title: Lessons learnt from the CERCA Project, a multicomponent intervention to promote adolescent sexual and reproductive health in three Latin America countries: a qualitative post-hoc evaluation.
abstract: The Community-Embedded Reproductive Health Care for Adolescents (CERCA) Project was implemented in Bolivia, Ecuador and Nicaragua (2011-2014) to test the effectiveness of interventions preventing teenage pregnancies. As the outcome evaluation showed limited impact, a post-hoc process evaluation was carried out to determine if and how CERCA's design, implementation, monitoring and evaluation affected the results. We did a document analysis and conducted 18 in-depth interviews and 21 focus group discussions with stakeholders and beneficiaries. Transcripts were analyzed using directed content analysis. Data showed that CERCA sensitized stakeholders and encouraged the discussion on this sensitive issue. In terms of design, a strong point was the participatory approach; a weak point was that the detailed situation analysis was completed too late. In terms of implementation, a strong point was that multifaceted activities were implemented; a weak point was that the activities were not pilot tested for feasibility/acceptability and evolved substantially throughout the Project. In terms of monitoring, strong points were that regular monitoring kept the Project on track administratively/financially; a weak point was that monitoring indicators did not change as the intervention package changed. In terms of evaluation, weak points were the substantial attrition rate and narrow focus on adolescents. This study provides recommendations for future projects.
authors.affiliation: International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 UZP 114, Ghent 9000, Belgium. Electronic address: olena.ivano@gmail.com.
authors.forename: Olena
authors.initials: O
authors.lastname: Ivanova
authors.affiliation: South Group, C. Ecuador O-138, Edificio Holanda, A-3A, Cochabamba, Bolivia. Electronic address: kathya.cordova@southgroup.nl.
authors.forename: Kathya
authors.initials: K
authors.lastname: Cordova-Pozo
authors.affiliation: Instituto CentroAmericano de Salud (ICAS), Managua, Nicaragua. Electronic address: zoylasegura@gmail.com.
authors.forename: Zoyla Esmeralda
authors.initials: ZE
authors.lastname: Segura
authors.affiliation: University of Cuenca (UC), Av. 12 de Abril y Agustín Cueva, Cuenca, Ecuador. Electronic address: bernardo.vegac@ucuenca.edu.ec.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Vega
authors.affiliation: Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland. Electronic address: chandramouliv@who.int.
authors.forename: Venkatraman
authors.initials: V
authors.lastname: Chandra-Mouli
authors.affiliation: Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland. Electronic address: hindinm@who.int.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Hindin
authors.affiliation: Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland. Electronic address: temmermanm@who.int.
authors.forename: Marleen
authors.initials: M
authors.lastname: Temmerman
authors.affiliation: International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 UZP 114, Ghent 9000, Belgium. Electronic address: peter.decat@ugent.be.
authors.forename: Peter
authors.initials: P
authors.lastname: Decat
authors.affiliation: International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 UZP 114, Ghent 9000, Belgium. Electronic address: saraA.DeMeyer@ugent.be.
authors.forename: Sara
authors.initials: S
authors.lastname: De Meyer
authors.affiliation: International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 UZP 114, Ghent 9000, Belgium. Electronic address: kristien.michielsen@ugent.be.
authors.forename: Kristien
authors.initials: K
authors.lastname: Michielsen
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration; D002648:Child; D003153:Community Health Services / Q000458:organization & administration; D055812:Community-Based Participatory Research; D005260:Female; D017144:Focus Groups; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D008297:Male; D009527:Nicaragua; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control*; D015397:Program Evaluation / Q000379:methods*; D036301:Qualitative Research; D060728:Reproductive Health / Q000208:ethnology*; D012725:Sexual Behavior / Q000208:ethnology; D000074384:Sexual Health / Q000208:ethnology*; D013020:South America
keywords: Adolescents; Complex intervention; Latin America; Post-hoc evaluation; Sexual and reproductive health