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Reproductive Health volume 16Article : Cite this article.

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Metrics details. Communication on sexuality within the family has been considered a determinant factor for the sexual behaviour of young women, contributing to delaying sexual initiation. Taking into that young women are increasingly exposed to sexualized messages, they need clear, trustful and open communication on sexuality more than ever. However, in Mozambique, communication about sexuality is hampered by strict social norms.

This paper evaluates the case of an intervention aimed at reducing the generational barrier for talking about sexuality and to contribute to better communication within the family context. The intervention consisted of three weekly one-hour coached sessions in which female adults and young interacted about sexuality.

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Realist evaluation was used as a framework to assess context, mechanisms, and outcomes of the intervention. Interviews were conducted among 13 participants of the sessions. The interaction sessions were positively appreciated by the participants and contributed to change norms and attitudes towards communication on sexuality within families.

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Recognition of similarities and awareness of differences were key in the mechanisms leading to these outcomes. This was reinforced by the use of visual materials and the atmosphere of respect and freedom of speech that characterized the interactions. Limiting factors were related to the long-standing taboo on sexuality and existing misconceptions on sexuality education and talks about sex. By elucidating mechanisms and contextual factors our study adds knowledge on strategies to improve transgenerational communication about sexuality.

Trece participantes a las sesiones han sido entrevistadas. El reconocimiento de similitudes y la conciencia de diferencias fueron mecanismos claves para llegar a los resultados. Peer Review reports.

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Given the existence of several sources of sexualized messages, young people, especially young women need clear, trustful and open communication on sexuality issues within the household context. However, in Mozambique, culturally established norms make this difficult. This paper is about the experience of a conversation about sexuality between female adults and young implemented in one of the municipal districts of the Maputo city, in Mozambique. This experience consisted of three one-hour per week sessions of conversation between young and adult women.

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During the sessions, female adults and young women interacted about sexuality issues. The experience was classified as positive and contributed to a change in norms and attitudes about conversations on sexuality within families. Female adults and young recognized that they have similarities, but they also were aware of their differences. This aspect was important for exchanging their experiences.

The use of visual materials, respect, and freedom of speech helped the interactions. The barrier on this experience was related to taboo and beliefs in sexuality education and talks about sex. By explaining the drivers and condition under which this experience occurred, this study adds knowledge on strategies to improve conversations about sexuality between adults and young women. The communication on sexuality within the family context has been considered a determinant factor for sexual behaviour of young women [ 1234 ] since the family provides the role models and standards of sexual conduct [ 5 ].

Evidence shows that good parent-adolescent communication on sexuality delays sexual initiation [ 6789 ], and contributes to healthy decision-making related to sexuality and relationships [ 1011 ]. Young women are increasingly exposed to sexualized messages from peers, media, television soap operaand the internet. Consequently, they need a clear, trustful and open communication on sexuality.

However, studies in East-African countries have shown that communication on sexuality issues in the family context between adults and adolescents is almost inexistent [ 1213 ].

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If any, the messages about sexuality are usually based on fear, which may discourage adolescents from asking for information [ 1213 ]. A variety of factors hinder sexuality communication between parents and adolescents: gender differences, level of education, religion [ 1415 ], traditional norms which establish who can and cannot provide information about sexuality to young women [ 12141617 ], and the fear of the parents to make young women curious and push them to premarital sex [ 121618192021 ]. Several interventions have been implemented in order to overcome those obstacles.

An intervention to stimulate improved household sexual communication in rural South Africa led to improved communication on sexuality within families and a content shift from vague to concrete messages on sexuality [ 22 ]. Also, an assessment of a one-year-intervention about Families Matter Program FMPdeed to improve parent-child communication about sexual risk reduction and parenting skills in rural Western Kenya demonstrated a more positive attitude of parents regarding sexuality education, a reinforcement of the level of parental monitoring and an improved relationship between parents and adolescents [ 23 ].

However, this intervention targets adolescents and youths outside their family context and does not focus on promoting intergenerational communication on sexuality. Thus, there is a need to know how sex dialogue between adolescents and adults could be improved in Mozambique. This paper describes the evaluation of an intervention promoting communication about sexuality between female adults and young women, implemented in Maxaquene A, Maputo. The intervention was based on the hypothesis that coached interaction between adults and adolescents reduces generational barriers for talking about sexuality and contributes to better communication within families.

Adult and young women communication on sexuality: a pilot intervention in maputo-mozambique

This intervention study was implemented within a broader research project on Pregnancy during Adolescence and youth: analysis of the factors influencing abortion decision-making and utilization of reproductive health services in Maputo and Quelimane cities, Mozambique. Almost all households had access to piped water and electricity. However, the quality of housing was poor. The main source of income for the households is small businesses such as selling food, water, vegetables, and other basic need products, near their residences or at the local informal market.

The intervention aims at changing behaviours, namely improving communication on sexuality within families. Behavioural change theories identify precursors of behavioural change. Evidence shows that health promoting interventions are more efficient when based on behavioural theories [ 28 ]. Theory of Planned Behaviour TPB focuses on theoretical constructs related motivational factors that determinants of the likelihood of performing a specific behaviour.

According to the TPB, behaviours are determined by norms, attitudes and perceived behaviour control [ 3233 ]. In our case, factors that inhibit open communication on sexuality within families are, amongst others, the attitude that talking about sexuality drives adolescents to sexual intercourse, the norm that adolescents should not talk about intimate things with parents; and the perceived inability to use direct language [ 18 ].

Adult and young women communication on sexuality: a pilot intervention in maputo-mozambique

TPB focuses on individual factors influencing behaviour. However, ones behaviour highly depends on the perception of the existence of others which can or cannot approve certain conduct. Therefore we added to the concepts of TPB the assumption that interpersonal interaction is the main driver for changing norms, attitudes and perceived behaviour control [ 34 ]. Identification of the participants was made through the focal point of health in the referred Municipal District. This focal point was responsible for displaying the information about the intervention among the community members, encouraging them to freely participate.

In order to improve the exchange of sensitive experiences between women of different age, the sessions were facilitated by both a female adult and a young women. Relatives in the first degree were excluded from participating together in the sessions with the purpose of creating a safe environment to talk freely about sexual health issues.

This decision does not disregard the important role that family plays regarding social norms related to sexuality as we recognize the African perspective of extended family. This means that members of the extended family or community take responsibility for young individuals [ 3536 ].

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In Africa, sexuality is discussed with grandmother, aunt or other adults from the community, which constitutes the extended family. Among young women three were mothers, three did not complete primary school, and three were attending secondary school. From adult women, all were mothers, four of them had only attended primary school, four completed or were attending secondary school, and three were mothers of adolescents. Most of the participants earned their living through small businesses such as selling products at an informal market or near their residences.

Four women were activists working with HIV positive children. In the first session, participants interacted about puberty, starting by sharing experiences on how and what is said to children and adolescents about the transformations in this period. The second session focused on dating-related risks by exploring the perceptions about the best time to talk about dating, the role of parents, and the consequences of dating without information about the precautions to take.

The third session focused on teenage pregnancy discussing amongst others about consequences, the role of the parents in preventing pregnancy, and how to cope with early pregnancy.

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The central point in the sessions was the reflection on communication between adults and adolescents and within families. The sessions and interviews were held in two languages, namely Portuguese and Cichangana local language. The sessions were facilitated by one female adult the main researcher MF and one young woman a researcher assistant. Attitudes, knowledge, norms, and beliefs were shared between participants, with each participant trying to explain the real situation in their families and communities.

The researcher and the research assistant observed and recorded the sessions for later analysis.

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Realist evaluation was used as a method to identify the mechanisms through which the implementation of the intervention contributed to improved communication on sexuality. The aim was to understand how, why, for whom, and under what circumstances an intervention worked. This approach allows the extrapolation of the across different situations as it aims at formulating plausible explanations and conditions on how the intervention might work.

The evaluator hypothesizes in advance the program theory, including mechanisms that are likely to operate, the contexts in which they might operate, and the expected outcomes [ 37383940 ].

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Data were collected through 13 in-depth interviews with participants selected from the intervention group. Of those six were young women ages 15—24and seven were female adults. Three refused to participate in the interviews. We are unsure about the reason for the refusal. The interviews occurred 1 week after the last session.

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The interviews guideline was initially based on the above-mentioned mechanisms from the evaluation theory and was adapted organically during the data collection process. Then, the interviews were audio-recorded and transcribed. Transcripts were imported into NVivo We conducted interviews in both Cichangana and Portuguese languages.

Interviews in local language were translated into Portuguese, and then all were translated into English.

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The first author structured the data following the context-mechanism-outcome CMO of the realist evaluation approach and the constructs of the Theory of Planned Behaviour [ 3233 ]. The codes were extensively discussed with the other authors. Critical realist grounded theory was used as a methodology for the generation of new underlying mechanisms [ 41 ].

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