1. After reading the article by Thomas et al., comment on where your research, or your research interests, fit into the generational framework for health disparities research. If your work is 1rst or 2nd generation, comment on how your work could lead in the future to 3rd or 4th generation work. If your work is 3rd or 4th generation, comment on what 1rst and 2nd generation work was necessary as a foundation for your current work (or current interests).
My research interest is in the sexual reproductive health and psychosocial functioning among adolescent girls and young women. My current research can be considered as second generation. I am looking at adolescent girls as a group which has been systematically isolated and has not been the focus of many health interventions. As such – adolescent girls in sub Saharan Africa experience worse outcomes when compared to adolescent boys or to other older groups. My research is looking at the role that household level factors such as food insecurity, household wealth and household functioning (including parental stress) affects sexual reproductive health and psychosocial functioning among adolescent girls.
I found the reading interesting – because my project is nested within a 3rd generation level research which has been designed to improve health outcomes for adults and children under 5 years. The parent project is looking at the impact of an income generating agricultural intervention on HIV outcomes in parents and children aged <5years. It is anticipated (though not stated) that the intervention benefits will trickle down to the adolescents in the household. It is my strong argument in designing my study that this blanket type interventions which are not cognizant of the structural drivers and social determinants of poor health in adolescent girls do little to improve health outcomes for adolescent girls. As such, I am focusing on deciphering the causal and mediating pathways linking food security, household wealth and household functioning and adolescent outcomes. I am using a cluster randomized design and comparing outcomes in adolescent girls leaving in homes receiving the intervention versus those who don't using both qualitative and quantitative methods.
2. The barbershop hypertension intervention, while essentially a clinical services intervention operating at either the fence or safety-net level as described by Jones, has some engagement with the social determinants of health. What types of clinical interventions can you think of in your area of research that could similarly bridge levels of the socioecological model?
Numerous studies have demonstrated that adolescents prefer services that are “local, integrated, quick, confidential,non prejudice, hassle free and free (or inexpensive). Similar to the barbershop, we have begun experimenting with using hair salons to provide family planning and pre-exposure prophylaxis (PrEP). Moreover, salons are socialisation spaces and are often very age stratified. Unlike what I see here in America, howsalonists are often young (<30 years) and canage-identify with the targeted adolescent groups (15-24 years). By providing access to pregnancy and HIV prevention services in anonymized “safe places” like hair salons – we hope that these will help to tide over youth over the difficult transition of sexual debut experimentation and unbalanced sexual relationships and be associated with better sexual reproductive health outcomes. In addition, I recognise that adolescents are at an increased risk of HIV and pregnancy due to the multiple biological, psychological and developmental transitions including the seeking of identity. I plan to have the hair salonists be trained in peer and psychosocial counselling and to be able to support provision of discreet psychosocial counselling and mental wellness services to the adolescents. This service although recognised is not provided in the health facility. In deed,we only have 1 resident psychiatrist for a population of nearly 3million, and no trained adolescent psychologists.