Teen pregnancy involvement among African, Caribbean and Black adolescent boys and girls: a scoping review protocol

Abstract

Introduction

African, Caribbean and Black (ACB) adolescents are disproportionately affected by teen pregnancy in North America. Teen pregnancy poses risks to the quality of life of adolescent boys and girls, including physical, psychosocial and socioeconomic risks. Our review aims to explore this public health concern for ACB adolescents within North America. We aim to identify and analyse available evidence on the incidence and prevalence of, associated factors of and interventions to curtail teen pregnancy involvement (TPI) among ACB adolescent boys and girls in North America. This review will explore TPI, rather than teen pregnancy, to ensure a review of men’ involvement in teen pregnancy outcomes.

Methods and analyses

Health literature databases such as CINAHL, OVID (Medline and Embase) and CAB direct. Searches will be conducted for evidence published from 2001 to October 2021. Search results will be exported to Covidence for subsequent steps of the review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review guidelines will be used to ensure reproducibility and transparency. We will include all study designs focused on ACB boys and girls between 10 and 19 years old, residing in North America. Studies with a mixed racial sample will be included if sample consists of greater than 50% ACB individuals.

Ethics and dissemination

TPI is a public health concern with socioeconomic and health consequences for ACB teens in North America. A scoping review such as this will provide direction for healthcare practice, policy changes, education and further research in reducing the incidence of TPI in North America. Study results will be disseminated via presentations at conferences, at target populations, communities and organisations and publications via peer-reviewed journals. As knowledge generated from this scoping review will stem from previously published evidence, an ethical approval is not needed

Correspondence to Dr Emmanuela Ojukwu; [email protected]

STRENGTHS AND LIMITATIONS OF THIS STUDY

• The study will be the first to review and summarise the current state of knowledge including rates, associated factors and interventions to address teen pregnancy involvement among African Caribbean and Black Adolescent boys and girls residing in predominantly White geographic locations such as North America.

• This study will provide a unique cultural perspective on ways to address issues related to adolescent pregnancy involvement for a minority population.

• This study will also offer a unique perspective by including and exploring male involvement in adolescent pregnancy outcomes; thus, the choice of term ‘teen pregnancy involvement’, rather than just ‘teen pregnancy’, which often omits male involvement in its discourse.

• The study will include the unique voices of an advisory committee (consisting of African, Caribbean and Black (ACB) healthcare providers, policymakers, researchers, knowledge users, parents and teenagers themselves) in its methodology, who will provide critical data to guide the data collection and analyses of the review processes.

• The study might be limited in generalisability to ACB adolescent boys and girls in other parts of the world as it is important to note and appreciate the diversity and heterogeneity that still exist within the African/Black culture.

Introduction

Pregnancy occurring among adolescent girls, otherwise known as adolescent pregnancy or teen pregnancy is a public health concern.¹ Teen pregnancy has been associated with detrimental health and socioeconomic outcomes, including higher incidences of rapid-repeat pregnancies, birth complications and death, postpartum depression, decreased self-esteem, poverty, low-income jobs, lower levels of education and financial dependency,^{2 3} while the WHO reports an overall decline in teen pregnancy rates by 11.6% in the last 20 years.⁴ A paucity of recent data to estimate rates for African, Caribbean and Black (ACB) adolescents exists within certain countries;⁵ and when such data are available, evidence shows significant disparities persist across countries in terms of rates, associated factors and the health and socioeconomic outcomes of teen pregnancy.^6–8 In 2010, USA teenage birth rates were nearly double (51.4%) for Black adolescents compared with White and non-Hispanic teenagers (23.6%). Similarly, abortion rates of ACB youths were triple (34.5%) those of White and non-Hispanic teenagers (8.5%).⁵ From 2018 to 2019, teen birth rates decreased by 5.2% and 5.8% in Hispanic and non-Hispanic White women between the ages of 15 and 19 years, respectively; however, only a 1.9% decrease was observed in Black women.⁸ These statistics demands a closer examination of teen pregnancy involvement (TPI) rates and their associated factors within this target population.

Scarce research is available to support ACB-specific incidences and prevalence of teen pregnancy, associated factors and available interventions to address this problem, especially in geographic locations like North America consisting of a predominantly White population and, thus, with a paucity of this information available for minority Black populations. Most pregnancy prevention programmes have focused on addressing parental involvement and the teen’s perceived social expectations of early childbearing,⁹ with only a few studies focusing on possible disparities that may exist across races and the associated factors. Available evidence acknowledges the importance of investigating the disparities in teen pregnancy problem that exists among ACB populations compared with other racial groups,^{10 11} with particular attention being paid to socioecologic factors such as the individual’s identities (eg, age, gender, etc), socioeconomic status, psychosocial vulnerabilities (eg, discrimination based on race, gender),^{10 11} among others. Furthermore, given that an apparent gap exists in the teen pregnancy discourse for adolescent men, and the ACB population. in general, the current study will focus on the concept of TPI^{12 13} for ACB populations, described as sexual activities that have resulted in pregnancy outcomes among ACB adolescent boys and girls.

Preliminary literature reviews of CAB Direct, CINAHL, OVID-Embase and OVID-MEDLINE showed a paucity of research on TPI rates for ACB adolescents in North America, with most studies originating from the USA, and little or no studies from other Northern American countries. Most identified studies had limited evidence on the adolescent men's involvement in teen pregnancy. Therefore, this scoping review focuses on three aims: (1) to provide an overview of the TPI incidence and prevalence among ACB adolescent boys and girls in North American countries published between 2010 and 2021, (2) to identify associated factors (facilitator and barriers) of TPI among ACB adolescent boys and girls and (3) to identify available interventions aimed at curtailing TPI incidence among ACB adolescent boy and girls. Given the paucity of available evidence in this area for ACB adolescents in North American countries, and male involvements, a scoping review is appropriate. Scoping reviews are appropriate to ‘identify the types of available evidence in a given field, to identify key characteristic or factors related to a concept and to identify and analyse knowledge gaps’.¹⁴

Review question

What is the current state of knowledge on the incidence, prevalence, associated factors of and interventions to mitigate TPI rates among ACB adolescent boys and girls in North America?

Eligibility criteria

Participants

This scoping review will consider peer-reviewed studies published from 2010 to 2021. The focus will be on adolescent boys and girls between the ages of 10 and 19. Therefore, participants will be adolescent men and women living in North America who identify as ACB) and have been involved in activities leading to pregnancy

Concept

The discourse on teenage or adolescent pregnancy often focuses on females alone, excluding the important roles that males play in outcomes of teen pregnancy. Research also finds that although both males and females play a role in pregnancy, most pregnancy prevention research focuses on adolescent females, with few studies focusing on both populations.¹² The Centres for Disease Prevention and Control and the United States Office of Population Affairs recommends providing pregnancy prevention services to both adolescent males and females.¹⁵ Therefore, our review would focus on the concept of TPI, which allows us to explore the important roles of adolescent boys also play in teen pregnancy outcomes. This review will focus on ACB adolescent boys and girls within North America.

Context

The scoping review will include peer-reviewed articles, prospective and retrospective cohort studies, case–control studies, descriptive observational studies, literature reviews, systematic reviews/meta-analysis and analytical cross-sectional studies that examine adolescent ACB men and women between the ages of 10 and 19 years within North America. The scoping review will also include all setting relevant to this topic, including educational institutions, community spaces, teen parent support groups, among others.

Type of sources

We will include studies of all designs (qualitative, quantitative and mixed methods) that examine TPI among ACB adolescents within North America, and grey literature including preprint conference abstracts, editorials, among others, found to be pertinent in addressing the research question. We will exclude studies not written in English, articles published before 2010 (this timeline was chosen to include more recent literature), articles whose primary focus or outcome is not teen pregnancy, studies with less than 50% ACB population, studies whose age range overlaps with our intended age range for the study (10–19) in ways that we are unable to separate out or glean results for each age group. Finally, given our focus on TPI, we will review all available evidence from studies conducted on adolescent girls, adolescent boys and/or both.

Methods

This proposed scoping review will follow the Joanna Briggs Institute methodology for scoping reviews.¹⁶ Thus, we aim to bring together a variety of study designs examining TPI for ACB adolescent boys and girls, with an intent on exploring and synthesising its broader knowledge base, identifying any research gaps and summarising the final results, which will be useful for research, education, practice and policy.¹⁷ Specifically, on the subject matter of TPI, we will explore sources focused on discussing the incidence and prevalence of TPI among ACB adolescent boys and girls in North America, the associated factors related to TPI and identify any interventions aimed at addressing this public health concern. A search on the international prospective register of systematic reviews (PROSPERO) and other relevant registries revealed no ongoing literature review on this topic. Thus, the present review has been registered on open science framework.

Search strategy

Our aim is to comprehensively explore what is known about TPI in existing literature by identifying any relevant evidence. Searches will be conducted for evidence published from 2001 to 2021. Thus, in consultation with librarians from the University of British Columbia, we will search key health literature databases, including Ovid Medline, Ovid Embase, CINAHL and CAB direct. To begin this process, we conducted a preliminary search in CINAHL to identify relevant keywords from words contained in the titles and abstracts of relevant articles. In consultation with the librarian, several other keywords were incorporated with various Boolean operators to develop the search strategy (see online supplemental appendix A). As the study progresses, the search strategy, including all identified keywords and index terms, will be adapted and replicated in all other databases we search (see online supplemental appendix B). The reference list of all selected articles will also be reviewed to identify additional sources of evidence.

Study/source of evidence selection

Following the search, all identified citations will be collated and uploaded into COVIDENCE, a software which supports systematic, scoping and literature reviews. Covidence will automatically remove all duplicates. Following the duplicate removal, titles and abstracts will then be screened by two or more independent reviewers to assess whether they meet the inclusion criteria for the review. Similarly, the full text of selected citations will be assessed in detail for inclusion two or more independent reviewers. Reasons for excluding sources of evidence in the full text will be recorded and reported in the scoping review. Articles of conflict or disagreements between two reviewers will be resolved by a third reviewer. Further disagreements or discrepancies about studies to be included after full-text reviews will be resolved through discussion and with an additional reviewer/s. The search results and article inclusion process will be reported in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review (PRISMA-ScR) in a PRISMA-ScR flow diagram.^{16 18} In addition, we will also include patient/public opinion in the conduct, reporting and dissemination of results from the scoping review.

Data extraction

Data extraction will be done using a data extraction tool (see online supplemental appendix B) and will include specific details about the concept, participants, context, study methods and key findings relevant to the review question/s.

Data analysis and presentation

The data will be collated, and presented in a tabular form, with a detailed narrative summary to describe the various concepts and how they address the objectives of the scoping review. Specifically, our results will closely follow the PRISMA extension for scoping reviews’ checklist¹⁹ to summarise available evidence on the incidence and prevalence of TPI among ACB adolescent boys and girls; the associated factors (both facilitators and barriers); and identify interventions to curtail TPI incidence among this population. The results of this scoping review will be critical to map the scope of evidence available on TPI among ACB adolescent boys and girls in North America. We will also discuss inherent implications of findings for research, education, practice and policy as applicable and identify knowledge gaps to be examined in future studies.

Patient and public involvement

The study will involve an advisory board of ACB healthcare providers, parents and teenagers who will contribute to the validity and reliability of the review processes, data analyses and results.

Ethics and dissemination

TPI is a public health concern with socioeconomic and health consequences for ACB teens in North America. A scoping review such as this will provide direction for healthcare practice, policy changes, education and further research in reducing the incidence of TPI in North America. Study results will be disseminated via presentations at conferences, at target populations, communities and organisations and publications via peer-reviewed journals. As knowledge generated from this scoping review will stem from previously published evidence, an ethical approval is not needed.

We would like to acknowledge UBC Librarian and Library Research Commons team member—Katherine Miller and Elham Esfandiari, for their assistance in refining the search strategy. Particularly, Katherine Miller, who had repeated meetings with team members to refine their searches in the various databases.

Ethics statements

Patient consent for publication

Not applicable.

Footnote

Contributors EO: conceived the idea for the scoping review and designed the protocol, performed supervisory roles, and contributed to the writing of the original draft and reviewed and edited subsequent drafts to ensure intellectual content. EB: contributed to the writing and editing of the manuscript, particularly, the methodology section. SA: contributed to writing and editing of the manuscript, particularly, the abstract and introduction sections. SS: contributed to the writing and editing of the manuscript, particularly, the introduction section. HG: contributed to writing of the keywords, eligibility criteria and editing of manuscript. ZR: contributed to writing of the keywords, eligibility criteria and editing of manuscript. EM: contributed to the writing and editing of the manuscript, particularly, the introduction section. All authors contributed to data acquisition, writing the original draft, reviewing and approving the final version for submission, based on guideline by the International Committee of Medical Journal Editors (ICMJE).

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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