Impact Data - Promoting Sexual Responsibility among Youth
Date
The Promoting Sexual Responsibility Among Youth project was a 6-month multimedia campaign based on the "steps to behaviour change" theory. The theory’s framework describes 5 stages of behaviour change knowledge, approval, intention, practice, and advocacy. Designed to reach urban and rural youth aged 10 to 24 in Zimbabwe, the campaign’s major components included 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 included posters, leaflets, a hotline, and peer education. Community-based theatre troupes performed interactive dramas focused on sexual health issues at schools, churches, and town centres.
Methodologies
The survey was carried out among urban and rural youth aged 10 to 24 living in small town centres in rural areas, using a quasi-experimental evaluation design with youth in 5 intervention and 2 comparison sites. The campaign ran at 5 sites: one in an urban area (Mutare) and four in growth points (small towns at the center of rural districts). Youth in 2 other sites (one city and one growth point) comprised the comparison group (though they were inevitably exposed to some elements of the campaign, such as the radio programme Youth for Real). The baseline survey was conducted at 3 months prior to the campaign's launch among 1,426 randomly selected youth; follow-up was one year later, 3 months after the campaign’s end, and included 1,400 randomly selected youth. 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.
Almost equal numbers of young men and young women were interviewed in intervention and comparison sites at baseline and follow-up. However, 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: 4 of 5 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.
Almost equal numbers of young men and young women were interviewed in intervention and comparison sites at baseline and follow-up. However, 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: 4 of 5 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.
Practices
On the whole, evaluators found that the campaign:
Broadly, the odds of sexually experienced intervention site respondents having taken any action in regard to safer sexual behaviour was 8.8 (41% of intervention respondents versus 10% of comparison youth). Specifics included stopping having sex, sticking to one partner, starting to use condoms, or asking partners to use condoms.
For instance, 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% of intervention site respondents reported saying no to sex, versus 32% in comparison sites. The proportion of respondents in the intervention site who reported continuing to delay the initiation of sex was 32% versus 22% in the comparison area (OR=1.2), a statistically significant finding. Youth at the intervention sites were also significantly more likely to report avoiding "sugar daddies" than were youth at comparison sites (11% versus 9%, respectively; OR=1.1).
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 2%, respectively; OR=26.1).
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% at baseline to 67% at follow-up). Use of modern methods did not change significantly among youth in the comparison areas. 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 2%, respectively; OR=5.7).
Analysis showed that young people in intervention sites were significantly more likely to visit a health or youth centre than youth in comparison sites (34% versus 10%; OR=7.6). Notably, the campaign encouraged health centre visits by groups historically less likely to seek services - males, single youth, and sexually inexperienced youth.
- 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
Broadly, the odds of sexually experienced intervention site respondents having taken any action in regard to safer sexual behaviour was 8.8 (41% of intervention respondents versus 10% of comparison youth). Specifics included stopping having sex, sticking to one partner, starting to use condoms, or asking partners to use condoms.
For instance, 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% of intervention site respondents reported saying no to sex, versus 32% in comparison sites. The proportion of respondents in the intervention site who reported continuing to delay the initiation of sex was 32% versus 22% in the comparison area (OR=1.2), a statistically significant finding. Youth at the intervention sites were also significantly more likely to report avoiding "sugar daddies" than were youth at comparison sites (11% versus 9%, respectively; OR=1.1).
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 2%, respectively; OR=26.1).
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% at baseline to 67% at follow-up). Use of modern methods did not change significantly among youth in the comparison areas. 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 2%, respectively; OR=5.7).
Analysis showed that young people in intervention sites were significantly more likely to visit a health or youth centre than youth in comparison sites (34% versus 10%; OR=7.6). Notably, the campaign encouraged health centre visits by groups historically less likely to seek services - males, single youth, and sexually inexperienced youth.
Attitudes
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.
Increased Discussion of Development 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% versus 20% of youth from comparison sites (OR=5.6)
- ...friends was 72% versus 33%... (OR=5.7)
- ...siblings was 49% versus 20%... (OR=3.8)
- ...parents was 44% versus 15%... (OR=4.3)
- ...teachers was 34% versus 14%... (OR=3.5)
- ...a partner was 28% versus 13%... (OR=3.8).
Other Impacts
Evaluators stress that 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 centres. Community support also meant continuance of some components, including training and support for peer educators and support for youth-friendly health centres and the hotline.
Source
Sue Alford, MLS, Nicole Cheetham, MHS, and Debra Hauser, MPH, "Science and Success in Developing Countries: Holistic Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections" [PDF] (Advocates for Youth, 2005).
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