Making Data Useful, Making Data Meaningful: Participatory Evaluation in the Youth First initiative

By Jeff Desmarais, MA, Maeve Conlin, MPH, Nazmim Bhuiya, MPH

May was teen pregnancy prevention month, which is a chance to highlight the Institute for Community Health’s (ICH) partnership focusing on teen pregnancy prevention. Massachusetts has made great strides in reducing the teen birth rate in the past decade, as evidenced by 2010 community-level teen birth rate data recently released by the Massachusetts Department of Public Health. In 2010, Massachusetts teen birth rate was 17.1 per 1,000 adolescent females aged 15-19, the lowest birthrate on record, continuing the state’s downward trend. While progress has been made, strong racial and geographic disparities in teen birth rates persist among Massachusetts’ communities. These disparities must be addressed through collaborative, multilevel efforts, such as Youth First, an initiative that aims to reduce the teen birth rate in Springfield and Holyoke, two communities with some of the highest teen birth rates in Massachusetts. In 2010, Holyoke had the highest teen birth rate in the state and Springfield had the third highest.

Youth First, a 5-year CDC-funded initiative, seeks to address teen birth rate disparities through a community-wide collaborative approach to enhance access to quality sexual health education and reproductive health services. This collaboration involves the lead organizations, Massachusetts Alliance on Teen Pregnancy (MATP) and the Youth Empowerment and Adolescent Health (YEAH!) Network, as well as a host of Springfield and Holyoke-based clinical and community partners. These partners aim to mobilize the community, empower youth through engagement and enhance the quality of clinical and health education services for sexual and reproductive health.

Working in partnership as the evaluator for this initiative, ICH’s role is to facilitate data collection and help our partners utilize this data to drive program improvements and decisions. Since ICH utilizes a participatory research approach to guide the evaluation process, we are simultaneously building our partners’ capacity to collect, analyze, and interpret data for their current and future work. This data allows our partners to think about their programs’ impact—to see how their hard work is making a difference in the lives of the youth they serve and the community more broadly—and informs their services in the future.

As we reflect on this important partnership and the value it brings to the health of populations, we have several critical lessons to share as evaluators:

First, in order for data to be useful for our community partners, it must be meaningful to them. As an evaluator, you can’t assume that all partners will have an understanding of how to interpret and use data to improve their communities. Building an understanding of what data actually tells us and how it can be used to inform programs’ strengths, gaps, needs, and target populations is an important step in any partnership. Having these conversations early on in the collaboration will help you identify which capacities must be improved so that data can be collected and used effectively.

Additionally, as evaluators we must help build communities’ data collection infrastructure to enable partners to collect and use data independently, so that teen pregnancy prevention efforts can be continuously improved and sustained even after grant funding ends. With a strong data collection system in place, the partners can better understand and improve their programs and in turn, their communities.

The Youth First initiative’s multifaceted approach to teen pregnancy prevention is what makes the program distinctive. Our work as evaluators is a small but very important piece of the initiative. Erica Fletcher, Prevention Director at MATP, describes our strong partnership as a unique project element and states that ICH has been instrumental to the initiative’s planning, implementation, and ongoing quality improvement efforts. Given that May was teen pregnancy prevention month, it is an opportune time to highlight strategies and share tips with other evaluators aiming to reduce teen pregnancy.  Strong partnerships with the community and a participatory evaluation approach are key steps towards recognizing opportunities to address social, behavioral and environmental factors that impact teen pregnancy.

Special thanks to Shalini Tendulkar, ScD, ScM, and Jessica Waggett, MPH at ICH and Erica Fletcher, Ed.M. Prevention Director at the Massachusetts Alliance on Teen Pregnancy for their support and guidance. 

 

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The views expressed on the Institute for Community Health blog page are solely those of the blog post author(s), and do not necessarily reflect the views of ICH, the author’s employer or other organizations with which the author is associated.

To Shame or Not to Shame—NYC’s New Teen Pregnancy Prevention Campaign

By Nazmim Bhuiya, MPH

Doleful, doe-eyed babies plastered throughout subways and bus stops reading “I’m as twice as likely not to graduate high school because you had me as a teen”, “Dad, you’ll be paying to support me for the next 20 years”, “Honestly Mom…chances are he won’t stay with you. What happens to me?”

These are the descriptions of New York City’s (NYC's) recently launched ad campaign targeting teen pregnacy—a campaign that has sparked much discussion and controversy. The situations highlighted in the ads depict the imminent consequences of teen pregnancy “through the lens of the children.” In a city that is requiring schools to provide comprehensive sexual health education and is increasing access to birth control, I was disheartened to see that a shaming message focusing solely on the negative consequences of teen parenthood was used as an educational tool for adolescents. Teen mothers have also been dismayed by these messages. NPR recently interviewed Gloria Malone, a former teen mom who now runs the blog Teen Mom NYC. Gloria said these ads “brought back all of the insults and stereotypes and stigmas that I had to fight against in high school and everywhere else . . . And the shame and the stigma is what kept me in unhealthy situations.” Shameful, fear-inducing, negative messaging is not an effective strategy in changing behavior, and moreover, this strategy may inadvertently have adverse effects, as research on anti-smoking/anti-drinking ads for teens has illustrated.

Having worked in teen pregnancy prevention for several years now, I have seen the many layers and complexities of this public health issue. Factors contributing to particular behaviors (e.g. early sexual initiation) that may lead to teen pregnancy are multi-faceted and go beyond the individual level to the socio-ecological determinants of health. Many young people who become teen parents grow up in surroundings entrenched in poverty, violence, and a myriad of other risk factors. Some view pregnancy as the only path they are destined to take because they do not see any hope for a promising road ahead. For others, pregnancy is a way of having a family of their own and being loved— something they may not have experienced.

                                                                                      

Shameful messaging may help to avert some pregnancies, but it still does not respond to the larger issues at play. Efforts need to focus on creating a supportive environment for young people. Systems need to be in place to ensure they have the resources they need whether they decide to have a child or not. Young people need to be provided with tools to make healthy decisions and with opportunities that will empower them, cultivate their development, and reinforce their hopes. There needs to be a shift in our overall approach in addressing teen pregnancy to truly mitigate this issue.

Nazmim Bhuiya, MPH is a Research Associate II at the Institute for Community Health.

References:

1) Agrawal N, Duhachek, A. Emotional Compatibility and the Effectiveness of Antidrinking Messages: A Defensive Processing Perspective on Shame and Guilt. Journal of Marketing Research. 2010; 47(2):263-273.

2) Henriksen L, Dauphinee AL, Wang Y, Fortmann SP. Industry sponsored anti-smoking ads and adolescent reactance: test of a boomerang effect. Tob Control. 2006;15(1):13-8.

3) Snyder, LB, Blood, DJ. Caution: Alcohol advertising and the Surgeon General's alcohol warnings may have adverse effects on young adults. Journal of Applied Communication Research 1992; 20(1): 37-53.

4) Wolburg, JM. The need for new anti-smoking advertising strategies that do not provoke smoker defiance. Journal of Consumer Marketing. 2004; 21(3): 173-174.

5) New York Ads Resurrect Stereotypes For Former Teen Mom [transcript]. Weekend Edition Sunday. National Public Radio. March 24, 2013.

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The views expressed on the Institute for Community Health blog page are solely those of the blog post author(s), and do not necessarily reflect the views of ICH, the author’s employer or other organizations with which the author is associated.