PREPARE_project_Nov prepare meeting Cape Town team

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27 -29 Nov 2013
AIMS
 Primary: To postpone sexual debut, reduce the number of
sexual partners and to increase condom use
 Secondary: To reduce intimate partner violence (IPV),
sexual violence and to change harmful gender stereotypes
STUDY DESIGN
 RCT among Grade 8s in 42 schools in W Cape
 20 schools were randomly allocated to the intervention
INTERVENTION
 Predominantly delivered by the research team after school,
in school premises, by facilitators hired by our team.
Sampling
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6244 learners invited to participate & given
parental consent forms
3666 (58.7%) parental consents
281 (4.5%) parental refusals
3454 (55.3%) learner assents
69 (1.1%) learner refusals
Leaving a total of 3454 (55.3%) learners
completing the surveys
Learner refusals
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7 learner refusals
Absent learners
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366 learners were absent on the day of data
collection
325/366 (88.8%) learners we were able to survey
after visiting the school twice more
41 learners were still absent upon 3 visits to the
school
Left school
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88 learners left school
7 learners who left school we followed up and let
them complete the survey at home or at their new
school
Total attrition
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Total of 136 (3.9%) learners were lost to follow-up
A total of 3319 (96.1%) learners
completed the questionnaire !!!!!
!!!!!!!!!!!!!!☻♫☺♪☺☻
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Mean Age: 13.71 years
Sex: 58.7% females and 38.7% males
◦ 66% knew that if you have sex only once with a
person who is HIV positive, you can become
infected with HIV
◦ 52% said that it is true that a person who looks
strong and healthy can be HIV positive
◦ 41% knew that a condom has an expiry date
◦ 24% knew that when a girl used contraceptive pills
or the injection, this does not protects her against
sexually transmitted infections
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28% of boys and 8% of girls said that they had
had sex
67% of them said that they used a condom
the last time they had sex
The first time learners had sex was it their
own choice or were they forced? (N=249
sexually active)
◦ 41% of girls and 74% of boys said they wanted it
◦ 23% of girls and 13% of boys said it was something
they did not want
◦ 7% of girls and 5% of boys said they were forced
◦ 5% of girls and 1% of boys said they were raped
◦ Physical: 16% said that their boyfriend or girlfriend
hit, pushed, kicked or choked them in the past 6
months
◦ Sexual: 8% said that their boyfriend or girlfriend
had forced them to have sex in the past 6 months
◦ Psychological: 30% said that their boyfriend or
girlfriend insulted them, or humiliated them, or
made them feel bad about themselves in the past 6
months
◦ Threats: 17% said that their boyfriend or girlfriend
threatened to hurt them in the past 6 months
◦ Physical: 10% of learners said that they had hit,
pushed, kicked or choked their boyfriend or
girlfriend
◦ Sexual: 6% of learners said that they had forced
their boyfriend or girlfriend to have sex, or touched
his or her private parts
◦ Psychological: 14% of learners said that they had
insulted, or humiliated their boyfriend or girlfriend,
or made him or her feel bad about themselves
◦ Threat: 10% of learners said that they had
threatened to hurt their boyfriend or girlfriend
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Other types of violence learners were
involved in
◦ 18% said that they had been beaten or physically
punished by a teacher at school
◦ 22% said that they had been insulted or humiliated in
front of other people at school
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Alcohol and drug use in the past 3 months
among learners
◦ 6% said they
on the same
◦ 3% said they
◦ 1% said they
had drunk more than one drink of alcohol
day
had used dagga (marihuana)
used tik (methamphetamine)
Positive experiences
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71% said that it felt good to be open and honest
about themselves, and all learners said that it
helped to share the bad things that they have been
through
86% of them would still participate if they had
known what it was like
Negative experiences
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12.7% said it made them feel distressed (sad,
upset, angry)
32% said the questions were too private/personal
Comprised of 3 components
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PREPARE curriculum/After school sessions
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School based health service (SBHS)
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School safety and Photo-voice project
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Facilitator training in Jan 2013 and when
needed
Nurses’ training Feb 2013
Police and school principals training Feb
2013
Photo-voice facilitators training June 2013
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Aimed to prepare learners to prevent IPV and
HIV and to have healthy relationships
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Activity based sessions
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Once a week over 10 weeks
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By PREPARE facilitators
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Mean session attendance was 8.2
Facilitating factors:
Facilitators
Loyalty cards and incentives
Barriers:
Transport
Turn-over of facilitators
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Aimed to give learners access to preventive SRH services
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Nurses visited school for one hour
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Referrals were made to more specialist services as
necessary
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17 out of 19 intervention schools had this service
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21% of learners in intervention sample consulted the nurse
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HIV/STI and condom line up PREPARE curriculum session
given by nurses in classroom
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Screening
◦ Blood pressure, height and weight, vision, dental and
hearing
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SRH
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R U Ready” guidance on relationships aimed at delaying
sexual debut
Advice on contraception/condoms as deemed
appropriate
Other
◦ Minor ailments
◦ Abuse/relationships
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Referrals
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To reduce acceptability and prevalence of violence in
school especially sexual violence
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17 of 20 schools participated in the training
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Safety session in PREAPRE curriculum given by police
in 18 intervention schools
Barriers
-Difficult to implement as required the 2 groups to
foster their own relationships
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Facilitators
-Existing relationships prior to the project
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A student participatory photography project
Aimed to actively involve students in changing
the school environment to make it safer, and to
reduce all forms of violence
Also aimed to mobilize social support from
parents and other key stakeholders in the
school community
Implemented in 10 schools
PREPARE INTERVENTION
Process evaluation
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AIM: to evaluate effectiveness of training
Open-ended questions, self-completed
◦ Expectations
◦ Beliefs & values – teenage sexuality /SHS / corporal
punishment & community violence
◦ What services should / should not be offered
◦ Skills required / skills acquired
◦ Comment on curriculum, objectives, messages
◦ Expected difficulties
◦ Appropriateness of services, topics, content
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AIMS: To explore intervention feasibility & to
assess intervention fidelity
Self-completed, structured form for each
session
◦ Document what parts of individual sessions /
activities implemented or not
◦ Reasons for non-implementation
◦ Challenges / enablers
◦ Learner response
◦ Comments / suggestions
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AIM: To assess intervention fidelity
Unannounced observations of sessions
2 observers (inter-rater scores) coupled with
assessments = objective data
Each facilitator observed twice
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Facilitation skills
Coverage of content / activities
Interaction with learners
General comments
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AIMS: To assess intervention fidelity & assess
intervention acceptability
Structured / open-ended questionnaires
Completed on observation days
◦ What did you think of the facilitator?
◦ What did you think of the session content?
◦ What did you think about the learning methods and
materials?
◦ What did you enjoy most / least?
◦ Suggestions for changes
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AIMS: To assess SHS feasibility & acceptability
◦ The fact that there is someone there that can see to their
well being made them very excited. Children that were not
part of the PREPARE project would come up to me and say
“Doctor can I see you too?”
◦ Learners in high schools don’t get noticed and the
pressures they face go unnoticed. And they don’t have
someone who is outside the school who is neutral to talk to
◦ I think the project is a very good idea, specifically for that
age group because not many of them are sexually active yet
hence it is a good time to speak to them about these things
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AIMS: To assess intervention feasibility &
acceptability
◦ I think it’s important because it addressed certain issues
that we weren’t dealing with like sexual health and
violence
◦ I find that they (learners who participated) can
communicate more effectively, they are confident and
they are not giving us any behaviour problems
◦ After school was just not a good time. It will always be a
problem. We would have liked all learners to participate
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AIMS: To assess intervention feasibility &
acceptability
◦ Certain sessions were highlighted (easiest to
implement / enjoyed most)
◦ Learner response varied by school
◦ Disappointment in learner numbers (falling)
◦ Personal growth (“The things I facilitated helped me
as well”)
◦ Inability to transcend own values & beliefs
◦ Innovation (intervention fidelity??)
◦ Very positive overall impression of potential impact
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