health-care providers’ attitudes, knowledge, and skills foster engagement with adolescents while maintaining a level of engagement with families.

Schools

Student health, school attendance and academic achievement are linked.

  • Healthy students are more effective learners,
  • Academic success and achievement strongly predict overall adult health outcomes. Proficient academic skills are associated with lower rates of risky behaviours and higher rates of healthy behaviours
  • Graduating from high school (matriculation) leads to lower rates of health problems and risk for incarceration, as well as enhanced financial stability and socio-emotional well-being during adulthood.
  • The school social environment affects student attendance, academic achievement, engagement with learning, likelihood of graduation, social relationships, behaviour, and mental health.
  • A safe school environment (no violence or abuse) situated within a safe (non-violent, well resourced) community environment.
  • Positive peer norms at school create a healthy environment for adolescents.
  • The expansion of secondary education in many countries, particularly for girls, offers remarkable opportunities for health and wellbeing.
  • Schools provide a platform for health promotion that extends from the provision of essential knowledge for health, including comprehensive sexuality education, to maintaining lifestyles that minimise health risks.

Community

Adolescents raised in distressed communities with high rates of poverty are at increased risk of violence and a variety of negative outcomes, including poor physical and mental health, delinquency, and risky sexual behaviour.

  • Community services and resources provide support to families and schools.
  • Interventions and research methodologies must be adapted to fit the broader community context.

Media

Although not directly part of the key stakeholder’s component, social media offers important benefits to adolescents, such as exposure to health promotion, communication, education, and entertainment, but it increases risks for exposure to cyberbullying, engagement in “sexting,” and depression.

  • Digital media and broadband technologies offer outstanding new possibilities for engagement and service delivery.
  • Adolescents are biologically, emotionally, and developmentally primed for engagement beyond their families. That engagement is essential for their social and emotional development.
  • Social networking technologies have the potential to galvanise, connect, and mobilise this generation and to promote health engagement (10-13)

Legislation

Laws affect adolescents and their future health by governing both access to resources for health and protection from hazards. Some specifically address health (e.g., access to health care including effective contraception); others address health risks (e.g., consumption of alcohol, access to tobacco); and others address social determinants of health e.g., age of marriage, protection from hazardous work).

  • Legislation, policy and national guidelines can have implications on the rights, health and lives of adolescents as well as adults. These will differ from country to country.
  • Laws have profound effects on adolescent health and wellbeing.
  • Some laws protect adolescents from harms (e.g., preventing child marriage); while others could be damaging in limiting access to essential services such as contraception.

BY YOLISWA NTSEPE (MA, PhD)
ADOLESCENT PROGRAMMES MANAGER

UPDATED NOV 22, 2023

TABLE OF CONTENTS:

  1. why adolescents?
  2. where do adults fit in?
  3. research methods and designs
  4. ethical concerns with adolescents
  5. protocol development
  6. adolescent friendly site assessment
  7. adolescent peer supporters
  8. implementation frameworks
  9. standard operating procedures
  10. data collection
  11. dissemination

REFERENCES & ADDITIONAL RESOURCES:

The Role of Families in Adolescent HIV Prevention: A Review.
Perrino T, González-Soldevilla A, Pantin H, Szapocznik J. Clin Child Fam Psychol Rev. 2000;3(2):81–96.

Working with families in the era of HIV/AIDS.
Pequegnat W, Szapocznik J.  Sage; 2000. 328 p.

Factors Associated with Parent–Child Communication About HIV/AIDS in the United States and Kenya: A Cross-Cultural Comparison.
Poulsen MN, Miller KS, Lin C, Fasula A, Vandenhoudt H, Wyckoff SC, et al.  AIDS Behav [Internet]. 2010 Oct 11 [cited 2020 May 17];14(5):1083–94.
Available from: http://link.springer.com/10.1007/s10461-009-9612-4

Mother–daughter communication about sexual maturation, abstinence and unintended pregnancy: Experiences from an informal settlement in Nairobi, Kenya.
Crichton J, Ibisomi L, Gyimah SO. J Adolesc [Internet]. 2012 Feb [cited 2020 May 17];35(1):21–30.
Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140197111000698

Adolescent experiences of HIV and sexual health communication with parents and caregivers in Soweto, South Africa.
Soon CN, Kaida A, Nkala B, Dietrich J, Cescon A, Gray G, et al. SAHARA-J J Soc Asp HIV/AIDS [Internet]. 2013 Dec 9 [cited 2020 May 17];10(3–4):163–9.
Available from: http://www.tandfonline.com/doi/abs/10.1080/17290376.2014.902769

Developing family interventions for adolescent HIV prevention in South Africa.
Kuo C, Atujuna M, Mathews C, Stein DJ, Hoare J, Beardslee W, et al. AIDS Care – Psychol Socio-Medical Asp AIDS/HIV. 2016;28.

The Role of Families in Health and Behavior.
Atujuna, M., Montgomery, E.T., Hartmann M et al. AIDS Behav. 2021;

School , Supervision and Adolescent-Sensitive Clinic Care : Combination Social Protection and Reduced Unprotected Sex Among HIV-Positive Adolescents in South Africa.
Toska E, Cluver LD, Boyes ME, Isaacsohn M. 2016.

Improving lives by accelerating progress towards the UN Sustainable Development Goals for adolescents living with HIV: a prospective cohort study.
Cluver LD, Orkin FM, Campeau L, Toska E, Webb D, Carlqvist A, et al. Lancet Child Adolesc Heal. 2019;3(4):245–54.

Meet us on the phone: mobile phone programs for adolescent sexual and reproductive health in low-to-middle income countries.
Ippoliti NB, L’engle K. [cited 2021 Mar 6];
Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5240300/pdf/12978_2016_Article_276.pdf

Understanding partial protection and HIV risk and behavior following voluntary medical male circumcision rollout in Kenya.
Health Educ Res. L’Engle K, Lanham M, Loolpapit M, Oguma I. 2014 Feb;29(1):122–30.

Mobile Phone Interventions for Adolescent Sexual and Reproductive Health: A Systematic Review [Internet]. Vol. 138, REVIEW ARTICLE PEDIATRICS.
L’engle KL, Mangone ER, Parcesepe AM, Agarwal S, Ippoliti NB. 2016 [cited 2021 Mar 6].
Available from: www.aappublications.org/news

DIGITAL HEALTH Exploring the ambivalent evidence base of mobile health (mHealth): A systematic literature review on the use of mobile phones for the improvement of community health in Africa.
Krah EF, De Kruijf JG. [cited 2021 Mar 6];
Available from: https://us.sagepub.com/en-us/nam/open-access-at-sage