INTRODUCTION Community-based sexual reproductive interventions are key in attaining universal health coverage for all by 2030, yet adolescents in many countries still lack health services that are responsive to their sexual reproductive health and rights' needs. As the first step of realist evaluation, this study provides a programme theory that explains how, why and under what circumstances community-based sexual reproductive health interventions can transform (or not) 'ordinary' community-based health systems (CBHSs) into systems that are responsive to the sexual reproductive health of adolescents. METHODS This realist approach adopted a case study design. We nested the study in the full intervention arm of the Research Initiative to Support the Empowerment of Girls trial in Zambia. Sixteen in-depth interviews were conducted with stakeholders involved in the development and/or implementation of the trial. All the interviews were recorded and analysed using NVIVO version 12.0. Thematic analysis was used guided by realist evaluation concepts. The findings were later synthesized using the Intervention-Context-Actors-Mechanism-Outcomes conceptualization tool. Using the retroduction approach, we summarized the findings into two programme theories. RESULTS We identified two initial testable programme theories. The first theory presumes that adolescent sexual reproductive health and rights (SRHR) interventions that are supported by contextual factors, such as existing policies and guidelines related to SRHR, socio-cultural norms and CBHS structures are more likely to trigger mechanisms among the different actors that can encourage uptake of the interventions, and thus contribute to making the CBHS responsive to the SRHR needs of adolescents. The second and alternative theory suggests that SRHR interventions, if not supported by contextual factors, are less likely to transform the CBHSs in which they are implemented. At individual level the mechanisms, awareness and knowledge were expected to lead to value clarification', which was also expected would lead to individuals developing a 'supportive attitude towards adolescent SRHR. It was anticipated that these individual mechanisms would in turn trigger the collective mechanisms, communication, cohesion, social connection and linkages. CONCLUSION The two alternative programme theories describe how, why and under what circumstances SRHR interventions that target adolescents can transform 'ordinary' community-based health systems into systems that are responsive to adolescents.

中文翻译：

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性健康干预措施能否使基于社区的卫生系统对青少年做出更好的反应？在赞比亚农村进行的现实主义知情研究。

引言基于社区的性生殖干预措施是到2030年实现全民健康覆盖的关键，但是许多国家的青少年仍缺乏能够满足其性生殖健康和权利需求的卫生服务。作为现实主义评估的第一步，本研究提供了一种程序理论，该理论解释了基于社区的性生殖健康干预措施如何，为何以及在何种情况下可以将（或不能）转化为基于社区的“普通”卫生系统（CBHS）对青少年的性生殖健康有反应。方法这种现实主义的方法采用了案例研究设计。我们将这项研究嵌套在“研究计划”的全面干预部门中，以支持赞比亚增强女孩权能试验。与参与试验开发和/或实施的利益相关者进行了十六次深入访谈。所有访谈均使用NVIVO 12.0版进行记录和分析。主题分析是在现实主义评估概念的指导下进行的。后来使用干预-上下文-演员-机制-结果概念化工具对发现进行了综合。使用追溯方法，我们将调查结果总结为两个程序理论。结果我们确定了两种可测试的初始程序理论。第一种理论认为，受情境因素（例如与SRHR相关的现有政策和指南）支持的青少年性生殖健康和权利（SRHR）干预措施，社会文化规范和CBHS结构更有可能在不同参与者之间触发机制，从而鼓励采取干预措施，从而有助于使CBHS适应青少年的SRHR需求。第二种和另一种理论表明，SRHR干预措施，如果没有上下文因素的支持，则不太可能改变实施这些措施的CBHS。在个人层面，期望通过机制，意识和知识来澄清价值，这也将导致个人对青少年SRHR形成“支持态度”。预计这些单独的机制将反过来触发集体机制，沟通，凝聚力，社会联系和联系。