6th UK and Ireland Implementation Science Research Conference 2023
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PRESENter
Mangenda Kamara
presenter biography
Mangenda is a Gender specialist and an educator; her research area for her M.Phil in Gender Studies was on the school going experiences of pregnant and mothering teenagers. She co-founded 2YoungLives, a community-based mentoring scheme for pregnant adolescents, in 2017 and became the Research Assistant for this project as part of CRIBS, a NIHR-funded global health group in 2021. She is currently studying for her PhD at the University of Sierra Leone where she will be focussing on using photovoice methodology to better understand the lived experiences of this group of young women in Sierra Leone.
background
2YoungLives is a community-based mentoring scheme for pregnant adolescents in Sierra Leone developed by community-based organisation Lifeline Nehemiah Projects (LNP) [1] after exploring contributing factors to high adolescent maternal mortality [2]. Women are trained to mentor pregnant girls to; start a small business, reconcile with families, take up maternity care and postpartum contraception, breastfeed exclusively, and re-engage in education. A pilot cluster-randomised trial is underway to assess feasibility and implementation strategies in new communities and to inform future scale-up [3].
MEthod
We discuss the strategy for meaningful and comprehensive community engagement and involvement (CEI), a core component of the 2YoungLives programme, essential for scale-up and sustainability. The strategy included three CEI visits to each intervention site: 1) introductions and paying respects to town chiefs; 2) meeting key stakeholders and conducting open community-wide meetings to share local beliefs and voice concerns; 3) identify mentors in collaboration with community stakeholders. Listening, discussing and connecting is imperative to building trusting relationships, mitigating issues which inevitably arise during implementation.
results
Important barriers were raised and discussed (i.e. cultural/ religious, historical, political), and time given for co-development of bespoke solutions. For example, in one community, mentees were reluctant to attend the government health facility for fear of a practice of reporting pregnant under-18s to the police. The LNP team engaged facility staff and community stakeholders, and invited the midwife to attend the monthly 2YoungLives meeting, building a trusting relationship and giving girls confidence to attend. There are many examples of discussions about gender-based issues such as child-marriage or FGM leading to wider socio-cultural changes to attitudes and practices beyond the 2YoungLives intervention.
Conclusion
The CEI showcased in this case-study is not a tick-box exercise but a vital component of successful implementation and sustainability with many lessons learned for others implementing complex interventions in similar contexts.