Impact of climate change on child outcomes: an evidence gap map review.

BACKGROUND: Climate change and extreme weather events significantly threaten neonatal and child health. This review aims to provide a comprehensive overview of the current evidence on the impact of climate change on child health, using the evidence gap map (EGM) to address knowledge gaps and establish a foundation for evidence-based interventions and future research. METHOD: From inception, academic databases (such as MEDLINE, EMBASE, Global Health, CINAHL and Scopus) and grey literature were systematically searched. We included climate change-related studies involving children aged 0-5 worldwide. Covidence facilitated a rigorous screening process, and we conducted a critical appraisal. Two independent reviewers handled screening and data extraction. Eligible studies underwent coding and extraction using Evidence for Policy and Practice Information (EPPI) reviewer software. The EGM was constructed using EPPI Mapper, and comprehensive findings were presented through live links and figures. RESULT: We identified 196 studies, comprising 59.2% children and 40.8% neonates, with diverse research approaches, including 94% quantitative studies. There has been a notable increase in research publications over the past 5 years. Evidence is heavily concentrated in Asia (93 studies) and Africa (47 studies). The most frequently studied exposures are those related to extreme climate events, followed by drought and floods. However, there are gaps in the study of extreme cold and storms. The significant outcomes comprised preterm birth (55 studies), low birth weight (27 studies), malnutrition (59 studies) and diarrhoeal diseases (28 studies). Evidence on mental health problems and congenital disabilities receives relatively less attention. CONCLUSION: This EGM is crucial for researchers, policymakers and practitioners. It highlights knowledge gaps and guides future research to address the evolving threats of climate change to global child health. TRIAL REGISTRATION NUMBER: INPLASY202370086.

Prevalence and risk factors of perinatal depression among mothers and fathers in Pakistan: a systematic review and meta-analysis.

Background: Perinatal mental health issues affect approximately 10% of women in high-income countries and 30% in low- or middle-income countries. This review aims to determine the prevalence of perinatal depression among mothers and fathers in Pakistan and identify associated risk factors. Methods: We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We included quantitative studies on the prevalence or incidence of maternal and paternal perinatal depression, including antenatal or postnatal depression in Pakistan, with or without associated risk factors. We performed an electronic search, dual-title/abstract and full-text screening, and data extraction. Analysis was conducted on Revman and JBI SUMARI software. The quality of the included studies was assessed with the NHLBI tool. This review updated a previously published review that included 43 studies, with the last search date of 31st May 2019, now extended to literature published up to June 30, 2023. Results: Consistent with the previous review, our analysis of 61 studies indicated a pooled prevalence of 37% (95% confidence interval (CI): 30.6-43.6) for maternal antenatal depression. Postnatal depression at different time points, revealed rates of 34.2% (95% CI: 22.7-46.7), 40.9% (95% CI: 0-97.4), and 43.1% (95% CI: 24.4-62.9) at 3, 6 and 12 months, respectively. Paternal postnatal depression was observed at 40.5% (95% CI: 14.9-69) based on two studies. Risk factors for maternal perinatal depression include multiparity, contraceptive failure, inadequate antenatal care, pregnancy-induced hypertension, previous psychiatric illness, passive smoking, drug abuse, low socio-economic status, marital problems, family hardships, recent bereavement, housing difficulties, food insecurity, husband's illiteracy, his unemployment, and being blamed for child disability. Conclusion: The findings reveal a high prevalence of perinatal depression among mothers with very limited evidence of fathers residing in Pakistan, emphasising the need for prospective studies addressing mental health challenges. Registration: This review is registered on PROSPERO (CRD42023442581).

A Concept Analysis of Maternal Resilience against Pregnancy-Related Mental Health Challenges in Low- and Middle-Income Countries.

Suicide accounts for 33% of deaths of women during the postnatal period in many low- and middle-income countries (LMICs). Resilience refers to an ability to adapt and recover from adversity or misfortune. Resilience building against mental health challenges during pregnancy and the postnatal period is critical for women to raise their child efficiently and maintain a healthy life. The exploration of maternal resilience against mental health challenges including its developmental processes and the determinants of its successful or unsuccessful cultivation among mothers during pregnancy and childbirth is of paramount importance. Understanding why a subset of mothers effectively develops resilience while others significantly struggle is critical for devising targeted interventions and support mechanisms aimed at improving maternal well-being. This inquiry not only seeks to delineate the factors that contribute to or hinder the development of resilience but also aims to inform the creation of comprehensive support systems that can bolster maternal health outcomes. This paper endeavors to present a comprehensive analysis of maternal resilience, aiming to cultivate a nuanced and profound understanding of the concept within the framework of previous traumatic events and adverse pregnancy outcomes in LMICs. The eight-step method approach proposed by Walker and Avant was utilized for this concept analysis. Several defining attributes were identified in the analysis including social adaptation, support system, optimistic approach, and mindfulness. This analysis contributes to knowledge advancement regarding maternal resilience and provides nurses and other healthcare professionals with a clear understanding of the concept of maternal resilience to help promote resilience among mothers.

Impact of climate change on maternal health outcomes: An evidence gap map review.

Climate change poses unique challenges to maternal well-being and increases complications during pregnancy and childbirth globally. This evidence gap map (EGM) aims to identify gaps in existing knowledge and areas where further research related to climate change and its impact on maternal health is required. The following databases were searched individually from inception to present: Medline, EMBASE, and Global Health via OVID; Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCOhost; Scopus; and organizational websites. In this EGM, we integrated 133 studies published in English, including qualitative, quantitative, reviews and grey literature that examined the impact of climate change on maternal health (women aged 15-45). We used Covidence to screen studies and Evidence for Policy and Practice Information (Eppi reviewer)/Eppi Mapper software to generate the EGM. Data extraction and qualitative appraisal of the studies was done using critical appraisal tools. The study protocol was registered in International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) # INPLASY202370085. Out of 133 included studies, forty seven studies were of high quality, seventy nine moderate equality and seven low quality. This EGM found notable gaps in the literature regarding the distribution of research across regions. We found significant research in North America (51) and Asia (40 studies). However, Africa and the Caribbean had fewer studies, highlighting potential disparities in research attention and resources. Moreover, while the impact of extreme heat emerged as a prominent factor impacting maternal well-being, there is a need for further investigation into other climate-related factors such as drought. Additionally, while preterm stillbirth and maternal mortality have gained attention, there is an overlook of malnutrition and food insecurity indicators that require attention in future research. The EGM identifies existing research gaps in climate change and maternal health. It emphasizes the need for global collaboration and targeted interventions to address disparities and inform climate-responsive policies.

Community Group-Based Physical Activity Programs for Immigrant Older Adults: A Systematic Realist Review.

Physical activity program interventions often lack sensitivity to the needs of older immigrant adults. The objective of this systematic realist review is to explain how, why, for whom, and under which circumstances community group-based physical activity programs work for immigrant older adults. The initial program theory was developed using prior research, team expertise, social cognitive theory, and knowledge user consultations. The program theory was tested and refined via a systematic review of the literature. Database searches were conducted in MEDLINE, EMBASE, CINAHL, Scopus, Cochrane Library, Sports Medicine and Education Index, and SPORTDiscus. A total of 22 sources of evidence met inclusion criteria and included intervention studies, systematic reviews, and a discussion paper. Intervention studies were appraised using the Mixed Methods Appraisal Tool. The final program theory constituted eight context-mechanism-outcome configurations that highlight the importance of facilitator characteristics, access to safe spaces, group dynamics, and social support. A limitation was the small number and variable quality of included evidence. Physical activity programs that target immigrant older adults must strengthen physical and psychological safety and maximize opportunities for role modeling and socialization. This research was supported by the Alberta Health Services Seniors Health Strategic Clinical Network and is registered in PROSPERO (ID#258179).

Preconception Care Interventions for Adolescents and Young Adults to Prevent Adverse Maternal and Child Health Outcomes: Protocol for an Evidence Gap Map.

BACKGROUND: Preconception is the period before a young woman or woman conceives, which draws attention to understanding how her health condition and certain risk factors affect her and her baby's health once she becomes pregnant. Adolescence and youth represent a life-course continuum between childhood and adulthood, in which the prepregnancy phase lacks sufficient research. OBJECTIVE: The aim of the study is to identify, map, and describe existing empirical evidence on preconception interventions that enhance health outcomes for adolescents, young adults, and their offspring. METHODS: We will conduct an evidence gap map (EGM) activity following the Campbell guidelines by populating searches identified from electronic databases such as MEDLINE, Embase, CINAHL, and Cochrane Library. We will include interventional studies and reviews of interventional studies that report the impact of preconception interventions for adolescents and young adults (aged 10 to 25 years) on adverse maternal, perinatal, and child health outcomes. All studies will undergo title or abstract and full-text screening on Covidence software (Veritas Health Innovation). All included studies will be coded using the Evidence for Policy and Practice Information (EPPI) Reviewer software (EPPI Centre, UCL Social Research Institute, University College London). Cochrane Risk of Bias tool 2.0 and Assessing the Methodological Quality of Systematic Reviews-2 (AMSTAR-2) tool will be used to assess the quality of the included trials and reviews. A 2D graphical EGM will be developed using the EPPI Mapper software (version 2.2.4; EPPI Centre, UCL Social Research Institute, University College London). RESULTS: This EGM exercise began in July 2023. Through electronic search, 131,031 publications were identified after deduplication, and after the full-text screening, 18 studies (124 papers) were included in the review. We plan to submit the paper to a peer-reviewed journal once it is finalized, with an expected completion date in May 2024. CONCLUSIONS: This study will facilitate the prioritization of future research and allocation of funding while also suggesting interventions that may improve maternal, perinatal, and child health outcomes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56052.

Understanding the contents and gaps in sexual and reproductive health toolkits designed for adolescence and young adults: a scoping review.

INTRODUCTION: Adolescence is a crucial stage of physical and sexual maturation and development and a period in which understanding sexual and reproductive health (SRH) is important. SRH interventions and toolkits provide a range of valuable resources and information to young people, educators, and members of the community on numerous topics, including contraception and puberty. OBJECTIVES: The usefulness and reliability of these available toolkits have not been previously studied, thus limiting our understanding of their appropriateness and contents. Hence, this scoping review aimed to synthesize the available toolkits aimed at the SRH of adolescents and young adults to understand the contents, design, and information gaps. METHODS: A systematic search was conducted of 6 medical databases and 12 gray literature sites. Sixteen toolkits published globally before May 2023 were included in our review. RESULTS: The majority of toolkits (n = 12) contained information related to general SRH knowledge and contraception, whereas only 3 contained information on teenage pregnancy. We found that aiming the toolkits toward educators and health care workers was a favorable design over targeting adolescents and young adults directly and that vulnerable youth-including LGBTQI+ (lesbian, gay, bisexual, transgender, queer or questioning, asexual or allied, intersex, and additional identities) and youth from humanitarian settings-were not well represented. CONCLUSION: We identified key gaps in the inclusion of information in a range of SRH topics, such as LGBTQI+ sexuality, teenage pregnancy, and safe abortion, in the currently available SRH toolkits and their lack of applicability in a global context. Furthermore, we provide recommendations for areas of improvement to encourage adolescents' agency in their SRH education.

Human papillomavirus vaccine coverage among immigrant adolescents in Alberta: a population-based cohort study.

BACKGROUND: Little is known about human papillomavirus (HPV) vaccination among immigrant children in Canada. We conducted a study in Alberta, Canada to assess HPV vaccine coverage among school-aged immigrant children compared with non-immigrant children. METHODS: This cohort study analysed population-based linked administrative health data to measure HPV vaccine coverage for 346 749 school-aged children, including 31 656 immigrants. Coverage was examined at 12 y of age from 2008 to 2018 for females, and from 2014 to 2018 for males and both sexes combined; vaccine series completion was considered receipt of three doses, with initiation (one or more dose) as a supplementary analysis. Multivariable logistic regression examined the association of vaccine coverage with migration status, adjusting for sociodemographic variables. RESULTS: Between 2014 and 2018, HPV vaccination coverage among immigrant children at age 12 y was significantly higher (52.58%) compared with non-immigrant children (47.41%). After controlling for place of residence, income quintile, biological sex and year, immigrant children had 1.10 greater odds (95% confidence interval 1.07 to 1.14) of receiving three doses of HPV vaccine compared with non-immigrant children. Immigrants from Asia and Africa had the highest coverage (60.25-68.78%), while immigrants from North America, Oceania and South America had the lowest coverage (39.97-48.36%). CONCLUSIONS: It is encouraging that immigrant children had higher HPV vaccine coverage compared with non-immigrants. Among immigrants, routine immunization promotion strategies should be tailored based on the country of origin.

Exploring preconception health in adolescents and young adults: Identifying risk factors and interventions to prevent adverse maternal, perinatal, and child health outcomes-A scoping review.

BACKGROUND: Preconception health provides an opportunity to examine a woman's health status and address modifiable risk factors that can impact both a woman's and her child's health once pregnant. In this review, we aimed to investigate the preconception risk factors and interventions of early pregnancy and its impact on adverse maternal, perinatal and child health outcomes. METHODS: We conducted a scoping review following the PRISMA-ScR guidelines to include relevant literature identified from electronic databases. We included reviews that studied preconception risk factors and interventions among adolescents and young adults, and their impact on maternal, perinatal, and child health outcomes. All identified studies were screened for eligibility, followed by data extraction, and descriptive and thematic analysis. FINDINGS: We identified a total of 10 reviews. The findings suggest an increase in odds of maternal anaemia and maternal deaths among young mothers (up to 17 years) and low birth weight (LBW), preterm birth, stillbirths, and neonatal and perinatal mortality among babies born to mothers up to 17 years compared to those aged 19-25 years in high-income countries. It also suggested an increase in the odds of congenital anomalies among children born to mothers aged 20-24 years. Furthermore, cancer treatment during childhood or young adulthood was associated with an increased risk of preterm birth, LBW, and stillbirths. Interventions such as youth-friendly family planning services showed a significant decrease in abortion rates. Micronutrient supplementation contributed to reducing anaemia among adolescent mothers; however, human papillomavirus (HPV) and herpes simplex virus (HSV) vaccination had little to no impact on stillbirths, ectopic pregnancies, and congenital anomalies. However, one review reported an increased risk of miscarriages among young adults associated with these vaccinations. CONCLUSION: The scoping review identified a scarcity of evidence on preconception risk factors and interventions among adolescents and young adults. This underscores the crucial need for additional research on the subject.

Use of contraceptives, empowerment and agency of adolescent girls and young women: a systematic review and meta-analysis.

INTRODUCTION: The evidence on adolescent empowerment, which involves access to personal and material resources for reproductive autonomy and economic equity, is limited. This systematic review assesses the use of contraceptives in empowering and strengthening the agency and vice versa among adolescents and young women. METHODS: We ran the searches in six electronic databases: Cochrane Database of Systematic Reviews (CDSR) and the Cochrane Central Register of Controlled Trials (CENTRAL), The Campbell Library, MEDLINE (PubMed), EMBASE, Cumulated Index to Nursing and Allied Health Literature (CINAHL) and Web of Science. The methodological quality of studies was assessed using ROBINS-I and ROB-II tools as appropriate. Meta-analysis was performed using Review Manager 5.4. RESULTS: Forty studies that assessed the impact of empowerment on contraceptive use were included. Of these, 14 were non-randomised studies for intervention (NRSIs), and the remaining 26 were randomised controlled trials (RCTs). The results from RCTs show a significant effect of the sexual and reproductive health empowerment in increasing ever use of contraception (RR 1.22; 95% CI 1.02, 1.45; n=9; I²=77%; GRADE: Very Low), and insignificant effect on unprotected sex (RR 0.97; 95% CI 0.74, 1.26; n=5; I²=86%; GRADE: Very Low) and adolescent pregnancy (RR 1.07; 95% CI 0.61, 1.87; n=3; I²=36%; GRADE: Very Low). None of the studies assessed impact of contraceptive use on empowerment. CONCLUSIONS: Empowerment of adolescents and young women certainly improves contraceptive use in the immediate or short-term period. However, more robust studies with low risk of bias, longer-term outcomes, and impact of contraceptive use on empowerment and agency-strengthening are required. To increase contraceptive use uptake, tailored policies and delivery platforms are necessary for youth in low- and middle-income countries.

Mental health outcomes beyond the post-partum period among adolescent mothers: a systematic review and meta-analysis.

Background: Adolescence is the most crucial part of life. The vulnerability of adolescent mothers is even more pronounced and can affect various health aspects. While they suffer from social and emotional stresses shortly after giving birth, the long-term effect after the post-partum period of adolescent pregnancy on the mental outcomes holds prime importance. Thus, this systematic review aims to ascertain the association between adolescent pregnancy on mental health outcomes. Methods: The search strategy was run in June 2023 on databases including PubMed, CINAHL, Scopus, Psych Info, and Embase . Quality assessment of the studies was done using the National Institute of Health (NIH)'s National Heart, Lung and Blood Institute (NHLBI) tool for observational studies. For studies that measured similar outcomes, a meta-analysis was conducted. Findings: The search strategy yielded 21 results from all databases and cross-referencing. Of these, all except for one (case-control) were cross-sectional and cohort studies. The pooled analysis found a significant association between adolescent pregnancy and depression (RR 1.34; 95% CI 1.05, 1.72, 6 studies, heterogeneity: Chi2 P 0.01; I2 = 60%); however, no association was found in anxiety (RR 1.05; 95% CI 0.26, 4.14, 2 studies; heterogeneity: Chi² P = 0.0003; I2 = 93%) and suicidal ideation (RR 3.21; 95% CI 0.17, 59.33; 3 studies; heterogeneity: Chi2 P < 0.00001; I2 = 98%). Implication: These findings suggest that the mental health needs of adolescent mothers must be addressed and innovative and effective interventions that support and address the mental health needs of adolescent mothers are needed to improve their mental health.

Digital Knowledge Translation Tools for Disseminating Sexual and Reproductive Health Information to Adolescents: Protocol for an Evidence Gap Map Review.

BACKGROUND: Digital or eHealth knowledge translation (KT) interventions have been identified as useful public health tools, particularly to advance sexual and reproductive health (SRH) among adolescents. Existing literature reviews on digital health interventions for adolescents' SRH demonstrate limitations, including shortcomings in reporting and comprehensiveness that limit the utility and trustworthiness of findings. However, there is a lack of evidence synthesis on the effectiveness of available digital or mobile health KT tools to promote SRH interventions for adolescents. OBJECTIVE: We aim to identify, map, and describe existing empirical evidence on the digital KT tools developed to improve adolescent SRH outcomes globally. METHODS: This study will be conducted using an evidence gap map (EGM) approach to address the objectives, including reviewing relevant literature and a landscape analysis of the outcomes of interest. The following electronic databases will be searched for retrieval of literature: MEDLINE (1946-present), Embase (1974-present), and Global Health (1910-present) via OVID; CINAHL (1936-present) via EBSCOhost; Scopus (1976-present); and Cochrane Library (1993-present) via Wiley. We will include only those studies that focused on adolescents aged 10-19 years and addressed SRH outcomes. We will include experimental studies (randomized or cluster randomized and nonrandomized controlled trials, including quasi-randomized, controlled before-after, and interruptive time series) and observational studies, that is, including prospective cohort and case-control studies. The experimental and observational studies will only be included in the presence of control or comparison arms. Studies with a historical control arm will be excluded. The systematic review software, Covidence (Ventas Health Innovation), will be used to screen and select the studies. Further, 2 independent reviewers will complete the first and second levels of screening of studies and any conflicts arising will be resolved by consensus between the 2 reviewers or by involving the third reviewer. We will conduct the quality assessment of all included studies using the Risk of Bias tool for randomized controlled trials and nonrandomized controlled trials, and AMSTAR2 for systematic reviews. RESULTS: Papers screening, data extraction, and synthesis will be completed by March 2024. We will use EPPI-Mapper (The International Public Policy Observatory) software to generate an online evidence map and to produce the tables and figures for the descriptive report. This EGM review will identify areas with high-quality, evidence-based digital KT tools (for immediate scale and spread) and areas where few or no KT tools exist (for targeted KT tool development and research or policy prioritization). CONCLUSIONS: This protocol focused on mapping eHealth KT tools that have been used in the literature to address SRH among adolescents. This will be the first EGM exercise to map digital KT tools to promote adolescents' SRH and will incorporate a range of published sources. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55081.

Impact of the COVID-19 pandemic on the sexual and reproductive health of adolescents in Alberta, Canada.

PURPOSE: The COVID-19 pandemic led to major service disruptions in the healthcare sector, especially regarding sexual and reproductive health services. However, the impact of the pandemic on Canadian adolescents is relatively unknown. This study aimed to investigate the impacts of the COVID-19 pandemic and associated public health measures on the sexual and reproductive health (SRH) of adolescents in Alberta, Canada. METHODS: A qualitative study using an interpretive description (ID) approach and community-based participatory research principles was conducted to capture the subjective experience and perceptions of adolescents and service providers. With the collaboration of the Adolescent Advisory Group and community partners, 18 adolescents and 15 service providers were recruited for the study through purposive sampling. Findings from the qualitative interviews were analyzed using thematic analysis. RESULTS: Three major themes emerged from the analysis: (1) COVID-19 SRH experience, (2) barriers to SRH, and (3) adolescent SRH strategies. Our findings highlight numerous barriers and challenges that prevented adolescents from accessing SRH education, products, and services. CONCLUSION: The COVID-19 pandemic had a profound impact on the SRH and the well-being of adolescents. Our study reflects the need for diverse SRH strategies to maintain continued access to SRH resources during disruptive events, such as the pandemic.

Access to sexual and reproductive health (SRH) services is a basic human right. All individuals require access to appropriate SRH services to maintain their optimal sexual and reproductive health. Adolescents require special guidance, support, and youth-friendly services in matters of SRH as they enter puberty and explore their sexual identity. However, during the COVID-19 pandemic, many health and SRH services were suspended. Access to SRH products and services became difficult due to public health restrictions, which has possible negative consequences for adolescents' SRH. The experiences of adolescents during the COVID-19 pandemic regarding their SRH are not reported in Alberta, Canada. Therefore, we explored the impacts of these public health restrictions on adolescents' SRH. We performed qualitative interviews with adolescents and SRH service providers to know their perspectives on how the pandemic influenced the SRH of adolescents. This paper provides insights into the barriers faced by adolescents while accessing SRH services during the pandemic, as well as their perceptions of digital strategies, such as mobile applications, and other recommendations for supporting SRH education and services. Based on the study findings, an adolescent-friendly mobile application will be developed to provide a virtual platform connecting adolescents to SRH educational resources, services, and support.

Mental Health of Immigrant Children and Adolescents (6-17 Years) in Canada: Evidence from the Canadian Health Measures Survey.

BACKGROUND: Studies indicate a higher prevalence of mental health problems among immigrants, but findings on immigrant children and adolescents are mixed. We sought to understand the magnitude of differences in mental health indicators between immigrant and non-immigrant children and adolescents in Canada and the influence of age, sex, household income, and household education. METHODS: We completed a secondary analysis of data from the Canadian Health Measures Survey, using a pooled estimate method to combine data from four survey cycles. A weighted logistic regression was used to estimate the unadjusted and adjusted odds ratios with 95% confidence intervals. RESULTS: We found an association between the mental health of immigrant versus non-immigrant children and adolescents (6-17 years) as it relates to emotional problems and hyperactivity. Immigrant children and adolescents had better outcomes with respect to emotional problems and hyperactivity/inattention compared to non-immigrant children and adolescents. Lower household socioeconomic status was associated with poorer mental health in children and adolescents. CONCLUSION: No significant differences in overall mental health status were evident between immigrant and non-immigrant children and adolescents in Canada but differences exist in emotional problems and hyperactivity. Sex has an influence on immigrant child mental health that varies depending on the specific mental health indicator.

Can youth-engaged research facilitate equitable access to contraception in Canada? The qualitative study protocol for the Ask Us project.

INTRODUCTION: There is little to no evidence in Canada on the barriers that youth face when accessing contraception. We seek to identify the contraception access, experiences, beliefs, attitudes, knowledge, and needs of youth in Canada, from the perspectives of youth and youth service providers. METHODS AND ANALYSIS: This prospective, mixed-methods, integrated knowledge mobilisation study, the Ask Us project, will involve a national sample of youth, healthcare and social service providers, and policy makers recruited via a novel relational mapping and outreach approach led by youth. Phase I will centre the voices of youth and their service providers through in-depth one-on-one interviews. We will explore the factors influencing youth access to contraception, theoretically guided by Levesque's Access to Care framework. Phase II will focus on the cocreation and evaluation of knowledge translation products (youth stories) with youth, service providers, and policy makers. ETHICS AND DISSEMINATION: Ethical approval was received from the University of British Columbia's Research Ethics Board (H21-01091). Full open-access publication of the work will be sought in an international peer-reviewed journal. Findings will be disseminated to youth and service providers through social media, newsletters, and communities of practice, and to policy makers through invited evidence briefs and face-to-face presentations.

Co-designing a Sexual Health App With Immigrant Adolescents: Protocol for a Qualitative Community-Based Participatory Action Research Study.

BACKGROUND: Canada is one of the world's most ethnically diverse countries, with over 7 million individuals out of a population of 38 million being born in a foreign country. Immigrant adolescents (aged 10 to 19 years) make up a substantial proportion of newcomers to Canada. Religious and cultural practices can influence adolescents' sexual attitudes and behaviors, as well as the uptake of sexual and reproductive health (SRH) services among this population. Adolescence is a time to establish lifelong healthy behaviors. Research indicates an alarming gap in adolescents' SRH knowledge, yet there is limited research on the SRH needs of immigrant adolescents in Canada. OBJECTIVE: The purpose of this study is to actively engage with immigrant adolescents to develop, implement, and evaluate a mobile health (mHealth) intervention (ie, mobile app). The interactive mobile app will aim to deliver accurate and evidence-based SRH information to adolescents. METHODS: We will use community-based participatory action research to guide our study. This research project will be conducted in 4 stages based on user-centered co-design principles. In Stage 1 (Empathize), we will recruit and convene 3 adolescent advisory groups in Edmonton, Toronto, and Vancouver. Members will be engaged as coresearchers and receive training in qualitative and quantitative methodologies, sexual health, and the social determinants of health. In Stage 2 (Define and Ideate), we will explore SRH information and service needs through focus group discussions with immigrant adolescents. In Stage 3 (Prototype), we will collaborate with mobile developers to build and iteratively design the app with support from the adolescent advisory groups. Finally, in Stage 4 (Test), we will return to focus group settings to share the app prototype, gather feedback on usability, and refine and release the app. RESULTS: Recruitment and data collection will be completed by February 2023, and mobile app development will begin in March 2023. The mHealth app will be our core output and is expected to be released in the spring of 2024. CONCLUSIONS: Our study will advance the limited knowledge base on SRH and the information needs of immigrant adolescents in Canada as well as the science underpinning participatory action research methods with immigrant adolescents. This study will address gaps by exploring SRH priorities, health information needs, and innovative strategies to improve the SRH of immigrant adolescents. Engaging adolescents throughout the study will increase their involvement in SRH care decision-making, expand efficiencies in SRH care utilization, and ultimately improve adolescents' SRH outcomes. The app we develop will be transferable to all adolescent groups, is scalable in international contexts, and simultaneously leverages significant economies of scale. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/45389.

School reintegration of children and adolescents with chronic illness from the mothers' perspective: A qualitative study.

INTRODUCTION: The diagnosis of chronic illness in childhood implies frequent hospitalizations and, consequently, the interruption of school attendance. This study aimed to understand the process of school reintegration of children and adolescents with chronic illness from the mothers' perspective. METHOD: A qualitative descriptive-exploratory study was conducted with mothers who experienced the process of school reintegration of their child or adolescent, aged between 8 and 17 years old, and diagnosed with chronic illness. The participants were recruited by convenience and interviewed at the paediatric unit of a children's hospital. Data collection was interrupted when the data set was sufficient to answer the research question. The interviews were analysed using inductive thematic analysis. The study was approved by the research ethics committee. RESULTS: Eleven interviews were conducted, 10 with mothers and one with a grandmother, who played the maternal role. Participants' age ranged between 33 and 58 years old. A theme was developed-"School reintegration under the maternal vigilance"-which encompasses four subthemes: (1) What matters? My child's health comes first; (2) How to keep in touch with the school? (3) Back to the school: Are we ready? (4) Sharing vigilance: reality and expectations. The themes highlighted a cyclical, dynamic, and subjective school reintegration process, constantly permeated by maternal vigilance. CONCLUSION: A new understanding about school reintegration was evidenced, from the perspective of mothers of children and adolescents with different chronic illnesses. Mothers and children experience a nonlinear and recurrent process of leaving and returning to school, surrounded by a lack of communication and continuity in school activities. The results of this study may assist health professionals in planning care focused on the needs of the school reintegration of this population.

Environmental scan of mobile apps for promoting sexual and reproductive health of adolescents in low- and middle-income countries.

Background: Adolescence is a period of emotional, mental, and physical change. To increase health seeking behaviors, reduce risky sexual behavior, and improve sexual and reproductive health (SRH) knowledge, adolescents require support and access to SRH services. Providing evidence-informed SRH knowledge to adolescents in low- and middle-income countries (LMICs) can be a challenge as they face unique barriers such as lack of confidentiality, fear of refusal, and stigma from cultural norms. Increasing availability of mobile apps necessitates a comprehensive evaluation of the quality and classification of these SRH mobile applications so that accurate and evidence-based information is reaching its users. Failure to provide SRH services can have damaging effects throughout their development. Objective: Provide an overview of current adolescent SRH (ASRH) mobile applications targeting adolescents in LMICs by evaluating their quality and classifying their characteristics. Methods: 21 search terms related to ASRH mobile apps was developed. These terms were searched in the Apple IOS store and Google Play stores. Inclusion and exclusion criteria were used to screen these apps. Resulting apps were assessed using the Mobile App Rating Scale (MARS) tool. Data extracted was used to rank order each app and identify any gaps in quality. Results: Search strategy yielded 2,165 mobile apps. Of these, only 8 were assessed using the MARS tool. Functionality subdomain scored highest at 4.6, while Information scored lowest at 2.5. None of the assessed apps contained information on the MARS items: Evidence base and Goals. Too Shy to Ask had the highest individual app mean score of 4.1, while e-SRHR scored lowest at 2.3. Conclusions: The goal of this study is to classify and rate the quality of mobile apps designed to promote ASRH behaviors and knowledge in LMICs. Numerous apps were reviewed and all of them failed to provide evidence-based and goal oriented SRH information. Strengths include ease of use, navigation, and gestural designs. Weaknesses include evidence base, goals, willingness to pay, customization, and interactivity. These findings can be potentially used to guide future app development and educate decision makers responsible for policy changes.

Development of an adolescent advisory group to inform sexual and reproductive health research for first- and second-generation immigrant adolescents in Canada: A community-based participatory action research study.

Background: Despite the growing evidence supporting the benefit of engaging adolescents in research, the active engagement of immigrant adolescents in research is limited. Further, when exploring the sexual and reproductive health (SRH) needs of immigrant adolescents, utilization of adolescent advisory groups is finite. This study aimed to train and evaluate engagement of an adolescent advisory group (AAG) to inform SRH needs of immigrant adolescents in Canada. Methods: Using purposive sampling, 13 AAG members were recruited into this study. Members were trained in content related to SRH needs of adolescents and various research methodologies such as conducting a scoping review and qualitative interviews with adolescent participants. After 10 months of member engagement, their experiences were evaluated to identify areas of success and areas for improvement. These data were collected using the Public and Patient Engagement Evaluation Tool, which consisted of a Likert survey and open-ended questions, and analyzed in accordance to the Patient Engagement in Research (PEIR) framework. Findings: Ten members completed the evaluation survey. Likert survey responses were primarily positive. Majority of members showed positive demonstrations regarding various components of the PEIR framework, including contributions, support, research environment, and feeling valued. Conclusion: Findings illustrated that immigrant AAGs are constructive to informing SRH research. Not only can research teams benefit, but members are also empowered. This study provided the foundation for future immigrant adolescent engagement in research and knowledge translation, and effective means of evaluating engagement by utilizing the PEIR framework.

Promoting Adolescent Sexual and Reproductive Health in North America Using Free Mobile Apps: Environmental Scan.

BACKGROUND: Neglecting adolescents' sexual and reproductive health (SRH) can affect multiple domains of development. Promoting healthy adolescent SRH is increasingly done using mobile phone apps. Providing SRH information via mobile phones can positively influence SRH outcomes including improving knowledge, reducing sexual risk behavior, and increasing the use of health services. A systematic approach to establishing and evaluating the quality of adolescent SRH mobile apps is urgently needed to rigorously evaluate whether they are a viable and effective strategy for reaching adolescents and improving adolescent SRH knowledge and behaviors in particular. OBJECTIVE: This study aimed to conduct an environmental scan to produce an inventory of adolescent SRH-specific mobile apps with descriptions of their purpose, structure, operations, and quality of evidence. METHODS: We used a literature review to develop 15 search terms for adolescent SRH-related apps in the Canadian and US Apple and Google app stores. After generating the search results, inclusion and exclusion criteria were applied. Using the remaining apps, we built an evidence table of app information, and app reviewers assessed each included app using the Mobile App Rating Scale. App assessments were then used to highlight trends between apps and identify gaps in app quality. RESULTS: In total, 2761 apps were identified by our searches, of which 1515 were duplicates. Of the 1246 remaining apps, 15 met the criteria for further assessment. Across all subdomains, on a scale of 1-5, the mean app score was 3.4/5. The Functionality subdomain had the highest mean score of 4.1/5, whereas the Engagement subdomain had the lowest score of 2.9/5. The top 4 apps were Tia: Female Health Advisor (4.7/5), Under the Stethoscope (4.2/5), Condom Credit Card (4.1/5), and Shnet (3.7/5). CONCLUSIONS: This environmental scan aimed to provide a comprehensive overview of the mobile apps developed to promote adolescent SRH knowledge and outcomes. Of the 15 mobile apps available to provide information related to adolescent SRH, few provided comprehensive, reliable, and evidence-based SRH information. Areas of strength included the apps' gestural design, performance, ease of use, and navigation. Areas of weakness included app goals, evidence base, and app customization options. These results can be used to conduct future studies evaluating the use and efficacy of mobile apps on health knowledge and behaviors and promote adolescent SRH.