Acceptability and stakeholders perspectives on feasibility of using trained psychologists and health workers to deliver school-based sexual and reproductive health services to adolescents in urban Accra, Ghana.

BACKGROUND: Adolescent sexual and reproductive health is recognized as a key developmental issue of international concern. However, adolescents' access to sexual and reproductive health (SRH) information and services is largely inadequate in sub-Saharan Africa. With increasing enrollment in schools, this could be an avenue to reach adolescents with SRH information and services. This study was therefore conducted to assess the acceptability and stakeholders' perspectives on the feasibility of using health workers and trained psychologists to provide school-based SRH services in Ghana. METHODS: Fourteen (14) focus group discussions (N = 136) were conducted; 8 among adolescents aged 12-17 years (4 boys, 4 girls groups), 4 among parents (2 males, 2 females groups) and two among mixed teacher groups. We also conducted 18 in-depth interviews with teachers, managers of schools, health workers, clinical psychologists, as well as adolescent SRH program managers in the Ghana Health Service, Ghana Education Service, UNICEF, UNESCO and National Population Council, Ghana. We audio-recorded all interviews and took field notes. Interviews were transcribed and transcripts imported into NVivo 11 for analysis using grounded theory approach to qualitative data analysis. RESULTS: Many respondents reported that it was challenging for parents and/or teachers to provide adolescents with SRH information. For this reason, they agreed that it was a good idea to have health workers and psychologists provide SRH information and services to adolescents in school. Although, there was general agreement about providing SRH services in school, many of the respondents disagreed with distribution of condoms in schools as they believed that availing condoms would encourage adolescents to experiment with sex. While majority of respondents thought it was acceptable to use psychologists and health workers to provide school-based sexual and reproductive health to adolescents, some teachers and education managers thought the implementation of such a program would oppose practical challenges. Key among the challenges were how to pay for the services that health workers and trained psychologists will render, and the availability of psychologists to cater for all schools. CONCLUSION: Stakeholders believe it is feasible and acceptable to use trained psychologists and health workers to deliver school-based SRH information and services in the Ghanaian school context. However, provisions must be made to cater for financial and other logistical considerations in the implementation of school-based SRH programs.

The Specter of Divorce: Views From Working- and Middle-Class Cohabitors.

Young Americans increasingly express apprehension about their ability to successfully manage intimate relationships. Partially in response, cohabitation has become normative over the past few decades. Little research, however, examines social class distinctions in how emerging adults perceive challenges to sustaining intimate unions. We examine cohabitors' views of divorce and how these color their sentiments regarding marriage. Data are from in-depth interviews with 122 working- and middle-class cohabitors. More than two thirds of respondents mentioned concerns with divorce. Working-class women, in particular, view marriage less favorably than do their male and middle-class counterparts, in part because they see marriage as hard to exit and are reluctant to assume restrictive gender roles. Middle-class cohabitors are more likely to have concrete wedding plans and believe that marriage signifies a greater commitment than does cohabitation. These differences in views of marriage and divorce may help explain the bifurcation of cohabitation outcomes among working- and middle-class cohabitors.