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

Aim

The review aimed to expand the scope of TPI rates, associated factors and relevant interventions among ACB adolescents. The review focused on the concept of TPI which counteracts the exclusion of male involvement, a typical occurrence in the discourse regarding teen pregnancy wherein the sole focus is on girls. Considering that teen pregnancy is a global health issue, we broadened this review to include studies from North American countries including Canada.

Concept

This review focused on the concept of TPI. This concept extended beyond the concept of teen pregnancy by acknowledging the involvement of boys in the outcomes of pregnancy. A majority of literature pertaining to teen pregnancy and pregnancy prevention programmes mostly focused on girls alone,8 which is problematic; this scoping review aimed to identify all available evidence also inclusive of male involvement in the outcomes of teen pregnancy.

Methods

Design: This study is a scoping review aimed at mapping the literature and synthesising all available evidence related to teen pregnancy among ACB adolescent boys and girls. In our study, the choice of a scoping review methodology was grounded in the need to thoroughly explore the under-researched area of teen pregnancy among ACB adolescents. Scoping reviews, known for their efficacy in identifying key concepts, strengths, limitations and diverse sources of evidence, align with our goal of informing practice, policy-making and gaining a comprehensive understanding of this nuanced subject.19 This approach allowed us to delve into the socio-cultural factors shaping experiences and outcomes, contributing valuable insights to the existing knowledge base. Scoping reviews also identify gaps in a research area, which provides opportunities for future research. To increase the reliability and level of confidence in the study processes as well as to obtain public opinion on the study, an advisory board consisting of ACB healthcare providers, parents and teenagers was convened to guide the study analyses, processes and results and to provide expert advice and feedback.20

Search methods: With a broad focus of the study on the incidence, associated factors and interventions related to TPI, a scoping review was deemed to be most appropriate to analyse all available evidence. A search of PROSPERO and relevant registries revealed no ongoing literature review on this topic. Thus, the present review has been registered on open science framework. A review protocol was first developed using the Joanna Briggs Institute methodology21 and the results were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist.22

Inclusion criteria: Studies that had participants who were ACB adolescent boys and girls aged between 10 and 19 were included. Studies that had a sample of both adolescent boys and/or girls were included. Peer-reviewed studies of all research designs and non-peer-reviewed literature from 2010 to 2023 were included to account for all available evidence. All types of settings such as health clinics, schools and support groups were included to allow for a variable sample. A total of five pertinent health literature databases were searched: Ovid Medline, Ovid Embase, CINAHL, CAB Direct and Google Scholar.) In consultation with a reference librarian, a search strategy was developed based on a combination of relevant keywords, MeSH terms and subject headings (see an example with CINAHL search, provided in online supplemental appendix A – supplemental material 1). The search was first conducted on CINAHL, and subsequently replicated and modified for other databases.

Exclusion criteria: Since there are many different intersecting areas of adolescent sexual and reproductive health, such as sexually transmitted infections (STIs), unsafe abortions and unwanted pregnancies,23 studies whose primary outcome was not teen pregnancy were excluded. Studies published before 2010 were excluded to limit outdated evidence. Studies conducted outside North America were excluded. Finally, studies that included a mixture of races and had a sample that comprised less than 50% of ACB participants were excluded, except such studies that presented separate findings for each race such that specific information on the ACB sample could be easily identified. Similarly, studies involving different age groups (eg, young adults and youths) were excluded if their data analyses and results were not done separately for the different age groups, and the results for our desired age range could not be easily gleaned out.

Study selection: Articles retrieved from the database search were imported into Covidence, which is a software that supports article screening and full-text reviews.24 A team of four independent reviewers conducted a two-step screening process for the retrieved articles. Initially, the title and abstract of the records were screened, leading to the removal of ineligible articles. Subsequently, the full text of the remaining articles underwent a thorough review based on predetermined inclusion and exclusion criteria. Eligible studies from this process were then included in the final analysis of the results. Additionally, the PRISMA-ScR flow chart for scoping reviews and meta-analysis was used as the preferred reporting tool for the results and items identified in the articles.

Quality appraisal: The quality of evidence in this scoping review was assessed methodologically. Our methodological approach involved a thorough quality assessment for both qualitative and quantitative studies to ensure robust and valid findings. For quantitative studies, we focused on internal validity aspects such as study design and blinding, while also considering external validity factors like population characteristics and cultural nuances. In the case of qualitative studies, we employed a nuanced assessment, considering factors such as credibility, dependability and transferability. Credibility was ensured by aligning researchers’ interpretations with participants’ perspectives while dependability was maintained through a logical research process. Transferability considerations gauged the relevance of findings to different contexts. To avoid the risk of bias in data selection, inclusion, exclusion and extraction, study articles and titles were screened independently by two or more reviewers. Likewise, full-text citations were critically assessed by two independent reviewers for inclusion and notes were written under history in COVIDENCE with rationales for articles that were excluded. In cases where there were disagreements or conflicts about an article(s) by two reviewers, the conflict was resolved by a third reviewer. Further, discrepancies after full-text reviews were resolved through discussions with other reviewers. This thorough process of inclusion and exclusion was to ensure that all extracted studies were valid and that there was consistency in the review process. Further, the use of the advisory board to provide feedback and critical thoughts on study findings promotes the quality and reliability of the study.20 25

Data extraction and synthesis: Following the full-text review, a data extraction form was developed by the principal author and categorised into variables corresponding to the research question such as concept, participants, study methods, associated barriers and facilitators, interventions, implications, strengths, and limitations of the study (see online supplemental appendix B – supplementary material 2). Four independent reviewers completed a thorough review of the 32 articles to extract and capture the data into the form based on the variables. If there was ambiguity or conflict regarding the extracted data, the review authors held a discussion and subsequently refined the extracted data based on the decision made.

The study methodology and results were aligned with the PRISMA-ScR checklist (see online supplemental appendix C – supplementary material 3). The processes of screening and selection of relevant studies are presented in online supplemental figure 1. Using the SEM, the associated factors and barriers are summarised in a concept diagram. The interventions were summarised by themes based on the targeted risk factor or behaviour being promoted. Finally, on data analysis, the implications and significance of the results as well as any identified knowledge gaps are discussed and reported.

Scoping review limitations: While scoping reviews provide a comprehensive overview, potential limitations arise due to the diverse inclusion of study designs. Our review on teen pregnancy among ACB adolescents included various research methodologies, potentially impacting the consistency of methodological rigour. The broad inclusion of settings and North American countries introduced contextual variability, impacting the generalisability of findings. The expansive age range (10–19 years) acknowledged adolescence’s diversity but may lead to heterogeneity in experiences and outcomes. To address these concerns, we employed rigorous quality appraisal and involved an advisory board for diverse perspectives. Despite these efforts, readers should recognise the trade-offs in scoping reviews between inclusivity and potential variations in study quality.