Description
You are designing an executable population-based change project addressing identified practice-related problems or questions. This strongly emphasizes collaboration between advanced practice nurses and community agencies and includes working with an agency using practice data to provide answers, which are responsive to the needs of clinicians, administrators, and policy makers for improvement of programs or practices.
This section of the change project should include a discussion of key concepts.
Clarify the issue under study.
Propose solutions or interventions based on the literature review.
Compare other views on the problem and solutions.
Address the APRN role in the intervention and discuss implications for clinical practice.
Discuss the implications of your change project.
Some important things to consider and address:
Does your intervention have a clear connection to your research problem?
What are the specific methods of data collection you are going to use, such as surveys, interviews, questionnaires, or protocols?
How do you intend to analyze your results?
Provide a justification for subject selection and sampling procedure.
Describe potential limitations. Are there any practical limitations that could affect your data collection? How will you attempt to control the limitations?
How will your change project help fill gaps in understanding the research problem?
This section should be 6–7 pages in length, not including the cover or reference page. You must reference a minimum of 5 scholarly articles
Topic: Adolescents and unwanted pregnancies/ STDs
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Adolescents and Unplanned Pregnancies: A Conceptual Framework
Suzanna Changulyan
Dr. Fuson
October 8, 2023
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Theoretical Perspectives to Understand Unplanned Pregnancies
The foundation that can be used toward building a suitable framework for understanding
the research problem begins with identifying the pertinent theoretical perspectives. The
problem and solutions that can be used to address unintended pregnancies among adolescents
can be understood using various theories including; social learning theory and social-ecological
model.
Social Learning Theory
The social learning theory, a concept introduced by Albert Bandura, posits that learning
often occurs as a result of various components such as imitation, observation, and modeling
(McLeod, 2011). Besides, this theory suggests that learning is influenced by other factors such
as the emotions, attitudes, and even the level of attention of an individual. This theory can act
as part of the building basis for understanding the various components that contribute to
unplanned pregnancies among adolescents in society.
Social-ecological model
The social-ecological model is a framework that creates a connection between the societal,
community, relationship, and individual factors. Ideally, this theory explores the potential
influence of the aforementioned factors on the healthcare of an individual. As such, this theory
understands that individual, societal, community, physical, and even environmental
interactions influence health (Centers for Disease Control and Prevention, 2015). This theory
can be used to understand the various factors that influence the high prevalence of unplanned
pregnancies among adolescents in society.
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Developing Conceptual Framework
The development of the conceptual framework that will be used for this research study
will be borrowed from the insights and perspectives presented by past research studies. The
process of the development of the conceptual framework of this project will involve the
identification of the various factors that contribute to unintended pregnancies among
adolescents. In this case, the process will involve selecting the proper dependent variable,
independent variables, and even the intervening variables. This research aims to implement a
conceptual framework similar to the study conducted by (Hall, Mann, Lewis, Stephenson, &
Morroni, 2016), to integrate the concept of planning and preventing unwanted pregnancies.
Assumptions and components of the framework
The primary objective of the conceptual framework in this research is to build a
connection between the potential various demographic and socio-economic factors to address
the problem of unplanned pregnancies. One of the assumptions that will be used to develop the
conceptual framework is that socioeconomic factors in society influence the rate of unplanned
pregnancies. Another assumption that will be used in this framework is that the level of parental
education has a significant influence on the rate of unplanned pregnancies among adolescents.
Ideally, this assumption can further be expounded that adolescents with more educated parents
are less likely to encounter unplanned pregnancies compared to those without educated parents.
Besides, this framework is based on the assumption that religion influences the prevalence of
unplanned pregnancies among adolescents.
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The main components, presented in Figure 1 below, of the conceptual framework will
include; independent variables, dependent variables and the dependent variable and the
intervening variable. The independent variable in this framework will include; socioeconomic
factors of the individuals, level of parent education, and religion. The intervening variables will
include; access and usage of birth control methods. The dependent variable, on the other hand,
is the rate of unplanned pregnancies among the adolescent.
The elements of social learning and the social-ecological theories can be used to
understand the connection between the identified dependent and the independent variables.
Ideally, these theories can be used to understand the impact of the independent variables on the
prevalence of unplanned pregnancies among adolescents in the community. The rationale
behind the implementation of the selected theories and components in the conceptual
framework is to understand the impact of the various physical, socioeconomic, and
environmental factors on unplanned pregnancies. This framework is also used in identifying
any potential gaps in research and the possible future recommendations that can be undertaken
by the research stakeholders and the policy planners to fight unplanned pregnancies.
Conclusion
This project will adopt the conceptual framework approach to address the problem of
unplanned pregnancies among adolescents. In particular, the development of this framework
begins with the identification of the theoretical perspectives including; social learning theory
and social-ecological model. Besides, the development of this framework will be based on
various components. The framework will be based on the assumption that socio-economic
factors, level of parent education, and religion influence the rate of unplanned pregnancies
among adolescents. The rationale behind this conceptual framework will be to develop a
connection between the dependent and the independent variables in the study.
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Figure 1: Conceptual Framework
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References
Centers for Disease Control and Prevention. (2015). Models and frameworks for the practice
of community engagement. Retrieved November, 16, 2021.
Hall, J. A., Mann, S., Lewis, G., Stephenson, J., & Morroni, C. (2016). A conceptual
framework for integrating ‘Pregnancy Planning and Prevention’(P3). Journal of
Family Planning and Reproductive Health Care, 42(1), 75-76.
McLeod, S. (2011). Albert Bandura’s social learning theory. Simply Psychology. London.

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Adolescent Unwanted Pregnancy and STDS
Suzanna Changulyan
West Coast University
Professor Fuson
NURS 619A
October 1, 2023

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The Impact of the Project
This project on the impacts and prevalence of unintended pregnancies and STDs plays a
significant role in improving the public health sector’s understanding and approach to this
significant issue (Vaina & Perdikaris, 2022). The exploration of variations in teen births across
different demographics offers crucial insights that have wide-ranging benefits in terms of cost,
time, and quality for people, programs, institutions, and communities.
Cost Benefits
The first benefit is economical resource allocation. Identifying the areas with high
prevalence rates and understanding demographic variations allows resources to be allocated
more efficiently, potentially reducing the economic burden associated with unintended
pregnancies and STDs. Implementing tailored preventive measures can potentially reduce the
future economic costs associated with healthcare, social services, and educational support that
teenage parents and their children require (Vaina & Perdikaris, 2022). Also, reducing unplanned
pregnancies can lead to long-term savings for healthcare systems by averting costs related to
pregnancy complications and long-term health implications for young mothers and their children.
Time Benefits
The project’s insights into demographic variations enable the development of targeted
interventions, thus maximizing efficiency and minimizing the time taken to address high-risk
populations. The research helps quickly identify the needs and modifications in the policies

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addressing unintended pregnancies and STDs, allowing for swift amendments and
implementations. According to Javidi et al. (2021), understanding the prevalent demographics
helps in prioritizing and streamlining educational interventions, saving time in curriculum
development and implementation.
Quality Benefits
Insights drawn from this project aid in developing high-quality, culturally sensitive
interventions that address different demographics’ specific needs and circumstances. This
research facilitates improvements in the quality of healthcare services by offering a nuanced
understanding of the varying needs and challenges associated with different demographics facing
unintended pregnancies. Knowledge from this research supports the enhancement of sex
education quality by addressing the diverse needs and concerns of varied demographics, making
it more impactful and relevant.
Addressing Needs or Changes
This project provides communities, particularly those marginalized or underrepresented,
with the information and resources to effectively address and prevent unintended pregnancies
and STDs. The rich, demographic-specific insights ensure that interventions and policies are
adaptable and responsive to the evolving community needs and changes (Javidi et al., 2021).
This research is crucial in heightening awareness about the socio-economic and racial disparities
in unintended pregnancies and contributes to a more informed dialogue and action.
Impacts and Consequences

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This project helps in reducing disparities. It highlights disparities in teen births across
various demographics, which acts as a catalyst for change, promoting equitable access to
resources and services (Harris et al., 2023). The comprehensive insights derived from this study
empower individuals, communities, and policymakers to make more informed decisions
regarding reproductive health. The overall improvements in the efficiency, effectiveness, and
relevance of interventions lead to a holistic enhancement in the well-being and quality of life of
individuals and communities affected by unintended pregnancies.
Therefore, this project is not just an academic endeavor but a transformative initiative
with far-reaching implications. It addresses the diverse impacts of unplanned pregnancies and
explores demographic-specific challenges, fostering a better, more equitable, and informed
approach to reproductive health. This has the potential to revolutionize public health policies,
community interventions, and individual choices.
Goals and objectives
To create measurable, shared, and hypothetically agreed-upon goals and objectives for the
project addressing unintended pregnancies and sexually transmitted diseases (STDs), I aligned
them with the project’s success factors. The first goal is to reduce the incidence of unintended
pregnancies and STDs among teenagers in both high-income and lower or middle-income
countries. The objectives of these goals are to decrease the teenage pregnancy rate by 40% over
the next five years and to lower the incidence of STDs among teenagers by 45% in targeted
regions within five years.

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Another goal is to enhance the accessibility and effectiveness of preventive measures for
unintended pregnancies and STDs. The objectives of this goal are to increase the distribution of
contraceptives to teenagers in prone regions by 30% within the next two years and to improve
sex education in learning centers by introducing comprehensive and evidence-based sex
education programs in 60% of schools within three years. The third goal is to understand and
address demographic disparities in the prevalence of unintended pregnancies and teen births. The
objective is to conduct comprehensive research on the factors contributing to demographic
disparities in unintended pregnancies and teen births, with a focus on race, socio-economic
status, and geography, to publish findings within two years.
Variables to Consider
The first variable to be considered is budget. Budget is a critical variable in this project if
I implement a clinic-wide practice change. In this project, I will need to secure funding.
Consequently, it is crucial to develop a budget plan for prospective financing avenues
(Gusmartina et al., 2021). I will seek grants, partnerships, and fundraising opportunities if
necessary. The second variable is the staff. I will determine the staff and expertise required for
the project to ensure that I have the necessary human resources, whether hiring new staff,
training existing ones, or collaborating with external experts. Another important variable in this
project is regulations and compliance. I will maneuver this by understanding and complying with
relevant regulations and ethical considerations, especially in healthcare research.
Research Method

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Due to the complex nature of this project, I intend to deploy both qualitative and
quantitative research methods. Quantitative methods will provide statistical insights into the
prevalence of unintended pregnancies and STDs. In contrast, qualitative methods will help
understand the affected population’s underlying causes, experiences, and attitudes, especially
teenage mothers.
Research Contribution to the Community or Social Change
This project aims to foster communal well-being while cultivating meaningful reform
through engaged cooperation by empowering members and inspiring collective progress. The
research will empower policymakers and healthcare professionals to make informed
interventions and resource allocation decisions. The project will reduce health inequalities,
ensuring healthcare services are more equitable across different groups. According to Parida et
al. (2021), a well-rounded education that holistically addresses relationships, health, and
sexuality could cultivate adolescents’ capacities for discovering their own interests while
respecting others’, empowering youth to navigate intimacy with care, responsibility, and mutual
understanding.
Project Purpose, Focus, and Expected Accomplishments
The project aims to curb unintended pregnancies and the spread of STDs by addressing
the challenges faced disproportionately by teenage mothers and certain demographics through
focused interventions and awareness campaigns. The primary focus is on reducing unintended
pregnancies and STDs among teenagers, especially those of disadvantaged demographics. The
project takes a public health perspective, viewing the reduction of unintended pregnancies and

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STDs as a vital aspect of community well-being. The project expects to significantly reduce
teenage pregnancies and STD rates, with a particular focus on closing demographic disparities.
Timeline
The project will take about six years. The 1st and 2nd years shall be dedicated to
acquiring financing, forming a collaborative group of specialists, and drafting a strategic research
plan. The researchers will use their third and fourth years to collect data and scrutinize results to
gain insights. The 5th and 6th years will be for developing and implementing interventions and
monitoring the progress.

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References
Harris, B., McCredie, M. N., Truong, T., Regan, T., Thompson, C. G., Leach, W., & Fields, S. A.
(2023). Relations between adolescent sensation seeking and risky sexual behaviors across
sex, race, and age: A meta-analysis. Archives of Sexual Behavior, 52(1), 191-204.
Gusmartina, S., Azlina, N., & Julita, J. (2021). The Effect of Budget Planning, Budget
Implementation, Procurement of Goods and Services, Competence of Human Resources
and Budget Politics on Budget Absorption (Empirical Study on Opd Pelalawan
District). AFEBI Accounting Review, 6(1), 1-9.
Javidi, H., Widman, L., Lipsey, N., Brasileiro, J., Javidi, F., & Jhala, A. (2021). Redeveloping a
digital sexual health intervention for adolescents to allow for broader dissemination:
Implications for HIV and STD prevention. AIDS Education and Prevention, 33(2),
89-102.
Parida, S. P., Gajjala, A., & Giri, P. P. (2021). Empowering adolescent girls, is sexual and
reproductive health education a solution? Journal of Family Medicine and Primary
Care, 10(1), 66.
Vaina, A., & Perdikaris, P. (2022). School-based sex education among adolescents worldwide:
Interventions for the prevention of STIs and unintended pregnancies. British Journal of
Child Health, 3(5), 229-242.
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Adolescents and Unplanned Pregnancies: An Integrative Literature Review
Suzanna Changulyan
NURS 619A
Professor Fuson
September 24, 2023
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Introduction
Unintended pregnancies and sexually transmitted diseases (STDs) are represented as
an important problem in the public health sector not only in the high-income countries but also
in the lower and middle-income earning countries. Numerous preventive measures are often
implemented by not only healthcare institutions but also the general community. Some of the
common measures include; the integration of sex education in learning centers and enhancing
the distribution and the accessibility of contraceptives. To fully address this problem, there is
a need to understand not only the challenges caused by the problem but also the differences in
the level of prevalence of the healthcare problem in demographics such as; race and the socioeconomic status in the community. This paper presents an integrated research review on the
various challenges of unplanned pregnancies and the variation in teen births in various
demographics including; race, socio-economic status, and geography.
The impact of unplanned pregnancies on adolescents
According to research conducted by the World Bank in 2022, there were more than 12
million girls, aged between 15 and 19, who gave birth. The World Bank (2022), noted various
challenges encountered by teenage mothers including; social stigma, health risks, and possible
adverse economic impacts for the rest of their adult lives. Gurung, et al. (2020), in their
research, also attempted to explore the various consequences associated with teenage
pregnancy. Through an observational study, Gurung, et al. (2020) noted that pregnant
adolescents are at risk of prolonged labor compared to adult mothers. Besides, this research
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identified that the risk of malfunction is more than two-fold in the case of adolescent mothers
in comparison to adult mothers. The World Bank (2022) further improves on this comparison
by stating that pregnant adolescent girls experience more birth complications such as low baby
weight and severe neonatal conditions compared to pregnant mothers aged between 20 and 24.
Chakole, Akre, Sharma, Wasnik, & Wanjari (2022), in their research, also conducted
a narrative literature review to explore the impact of teenage pregnancy. According to this
study, teenage pregnancy can result in a high mortality rate because of delivery challenges or
even illegal and botched abortions. According to a study conducted by The World Bank
(2022), more than half of the abortions that occur among adolescent girls across the globe are
unsafe. Besides, the World Bank (2022) also reported on the risk of the high rate of mortality
in pregnant adolescents compared to older pregnant women.
Adolescent pregnancy is also more likely to undermine the economic potential of
teenage mothers. According to The World Bank (2022), teenage mothers are less likely to
proceed with education, which can prevent them from not only realizing but also reaching their
true potential. The inability to proceed with education can undermine the future earnings of the
teenage mother and even contribute to the intergenerational cycles of poverty. Moreover,
pregnancy among adolescents is likely to contribute to psychological impact on the individuals.
According to Chakole, Akre, Sharma, Wasnik, & Wanjari (2022), the physical and financial
stress associated with teenage pregnancy can undermine the emotional stability of an
individual. E, R, & HS, (2023) further expand on the connection of mental health to unplanned
pregnancies among teenagers by indicating that adolescent mothers are likely to get less rest
and sleep, be introverted, and even into anxiety and depression compared to the older pregnant
mothers. The research presented in this study can be used to understand the various problems
that can be encountered by pregnant adolescents and young mothers. Ideally, the information
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from these articles can offer a proper framework for not only addressing any existing research
gaps but also formulating a basis for implementing the proper interventions to help address the
problem in the various communities across the globe.
Racial and ethnic disparities on adolescents’ unplanned pregnancies
The assessment of the racial and ethnic differences in prevalence of the unplanned
pregnancies among adolescents is another important component that can be used in
understanding the foundation of implementing the proper interventions to address the problem.
According to past research studies, demographic factors such as age, race, social economic
factors, and geographic factors can impact the rate of teen births. Ideally, understanding the
differences in the racial and ethnic teen birth rates can help foster a plan, which can be used to
mitigate the problem.
Among the researchers who have examined the racial and ethnic differences in teen
births is Cox (2020), who explored the differences in the pregnancy rates among black and
white teens in the United States. In 2018, there were more than twice the birth rates of black
and Hispanic teens as that of white teens (Cox, 2020). Dumas, Chu, & Horswell (2020) also
affirm that black teens in the United States have an overall high pregnancy and birth rates
compared to white teens. The racial differences in teen birth rates among various ethnicities
can be due to the different perceptions of access to reproductive healthcare and contraception.
According to Galloway, Duffy, Dixon, & Fuller (2017), the disparities in access to
sexual reproductive services and sexual healthcare among African-American and Hispanic
teens are heavily influenced by inaccurate perceptions and beliefs regarding the reliability of
contraceptives. Besides, this study reported concerns about the side effects of birth control as
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a major contributor to the adoption of contraceptives among black and Hispanic teens.
Sychareun, et al. (2018), in their qualitative research also noted the negative perceptions of the
reliance on contraceptives as a major contributor to teenage pregnancy. While this study only
focuses on rural Lao, the findings presented in the research can play an essential role in
understanding the differences in teenage birth rates among various races and ethnicities.
Social-economic differences in the adolescents’ unplanned pregnancies
Socioeconomic status is another area of exploration that can be examined to identify the
differences in unplanned pregnancies among adolescents. Ideally, the differences in socioeconomic status can help further identify the distribution of interventions and ultimately
address the problem. Gurung, et al. (2020), in their study, identified that two-thirds of their
research participants, who were adolescent mothers, were from disadvantaged ethnic groups.
Besides, the research noted that individuals who lacked formal education were more likely to
be teenage mothers compared to those with formal education.
Chirwa, et al. (2019), in their research, explored the socio-economic differences in
teenage pregnancies in Malawi. The findings of this research suggested that teenage bearing
and childbearing were more prevalent in the communities with the lower socio-economic status
in the country. Ideally, this study noted wealth status in the families was an important
contributor to teenage pregnancies. Cox (2020) further explored the aspect of socioeconomic
status about the difference in teen birth rates. According to the study, the comparison of the
teens in the black and white communities of equally lower socio-economic status suggested a
reduction in the racial differences in the teen birth rates.
The findings of Dumas, Chu, & Horswell (2020) also support the conclusions presented
by Cox (2020), as the research mentions the lack of significant differences in teen births
between black and white communities. Individuals of lower socioeconomic status, irrespective
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of age and race, were more likely to encounter teenage pregnancy compared to those of higher
socioeconomic status (Cox, 2020). Okoli, Hajizadeh, Rahman, Velayutham, & Khanam
(2022), in their study, also identified teenagers from lower socio-economic communities were
more likely to encounter unplanned pregnancies. This article noted that the existence of social
economic inequality limited access to information, which in turn contributes to higher birth
rates among adolescents.
Geographic Differences
Moreover, geographic differences can also play a part in the assessment of the
differences in teen births. Ideally, the findings from the exploration of this component can be
used to understand the various gaps and the possible solutions that can be implemented to help
further address the problem. According to the study conducted by Cox (2020), there is a higher
teen birth rate among the communities residing in Arkansas compared to those residing in
Massachusetts. Byonanebye, Brazauskas, Tumwesigye, Young, & Cassidy (2020), also
conducted a geographic variation on teenage pregnancies in Uganda. The findings of this study
indicate that there are higher birth rates among the communities in the Eastern central region
compared to the other regions in the country. The findings of these two studies offer an
informative view regarding the component of geographic variation and its importance in
understanding and noting the differences in teenage birth rates in a country.
Conclusion
Unplanned pregnancies and sexually transmitted diseases form part of important public
health problems not only in the high-income countries but also in the middle income and the
low-income earning countries. The integrated research review reveals unplanned pregnancies
have a significant impact not only on the physical and mental health of an individual but also
on the economic stability and potential. Besides, the review uncovers that teenage pregnancies
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are more prevalent in the less advantaged racial and ethnic groups and communities in socioeconomic status. Geographical variation also plays a part as a factor that determines the
differences in teen births in various countries. Understanding the challenges caused by teenage
pregnancies and differences in teen births in various communities can help formulate a proper
plan for investment in the proper interventions.
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References
Byonanebye, J., Brazauskas, R., Tumwesigye, N., Young, S. M., & Cassidy, L. (2020).
Geographic variation and risk factors for teenage pregnancy in Uganda. African
Health Sciences, 20(4), 1898-907.
Chakole, S., Akre, S., Sharma, K., Wasnik, P., & Wanjari, M. B. (2022). Unwanted Teenage
Pregnancy and Its Complications: A Narrative Review. Cureus 14(12): e32662.
doi:10.7759/cureus.32662.
Chirwa, G. C., Mazalale, J., Likupe, G., Nkhoma, D., Chiwaula, L., & Chintsanya, J. (2019).
An evolution of socioeconomic related inequality in teenage pregnancy and
childbearing in Malawi. PloS one, 14(11), e0225374.
Cox, J. E. (2020). Understanding the Differences in Pregnancy and Birth Rates for Black and
White Teens. Journal of Adolescent Health .
Dumas, S. A., Chu, S., & Horswell, R. (2020). Analysis of pregnancy and birth rates among
black and white medicaid-enrolled teens. Journal of Adolescent Health, 67(3), 409415.
E, E., R, W., & HS, M. (2023). The Impact of Unwanted Pregnancy in Adolescents toward
Pregnancy Care: A Systematic Review. . Open Access Maced J Med Sci [Internet].
2022 Feb. 5 [cited 2023 Sep. 22];10(F):7-14. Available from:
https://oamjms.eu/index.php.
Galloway, C. T., Duffy, J. L., Dixon, R. P., & Fuller, T. R. (2017). Exploring AfricanAmerican and Latino Teens’ Perceptions of Contraception and Access to
Reproductive Health Care Services. National Library of Medicine .
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Gurung, R., Målqvist, M., Hong, Z., Poudel, P., Sunny, A., Sharma, S., & Kc, A. (2020). The
burden of adolescent motherhood and health consequences in Nepal. BMC pregnancy
and childbirth , 20 , 1-7.
Okoli, C. I., Hajizadeh, M., Rahman, M. M., Velayutham, E., & Khanam, R. (2022).
Socioeconomic inequalities in teenage pregnancy in Nigeria: evidence from
Demographic Health Survey. BMC Public Health, 22(1), 1-11.
Sychareun, V., Vongxay, V., Houaboun, S., Thammavongsa, V., Phummavongsa, P.,
Chaleunvong, K., & Durham, J. (2018). Determinants of adolescent pregnancy and
access to reproductive and sexual health services for married and unmarried
adolescents in rural Lao. BMC pregnancy and childbirth , 18 , 1-12.
The World Bank . (2022). The Social and Educational Consequences of Adolescent
Childbearing. From: https://genderdata.worldbank.org/data-stories/adolescentfertility/.
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