Adapting a Stigma-Reduction Workshop for Adolescent Sexual and Reproductive Health and Contraceptive Stigma in Kilimanjaro, Tanzania: A Methodological Study

Background Although contraception is free of charge in Tanzania, adolescent girls and young women (AGYW) often avoid seeking services due to stigma and moral judgments around adolescent sexuality. Existing stigma-reduction programs in Tanzania primarily target HIV-related stigma in clinical settings and have not been tailored to the unique social context of sexual and reproductive health (SRH) and contraceptive stigma in youth populations. Objective This methods paper describes the design, adaptation, and implementation of a participatory stigma-reduction workshop program aimed at addressing SRH and contraceptive stigma among AGYW in Kilimanjaro, Tanzania. Methods The adapted intervention consisted of a three-session workshop series delivered separately to urban and rural groups of female adolescents. We adapted the Expanded Total Facility Approach Stigma-reduction Training for Health Workers, originally developed for reducing HIV-related stigma among healthcare workers, into a youth-centered, community-based workshop model. This adaptation was guided by the Health Stigma and Discrimination Framework, Stigma Power Process Model, and Participatory Action Research. Through a collaborative, iterative process with local stakeholders, the content was modified to reflect the sociocultural drivers of SRH and contraceptive stigma affecting AGYW. The adapted intervention was implemented between February and March 2025 among 40 female adolescent participants aged 15-20 years old in urban and rural Kilimanjaro. Facilitators were Tanzanian women researcher coordinators who were trained to deliver the workshops using interactive, peer-based methods. Evaluation of feasibility, acceptability, and potential efficacy used a concurrent mixed-methods approach, including pre/post questionnaires, focus group discussions, and facilitator reflection sessions that guided adaptation, ensured cultural and developmental relevance. Conclusion This study demonstrates the feasibility of adapting facility-based stigma interventions to community settings and younger populations. It offers a replicable model for future efforts to reduce SRH stigma through culturally grounded and participatory approaches. This paper provides a methodological framework for adapting stigma-reduction interventions using participatory and qualitative approaches in youth SRH research.