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Table 4 Example extracts from the literature and stakeholder events used to develop CMO 3

From: Reducing repeat pregnancies in adolescence: applying realist principles as part of a mixed-methods systematic review to explore what works, for whom, how and under what circumstances

CMO 3 - Barriers and facilitators to accessing services, trigger notions of connectedness, support and self-determination; resulting in the tailoring of interventions so they are relevant to young persons and improve access to services and engagement with the issue of pregnancy in adolescence.
Clarke [41] “…a purely mechanical approach to contraceptive provision is very unlikely to work for many young people…Therefore, contraceptive providers…need to widen their approach to ensure that there are opportunities for the many emotional and psychological to contraceptive use…”
Haamid & Wiemann [44] “There was a lack of intention associated with repeat pregnancy…The adult who expects young people to engage in premeditated sex after deliberating the costs and rewards of an unintended pregnancy is not looking at sex and pregnancy from an adolescent viewpoint…interventions must be created that take the nature of this sexual activity into account.”
Key et al [47] “Adolescent mothers face a difficult course navigating obstacles such as school failure and repeat pregnancy.”
Stakeholders involved in the research stated “Schemes that involve home visits are likely to be more successful than involving people getting to clinics using public transport.”
Stakeholders involved in the research stated “Childcare to support young mothers going back into education should be more supported and facilitated”.
Stakeholders involved in the research stated “Interventions need to be tailored to the individual according to circumstances at the time – girls complain that they are not listened to by professionals”.
Stakeholders involved in the research stated “We really need to find out what they really need and want and understand what they are asking for – there is too much generalisation, and perceptions of what girls want are not accurate”.
Young mothers in a service user feedback group stated they would like services/interventions to have; “Positive discussion about contraception choices, teen centred groups and flexible services that allow for travel issues, difficulties in getting children ready to leave the house and absences due to child sickness.”
Young mothers in a service user feedback group stated “In a group, we can see everyone, hear everyone’s opinion and if I feel something I am not alone.”