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Parents involvement and barriers of programme interventions to reduce adolescent pregnancy

Adolescence is a stage of development for humans that is marked by changes in physical, emotional, psychological and knowledge development. This is an important transformation stage and it is considered a period of vulnerability associated with risk behaviors such as drug abuse, unsafe sexual practices, leading to the risk of infection and unplanned pregnancy (Buratto, Kretzer, Freias, Traebert, & Nunes, 2019). According to the United Nations Population Fund (UNFPA) states that the number of adolescents in the world is estimated at 1.2 billion. Based on this number, there are 88% of them living in developing countries with a range of 49% of female adolescents living in six countries i.e. China, India, Indonesia, Nigeria, Pakistan and the United States (UNFPA, 2013). Based on the results of the Central Statistics Agency (BPS) the ratio of adolescent population in Indonesia in 2017 aged 0-17 years reached 30.5% while at the age of> 18 years amounted to 69.5% ( BPS, 2018). Adolescent pregnancy can occur at the age of 13-19 years, the incidence of adolescent pregnancy is 25% of women worldwide, but this incident continues to decline due to the support of education, contraception and prevention strategies for teen pregnancy (Leftwich, 2017). Adolescent pregnancy is an international phenomenon that has yet to be resolved, this indicates the case needs public health attention (WHO, 2012). AR TI C LE I N F O ABSTRACT


Introduction
Adolescence is a stage of development for humans that is marked by changes in physical, emotional, psychological and knowledge development. This is an important transformation stage and it is considered a period of vulnerability associated with risk behaviors such as drug abuse, unsafe sexual practices, leading to the risk of infection and unplanned pregnancy (Buratto, Kretzer, Freias, Traebert, & Nunes, 2019). According to the United Nations Population Fund (UNFPA) states that the number of adolescents in the world is estimated at 1.2 billion. Based on this number, there are 88% of them living in developing countries with a range of 49% of female adolescents living in six countries i.e. China, India, Indonesia, Nigeria, Pakistan and the United States (UNFPA, 2013). Based on the results of the Central Statistics Agency (BPS) the ratio of adolescent population in Indonesia in 2017 aged 0-17 years reached 30.5% while at the age of> 18 years amounted to 69.5% ( BPS, 2018). Adolescent pregnancy can occur at the age of 13-19 years, the incidence of adolescent pregnancy is 25% of women worldwide, but this incident continues to decline due to the support of education, contraception and prevention strategies for teen pregnancy (Leftwich, 2017). Adolescent pregnancy is an international phenomenon that has yet to be resolved, this indicates the case needs public health attention (WHO, 2012).

Article History
Received, 28 -th January 2020 Revised, 28 -th January 2020 Accepted, 7 -th April 2020 Adolescent pregnancy is defined as a pregnancy between the ages of 13-19 years, adolescent pregnancy occurs around 25% of women worldwide, but this number continues to decline due to educational support, contraception and prevention strategies for adolescent pregnancy. Evidence shows that there were programme interventions to reduce adolescent pregnancy such as encouraging people to participate in comprehensive prevention of adolescent pregnancy programs and health campaign to avoid unsafe sexual relationships. This scoping review was aimed to map out available evidence related to the parents' involvement and barriers of programme intervention to reduce adolescent pregnancy. This scoping review followed the framework of Arksey and O'Malley, which consists of identifying the review questions; look for relevant evidence; selecting relevant studies; maping the data; and medicate, conclude and report results. PRISMA flowchart was used to display the evidence search flow. The results of the review indicated that there were 12 included articles from the search process. This review emerged 3 themes: efforts to reduce adolescent pregnancy rates, support for adolescent reproductive health services, barriers to reproductive health services for adolescents.
It is important encouragage people to participate in comprehensive adolescent pregnancy prevention programs in including provision of information about the dangers of adolescents' pregnancy, reproductive health, and maintain positive relationship with the family.
Given the attachment of adolescents to the family makes parents have an important influence on future choices to prevent adolescent pregnancy. A good parental relationship before the onset of pregnancy may affect the expectations of adolescents in maintaining their pregnancy for months because of the support of their families (Madkour et.al, 2013). The main member in adolescent family support is the mother, then followed by the father. It is known that the type of support most often given is love and trust. On the other hand, the role of the mother for pregnant adolescents will have an impact on nutritional status, encouragement to use contraception in the prevention of recurrent pregnancy and the existence of emotional support during pregnancy and after pregnancy (Reyna et al., 2019) The home environment is an environment that influences adolescent development, so adolescents get a lot of experience and understanding from parents as educators and directors. Parents are teachers who give a big influence on their children, while the loss of good influence will result in adolescents losing their identity. So that the relationship with parents in general is based on the principle of mutual communication and building relationships that encourage healthy relationships. Therefore parents have a great influence on the development of adolescents as the next generation (Irianto dkk, 2018).

Method
The study used in this study is a scoping review that is used as a precursor to a systematic study, to be able to identify the types of evidence available in accordance with the topics discussed, look for an overview of how the research is carried out on a particular topic or area, to identify characteristics or key factors related with a concept (Munn, Z., Peters, M.D.J., Stern, C., Tufanaru, C., McArthur, A., Aromataris, 2018). This study deals with the support and obstacles of the parent involvement program in efforts to reduce teen pregnancy rates, which systematically maps the available literature on a topic, discusses key concepts, theories and sources of evidence that aim to discuss the level, scope and nature of research available in research questions. and summarizing the results of research based on evidence based in order to recommend further research (Tricco, A.C., Antony, J., Zarin, W., Strifler, L., Ghassemi, M., Ivory, J., Perrier, L., Hutton, B., Moher, D., Straus, 2015). The stages in conducting a scoping review that must be carried out are the focus of the review, using the PEOS framework (Problem, Exposure, Outcome and Study design), identifying relevant studies, selecting studies with PRISMA flowcharts, charting data and mapping data or scoping (Arksey, H., O'Malley, 2005), as follows:

a. Identify the review question or focus of the review
This review scoping review aims to find out "Support and obstacles of parent involvement program in efforts to reduce teen pregnancy rates?". The need for this literature review is a synthesis of research aimed at seeking the implementation of empowerment of family or parent community in reducing teen pregnancy rates and identifying key concepts, gaps in research and sources of evidence to inform practices, policies and research on the implementation of family or parent communities (Pham, M.T., Rajić, A., Greig, J.D., Sargeant, J.M., Papadopoulos, A., McEwen, 2014). The review question is How do adolescent reproductive health services that involve the role of family and parents in reducing teen pregnancy rates?

b. Framework PEOS
Developing the focus of review and search strategies, researchers used Framework Population, Exposure, Outcome and Study Design (PEOS) in managing and solving the focus of review described in table 1. The use of PEOS helps to identify key concepts in the focus of the question, develop appropriate search terms to describe the problem and determine the inclusion and exclusion criteria. PEOS is used to identify elements of qualitative research questions (Halas, G.,Schultz, A.S.H., Rothney, J., Goertzen, L., Wener, P., Katz, 2015).

c. Identifying Relevant Studies
The article search strategy was developed using several databases, which only focus on peer review articles. The use of peer review articles is expected to ensure credibility in the information contained in a scientific work that is more true, accurate and all of its contents can be used as data sources. The keywords used in searching for articles on the topic are as follows: "community empowerment" or "community engagement" or "community involvement" or "parents community" or "community health worker" and "adolescents pregnancy" or "teenage pregnancy" or " adolescents in pregnancy "or" pregnancy in Adolescents "and" Perspective "or" Views "or" Opinion "or" Intervention "or" Program "or" Strategies ". The database for finding peer review articles with sources used is Pubmed, Proquest, ScienceDirect, EBSCO.

d. Study Selection
For the selection of studies determined using inclusion and exclusion criteria. The inclusion and exclusion criteria are described in table 2. The data filtering process is using PRISMA Flowchart. PRISMA is a Prefererd Reporting Items for Systematic reviews and Meta-Analyzes, developed to assist authors in reporting systematic reviews (SR) and Meta-Analyzes (MA). PRISMA is considered appropriate because it can improve the quality of publication reporting (Peters, M.D.J., Godfrey, C.M., Khalil, H., McInerney, P., Parker, D., Soares, 2015). After obtaining evidence, a critical appraisal is performed using a form from the Critical Appraisal Skills Program (CASP) to assess the quality of the evidence. The data is filtered according to criteria that researchers determine. The stages of data filtering are as described in figure 1.

f. Mapping/Scoping 1) Geographical Characteristics
The results of a systematic search obtained twelve articles published from 2009-2019, the journals used in the twelve articles taken for scoping this review are articles with grade A and B quality. The results of article review were obtained from developing countries, namely Kenya, Ghana, Oklahoma, Ethiopia, New England City, South Africa, North Carolina, Latino, Bokeo and Luang, Iran. The twelve articles were obtained using qualitative and quantitative research studies.

2) Thematic
The results of the review found several themes that fit the focus of the review of several themes that fit the focus of the review, show on table 4. c. Improved health service strategy 5,9,10 Barriers to Reproductive Health Services in Adolescents to Reduce Adolescent Pregnancy Rates a. The high value of culture 6,10,11,12 b. Perception and knowledge of parents 3,5 c. The need for access to health services 4,7,10,12 d. Lack of Parent-Child Communication 2,3

Results and Discussion
The cause of premarital sex for teenagers is due to lack of affection from the family. As a result teens will try to meet their needs by seeking attention from both friends and girlfriends even with sexual satisfaction. Premarital sex can cause pregnancy which will cause a variety of negative emotions and dissatisfaction. If adolescents get support from the family then they will experience positive emotions and be able to adjust to the situation they are experiencing (Sonata, 2014).
Patterns of communication that are open from two directions between adolescents with fathers and mothers will be able to help convey good information from parents to adolescents in explaining reproductive health issues. Ineffective parenting is the inability of parents as the primary care giver in creating, maintaining and regaining an environment that promotes optimal adolescent growth and development. Because of the need for interventions from health services with a program for parents about the introduction of parenting and the characteristics of family development with adolescents, discussion about the consequences of not fulfilling adolescent development, teaching parenting and effective communication patterns with adolescents, arranging adolescent activity schedules, use a counseling center in remeja parenting in the family (Susanto, 2010). Vol. 3, No. 2, November 2020, pp. 73-86 Dwi Kartika Cahyaningtyas et.al (Parents involvement and barriers of programme interventions to…) The review of articles obtained in support of improving adolescent and adolescent family programs based on the results of mapping scoping as follows:

1) Efforts To Reduce Teenage Pregnancy
Teenage pregnancy is a global problem that is currently faced in high, middle and low income countries. Throughout the world teenage pregnancies occur in many marginalized communities, generally driven by poverty and lack of education and employment opportunities. In some cases, girls may face social pressure to get married and so get married to have children (WHO, 2018).

a) Reproductive Health Education
Each school, most of the students have received skills-based reproductive health education by demonstrating the use of condoms, in addition to various positive experiences regarding reproductive health. Information obtained by young women about infectious diseases, HIV / AIDS, teen pregnancy, and teaching young women how to prevent infectious diseases and teenage pregnancy (Krugu, Mevissen, Prinsen, & Ruiter, 2016). Emphasize teenagers to support reproductive health information. Despite the many challenges of every teenager, young people will benefit from guidance in developing skills and knowledge (Johnson et al., 2018).
Primary health education is parents, but health education needs to be school based to improve reproductive health education and support the supervision of young people in the school area. Schoolbased reproductive health education can be done with the availability of school counselors or psychologists to communicate appropriately with teenagers (Johnson-Motoyama et al., 2016)

b) Open Communication Between Parents And Children
Healthy communication requires confidence and open expression. Open communication as a form of building trust between parents and teenagers, so that teens can share problems and ask questions and parents can trust youth decision making. The way parents can achieve comfortable communication with their teenagers is to talk like a friend in a soft voice and a subtle topic (Johnson-Motoyama et al., 2016).

c) Increase Organizational Readiness And Resources
Efforts to overcome teenage pregnancy from lack of infrastructure and health workforce resources, by providing training to each stakeholder and adding staff to support appropriate prevention efforts. So that government stakeholders need to provide funding, training and technical assistance in the form of training on adolescent pregnancy prevention programs, training on evidence-based sexual health education curricula and guidelines for selecting and implementing curriculum in accordance with culture (Bhuiya et.al., 2017). d) Community Involvement Juma et.al (2014) in his research through interviews that poverty in an area will affect risky cultural practices, so expect the prevention of teen pregnancy prevention that targets poverty and cultural factors by involving the community in all the implementation of adolescent activities, by providing knowledge about early marriage, reproductive health, treatment of teenage girls and boys, and a curfew for teenagers. Therefore prevention interventions must include the sensitivity of the community by identifying the right people to practice awareness and change behavior. That way we can reduce and eliminate the risk of pregnancy in adolescents.

2) Support for Adolescent Reproductive Health Services to Reduce Teenage Pregnancy
Many countries have taken actions aimed at preventing teenage pregnancy and in some cases supporting girls who have become pregnant. The experience of an effective program requires transformation from a narrowly focused intervention to a broad-based approach. The new paradigm must target the conditions, norms, values and structural forces that perpetuate adolescent pregnancies that require sexual access and reproductive health information and services and are not burdened with economic and social pressures, unrealized poverty (UNFPA, 2013).

a) The Role Of Parents
Reproductive health education is not only given by health workers but can be started from family or parents at home. Parents revealed that reproductive health education was positive in a school-based program and parents would try to motivate their children to participate in the program (Johnson-Motoyama et al., 2016). Journal of Health Technology Assessment in Midwifery ISSN 2620-5653 Vol. 3, No. 2, November 2020 Dwi Kartika Cahyaningtyas et.al (Parents involvement and barriers of programme interventions to…) Parents show concern for the welfare and future of their children. Parents acknowledge that information and knowledge about adolescent reproductive health and sexuality are obtained from close friends, personal experiences and rarely from school. The parents stated that the dangers of sexually transmitted infections, HIV and teenage pregnancy, so the need to find ways to keep teenagers from sexual intercourse. At the same time parents realize the need for information not only on education about reproductive health and sexuality, but as a tool for the future of adolescents (Alzate et al., 2018). b) The Role Of Health Care Providers Health service providers express the need for school-based reproductive health education and express concern about students who devote inaccurate information, believe in reproductive myths that lead to misunderstandings, especially as a result of limited access to accurate information. This is expected by health service providers the need for reproductive health education to be taught initially by parents at home (Johnson-Motoyama et al., 2016).
Service providers see sexuality as one aspect of the human condition and adolescent sexuality as part of normal growth. Service providers assume that the importance of education about sexuality and reproduction to live life. Most cases of teenage pregnancy are found in the characteristics that usually occur at the age of 15 years, lack of birth control at the beginning of sexual intercourse, adolescents lack information, or have misinformation or myths about reproductive health, birth control and sexuality in general (Alzate et al., 2018).

c) Improving Health Service Strategies
Research conducted (Maness, Buhi, Daley, Baldwin, & Kromrey, 2016) by conducting surveys covering education, economic stability, social and community context, health and health care, and the built environment. These findings provide support especially in relation to education and the social and community context, which is to focus resources and interventions on adolescent pregnancy. Good knowledge can be started from home and school. Support from the community is important for adolescent health, given the importance of sociocultural norms in influencing the social health practices involved in the community environment, especially among parents and community leaders, is the key to effective interventions. This study shows the need for greater emphasis in health promotion activities that further empower individuals to become active agents of change. As well as including the development of both knowledge and communication skills in adolescents so as to be able to make decisions and create opportunities to increase youth autonomy (Sychareun et al., 2018).

3) Obstacles To Reproductive Health Services In Adolescents To Reduce Adolescent Pregnancy
Teenage pregnancy that occurs worldwide because of marginalized communities, is generally driven by poverty and lack of education. Adolescents also face obstacles to accessing contraception due to laws and policy restrictions regarding the provision of contraception based on age or marital status, lack of willingness of health workers to recognize adolescent sexual health needs and the inability of adolescents themselves to access contraception due to knowledge, transportation and financial constraints (WHO, 2018).

a) High Cultural Values
Barriers to the behavior of adolescent girls in seeking information about reproductive and sexual health care are due to cultural and social conditions where there is still a dominant social stigma. Some parents believe that providing information about sexuality will lead teens to increase sexual activity (Shariati, Babazadeh, Mousavi, & Najmabadi, 2014). Sexual experiences and teenage pregnancy are now very common among teenagers. The occurrence of teenage pregnancy due to sexual intercourse of <15 years raised by a single parent or caregiver other than parents, promiscuity and environmental factors such as the existence of violence in the community (Brahmbhatt et al., 2014).
Research conducted by (Asnong et al., 2018) states that adolescents assume teenage pregnancy is a life event that can endanger their future. The main reason for teen pregnancy is due to cultural values and stigma about reproductive health issues so that knowledge about reproductive health and the ability to behave positively by refusing sexual intercourse for unmarried adolescents is necessary. Vol. 3, No. 2, November 2020, pp. 73-86 Dwi Kartika Cahyaningtyas et.al (Parents involvement and barriers of programme interventions to…)

b) Low Parent-Child Knowledge
The experience of providers when hearing parents and adolescents about reproduction is known that knowledge is still limited, parents and adolescents do not know because they have not received education. Other aspects related to limitations in infrastructure, socio-economics and culture (limited health insurance, costs, limited language skills, work demands, lack of supervision, stigma and prejudice), lack of comprehensive sexuality education in schools, besides the existence of social isolation , low levels of education, lack of training for service providers and funding restrictions (Alzate et al., 2018). c) The Need For Access To Health Services Service providers are also a source of information, but many teenagers do not seek reproductive health care and sexuality because of negative attitudes from health service providers, lack of confidentiality, lack of awareness of where to deliver services and information (Shariati et al., 2014). Research conducted by (Habitu et al., 2017) says that adolescents living in rural areas are four times more likely to experience teenage pregnancy. This happens because teenagers from rural areas are less educated and have limited access to health services.

d) Lack Of Parent-Child Communication
Teenage pregnancy usually occurs at the age of 15 years, due to the absence of control of sexual intercourse, lack of reproductive health information and adolescents get false information or myths about reproductive health. Service providers state that parents avoid talking about sexuality and limit conversations such as pregnancy, sexually transmitted infections or HIV, many parents expect and wait to sign forms for schools to talk about sexuality (Alzate et al., 2018).

Conclusions
Teenage pregnancy is an international phenomenon that has yet to be resolved, it is expected to become a worldwide concern. Efforts to reduce the number of teenage pregnancies which until now continue to occur by encouraging people to participate in comprehensive teen pregnancy prevention programs in the form of information about the dangers of teenage pregnancy, reproductive health, establish positive communication with the family. Given the closeness of children with family makes parents have an important influence on the future to prevent teenage pregnancy. Parents are teachers who can have a big influence on their children, while the loss of good influence from parents will result in adolescents losing their identity.

Recommendations
Based on the results of 12 review articles, it was found that efforts can be made on the problems of adolescents who until now are still a world phenomenon, namely by providing school and familybased information, reproductive health education not only in schools but the most basic primary education is obtained at home by doing positive and open communication with parents.

Strengths and Limitations
The topics taken in this scoping review allow us to investigate what is currently known about the support and obstacles of parents involvement programs in efforts to reduce teen pregnancy rates. In this review there are various efforts that can be done to reduce the problems of adolescents and reviewed journals selected in developing countries so that they can be generalized. The limitation obtained in this article is because of various journals discussing efforts, support and obstacles in adolescent issues especially reproductive health. However, this review did not get a journal describing an organization or special program for teenage parents.