Reciprocal Innovation – Chamas for Change: Adapting a community-based peer-support and health education model for pregnant and parenting adolescents in Kenya2020-08-12T12:03:46-04:00

Chamas for Change: Adapting a community-based peer-support and health education model for pregnant and parenting adolescents in Kenya

Principal Investigator Laura Ruhl, MD, MPH
International Collaborator(s)
Project Title Chamas for Change: Adapting a community-based peer-support and health education model for pregnant and parenting adolescents in Kenya
Priority Area Infant and maternal health
The Intervention This project plans to adapt a well-established Chamas community-based, peer-support and health education model based on a three-year curriculum to a new population of pregnant and parenting adolescents ages 15-19. Chamas represents a service delivery platform that is low-cost, community-run, independently sustainable, and culturally acceptable.
Key Facilitators This intervention is being piloted in Kenya with support of the public health system run by the Kenyan Ministry of Health. The Indiana CTSI is developing a program focused on reciprocal innovation that seeks to support the indentification, adaptation, implementation, and evaluation of promising interventions developed at LMIC partner sites for use in Indiana. This infrastructure provides funding and other resoruces to adapt interventions to a US context. Additional partners include international partnership between the Uasin-Gishu County Ministry of Health (MOH) and the Academic Model Providing Access to Healthcare (AMPATH) – including partners Indiana University, Moi University, Moi Teaching and Referral Hospital (MTRH) and the Rafiki Center of Excellence in Adolescent Health
Target Population The target population includes pregnant and parenting adolescents ages 15 to 19 in Uasin- Gishu County in western Kenya, specifically 10 adolescent Chamas that will have 15-20 participants each (150-200 participants total) in Uasin-Gishu County, Kenya. We will follow participants for one year to assess the feasibility and acceptability of the program and to describe participants’ antenatal, pregnancy, and early child care outcomes, as well as psychosocial and financial well-being.
Process to Implementation This intervention has not yet been implemented in Indiana but is being piloted in Kenya. If the pilot findings show positive outcomes, potential exists to apply this intervention to low resourced clinical settings in Indiana and the US. Following identification of potential pilot sites in Indiana, this intervention could be adapted and piloted for use in the US clinical context using support from the Indiana CTSI and other health partners in Indiana, e.g. State Department of Health, IU Health, Eskenazi, and other public health centers.
Key Stakeholders Stakeholders include adolescent patients, their caregivers, and Ministry of Health partners. We anticipate in transferring to the US that there would need to be similar stakeholders that would need to be engaged within the health systems.
Scaled or Transferred? Our program’s expansion to three counties with over 2,500 participating women, children and men demonstrate Chamas’ potential to serve as a highly adaptable vehicle to meet the unique needs of diverse populations and accelerate health impact at scale. We will use our findings to explore developing and adapting the Chamas model in Indiana.
Type of Research We propose a two-phased study design. In phase one, we propose to adapt an established community-based, peer-support care model known as Chamas for pregnant and parenting adolescents ages 15 to 19 in Uasin- Gishu County in western Kenya. In previous work, we showed that Chamas have a positive impact on a variety of maternal and child health outcomes. We also know, however, that pregnant and parenting adolescents face a host of complex and unique challenges that might be better addressed through more tailored Chamas that target these challenges and related needs. To adapt the Chamas model, we will employ two approaches. First, we will use FGDs with adolescents who previously participated in the Chamas program to assess how the structure and content of Chamas could better meet the particular needs of this population. Second, we will use a human centered design approach to gather the perspectives and insights from a diverse array of stakeholders on how an adolescent-focused Chamas program could leverage and be integrated with parallel adolescent health and social services. The results from FGDs and our human centered design workshops will be used to inform our adaptation of the Chamas model. In phase two, we will pilot 10 adolescent Chamas (5 in a peri-urban setting and 5 in a rural setting) for one year to assess the feasibility and acceptability of Chamas to pregnant and parenting adolescents as well as health and psychosocial outcomes. Our long-term goal is to intervene on the inequities that drive adolescent maternal and infant mortality globally, including in places such as Kenya. The Chamas model represents a service delivery platform that is low-cost, community-run, independently sustainable, and adaptable to address the needs of different populations and contexts.
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