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Background: Evidence shows that parenting behaviours, including the use of violent discipline, can be changed through programmatic interventions. This study seeks to examine how policymakers and service providers in Tanzania perceive the provision of parenting support as a strategy to prevent violence against children and what the enabling and hindering factors are for the scale-up of existing evidence-based parenting supports. It does this by applying Daly's analytical framework for parenting support. Methods: Qualitative research was undertaken, with interviews conducted with 20 key informants consisting of purposively sampled policymakers and service providers. The interview data were analysed using inductive and deductive coding and analysis. Results: The most prominent enabling factors noted for the scale-up of parenting support interventions in Tanzania include the existing supportive political commitment, the interventions currently on offer at the programmatic level, and the perceived understanding of Tanzanian caregivers of the importance of parenting and, thereby, a willingness to change. Current factors hindering the scale-up include the lack of a common understanding of what evidence-based parenting programmes entail, inadequate provision of human and financial capital to implement the programmes using community resources and deeply engrained social norms around adultism and gender. Conclusion: Daly's analytical framework allowed us to examine barriers and facilitators to scale-up the provision of parenting support to prevent violence against children, based on the viewpoints of policymakers and service providers. Understanding these barriers and facilitators will allow Tanzanian policymakers and service providers to further close the gap between the policies and the actual implementation of evidence-based parenting support programmes aimed at preventing violence against children. [ABSTRACT FROM AUTHOR]

Little is known about the nature and mechanisms of factors that facilitate or inhibit the scale-up and subsequent implementation of school-based adolescent sexual and reproductive health (ASRH) interventions. We present process evaluation findings examining the factors that affected the 10-fold scale-up of such an intervention, focussing on teachers' attitudes and experiences. Qualitative interviews and focus group discussions with teachers, head teachers, ward education coordinators and school committees from eight schools took place before, during and after intervention implementation. The results were triangulated with observations of training sessions and training questionnaires. The training was well implemented and led to some key improvements in teachers' ASRH knowledge, attitudes and perceived self-efficacy, with substantial improvements in knowledge about reproductive biology and attitudes towards confidentiality. The trained teachers were more likely to consider ASRH a priority in schools and less likely to link teaching ASRH to the early initiation of sex than non-trained teachers. Facilitating factors included teacher enjoyment, their recognition of training benefits, the participatory teaching techniques, support from local government as well as the structured nature of the intervention. Challenges included differential participation by male and female teachers, limited availability of materials and high turnover of trained teachers.

Background: While there are a number of examples of successful small‐scale, youth‐friendly services interventions aimed at improving reproductive health service provision for young people, these projects are often short term and have low coverage. In order to have a significant, long‐term impact, these initiatives must be implemented over a sustained period and on a large scale. We conducted a process evaluation of the 10‐fold scale up of an evaluated youth‐friendly services intervention in Mwanza Region, Tanzania, in order to identify key facilitating and inhibitory factors from both user and provider perspectives. Methods: The intervention was scaled up in two training rounds lasting six and 10 months. This process was evaluated through the triangulation of multiple methods: (i) a simulated patient study; (ii) focus group discussions and semi‐structured interviews with health workers and trainers; (iii) training observations; and (iv) pre‐ and post‐training questionnaires. These methods were used to compare pre‐ and post‐intervention groups and assess differences between the two training rounds. Results: Between 2004 and 2007, local government officials trained 429 health workers. The training was well implemented and over time, trainers' confidence and ability to lead sessions improved. The district‐led training significantly improved knowledge relating to HIV/AIDS and puberty (RR ranged from 1.06 to 2.0), attitudes towards condoms, confidentiality and young people's right to treatment (RR range: 1.23‐1.36). Intervention health units scored higher in the family planning and condom request simulated patient scenarios, but lower in the sexually transmitted infection scenario than the control health units. The scale up faced challenges in the selection and retention of trained health workers and was limited by various contextual factors and structural constraints. Conclusions: Youth‐friendly services interventions can remain well delivered, even after expansion through existing systems. The scaling‐up process did affect some aspects of intervention quality, and our research supports others in emphasizing the need to train more staff (both clinical and non‐clinical) per facility in order to ensure youth‐friendly services delivery. Further research is needed to identify effective strategies to address structural constraints and broader social norms that hampered the scale up., Background There is increasing recognition of the need to break down the barriers that prevent young people from accessing quality health care [1‐5]. This is especially so for sexually transmitted [...]

Background: Collaborative learning has been shown to be effective in improving health worker performance, but relatively little is known about the feasibility or acceptability of collaborative learning in youth-friendly health services (YFHS). This paper describes the characteristics, feasibility and acceptability of a collaborative learning approach implemented in YFHS in Moldova as part of a national scaling up process.Methods: We gathered and analysed data on the number, location, themes, and participants of sessions, as well as benefits and challenges of collaborative learning, using two information sources: 1) formal reports on collaborative learning sessions, and 2) two questionnaires conducted with participants and moderators.Results: Collaborative learning sessions have been implemented in 30 out of 35 YFHS in Moldova. In 2016, 464 collaborative learning sessions were conducted. Sessions were conducted one to three times per month, had a mean of 15 participants and an average duration of two - three hours. 74.3% of participants (n = 6942) were from rural areas and 55.1% were health professionals. The most common topics in 2016 were adolescent health and YFHS (159 of 464 sessions), sexual and reproductive health (103 sessions), and violence (76 sessions). Reported benefits for participants of collaborative learning fell into three categories: 1) improved knowledge on adolescent health / development and use of evidence-based resources; 2) strengthened teamwork and cooperation; and 3) empowerment to provide high quality, youth-friendly care. Moderators identified benefits for the quality, youth-friendliness, and positioning of YFHS as centres of excellence on adolescent health. Challenges included the time and resources required to start and maintain the program, developing a constructive multi-disciplinary learning culture, and ensuring the involvement of stakeholders from outside YFHS.Conclusion: This study confirms that collaborative learning within YFHS is feasible and acceptable, and offers benefits to both participants and YFHS. Collaborative learning may be a valuable strategy to improve the quality and youth-friendliness of services. It may also be relevant to key challenges in scaling up YFHS such as increasing utilisation and achieving long-term sustainability. Further research is required to confirm our results in other settings and to examine the effects of collaborative learning at the outcome and impact level. [ABSTRACT FROM AUTHOR]