The role of parent-adolescent communication interventions in improving sexual and reproductive health outcomes in sub-Saharan Africa: protocol for a systematic review and meta-analysis.

Adolescents in sub-Saharan Africa face what the authors term a 'triple tragedy' of unintended pregnancies, unsafe abortion, and sexually transmitted infections including HIV, partly attributable to poor parent-adolescent communication on sexual and reproductive health.

• The paper characterizes these three outcomes as a 'triple tragedy' affecting adolescents across sub-Saharan Africa.
• Poor parent-adolescent communication on sexual and reproductive health is identified as among the reasons for these outcomes.
• Limited research evidence is noted to exist on interventions to improve parent-adolescent communication on sexual and reproductive health specifically in sub-Saharan African countries.

Parent-adolescent communication is associated with reduced adolescent engagement in risky sexual behaviours, including early sexual initiation, lower rates of teenage pregnancy, sexually transmitted infections, and increased self-efficacy in decision making.

• The paper identifies parent-adolescent communication as a recognized 'protective factor for adolescent sexual and reproductive health outcomes.'
• Specific protective associations cited include reduced early sexual initiation, lower teenage pregnancy rates, reduced STIs, and increased self-efficacy.
• These associations are drawn from existing research cited in the background section, not from original data collected in this protocol paper.

The systematic review protocol specifies a search strategy spanning literature published from January 1990 up to and including February 2024 across multiple databases.

• Databases to be searched include PubMed, Web of Science, Scopus, African Journals Online, JSTOR, Directory of Open Access Journals, and Google Scholar.
• Only articles published in the English language will be included.
• Experimental, quasi-experimental, and observational study designs will be included.
• Two reviewers will conduct screening for titles, abstracts, and full texts, with a third reviewer arbitrating in cases of disagreement.

The review protocol specifies primary outcomes focused on adolescent sexual behaviour and reproductive health, including sexual initiation, condom and contraceptive use, risky sexual behaviours, and teenage pregnancy rates.

• The four specified outcomes are: initiation of sexual activity, use of condoms and contraceptives, reduced risky sexual behaviours such as unprotected sex, and lower rates of teenage pregnancy.
• A data extraction tool based on Microsoft Excel will be used to extract data items from included studies.
• Effect sizes will be reported as weighted mean differences for continuous data or as odds ratios for binary data, presented as proportions with 95% confidence intervals.

The protocol specifies use of a random effects model for meta-analysis to account for expected considerable variability across study designs.

• The authors justify the random effects model by stating they 'expect considerable variability across study designs.'
• This approach 'will provide an average effect size that accounts for variability of results within studies.'
• Sensitivity analysis will also be conducted to assess the robustness of the findings or conclusions of the meta-analysis.
• When feasible, articles will be combined for statistical meta-analysis, and findings will be reported according to PRISMA guidelines.
• The protocol is registered with PROSPERO under registration number CRD42024525191, registered on 27/03/2024.