The study aimed at evaluating Soul City school and mass media life skills education among junior secondary school learners in South Africa using a postintervention design. The sample consisted of 3150 learners, 44.1% were male and 55.9% female, and their mean age was 15.6 yrs (SD=1.6) ranging from 13 to 24 years. Results indicate that Soul City school life skills exposure was positively associated with puberty/body knowledge, HIV knowledge, HIV risk perception, and condom use at last sex. The Soul City life skills mass-media edutainment had mainly a significant positive impact on condom use knowledge, attitudes towards people with HIV/AIDS, self-efficacy, and delaying sex.
In 2002 the estimated national South African human immunodeficiency virus (HIV) prevalence rate was 15.5% among adults aged 15-49 years; it was 6% (4% in males and 7% in females) in 15 to 19 year-olds (Shisana & Simbayi, 2002).
Surveys of junior high school students in various countries including South Africa consistently identify significant gaps in adolescents' knowledge of HIV, especially regarding misconceptions about causal transmission and prevention. At the same time, these young people have a high prevalence of behaviors that put them at risk of HIV infection, including early sexual onset, infrequent condom use, and multiple sexual partners (Siegel, DiClemente, Durbin, Krasnovsky & Saliba, 1995; Stewart et al., 2001). Eaton and Flisher (2000) reviewed HIV/AIDS knowledge among South African "youth" aged 14-35 years and found that young people are very aware about the nature of the acquired immunodeficiency syndrome (AIDS) but were less knowledgeable about HIV transmission and prevention. Eaton, Flisher and Aaro (2003) reviewed unsafe sexual behavior among South African youth and suggest that at least 50% of young people are sexually active by age of 16, a considerable number had more than one lifetime partner and mostly used condoms irregularly. There was also uncertainty about the proper use of condoms (ibid.).
School-based HIV prevention education has been strongly recommended as a major strategy for increasing adolescents' HIV-related knowledge and prevention behaviors (Siegel et al., 1995). From a review of studies it was found that generally human-sexuality education does not increase the likelihood that students will begin sexual activity earlier (UNAIDS, 1997). Kaya and Mabetoa (1997) studied Black youth in South Africa and note the importance of the mass media - especially television and magazines - as well as friends as the main sources of information about sexual practices. A study of sexuality education programs in South Africa found that youth want more information, including help with decision making and coping skills, and the opportunity for individual counseling with someone they trust (Baue & Steinberg, 1995).
Harrison, Smit and Myer (2000) note that a number of prevention efforts in South Africa have been implemented by the national and provincial governments and various nongovernmental organizations (NGOs), which include three major areas: information, education and communication, peer education and behavioral risk reduction. "Lovelife", a national youth sexual health initiative, has started a mass media campaign using billboards, newspaper advertisements, radio and other outlets to address sexual and other health issues. Another program, Soul City, is a weekly drama that covers a range of health issues, disseminating basic information about the epidemic and its consequences. Working in conjunction with Soul City, the Departments of Health and Education have developed a national life skills program for Grades 8 through 12, the goal of which is to increase knowledge, develop skills, promote positive and responsible attitudes, and provide motivational supports. Soul City, an NGO, is a multimedia health and development project (television, radio, newspaper, school material) informed by the Soul City theory of social and behavioral change (Soul City, 2001a).
The Soul City school life skills materials are aimed at adolescents between the ages of 14 and 18 years (Grade 9 & 10), in particular to: (1) provide relevant information on the emotional and physical changes of puberty including contraception and pregnancy; (2) improve HIV/AIDS-related knowledge, and promote practices that effectively prevent the transmission of HIV/AIDS and other STDs; (3) develop skills that will enable young people to develop safe sexual behaviors or change risky behavior and make healthy choices for their lives; (4) build young people's capacity to develop healthy relationships; and (5) promote positive values and attitudes towards people living with HIV/AIDS (Soul City, 2001b).
There has been little research on how to translate and disseminate researchbased HIV prevention interventions to be implemented by service agencies such as schools on a large scale. Small-scale and pilot research on the implementation of life skills in some South African schools showed a positive response to the program, increase in HIV knowledge and some behavior change (e.g., Harvey, Stuart & Swan 2000; Visser, 1996).
The aim of this study was to evaluate Soul City school and mass media (television, radio, newspaper) life skills education among junior secondary school learners in South Africa.
The study was a cross-sectional postintervention survey on the evaluation of Soul City school and mass media life skills education among junior secondary school learners in South Africa.
SAMPLE AND PROCEDURE
In the first stage the sample of schools was drawn on the basis of a survey by letter and telephone on the exposure to Soul City life skills. In the second stage from schools which had been exposed a representative sample was drawn and in the third stage a sample of learners was randomly selected per school.
In April 2002 6950 self-addressed letters were sent out from the University of the North (Polokwane/Turfloop) to all secondary school principals in South Africa. School postal addresses were obtained from each of the nine provincial Departments of Education. A deadline of two months was given for the return of the survey questionnaire. Only 473 (6.8%) letters were returned. Thereafter a systematic random sample of 449 of 5977 secondary schools (excluding the 473 which had responded by letter and about 500 -mostly nonurban schools, which did not have a telephone) were followed up by telephonic interview. Therefore the total sample included 922 schools from which 522 indicated that they had received Soul City life skills materials (all in English) and 490 had indicated that they actually covered some (50.4%), half (38.4%) and most parts (11.2%) of the learners' work book. From this sample of 490 schools, a representative sample of 150 urban and rural schools was selected (which included schools servicing informal settlements) and some oversampling of schools with higher, as compared to lower, exposure to the Soul City life skills learners' work book (Soul City, 2001b). On-site exposure to the life skills materials was not always easy to assess since in some schools teachers reported that they had almost finished with the workbook while learners said they had just started. However, among this final sample of 150 schools 9.5% were found not to have used the learners' workbook at all contrary to their affirmative answers by letter or phone. These schools were classified as nonexposure schools to Soul City life skills workbooks. Five schools which refused the evaluation were replaced by other schools from the exposure list.
Within each participating school one class was selected in which the learners had been exposed to life skills education using Soul City materials. These were mainly learners in Grade 9 (87.6%) and only a few in Grade 10 (7%) and Grade 8 (4.7%). In each class a range of 19 to 29 learners (with a target of 20 for the administration of a questionnaire) was randomly selected.
The study was approved by the human ethics committee of the University of the North and all nine provincial Education Departments in South Africa. Consent was obtained from school principals, learners in the selected classes as well as from their parents/guardians.
Since the Soul City life skills and mass media materials were in English, the questionnaire was administered in English in a classroom situation under the supervision of two trained postgraduate research assistants. All questions were read out to learners in English and clarified during administration. Complete anonymity and confidentiality were assured.
The total sample consisted of 3150 learners, 44.1% were male and 55.9% female learners, and their mean age was 15.75 yrs (SD=1.61) ranging from 13 to 24 years; 1730 (54.9%) were from an urban school and 1420 (45.1%) from a nonurban school.
The racial distribution was African/Black (2775, 88.1%), Coloured (170, 5.4%), White (148, 4.7%), and Asian (57, 1.8%). The ethnic distribution among African/Black was Zulu (768, 24.7%), Northern Sotho (611, 19.4%), Xhosa (512, 16.3%), Tswana (331, 10.5%), Southern Sotho (318, 10.1%), Tsonga (160, 5.1%), Swazi (127, 4.0%), Ndebele (65, 2.1%) and Venda (47, 1.5%).
The questionnaire reflected the content of the Soul City life skills Grade 9 workbook (Soul City, 2001b). Other Soul City mass media exposures in the form of television, radio, and printed media were also assessed.
The questionnaire moved beyond traditional approaches to evaluating media campaigns, which tend to focus on the impact that interventions have on individual respondents' knowledge, attitudes, and practice. In addition to these three aspects, the questionnaire aimed to measure a range of constructs, which were identified as potentially important in changing social norms and behavior such as risk perception and self-efficacy (Soul City, 2001a). The range of items included:
-sociodemographic information (grade, age, sex, race, ethnic group).
-knowledge about the different units covered in the learners' workbook:
a) 5 items on puberty/body such as "Both boys and girls develop sexual feelings during puberty" (Soul City, 2001b) (response options were "yes" or "no"). The internal consistency reliability of the measure was .72 (standardized Cronbach's alpha) for this study sample;
b) 18-item Brief HIV Knowledge Questionnaire (Carey & Schroder, 2002) and an additional 7 items covering the South African context (Peltzer & Promtussananon, under review; Soul City, 2001b) (response options "true", "false", "do not know"). These items have been recoded to 0="wrong answer" or "do not know" versus 1="correct answer" (internal consistency reliability .76);
c) 4-items on condom use knowledge such as "Should a condom be put on before any contact with the vagina"), abbreviated from 10-item scale by the World Health Organization, 1990) (response options were "true" or "false"); (internal consistency reliability .76)
d) 6 items on contraceptive knowledge such as "Which sex uses the contraceptive pill?" (Soul City, 2001b) (response options were "yes" or "no") (internal consistency reliability .74);
-3 items on sexual behavior (delay of sex in sexually inactive, sexually active and condom use at last sex);
-4 items on attitudes towards people with HIV/AIDS such as "How comfortable would you feel being in the same classroom with someone who has AIDS?" (Ndeki, Klepp, Seha, & Leshabari, 1994) (response options from 1=completely comfortable to 3=not at all comfortable) (internal consistency reliability .81);
-3 items on HIV risk/susceptibility perception such as "My chances of getting HIV/AIDS are very small" (response options from 1=strongly agree to 5=strongly disagree) (Stanton et al., 1999) (internal consistency reliability .70);
-3 items on self-efficacy regarding reduction of sexual-risk behaviors, based on scenarios that called for the discussion or practice of safer sex. Participants were asked to indicate how confident they were that they could implement the safersex behavior (response options from 1=not at all confident to 3=very confident) (Basen-Engquist et al., 1999) (internal consistency reliability .77).
-learners were further asked about how often they heard about sex and HIV/AIDS from four different Soul City information sources other than Soul City school life skills (Soul City televisions and radio, an adult program, Soul buddyz TV, a children's program, and newspaper materials in the form of health education booklets) in the past, with response options from never to more than 10 times.
The questionnaire was pilot tested with Grade 9 learners in three focus group discussions. Then the final version of the questionnaire was administered with a sample of 60 Grade 9 learners (32 from a rural and 28 from an urban school) and readministered after three weeks; a test retest reliability of .88 was found.
(1) EXPOSURE TO SOUL CITY SCHOOL LIFE SKILLS WORKBOOK
The exposure to Soul City school life skills based on the coverage of the learners' workbook was low (1-3 units of the workbook) in 41.8% of the schools, medium (4-6 units) in 28.1%, high (7-8 units) in 20.3%, none in 9.5% of the schools and missing: 2%. Learners having been exposed to life skills education using Soul City materials were mainly in Grade 9 (87.6%) with only a few in Grade 10 (7%), Grade 8 (4.7%) and 0.6% missing. Grade 9 learners had been exposed to Soul City life skills materials in 2002, only a few Grade 10 learners had been exposed to it in 2001. This was due to the fact that materials arrived late in 2001 and were consequently only introduced at the beginning of 2002. Learners were asked to indicate against each of the eight learning units of the workbook (by presenting the titles of the units in the questionnaire) whether or not they had dealt with the unit in class (see Table 2).
According to the learners' assessment half of the learners had been exposed to at least 50% of all the units except for unit 6 (staying safe) and unit 8 (living with HIV/AIDS). This assessment appears to be higher than the assessment by the research assistants who also asked the learners about the coverage of the workbook where 42% had indicated a low exposure (1-3 units).
(2) EXPOSURE TO SOUL CITY LIFE SKILLS MASS MEDIA
Learners were surveyed on how often they heard about sexuality and HIV/AIDS from four different Soul City information sources (see Table 3).
More than one-third of the learners had been exposed to four different Soul City media sources more than 10 times, and about two-thirds 6 and more times. Urban learners were exposed more often to Soul City television and Soul Buddyz than were their rural counterparts, whereas Soul City radio was listened to more often by rural learners.
Table 4 shows the different Soul City media sources in relation to different outcome variables.
Soul City school life skills exposure was positively associated with puberty/body knowledge, HIV knowledge, HIV risk perception, and condom use at last sex.
Soul City television series exposure was positively associated with condom use, HIV, and contraceptive knowledge, attitudes towards people with HIV/AIDS, self-efficacy, and delay in sex.
Soul Buddyz television series was positively associated with condom use knowledge, attitudes towards people with HIV/AIDS, self-efficacy, and delay in sex.
Soul City radio programs were positively associated with attitudes towards people with HIV/AIDS.
Soul City newspaper materials were positively associated with condom use knowledge, self-efficacy, and delay in sex.
The study found that Soul City school life skills exposure was positively associated with puberty/body knowledge, HIV/AIDS knowledge, HIV risk perception, and condom use at last sex. The Soul City life skills mass media had mainly a significant positive impact on condom use knowledge, attitudes towards people with HIV/AIDS, self-efficacy, and delaying sex. Soul City school life skills seem to have had some positive outcomes over the short-term exposure to life skills (since program had just started) and longer-term exposure to Soul City mass media (television and radio series, and printed media have been in circulation for a number of years).
Kim, Stanton, Li, Dickersin, and Galbraith (1997) reviewed the effectiveness of 40 adolescent AIDS risk reduction interventions and found that a majority of studies found a positive intervention impact (88% of studies assessing changes in knowledge, 58% changes in attitude, and 73% in condom use).
This study found lower frequency of watching Soul City or Soul buddyz series among learners from rural as opposed to urban schools. Soul City is a program for adults while Soul buddyz is a program for children. Shisana and Simbayi (2002) suggest addressing these limitations by investing in community level communication systems that allow for interactive communication, and community-based health services.
The life skills evaluation was conducted retroactively and by self-report. The fact that no preintervention data existed made it more difficult to conclusively attribute observations to the program. Data collection took place while the intervention was in most cases still going on, which means that the longer term (or sustainable) impact of the program was not investigated.
Over the longer term, research using longitudinal pre-post designs need to be conducted to investigate stronger evidence and the sustained and longer term impact of the Soul City life skills program and mass media edutainment, which, if sustained, seems to have the potential to effect powerful change in a future generation of youth and adults.
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Human Sciences Research Council and University of the North, South Africa
University of Venda for Science and Technology, South Africa
Professor Karl Peltzer, Human Sciences Research Council and University of the North, South Africa and Dr. Supa Promtussananon, University of Venda for Science and Technology, South Africa.
This study forms part of an evaluation of Soul City life skills material commissioned by Soul City.
The contribution of Dr. S. Goldstein and Dr. L. Cherian towards the design of the evaluation and the work of the research assistants M. Bopape, G. Phaswana, E. Sethosa, S. Raphala, C. Ledwaba, M. Phoshoko, T. Rambau, and N. Rasodi is hereby acknowledged.
The authors are also grateful for the generous financial support of Soul City, Johannesburg.
Appreciation is due to reviewers including: Lisa Langhaug, Evaluation Coordinator, Regai Dzive Shiri, Mutre, Zimbabwe. Email:
Keywords: Soul City life skills, mass media edutainment, junior secondary school learners, evaluation, South Africa.
Please address correspondence and reprint requests to: Professor Karl Peltzer, Human Sciences Research Council, Private Bag X9182, Cape Town 8000, South Africa.
Phone: +27-21-4674497; Fax: +27-21-4610299; Email: