Sexual and reproductive health communication between parents and high school adolescents in vientiane capital, 2019

MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH and MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH VISANY VONGSAVANH H P Sexual and reproductive health communication U between parents and high school adolescents in Vientiane Capital, 2019 H MASTER OF PUBLIC HEALTH CODE: 8720701 HANOI, 2019 MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH and MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH VISANY VONGSAVANH H P Sexual and reproductive health communication between parents and high school adolescents in U Vientiane Capital, 2019 H MASTER OF PUBLIC HEALTH CODE: 8720701 Lao supervisor Vietnam supervisor Dr Vanphanom Sychareun Assoc Prof Vu Thi Hoang Lan HANOI, 2019 i ACKNOWLEDGEMENTS This independent study would not have been possible without the help and support of many people I am very thankful to the Ministry of Health of the Lao PDR and the LEARN project for funding my studies at the University of Health Science in Laos and Hanoi University of Public Health in Vietnam The help of the Health Personnel Department, Ministry of Health is also gratefully acknowledged for the leave granted to me to study at University of health science in Laos and Hanoi University of Public Health in Vietnam H P I would like to thank my thesis advisor Dr Vanphanom Sychareun, Dean, Faculty of Public Health in the University of Health Sciences and Assoc Prof Vu Thi Hoang Lan, Head, Faculty of Fundamental Science in Hanoi University of Public Health, who steered me in the right direction whenever they thought I needed it U I also would like to acknowledge the valuable comments and encouragement from the examination chair of my Independent Study Committee as well as the external member of the Independent Study Committee H I am most grateful to the directors, teachers and high school students of the Lao-Viet High School and Parkton High School who kindly agreed to help and participate in this research This study could not have been completed without their generous assistance I am grateful as well to all the lecturers, teachers and staff of the UHS and HUPH for their continuous assistance and helpful advice I would like to thank my classmates for their kindness during the period of my studies at UHS and HUPH Finally, I would like to thank my family for their love, understanding, support, and encouragement during the time I studied in Laos and Vietnam Mrs Visany Vongsavanh ii CONTENTS ACKNOWLEDGEMENTS i ABBREVIATIONS iv LIST OF TABLES v LIST OF FIGURES vii ABSTRACT viii INTRODUCTION OBJECTIVES OF STUDY CHAPTER LITERATURE REVIEW H P 1.1 Definition 1.1.1 Sexual health 1.1.2 Reproductive health 1.1.3 Adolescence 1.2 Adolescent sexual and reproductive health (ASRH) 1.2.1 Importance of SRH among adolescents U 1.2.2 Component of sexual and reproductive health 1.2.3 Adolescent-parents communication on SRH issues 1.3 Determinants of adolescent-parents communication on SRH issues 11 H 1.3.1 Predisposing factors 11 1.3.2 Reinforcing factors 15 1.3.3 Enabling factor 15 1.4 Theoretical framework 16 1.5 Conceptual framework 18 CHAPTER 20 SUBJECTS AND METHODS 20 2.1 Subjects 20 2.2 Setting and duration 20 2.3 Study design 21 2.4 Sample size 21 2.5 Sampling method 22 2.6 Data collection method 23 iii 2.7 Variables 24 2.8 Definitions, measurement and research instrument 24 2.9 Data analysis methods 27 2.10 Ethical issues 28 CHAPTER 29 RESULTS 29 3.1 Socio-demographic characteristics of students and their parents 29 3.2 Communication on SRH issues between adolescents and parents 31 3.3 Determinants of SRH communication between high school adolescents and their parents in Vientiane Capital 39 CHAPTER 46 H P DISCUSSION 46 CONCLUSION 52 RECOMENDATIONS 53 REFERENCE 54 ANNEXES 59 Annex 1: Table of definitions and measurements of variables in the study 59 U Annex 2: English version questionnaire 63 Annex 3: Information sheet and consent form (English version) 71 Annex 4: Certificate of approval 77 H Annex 5: Thesis comments 79 Annex 6: Minutes of explanation 85 iv ABBREVIATIONS AIDS Acquired immune deficiency syndrome ASRH Adolescent sexual and reproductive health HIV Human immunodeficiency virus ICPD International Conference on Population and Development LSB Lao Statistics Bureau LYU Lao People‟s Revolutionary Youth Union MOE Ministry of Education and Sports MOH Ministry of Health RH Reproductive health SDGs Sustainable Development Goals SRH Sexual reproductive health SRHR Sexual reproductive health right STDs Sexually transmitted diseases STIs Sexually transmitted infections UN United Nations UNFPA United Nations Fund for Population Assistance UNICEF United Nations Children‟s Emergency Fund WHO World Health Organization H P U H v LIST OF TABLES Table 2.1: Proportion of students selected in each grade 23 Table 3.1: Socio-demographic characteristics of students in Vientiane Capital 29 Table 3.2: Socio-demographic characteristics of their parents 30 Table 3.3: Content of SRH communication between high school adolescents and their fathers in Vientiane Capital 31 Table 3.4: Content of SRH communication between high school adolescents and their mothers in Vientiane Capital 32 Table 3.5: Communication on SRH issues between adolescents and parents in H P Vientiane Capital 33 Table 3.6: Reasons high school students did not communicate with fathers on SRH issues in Vientiane Capital, January 2019 34 Table 3.7: Reasons of high school students did not communicated with mothers on SRH issues in Vientiane Capital, January 2019 35 U Table 3.8: Attitudes towards general and SRH communication with parents 36 Table 3.9: Reasons for adolescents‟ choice of influential person to communicate with on SRH issues 37 H Table 3.10: Reasons for accessibility to SRH information sources 38 Table 3.11: Bivariate analysis of individual-demographic factors associated with SRH communication between students and parents in Vientiane Capital 39 Table 3.12: Bivariate analysis of parent demographic factors associated with SRH communication between students and parents in Vientiane Capital 40 Table 3.13: Bivariate analysis of attitudinal factors associated with SRH communication between students and their parents in Vientiane Capital 41 Table 3.14: Bivariate analysis of influential person factor associated with SRH communication between students and their parents in Vientiane Capital 42 vi Table 3.15: Bivariate analysis of resource factors associated with Sexual and RH communication between students and their parent in Vientiane Capital 43 Table 3.16: Multivariate analysis of factors associated with SRH communication between students and their parents in Vientiane Capital 44 H P H U vii LIST OF FIGURES Figure 1: Conceptual framework of SRH communication between high school adolescents and their parents in Vientiane Capital 19 Figure 2: Flow chart of sampling procedure 22 H P H U viii ABSTRACT Adolescent health has become a priority on the global health agenda with the added focus on addressing adolescent health in low and middle-income countries Many adolescents not feel comfortable discussing reproductive health with their parents However, when parents are more concerned about the values of their children, adolescents more often develop positive, healthy attitudes about themselves.The aim of this study was to describe the situation of SRH communication, and to determine the factors associated with SRH communication between high school students and their parents in Vientiane Capital This is an analytical study with a cross sectional design to collect quantitative data though a self-administered questionnaire The study population were 384 high school students H P aged 14-17 years old in Vientiane Capital were recruited in this study A multistage sampling technique was applied SRH communication in this study was recorded as the frequency with which adolescents discussed with their parents at least four topics on SRH issues during a six month period prior to the interview Data were entered and analyzed through Epi Data software version 6.0 and STATA version 14.2 Descriptive statistics were employed In addition, multiple logistic regression was applied to determine the factors U associated with dependent variables The main result was that slightly higher than one fifth of the students (21.3%) communicated with parents on SRH issues The multivariate logistic regression model H showed that male adolescents (AOR = 2.1; 95% CI : 1.2-3.5), urban school location (AOR = 0.2; 95% CI : 0.1-0.5), older age of father (AOR = 1.7; 95% CI: 1.0-2.9), positive attitudes towards general communication with parents (AOR = 2.2; 95% CI: 1.1-4.2) and accessibility to multiple SRH information sources (AOR = 5.2; 95% CI: 2.4-11.4) were significantly associated with adolescents-parents communication on SRH issues (P-value < 0.05) This study showed only a low proportion of students communicated on SRH issues with their parents Parents should focus on both male and female students equally in discussing SRH issues Policy makers should develop programs to improve SRH communication skills in all schools and encourage open discussion with family members In addition, positive attitudes of students and multiple sources of SRH information were also important factors in improving SRH communication Keywords: sexual reproductive health, communication, adolescents, Vientiane Capital 73  In the second stage, stratified random sampling is used to calculate the percentage of students in each grade level for a random number students to estimate the number of classes that will be suitable for the simple size;  In the third stage, the classes are selected by simple random sampling;  In the fourth stage, students in each class are selected by a systematic random sampling technique; Declaration by participants In participating in this study, you agree to the following declaration: “I volunteer to participate in this study as mentioned in the information sheet I am pleased to answer every single question in the questionnaire for H P 30 minutes I am assured that the data collection forms will be destroyed after the report has been completely done.” Conditions of participation Your volunteering to participate in this research project will be governed by the following conditions: U  You will be advised about the risk and inconvenience that may be involved during the research  You will be informed about the benefits you may receive from the research H  You will have the opportunity to ask about the research and its related processes  You may withdraw from the research at any time without having to give a reason and without any impact on yourself  If you agree to be a respondent, you are requested to provide written consent by signing a form  When answering the questionnaire from the researcher, you shall be under no duress  Answering the questionnaire will take about 30 minutes, beyond which there should be no physical, mental, social or economic effect on you as a result of your participation, nor will you be persuaded in any way against your principles, values or beliefs 74  If you have any questions or would like to obtain more information, you may contact the researcher Ms Visany VONGSAVANH at the University of Health Sciences, Vientiane Capital, Lao PDR or on her mobile phone at number 224 88885 at any time  If the researcher has new information regarding the benefits and/or risks or harm associated with this study, participants will be informed as soon as possible Benefits of the study This study will not be directly beneficial to you, but the results of this study will enable more understanding about parent-student communication and will be H P useful for the health sector to reduce the risky SRH behavior of adolescents in line with the SDGs for 2025 Confidentiality To keep the identities and answers of respondents confidential, the researcher will use a coding system and will explore, interpret and note all the U information obtained by herself as well as enter the data herself and with the help of an expert After the data has been analyzed and elucidated and the report has been completely done, the data collection forms will be destroyed H Research ethics contact information For questions or complaints about research ethics in this study or in general, please contact the Ethics Council at IRB HUPH, 1A Duc Thang Street, Bac Tu Liem district, Hanoi, Vietnam; email: irb@huph.edu.vn 75 Consent form (Students)  Title: Sexual and reproductive health communication between parents and high school adolescents in Vientiane Capital, 2019  Principle researcher’s name: Ms Visany Vongsavanh, MPH student English program I have been invited to participate in this research and have read the information regarding this study and the conditions of my participation in it I may ask questions of any point that I not understand or understand, and I have H P received satisfactory answers for the questions I have asked I am participating voluntarily in this study I can refuse at any time to participate in the study or withdraw my participation from the study, and I know that this decision will not in any way indict me I understand that my personal information will be protected and kept secret in the research, and I agree to be used for research and academic purposes only U I will receive one copy of the two copies of this written agreement H Name of research participants Name of the researcher Signature Date of agree (day / month/ year) Signature Date of agree (day / month/ year) 76 Consent form (Parents of students)  Title: Sexual and reproductive health communication between parents and high school adolescents in Vientiane Capital, 2019  Principle researcher’s name: Ms Visany Vongsavanh, MPH student English program By signing below, I am agreeing that my child, named , from class , may be a participant in this study I also affirm that H P I have read and understood the Participant Information Sheet for this research study Questions about my child‟s participation in this study have been answered satisfactorily I am willing for my child to take part in this study voluntarily I will receive one copy of the two copies of the written agreement U H Name of parent of student Name of the researcher Signature Date of agree (day / month/ year) Signature Date of agree (day / month/ year) 77 Annex 4: Certificate of approval H P H U 78 H P H U 79 Annex 5: Thesis comments HANOI UNIVERSITY OF PUBLIC HEALTH THESIS COMMENT FORM OF MASTER PROGRAM (For reviewer of thesis defence committee – Master Program) Sexual and reproductive health communication between parents and high school adolescents in Vientiane Capital Thesis topic: Thesis code: (Written on the right corner of thesis cover page) H P Hanoi, Date 15th May, 2019 Thesis topic has correct orientation and specialized codes (Master of public health applied science orientation/ Master of public health applied research orientation) Yes U Thesis title: Comments: The thesis is on track and in line with Master of public health - applied science track H Which part need to be edited, (if any): ……………………………………………… Need to add time of the study: 2019 Research summary: Comments: …The abstract summary all contents of the thesis… Which part need to be edited, (if any): ……………………………………………… No headings on abstract: Delete words “Introduction, objectives, method, Results” etc Introduction: Comments: ………………………………………………………………………… While there are components of SRH, in the introduction part, the author just mention about pregnancy and abortion? Which part need to be edited, (if any): ……………………………………………… Add issues on physical changes on puberty if available… Research Objectives: Comments: 80 First objective should be “to describe” instead of “to examine” Which part need to be edited, (if any): ……………………………………………… As above Literature review:  Comments: (structure and content of literature review are coherent with objectives and research topic, use updated reference and citation correctly, and other comments (if any): There is neither norm nor criteria on how often parents should communicate with adolescents? What kind of the talk? How to talk?  Factors in 1.3 are affecting factors or determinants?  Conceptual framework: Enabling factors needed to be state clearly, not “other” Which part need to be edited, (if any): … As above……………………………………… Subjects and research methods: H P Comments: (i) Subjects are suitable to objectives; (ii) Sample size and sample selection are appropriate and feasible; (iii) Variables/contents are suitable to objectives, orientation and specialized codes; (iv) Data collection is clear, feasible and appropriate with research content; (v) Data analysis and research ethic are written clearly and appropriately; (vi) Other comments (if any):  Study subject: high school grade – 12 or – 11???  2.2 Setting and duration: just state the setting (location), other description about Vientiant Capital should be moved to the end of the Literature review part  Why did you choose p = 0.5?  2.10 You should have decision numbers of ethical approvals from the HUPH and Laos committee U H Which part need to be edited, (if any): … As above …………………………………… Research results: Comments: (i) Research results are suitable with objectives, orientation and specialized codes; (ii) Research result is presented clearly and followed by objectives; (iii) Using data analysis appropriately and ensuring confidence of these methods; and other comments (if any):  Page 37: Attitudes of students does not fit with any of two objectives  Table 3.8 and 3.9: not BOLD number and percentage Which part need to be edited, (if any): ………………………………………………… As above Discussion: Comments: (i) Structure/Content of this part are suitable to objective and research results; (ii) Reference citation is correct: ………………………………………………… Poor discussion 81 Do not repeat results; add more part to discuss about similarity and/or differences with other studies Which part need to be edited, (if any): ………………………………………………… …As above… 10 Conclusion: Comments: (The main research result are given in this part and suitable to objectives) Conclude shortly about two objectives, not add discussion or recommendations in this part… Which part need to be edited, (if any): ……………………………………………… As above 11 Recommendations Comments: The recommendation is given appropriately and based on research results: No comment………… H P Which part need to be edited, (if any): ………………………………………………… 12 FINAL CONCLUSION: (NEED TO BE CLEARLY STATE): [ ] Approval [ x ] Approval with some conditions [ ] Reject Revise as recommended especially Discussion………… (Notes: Please not WRITE your name because this is a hidden comment round) H U Reviewer Nguyên Ngọc Bich 82 HANOI UNIVERSITY OF PUBLIC HEALTH THESIS COMMENT FORM OF MASTER PROGRAM (For reviewer of thesis defence committee – Master Program) Thesis topic: Sexual and reproductive health communication between parents and high school adolescents in Vientiane Capital Thesis code: (Written on the right corner of thesis cover page) Public Health H P Vientiane, 09/05/ 2019 13 Thesis topic has correct orientation and specialized codes (Master of public health applied science orientation/ Master of public health applied research orientation) Yes U 14 Thesis topic: Comments None Which part needs to be edited, (if any): None H Research summary: Comments: The study design is not descriptive, cross sectional Which part need to be edited, (if any): Change the design to be analytical study design 15 Introduction: Comments: Researcher doesn‟t mention about the significant of the problem, why she/he needs to study this issue Which part needs to be edited, (if any): The researcher should describe more about why she/he needs to study this issue especially in Vientiane Capital, what is the problem related to this issue in Vientiane, etc 16 Research Objectives: Comments 83 The word “situation “in the 1st objective is not clear what the research would like to examine Which part need to be edited, (if any): the researcher should define the word situation in some where 17 Literature review: Comments: (structure and content of literature review are coherent with objectives and research topic, use updated reference and citation correctly, and other comments (if any): None Which part needs to be edited, (if any): The definition of variables should be added after the conceptual framework in order to understand the meaning of the variables using Subjects and research methods: Comments: (i) Subjects are suitable to objectives; (ii) Sample size and sample selection are appropriate and feasible; (iii) Variables/contents are suitable to objectives, orientation and specialized codes; (iv) Data collection is clear, feasible and appropriate with research content; (v) Data analysis and research ethic are written clearly and appropriately; (vi) Other comments (if any): H P - According to WHO categorization, adolescents are the ones aged 10 to 19 years Why does the researcher choose the study subjects aged 14-17 years? - The exclusion criteria should not be the opposite of inclusion criteria U - Since one of the objectives is to determine the factors associated, this study is not descriptive study - The sample size determination should be also using the inferential formula H Which part needs to be edited, (if any): - the researcher should explain why choose these aged group - Should consider delete the phrase “less than 14 years old and higher than 17 years olds” - the limitations and bias (2.11) should be moved to discussions part because it related the finding and how they have impact to the results Research results: Comments: (i) Research results are suitable with objectives, orientation and specialized codes; (ii) Research result is presented clearly and followed by objectives; (iii) Using data analysis appropriately and ensuring confidence of these methods; and other comments (if any): OK Which part needs to be edited, (if any): None Discussion: Comments: (i) Structure/Content of this part is suitable to objective and research results; (ii) Reference citation is correct: 84 The discussions are ok but the research should also discus about the limitations and bias that may distort the results Which part need to be edited, (if any): Add discussion about limitation and bias Conclusion: Comments: (The main research result are given in this part and suitable to objectives) The way of writing seems to be the recommendation more than the conclusion It‟s quite difficult to differentiate which one is which objective Which part need to be edited, (if any): ……………………………………………… …………………………………………………………………………………………… 18 Recommendations H P Comments: The recommendation is given appropriately and based on research results: The recommendations should base on the finding Which part need to be edited, (if any): ………………………………………………… …………………………………………………………………………………………… 19 FINAL CONCLUSION: (NEED TO BE CLEARLY STATE): [ ] Approval [ √ ] Approval with some conditions U [ ] Reject Researcher need to consider revise some point based on comments (Notes: Please not WRITE your name because this is a hidden comment round) H Reviewer Dr Chanthanom Manithip 85 Annex 6: Minutes of explanation MINISTRY OF HEALTH FORM HANOI UNIVERSITY OF PUBLIC HEALTH MINUTES OF EXPLANATION AFTER THESIS/PROPOSAL DEFENCE Full name: Mrs Visany Vongsavanh Thesis title: Sexual and reproductive health communication between parents and high school adolescents in Vientiane Capital, 2019 TT Student’s explanations detail Comments (List all comments followed by outline/dissertation/thesis/thematic structure) H P (Clearly state how, which part, page that student edits if students disagree, reasons should be indicated) Orientation and specialized codes … Thesis topic U … None Abstract … Introduction None H Introduction should be more reasonable and shorter and meaningful Objectives Add year Delete and rewrite some sentence that not related with my topic and edited shorter paragraph in the introduction part about 1.5 page (page 1-2) Add year 2019 (page 3) Review of Literature/Theoretical framework All literature review need to revise and suitable for each variable Improve and add more the literature review of previous study that suitable in each variable (page 10-15) Clear criteria of frequency need to be clear: frequent, rare, sometime Add one paragraph about the concept of SRH communication measurement (page 10) as followed: The measurement of communication frequency of this study used the scale with four level as 0=never discussion, 1=rarely= time per six months, 86 2=sometime = time per six months and 3=often=more than time per six months (Fisher, 1987; Wang, 2009) Objects and research methods Education structure should be showed in Lao context: Lower, Upper… Attitude, item and too detail and no explanation, which content were negative or positive attitude Deleted table 3.8 and table 3.9 about attitude of students and change to new style of table 3.8 that show negative attitudes and positive attitude (page 36) The title of each table should be shorter Edited the long title change to shorter title in each table (page 29-45) Conclusions Deleted the sentence related with urban and rural perspective (page 52) Recommendations Deleted some sentence and edited some long sentences change to the short sentences (page 53) References … 13 Improved and add more discussion in every part of thesis (page 46-51) as followed: - Add introduction of discussion - More discussion of communication with father and mother - Add discussion about reason of non-communication - Edited discussion about factor association with SRH communication between adolescent-parent U H Recommendation should be shorter 12 H P Discuss Conclusion should be assumed from the study not own, should delete urban and rural perspective 11 The situation of students learning in primary education in Laos, general education was 12 years (5 in primary + in lower secondary + in upper secondary), and schooling starting at the age years old, so students age 6-10 study in grade 1-5, age 11-14 in grade 6-9 and age 15-17 in grade 10-12 (MOE, 2015) Study results Discussion need to 20-25% of total finding 10 Add the structure of primary education in Laos at setting and duration (page 20) as followed: None Questionnaire … None 87 14 Other comments Look at the comment of reviewer Done Format: follow the guideline of HUPH - The table of definition and measurement of variable move to Annex (page 57-60) - Explanation of the result in every table move to under table in the result part (page 28-44) - Deleted the research budget and research plan in Annex part English language need to be edited Done Notes: - Use lines to separate each comments and explanations Comments and equivalent explanations stay at the same row - Explanations should be written by following thesis structure (if any) Students not mention the examiners‟ name Day month year 2019 Student (Sign and full name) H P U 1st supervisor (Sign and full name) Mrs Visany Vongsavanh 2nd supervisor (Sign and full name) Supporting lecture (if any) (Sign and full name`) H Dr Vanphanom sychareun Assoc Vu Thi Hoang Lan Examiners’ comments (if any): ………………………………………………………………………………………… …… ……………………………………………………………………………………………… Day month year On behalf of the committee (Sign and full name) Dr Chengchanh Kounnavong