Academic journal article International Family Planning Perspectives

A Quasi-Experimental Study to Assess the Impact of Four Adolescent Sexual Health Interventions in Sub-Saharan Africa

Academic journal article International Family Planning Perspectives

A Quasi-Experimental Study to Assess the Impact of Four Adolescent Sexual Health Interventions in Sub-Saharan Africa

Article excerpt

CONTEXT: Rigorous evaluations are needed to assess whether adolescent sexual health interventions have an effect on young people's risk-related perceptions and behaviors.

METHODS: A quasi-experimental design was used to evaluate the impact of adolescent sexual health interventions conducted by social marketing programs in Cameroon, Botswan a, South Africa and Guinea in 1994-1998. The some statistical models, using data from baseline and postintervention surveys, were employed to study each intervention; the results are presented within the framework of the Health Belief Model.

RESULTS: The interventions were associated with improvements in a variety of health perceptions among women, including perceptions of benefits of and barriers to protective behavior; for women, the interventions also had positive impacts on contraceptive use. Effects were much more limited among men, although evidence from Cameroon and Botswana suggests that men were less likely after the intervention than before to have multiple or casual partners. The Cameroon intervention, the most successful of the four, used multiple communications media (including radio and peer education) and reached nine in 10 adolescents; the Botswana program also reached a high proportion of the target audience. In South Africa and Guinea, however, the programs were less intensive and had a more limited reach.

CONCLUSIONS: Interventions targeted at adolescents can be effective in changing attitudes and sexual behavior if they include multiple channels of communication, reach a substantial proportion of young adults and make contraceptives widely available. There remains an urgent need to identify ways to address young men's sexual health concerns effectively.

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The literature on the evaluation of adolescent sexual health interventions is growing in both developed (1) and developing countries. (2) However, because few evaluations have shown an impact on behaviors, rigorous assessments of interventions that target adolescents are still needed.

This study assesses the performance of four adolescent sexual health interventions implemented in Sub-Saharan Africa under the five-year Social Marketing Adolescent Sexual Health project, financially supported by the U.S. Agency for International Development's Africa Bureau. It is unique in that it uses a quasi-experimental design, covers programs in multiple countries--Cameroon, Botswana, South Africa and Guinea--and presents findings within the parameters of a well-articulated analytic framework, the Health Belief Model.

The Health Belief Model is one of the most widely used approaches to understanding individual health behaviors; studies in Sub-Saharan Africa indicate that it is good at explaining intentions and behavior there. (3) It is used for this study because its components broadly reflect the goals of social marketing efforts (i.e., to raise risk awareness, reduce barriers to safer sex and increase perceived benefits of prevention), and it allows the examination of a range of variables that are common to several widely used conceptual models.

The model is based on a cognitive approach that uses a cost-benefit perspective to understand preventive health behavior. It assumes that individual behavior change depends upon perceived severity of risk, perceived susceptibility to risk, perceived benefits of preventive action, perceived barriers to preventive action and perceived ability to take preventive action (self-efficacy). (4)

THE INTERVENTIONS AND STUDY DESIGN

All four interventions evaluated in this study were nested within national social marketing programs. The national programs sold subsidized, branded condoms to traditional outlets, such as pharmacies and clinics, and to nontraditional outlets, such as supermarkets, kiosks and street vendors. They promoted the use of their brand to sexually active adults through mass media advertising and through information, education and communication tools such as billboard messages about condom use and point-of-sales materials (stickers and posters) at condom outlets. …

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