Open access
Teen pregnancy involvement among
To cite: Ojukwu E, Bawafaa E,
Afsah S, et al. Teen pregnancy
involvement among African,
Caribbean and Black adolescent
boys and girls: a scoping
review protocol. BMJ Open
2023;13:e066713. doi:10.1136/
bmjopen-2022-066713
► Prepublication history and
additional supplemental material
for this paper are available
online. To view these files,
please visit the journal online
(http://dx.doi.org/10.1136/​
bmjopen-2022-066713).
Received 21 February 2023
Accepted 28 June 2023
© Author(s) (or their
employer(s)) 2023. Re-­use
permitted under CC BY-­NC. No
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1
School of Nursing, The
University of British Columbia,
Vancouver, British Columbia,
Canada
2
Cognitive Systems Program,
Department of Computer
Science, Linguistics, Philosophy,
and Psychology, The University
of British Columbia, Vancouver,
British Columbia, Canada
3
Department of Sociology, The
University of British Columbia,
Vancover, British Columbia,
Canada
Correspondence to
Dr Emmanuela Ojukwu;
​eojukwu@​mail.u​ bc.​ca
African, Caribbean and Black adolescent
boys and girls: a scoping
review protocol
Emmanuela Ojukwu ‍ ‍,1 Eunice Bawafaa ‍ ‍,1 Sara Afsah,1 Shivangi Singh,2
Harsimran Grewal,1 Zainab Raja,3 Emily McKay1
ABSTRACT
Introduction African, Caribbean and Black (ACB)
adolescents are disproportionately affected by teen
pregnancy in North America. Teen pregnancy poses risks
to the quality of life of adolescent boys and girls, including
physical, psychosocial and socioeconomic risks. Our
review aims to explore this public health concern for ACB
adolescents within North America. We aim to identify
and analyse available evidence on the incidence and
prevalence of, associated factors of and interventions
to curtail teen pregnancy involvement (TPI) among ACB
adolescent boys and girls in North America. This review
will explore TPI, rather than teen pregnancy, to ensure a
review of men’ involvement in teen pregnancy outcomes.
Methods and analyses Health literature databases such
as CINAHL, OVID (Medline and Embase) and CAB direct.
Searches will be conducted for evidence published from
2001 to October 2021. Search results will be exported
to Covidence for subsequent steps of the review. The
Preferred Reporting Items for Systematic Reviews and
Meta-­Analyses Extension for Scoping Review guidelines
will be used to ensure reproducibility and transparency.
We will include all study designs focused on ACB boys
and girls between 10 and 19 years old, residing in North
America. Studies with a mixed racial sample will be
included if sample consists of greater than 50% ACB
individuals.
Ethics and dissemination TPI is a public health concern
with socioeconomic and health consequences for ACB
teens in North America. A scoping review such as this will
provide direction for healthcare practice, policy changes,
education and further research in reducing the incidence
of TPI in North America. Study results will be disseminated
via presentations at conferences, at target populations,
communities and organisations and publications via
peer-­reviewed journals. As knowledge generated from
this scoping review will stem from previously published
evidence, an ethical approval is not needed
INTRODUCTION
Pregnancy occurring among adolescent girls,
otherwise known as adolescent pregnancy or
teen pregnancy is a public health concern.1
Teen pregnancy has been associated with
detrimental health and socioeconomic
Ojukwu E, et al. BMJ Open 2023;13:e066713. doi:10.1136/bmjopen-2022-066713
Protocol
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STRENGTHS AND LIMITATIONS OF THIS STUDY
⇒ The study will be the first to review and summarise
the current state of knowledge including rates, as-
sociated factors and interventions to address teen
pregnancy involvement among African Caribbean
and Black Adolescent boys and girls residing in
predominantly White geographic locations such as
North America.
⇒ This study will provide a unique cultural perspec-
tive on ways to address issues related to adolescent
pregnancy involvement for a minority population.
⇒ This study will also offer a unique perspective by
including and exploring male involvement in adoles-
cent pregnancy outcomes; thus, the choice of term
‘teen pregnancy involvement’, rather than just ‘teen
pregnancy’, which often omits male involvement in
its discourse.
⇒ The study will include the unique voices of an ad-
visory committee (consisting of African, Caribbean
and Black (ACB) healthcare providers, policymakers,
researchers, knowledge users, parents and teenag-
ers themselves) in its methodology, who will provide
critical data to guide the data collection and analy-
ses of the review processes.
⇒ The study might be limited in generalisability to ACB
adolescent boys and girls in other parts of the world
as it is important to note and appreciate the diversity
and heterogeneity that still exist within the African/
Black culture.
outcomes, including higher incidences of
rapid-­repeat pregnancies, birth complications
and death, postpartum depression, decreased
self-­esteem, poverty, low-­income jobs, lower
levels of education and financial depen-
dency,2 3 while the WHO reports an overall
decline in teen pregnancy rates by 11.6% in
the last 20 years.4 A paucity of recent data
to estimate rates for African, Caribbean and
Black (ACB) adolescents exists within certain
countries;5 and when such data are available,
evidence shows significant disparities persist
across countries in terms of rates, associated
1
Open access
factors and the health and socioeconomic outcomes of
teen pregnancy.6–8 In 2010, USA teenage birth rates were
nearly double (51.4%) for Black adolescents compared
with White and non-­Hispanic teenagers (23.6%). Simi-
larly, abortion rates of ACB youths were triple (34.5%)
those of White and non-­Hispanic teenagers (8.5%).5 From
2018 to 2019, teen birth rates decreased by 5.2% and 5.8%
in Hispanic and non-­Hispanic White women between the
ages of 15 and 19 years, respectively; however, only a 1.9%
decrease was observed in Black women.8 These statistics
demands a closer examination of teen pregnancy involve-
ment (TPI) rates and their associated factors within this
target population.
Scarce research is available to support ACB-­ specific
incidences and prevalence of teen pregnancy, associ-
ated factors and available interventions to address this
problem, especially in geographic locations like North
America consisting of a predominantly White population
and, thus, with a paucity of this information available for
minority Black populations. Most pregnancy prevention
programmes have focused on addressing parental involve-
ment and the teen’s perceived social expectations of early
childbearing,9 with only a few studies focusing on possible
disparities that may exist across races and the associated
factors. Available evidence acknowledges the importance
of investigating the disparities in teen pregnancy problem
that exists among ACB populations compared with other
racial groups,10 11 with particular attention being paid to
socioecologic factors such as the individual’s identities
(eg, age, gender, etc), socioeconomic status, psychoso-
cial vulnerabilities (eg, discrimination based on race,
gender),10 11 among others. Furthermore, given that an
apparent gap exists in the teen pregnancy discourse for
adolescent men, and the ACB population. in general,
the current study will focus on the concept of TPI12 13 for
ACB populations, described as sexual activities that have
resulted in pregnancy outcomes among ACB adolescent
boys and girls.
Preliminary literature reviews of CAB Direct, CINAHL,
OVID-­Embase and OVID-­MEDLINE showed a paucity
of research on TPI rates for ACB adolescents in North
America, with most studies originating from the USA,
and little or no studies from other Northern American
countries. Most identified studies had limited evidence
on the adolescent men's involvement in teen pregnancy.
Therefore, this scoping review focuses on three aims: (1)
to provide an overview of the TPI incidence and prev-
alence among ACB adolescent boys and girls in North
American countries published between 2010 and 2021,
(2) to identify associated factors (facilitator and barriers)
of TPI among ACB adolescent boys and girls and (3) to
identify available interventions aimed at curtailing TPI
incidence among ACB adolescent boy and girls. Given
the paucity of available evidence in this area for ACB
adolescents in North American countries, and male
involvements, a scoping review is appropriate. Scoping
reviews are appropriate to ‘identify the types of available
evidence in a given field, to identify key characteristic or
2 Ojukwu E, et al. BMJ Open 2023;13:e066713. doi:10.1136/bmjopen-2022-066713
factors related to a concept and to identify and analyse
BMJ Open: first published as 10.1136/bmjopen-2022-066713 on 26 July 2023. Downloaded from http://bmjopen.bmj.com/ on March 3, 2024 by guest. Protected by copyright.
knowledge gaps’.14
REVIEW QUESTION
What is the current state of knowledge on the incidence,
prevalence, associated factors of and interventions to
mitigate TPI rates among ACB adolescent boys and girls
in North America?
ELIGIBILITY CRITERIA
Participants
This scoping review will consider peer-­reviewed studies
published from 2010 to 2021. The focus will be on adoles-
cent boys and girls between the ages of 10 and 19. There-
fore, participants will be adolescent men and women
living in North America who identify as ACB) and have
been involved in activities leading to pregnancy
Concept
The discourse on teenage or adolescent pregnancy often
focuses on females alone, excluding the important roles
that males play in outcomes of teen pregnancy. Research
also finds that although both males and females play a
role in pregnancy, most pregnancy prevention research
focuses on adolescent females, with few studies focusing
on both populations.12 The Centres for Disease Preven-
tion and Control and the United States Office of Popula-
tion Affairs recommends providing pregnancy prevention
services to both adolescent males and females.15 There-
fore, our review would focus on the concept of TPI, which
allows us to explore the important roles of adolescent
boys also play in teen pregnancy outcomes. This review
will focus on ACB adolescent boys and girls within North
America.
Context
The scoping review will include peer-­reviewed articles,
prospective and retrospective cohort studies, case–control
studies, descriptive observational studies, literature
reviews, systematic reviews/meta-­analysis and analytical
cross-­sectional studies that examine adolescent ACB men
and women between the ages of 10 and 19 years within
North America. The scoping review will also include all
setting relevant to this topic, including educational insti-
tutions, community spaces, teen parent support groups,
among others.
Type of sources
We will include studies of all designs (qualitative, quan-
titative and mixed methods) that examine TPI among
ACB adolescents within North America, and grey litera-
ture including preprint conference abstracts, editorials,
among others, found to be pertinent in addressing the
research question. We will exclude studies not written in
English, articles published before 2010 (this timeline was
chosen to include more recent literature), articles whose
primary focus or outcome is not teen pregnancy, studies

with less than 50% ACB population, studies whose age
range overlaps with our intended age range for the study
(10–19) in ways that we are unable to separate out or
glean results for each age group. Finally, given our focus
on TPI, we will review all available evidence from studies
conducted on adolescent girls, adolescent boys and/or
both.
METHODS
This proposed scoping review will follow the Joanna
Briggs Institute methodology for scoping reviews.16 Thus,
we aim to bring together a variety of study designs exam-
ining TPI for ACB adolescent boys and girls, with an intent
on exploring and synthesising its broader knowledge
base, identifying any research gaps and summarising the
final results, which will be useful for research, education,
practice and policy.17 Specifically, on the subject matter
of TPI, we will explore sources focused on discussing the
incidence and prevalence of TPI among ACB adolescent
boys and girls in North America, the associated factors
related to TPI and identify any interventions aimed at
addressing this public health concern. A search on the
international prospective register of systematic reviews
(PROSPERO) and other relevant registries revealed no
ongoing literature review on this topic. Thus, the present
review has been registered on open science framework.
Search strategy
Our aim is to comprehensively explore what is known
about TPI in existing literature by identifying any rele-
vant evidence. Searches will be conducted for evidence
published from 2001 to 2021. Thus, in consultation
with librarians from the University of British Columbia,
we will search key health literature databases, including
Ovid Medline, Ovid Embase, CINAHL and CAB direct.
To begin this process, we conducted a preliminary search
in CINAHL to identify relevant keywords from words
contained in the titles and abstracts of relevant articles.
In consultation with the librarian, several other keywords
were incorporated with various Boolean operators to
develop the search strategy (see online supplemental
appendix A). As the study progresses, the search strategy,
including all identified keywords and index terms, will be
adapted and replicated in all other databases we search
(see online supplemental appendix B). The reference
list of all selected articles will also be reviewed to identify
additional sources of evidence.
Study/source of evidence selection
Following the search, all identified citations will be
collated and uploaded into COVIDENCE, a software
which supports systematic, scoping and literature reviews.
Covidence will automatically remove all duplicates.
Following the duplicate removal, titles and abstracts will
then be screened by two or more independent reviewers
to assess whether they meet the inclusion criteria for the
review. Similarly, the full text of selected citations will be
Ojukwu E, et al. BMJ Open 2023;13:e066713. doi:10.1136/bmjopen-2022-066713
Open access
assessed in detail for inclusion two or more independent
BMJ Open: first published as 10.1136/bmjopen-2022-066713 on 26 July 2023. Downloaded from http://bmjopen.bmj.com/ on March 3, 2024 by guest. Protected by copyright.
reviewers. Reasons for excluding sources of evidence in
the full text will be recorded and reported in the scoping
review. Articles of conflict or disagreements between two
reviewers will be resolved by a third reviewer. Further
disagreements or discrepancies about studies to be
included after full-­text reviews will be resolved through
discussion and with an additional reviewer/s. The search
results and article inclusion process will be reported in
the Preferred Reporting Items for Systematic Reviews
and Meta-­Analyses Extension for Scoping Review (PRIS-
MA-­ScR) in a PRISMA-­ ScR flow diagram.16 18 In addi-
tion, we will also include patient/public opinion in the
conduct, reporting and dissemination of results from the
scoping review.
Data extraction
Data extraction will be done using a data extraction tool
(see online supplemental appendix B) and will include
specific details about the concept, participants, context,
study methods and key findings relevant to the review
question/s.
Data analysis and presentation
The data will be collated, and presented in a tabular form,
with a detailed narrative summary to describe the various
concepts and how they address the objectives of the
scoping review. Specifically, our results will closely follow
the PRISMA extension for scoping reviews’ checklist19 to
summarise available evidence on the incidence and prev-
alence of TPI among ACB adolescent boys and girls; the
associated factors (both facilitators and barriers); and
identify interventions to curtail TPI incidence among
this population. The results of this scoping review will
be critical to map the scope of evidence available on TPI
among ACB adolescent boys and girls in North America.
We will also discuss inherent implications of findings for
research, education, practice and policy as applicable and
identify knowledge gaps to be examined in future studies.
Patient and public involvement
The study will involve an advisory board of ACB health-
care providers, parents and teenagers who will contribute
to the validity and reliability of the review processes, data
analyses and results.
Ethics and dissemination
TPI is a public health concern with socioeconomic and
health consequences for ACB teens in North America.
A scoping review such as this will provide direction for
healthcare practice, policy changes, education and
further research in reducing the incidence of TPI in
North America. Study results will be disseminated via
presentations at conferences, at target populations,
communities and organisations and publications via
peer-­reviewed journals. As knowledge generated from
this scoping review will stem from previously published
evidence, an ethical approval is not needed.
3
 Open access
Acknowledgements We would like to acknowledge UBC Librarian and Library
Research Commons team member—Katherine Miller and Elham Esfandiari, for
their assistance in refining the search strategy. Particularly, Katherine Miller, who
had repeated meetings with team members to refine their searches in the various
databases.
Contributors EO: conceived the idea for the scoping review and designed the
protocol, performed supervisory roles, and contributed to the writing of the original
draft and reviewed and edited subsequent drafts to ensure intellectual content.
EB: contributed to the writing and editing of the manuscript, particularly, the
methodology section. SA: contributed to writing and editing of the manuscript,
particularly, the abstract and introduction sections. SS: contributed to the writing
and editing of the manuscript, particularly, the introduction section. HG: contributed
to writing of the keywords, eligibility criteria and editing of manuscript. ZR:
contributed to writing of the keywords, eligibility criteria and editing of manuscript.
EM: contributed to the writing and editing of the manuscript, particularly, the
introduction section. All authors contributed to data acquisition, writing the original
draft, reviewing and approving the final version for submission, based on guideline
by the International Committee of Medical Journal Editors (ICMJE).
Funding The authors have not declared a specific grant for this research from any
funding agency in the public, commercial or not-­for-­profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were involved in the
design, or conduct, or reporting, or dissemination plans of this research. Refer to
the Methods section for further details.
Patient consent for publication Not applicable.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has
not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been
peer-­reviewed. Any opinions or recommendations discussed are solely those
of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and
responsibility arising from any reliance placed on the content. Where the content
includes any translated material, BMJ does not warrant the accuracy and reliability
of the translations (including but not limited to local regulations, clinical guidelines,
terminology, drug names and drug dosages), and is not responsible for any error
and/or omissions arising from translation and adaptation or otherwise.
Open access This is an open access article distributed in accordance with the
Creative Commons Attribution Non Commercial (CC BY-­NC 4.0) license, which
permits others to distribute, remix, adapt, build upon this work non-­commercially,
and license their derivative works on different terms, provided the original work is
properly cited, appropriate credit is given, any changes made indicated, and the use
is non-­commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
ORCID iDs
Emmanuela Ojukwu http://orcid.org/0000-0002-0700-8975
Eunice Bawafaa http://orcid.org/0000-0002-1357-261X
4 Ojukwu E, et al. BMJ Open 2023;13:e066713. doi:10.1136/bmjopen-2022-066713
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