Evidence Based Practice - PICO Or PS Worksheet -Teen Pregnancy/ Unexpected Pregnancy - Assessment Answer

Assignment Task

1.1Use the following categories to help define your problem and what you are looking at in simple terms

PICO: Patient/Problem, Intervention, Comparison, and Outcome. (Quantitative situation)

(remember to use your readings to help you if you are unsure)

Patient/Problem: Teen Pregnancy/ unexpected pregnancy

Intervention: School based sex education

Comparison: School based abstinence education

Outcome: Avoidance of teen pregnancy

1.2. Now use these terms from the question above to create your PICO research question so that you have a clear purpose for your search:

For teenagers, will school based sex education compared to school based abstinence education decrease the rate of teen pregnancy?

1.3. What type of question do you think this PICO answers?

Therapy

1.4. The table below will help you to think of the other terms that you might also like to look up when searching for evidence to help you answer your question – this is part of basic planning for a research search.

We ask you to look up alternative terms because sometimes articles from health systems call things different names – for example, in Australia we sometimes us the term ‘community nurses’, but in the UK they often talk about ‘district nurses’ – if you only searched under ‘district nurse’ you’d miss all the articles which used the other term – you would be missing some of the picture!

Introduction

The teenage pregnancy issue has been steadily escalating over the last few decades. Globally, the number of teenage parents is constantly rising and with this rise comes complications to both the teenage parents and the babies born. As teenage pregnancies rise, abortions also increase and this poses a grave health issue. In Australia, the number has decreased over the last few years, but the number is still worrying and needs to reduce further (Pregnancy Outcome in South Australia, 2012).

Significance of Teenage pregnancy in Australia

In Australia, pregnancy among teens is more prevalent among the indigenous communities. Statistically,out of the 25.3% teenage births, 21.3% were Indigenousteenagers as opposed to 4.2% non-indigenous. Such statics depict a bigger problem that exists among the indigenous people because they have a significantly higher teenage birth rate as compared to the rest of population (Pregnancy Outcome in South Australia, 2012).

Additionally, teenage pregnancy and abortions are closely interlinked. In 2010 for instance, 52% of pregnant teens underwent abortions. This is because some teenagers view abortion as the preferred solution for their unplanned births. Abortions have numerous health issues and could result in negative health outcomes among the teenagers like death. Abortions among indigenous teenagers are however significantly lower than abortions among the rest of Australia (Pregnancy Outcome in South Australia, 2012).

Teenage pregnancies have numerous costs on the young parents. Most girls who encounter teenage pregnancy end up leaving school prematurely. A large portion of them are not able to resume school after getting the baby, and this increases the illiteracy and low education levels in the societies. Such girls will not have career opportunities that would ensure financial stability (Jewell, Tacchi, & Donovan, 2000).

Financially, teenage parents are likely to suffer. They are not in a good financial position to take care of their children. They may also receive parental rejection which would render them either homeless or in poor housing arrangements. They may be unable to adequately care for the baby. If they do not get financial help, such parents are likely to raise children in poverty and may be unable to provide for all their needs (Udry, Talbert, & Morris, 1986).

Teenage pregnancies often create negative cycles in societies. Research suggests that children born from teenage pregnancies are likely to exhibit delinquency and have more problems with school and society than their counterparts. Consequently, such children could find themselves as teenage parent, and the cycle could keep recurring (Stier et al., 1993).

Teenage pregnancy is a negative cost to the society. Tax payer’s contributions are used to pay for programs that support teenage mothers in terms of welfare or health insurance. Teenage mothers are more likely to rely on welfare as compared to their older counterparts. This is because they are less likely to have financial stability and to have enough education qualifications to be self-sufficient (Jewell, Tacchi, & Donovan, 2000).

The likelihood of pregnancy complications among teens is higher than for older women. Such complications consist of miscarriages, stillbirths or death of birthing mothers. Due to such negative costs, stakeholders are tasked with reducing the teenage pregnancies because such costs are too high for societies (Allen & Bourke-Dowling, 1998).

Evidence Based Interventions

Due to the negative costs associated with these pregnancies, interventions have been implemented by the government and schools to reduce the pregnancy numbers and to ensure that children born from such pregnancies live a comfortable and good life. The programs also assist the teenage mothers continue with education to promote economic self-sufficiency. The interventions that are based on evidence have been highly effective in combating the rise of teenage pregnancies (Kelsey & Layzer, 2014).

In Australia, evidence-based programs have been widely applied in resolving the teen pregnancy issue. These programs are viewed as the programs that are effective based on research. To determine their effectiveness, health care professionals have to provide evidence of their effectiveness in diverse populations (Kelsey & Layzer, 2014).

While making decisions on what programs to implement, issues of program outcomes come up, and resources are usually allocated to programs that have exhibited positive changes in behaviour. For instance, if the provision of contraceptives produced positive outcomes, more resources could be allocated to it. If its outcomes are negative, they will not get resource allocations. Such programs ensure that only effective programs are continually implemented to assist in issue resolution (Baudry, 2013).

Although implementation of programs based on their effectiveness is ideal, some scholars advocate for the application of more caution in overall implementation. A program that has been totally effective in one community may totally flop in another. Some programs will not work in all communities because every community has unique characteristics and this should be factored in when developing the programs (Baudry, 2013).

Australia consists of diverse communities. If a program is effective among the urban population, it should not be assumed that the same program will work in rural and indigenous populations. This is due to cultural differences, socio-economic differences as well as religious differences. As such, programs need to be sensitive to the populations they are working with. If not, they will be resource wastages because they will not achieve any positive results (Baudry, 2013).

Support for Interventions

Sex education has been cited as an effective initiative by governments and schools. They believe that provision of adequate sexual education ensures that students are well versed with the issue of sex and can make informed decisions. Sex education has been incorporated into school’s curriculum, and as the students enter adolescents, they are introduced to sex education classes (Weaver, Smith, & Kippax, 2005).

This initiative treats information as a tool of empowering teenagers. They believe that if children are equipped with information, they will make better decisions as opposed to when they do not have sex education. This argument has encouraged continuous funding of sex education programs across high schools in the country (Weaver, Smith, & Kippax, 2005).

Educating teens about sex has been touted as a good tool for promoting responsible sexual habits. Sexual expression is important in the current society. By educating teens on their sexual identities, they are able to have proper sex images of themselves, and this will promote responsible sexual habits. If balanced education is administered teens are more likely to adhere to it (Smith et al., 2009).

Sex has been heavily socialised in the society. Both print and visual media have glorified sexual promiscuity and do not advocate for safe sexual behaviours. Australia has begun programs aimed at promoting media’s portrayal of sex. They are advocating for media campaigns that will advocate for safe sexual behaviour and depict the negative effects of sexual behaviour. Such programs are vital because they promote proper sexual behaviour (Smith et al., 2003).

Family planning services have also been vital in dealing with teenage pregnancies. Although information is important, the presence of accessible contraceptives will be effective in curbing the rising teen pregnancies. If such facilities are easily accessible and offer confidentiality, teenagers will view these locations as safe places where they can seek both contraceptives as well as ask for sexual advice (Smith et al., 2003).

These centres have been found to work best when they are provided in schools. For instance, when schools offer contraceptives, they ensure that students are using them and also avail opportunities for seeking further sexual information. By doing this, such centres have been found to have more effectiveness against teen pregnancies (Smith et al., 2003).

Blake et al. (2003) view onsite family planning centres as being beneficial to teens in school. This is because schools will offer more confidentiality and information. The health personnel are also available anytime, and they can consult on any issues with contraceptives. Some teens may be unable to travel to clinics and having the contraceptives accessible ensures that they are protected.

Intervention programs in the country have also started involving teenage boys in their programs. The role of the boys in contributing to pregnancies has been severely downplayed. Instead, girls have been the sole focus of the interventions. Programs that have involved teenage boys have seen more positive results because they will encourage both genders to take responsibility for their sexual habits (Jordan, Bayly, & Sawyer, 2005).

Opposition to Health Interventions

Although education is important, some education programs implemented are often unrealistic. For instance, Australia has implemented some programs that encourage abstinence, and that call for people to avoid sex till they wed. In the current society, such programs will be ineffective because teens are already having sex. Instead of creating programs that do not adhere to reality, education should be geared towards promoting responsible sexual behaviour rather than prohibiting sex (Sorenson & Brown, 2007).

Significant opposition has also been witnessed against sex education being implemented in schools. Some scholars especially those with religious affiliations believe that sex education should be performed by parents and not in schools. They believe that morality should be taught at home or in church and not in schools. In some communities, sex is viewed as a sensitive topic that shouldn’t be addressed in public. Due to this, sex education is viewed as wrong because it breaches those barriers and makes these communities uncomfortable (Whitehead, Wilcox, & Rostosky, 2001).

Provision of contraceptives in schools has also been heavily opposed to. Some scholars believe that providing them encourages teens to engage in sexual behaviour. They also believe that these contraceptives are given to teens without proper permissions from the parents (Bradley, Schwandt, & Kahn, 2009).

From a religions perspective, some churches are opposed to contraceptive use. Catholics are a prime example of such a church. They utterly prohibit the use of contraceptives and believe that schools that advocate for this are teaching the teens the wrong thing (Whitehead, Wilcox, & Rostosky, 2001).

Contraceptives have a propensity to fail because sometimes they are not effective in preventing pregnancy. Due to this, some scholars do not believe that they are an appropriate intervention in schools. Teens may depend on them, and the contraceptives may end up being ineffective. This will result to pregnancy which will defeat the original purpose of the contraceptives (Bradley, Schwandt, & Kahn, 2009).

In many cases, Sex education depicts contraceptives as an effective protection against both pregnancies and STIs. This is normally a false depiction, and it leads teens to engage in sexual habits that are highly risky because they think that the contraceptives will protect them. This is not usually the case, and the teens may expose themselves to high-risk diseases due to their limited knowledge (McKay, Pietrusiak, & Holowaty, 1998).

Sex education programs advocate for the delay of sex till one feels ready. Such statements may lead teens to engage in sex earlier than necessary because they perceive themselves as ready. Education also suggests to teens that engaging in sex while underage is permissible if consent is provided. This exposes young teens to sexual abuse because they could be exploited and not perceive it as sexual exploitation (Dyson, 2008).

According to Bradley, Schwandt, & Kahn (2009), availing contraceptives in schools has experienced backlash from both parents and some administrators of schools. Some argue that providing contraceptives amounts to giving the teens a green light to engage in sex. To them, it will indicate to the teens that the schools and parents support their sexual behaviours.

Comparisons and Contrasts of Teenage Pregnancy Studies

Systematic reviews and Randomised Controlled Trial have both been used in performing studies regarding teenage pregnancies. Systematic reviews sought to determine the impacts that teenage pregnancies have on society and the social disadvantages that the pregnancies cause to the teens. These reviews were accomplished by analysing the qualitative studies, databases as well as journals from experts in the teen pregnancy field (Harden et al., 2009).

From these studies, if intervention programs are implemented early and programs developed that would develop the youths created, teenage pregnancies could be significantly reduced. The qualitative studies also strongly showed that if public policies are created around such policies, teenage pregnancies rates could be reduced (Harden et al., 2009).

In Randomised Controlled Trials, people get chosen randomly and receive an intervention. Among the interventions available, one is a control or placebo and thus, could be non-effective. Such studies sought to establish which prevention program was most effective in reducing teen pregnancy numbers. The programs studies ranged from abstinence, contraceptives, extensive sex education among others (Key, Gebregziabher, Marsh, & O'Rourke, 2008).

The study determined that abstinence had the least effect on teen pregnancy while extensive education had the highest impact on reducing the teen pregnancy numbers. Contraceptives were also seen as having a positive effect on reducing the teen pregnancy numbers (Bennett & Assefi, 2005).

While systematic reviews seek to determine the impact of teenage pregnancies on society, controlled trials are more focused on finding solutions to the problem. They seek to find the most effective solution to the problem and are more effective in the pursuit of solutions. In this study, the controlled trials are seeking to determine which among the interventions will provide a preferable outcome (Key, Gebregziabher, Marsh, & O'Rourke, 2008).

Both studies have found abstinence-based education as ineffective in solving the teen pregnancy issue. In systematic reviews, the literature shows that abstinence based education is not realistic in the current society and is therefore bound to fail. Controlled trials have also shown the low effectiveness of abstinence-based education on teen pregnancy. Trials have shown abstinence as the least effective program on reducing teen pregnancy (Dicenso et al., 2002).

Strengths and Limitation of the Studies

Controlled trials are the most effective study for teen pregnancy. They are based on actual data and the information gathered from the study is directly obtained from the target populations. Such information is important when policies are being formulated because they are based on actual information (Harden et al., 2009).

In spite of their effectiveness, controlled trials have issues with treatment uniformity. In the case of teen pregnancy intervention studies, the most appropriate intervention for one group may prove totally ineffective in another group because it’s hard to determine all the unique characteristics that measure effectiveness for all groups (Harden et al., 2009).

Systematic reviews cater for the uniformity issues that ail controlled trial studies. Thus, because these studies are not experiment based, they are able to deal with biases that may occur while studying different populations and will be able to factor these biases in while making analysis (Dicenso et al., 2002).

Although Systematic reviews studies provide more information, they lack backing from actual population data. Information collected is more theoretical and may not have practical basis on the real population study. Information gathered may not be as effective as controlled trials in policy formulation (Dicenso et al., 2002).

Conclusion

Although the numbers have dropped, the current statistics are still alarming thus it is vital for Australia to deal with this issue. Education remains the foremost intervention that can effectively deal with this issue. Once teens have adequate information, they are likely to exhibit more responsible behaviours that will translate in lower pregnancy rates among teens. Despite the opposition to interventions, they are still the best remedies for this issue, and if implemented in consultation with other stakeholders, they can be very effective.