Evidence Review on Social and Behavior Change for Child Survival in Africa Scaling Up with Mass Media and ICT

The majority of these adolescents live in developing countries and are increasingly urbanized, facing unique challenges and opportunities for healthy and enriching lives. While adolescents share some similarities in their development and transition from adolescence to adulthood, the context in which they live can have a significant impact on their lives. Urban areas may have more infrastructure and services than rural areas, but the physical presence of these resources does not guarantee access, particularly for poor and marginalized youth. The sociocultural context surrounding urban youth is also different, both positively and negatively, influencing their behaviors and health outcomes. Adolescence is a critical period in life, during which behaviors are formed that can impact current and future health (Springer et al, 2006; Foulger et al, 2013). Efforts are needed to find effective ways to help youth make healthy choices and become capable adults who can contribute to the health, productivity, and development of future generations. Communication for Social and Behavioral Change (CCSC) is a means of inducing change through the strategic use of proven communication principles and methods to promote healthy decision-making and behavior models adapted to the needs of the target audience. The Health Communication Capacity Collaborative (HC3) conducted a document review and analysis of publications on adolescent and youth sexual and reproductive health (SRH) in urban areas to explore behavioral factors, barriers, and contextual factors, and to identify CCSC interventions targeting urban youth SRH. The results highlight promising practices and summarize lessons learned, while highlighting factors that can positively influence behavioral change among urban youth. Behavioral factors influencing youth SRH are influenced by the context in which they live and various protective and risk factors, functioning and interacting at multiple levels. At the individual level, protective factors include education, resistance to peer pressure, a strong desire to avoid pregnancy, fear of sexually transmitted infections (STIs), and good knowledge of SRH. In contrast, risks include alcohol and drug consumption, inability to negotiate, and low or lack of knowledge of SRH. At the family and social network level, protective factors for urban youth include living with at least one parent and open communication about SRH with friends, family, or partners. Risk factors include living alone, having a sister who has experienced out-of-wedlock pregnancy, and lack of communication about SRH with parents, friends, or partners. At the community level, access to reliable SRH information and the existence of a social network are protective, while access to misinformation, negative attitudes of service providers, and social isolation increase the risk of unhealthy sexual behavior. At the societal level, policies can create an environment conducive to healthy choices. Although the document review did not find a large number of information on this topic, policies can include services for youth and easy access to contraception. Risks present at the societal level include gender inequality, which hinders young women's ability to negotiate safe sexual relationships, and poverty, which marginalizes many youth and excludes them from urban benefits. A total of 29 CCSC interventions targeting behavioral change among urban youth in SRH were identified, spanning three continents: Africa, Asia, and Latin America. Most interventions were implemented in school or community contexts; four interventions were established in informal contexts. There was little variation in target groups, with most interventions limited to a specific age range or to schooled or unschooled youth. Four interventions targeted only vulnerable young women. Programs employed various approaches, including scenario-based sessions, peer education, positive modeling, a program to improve decision-making skills, and a comprehensive approach to general factors influencing adolescent urban health, such as poverty or excessive alcohol consumption. Most interventions included evaluations and analysis of results, allowing for the identification of the most promising approaches. However, intervention and evaluation methodologies varied significantly, making direct comparisons difficult. Key recommendations for program design and CCSC activities include creating an environment conducive to change, involving youth, segmenting and diversifying target audiences, and involving secondary audiences.