|
Science and Success in Developing Countries: Holistic Programs That Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections
Full Study Report [HTML] [PDF]
Executive Summary [HTML] [PDF]
Program Components
- Comprehensive sexual health campaign to encourage 1) delayed initiation of sex and 2) reductions in sexual risk-taking behaviors among sexually experienced youth
- Multimedia campaign lasting six months, directed at young people ages 10 to 24 and at adults who control youth's access to reproductive health services
- Three slogans appearing in all materials and activities, in English and native languages: "Have self-control," "Value your body," and "Respect yourself"
- Involvement of youth in designing materials and messages
- Involvement of communities in planning, launching, and executing activities
- Posters, leaflets, newsletter, radio program (Youth for Real), and a hotline
- Theater troupes performing interactive dramas on sexual health issues
- Peer educators, ages 18 to 24, speaking to groups of youth and adults
- Training of peer educators
- Training of health providers in making services youth-friendly
- Referral of youth to health care providers trained in youth-friendly services
For Use With
- Urban and rural youth, ages 10 to 24
- Youth living in small town centers in rural areas
Evaluation Methodology
- Quasi-experimental evaluation design with youth in five intervention and two comparison sites
- Baseline survey at three months prior to the campaign's launch and follow-up one year later, three-months after the campaign's end
- Baseline survey among 1,426 randomly selected youth at intervention and comparison sites; follow-up survey among
1,400 randomly selected youth at intervention and comparison sites
- A survey of youth ages 10 to 24 (n=700) living in six cities outside the campaign area, to assess the reach of Youth for Real
Evaluation Findings
- Increased communication with parents and others about sexual health
- Delayed initiation of sexual intercourse
- Increased abstinence among sexually experienced youth—females
- Reduced number of sex partners
- Increased use of contraception
- Increased use of condoms
- Increased use of health care services
Program Description
This six-month long, multimedia campaign is based on the "steps to behavior change" theory. The theory's framework describes five
stages of behavior change—knowledge, approval, intention, practice, and advocacy. The campaign focuses on the two earliest stages,
when people learn key information and skills, then discuss what they have learned with others, finding support for behavior change
among family, peers, and community. The theory posits that outside approval is critical because 1) young people's sexual decisions
are often strongly influenced by friends, family, and social norms, and 2) youth's access to sexual health information and services is
controlled by adults, including parents, service providers, and public policy leaders. The campaign focuses on youth ages 10 to 24 with
the objectives of encouraging 1) abstinence among youth who have not yet initiated sex and 2) sexual risk-reduction among sexually
experienced youth.[14]
The objectives of the campaign are to 1) increase youth's reproductive and sexual health knowledge; 2) heighten approval of safer
sexual behavior and of using family planning services; and 3) encourage youth to adopt safer sexual behaviors and attend health
services facilities. To achieve these objectives, the campaign has three slogans that appear in all its materials and activities: Have self-control,
Value your body, and Respect yourself. The campaign's major components include 1) use of radio, especially 26 episodes of Youth for Real, broadcast nationwide, 2) a combination of information and advice with music and mini-dramas, and 3) phone-in
opportunities for youth to speak with a peer educator and/or a doctor. Other components include posters, leaflets, a hotline, and peer
education. Community-based theatre troupes perform interactive dramas focused on sexual health issues at schools, churches, and
town centers. At the beginning of the campaign, local committees garner substantial support from local businesses and plan elaborate
launch activities—including performances by popular musicians, dramas, parades, speeches, and soccer games.[14]
The campaign aims at building support in the community and within the health care system for reproductive health information and
services for youth. As such, it empowers local committees (including representatives from local government, religious organizations,
and education, health, and business groups) to design activities to reach family, friends, and teachers. It also trains providers to
overcome entrenched biases against offering sexual health information and services to young people and involves health care providers
in campaign preparations and launch. Finally, peer educators, drama groups, and print materials refer young people to youth-friendly reproductive health clinics.[14]
Evaluation Methodology
The evaluation used a quasi-experimental design, with treatment and comparison conditions. The campaign ran at five sites—one in
an urban area (Mutare) and four in growth points (described as small towns at the center of rural districts). Youth in two other sites
(one city and one growth point) comprised the comparison group. Youth in the comparison sites were not targeted for the campaign;
nevertheless, these youth were exposed to some elements of the campaign, such as the nationally broadcast radio program,
advertisements for the hotline on Youth for Real, and other non-campaign materials such as posters, condom marketing, peer education,
and family life education in schools.[14]
The baseline survey was conducted among 1,426 randomly selected respondents in the intervention and comparison sites three months
before the campaign was launched. Follow-up occurred among 1,400 randomly selected respondents one year later, three months after
the major campaign activities ended. A demographic and health survey sampling frame was used to select houses randomly within
a 30-kilometer radius of the towns' center. Within each household, one youth ages 10 to 24, who was also the same gender as the
interviewer, was selected for interview. Before conducting the interview, the interviewer explained the reason for the research, described the content of the questionnaire, and asked permission of the parent or guardian of any potential respondent under age 15. In addition, 700 youth ages 10 to 24, living in six cities outside of the campaign area, were surveyed to determine the reach of Youth
for Real throughout Zimbabwe.[14]
Almost equal numbers of young men and young women were interviewed in intervention and comparison sites at baseline and follow-up.
Roughly 20 to 30 percent of respondents at both baseline and follow-up were ages 10 to 14; about 50 percent were ages 15 to 19;
and the remainder were ages 20 to 24. Roughly 90 percent were single and about 70 percent had never had sexual intercourse. At
baseline, respondents in intervention sites tended to be slightly younger and less well educated and were less likely to be married or
to report sexual experience than those in comparison sites. At follow-up, respondents in intervention sites tended to be somewhat older
and better educated and somewhat more likely to be sexually experienced than comparison youth were at baseline. The rural-urban
composition of the intervention and comparison samples also differed: four of five respondents from intervention sites lived in rural
areas, whereas half of the comparison respondents lived in rural areas. Given these differences, the researchers performed multivariate
logistic regression analyses to control for age, gender, education, sexual experience, marital status, and urban or rural residence.[14]
The strategy of involving local committees and training health care providers achieved high levels of parent-child discussions about
sensitive sexual health topics and increased the number of youth seeking reproductive health services, especially at youth-friendly
health centers. Community support also meant continuance of some components, including training and support for peer educators
and support for youth-friendly health centers and the hotline.[14]
Outcomes
- Behaviors—
- Increased communication about sexual health issues—Analysis revealed that, during and immediately after the campaign,
respondents in intervention sites were significantly more likely than those in comparison sites to discuss sexual health issues with
someone. The proportion of youth in intervention sites that discussed sexual health issues with:
- Anyone was 80 percent versus 20 percent of youth from comparison sites (OR=5.6)
- Friends, 72 percent versus 33 percent of youth from comparison sites (OR=5.7)
- Siblings, 49 percent versus 20 percent of youth from comparison sites (OR=3.8)
- Parents, 44 percent versus 15 percent of youth from comparison sites (OR=4.3)
- Teachers, 34 percent versus 14 percent of youth from comparison sites (OR=3.5)
- Partner, 28 percent versus 13 percent of youth from comparison sites (OR=3.8).[14]
- Delayed initiation of sexual intercourse—The proportion of respondents in the intervention site who reported continuing to delay the initiation of sex was 32 percent versus 22 percent in the comparison area (OR=1.2), a statistically significant finding.[14]
- Reduced sexual risk-taking among sexually experienced youth—The odds of sexually experienced intervention
site respondents having taken any action in regard to safer sexual behavior was 8.8 (41 percent of intervention respondents versus
10 percent of comparison youth). Specifics included stopping having sex, sticking to one partner, starting to use condoms, or
asking partners to use condoms. Details follow.
- Increased abstinence among sexually experienced youth—The odds that respondents in intervention sites reported saying no
to sex were 2.5 times greater than the odds of youth in comparison sites saying no to sex; 53 percent of intervention
site respondents reported saying no to sex, versus 32 in comparison sites. According to multiple regression analysis,
young women were more likely than young men to report having said no to sex. This may reflect a positive change in women's
belief that they have the right to refuse unwanted sex. Youth at the intervention sites were also significantly more likely to report
avoiding "sugar daddies" than were youth at comparison sites (11 versus nine percent, respectively; OR=1.1).[14]
- Reduced number of sex partners—The campaign's biggest effect, by far, was to convince sexually experienced youth to reduce
the number of their sexual partners. At follow-up, youth at intervention sites were significantly more likely to report sticking to
one partner than were youth at comparison sites (20 versus two percent, respectively; OR=26.1).[14]
- Increased use of contraception—At follow-up, the proportion of sexually experienced youth at the intervention sites
who reported using a modern method of contraception at most recent sex rose significantly (from 56 percent at baseline to 67
percent at follow-up). Use of modern methods did not change significantly among youth in the comparison areas.[14]
- Increased use of condoms—Sexually experienced youth at the intervention sites were significantly more likely to report starting
to use condoms than were youth at comparison sites (11 versus two percent, respectively; OR=5.7).[14]
- Increased use of health care services—Analysis showed that young people in intervention sites were significantly more likely
to visit a health or youth center than youth in comparison sites (34 versus 10 percent; OR=7.6). Notably, the campaign encouraged
health center visits by groups historically less likely to seek services—males, single youth, and sexually inexperienced youth.[14]
For More Information, Contact
|
