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PREPARE Project Cape Town Meeting

PREPARE Project Cape Town Meeting

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PREPARE Project Cape Town Meeting

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  1. PREPARE Project Cape TownMeeting 27 -29 Nov 2013

  2. Overview of PREPARE Cape Town 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.

  3. Sample

  4. Surveys

  5. Baseline Survey Sampling • 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

  6. Follow-up 1 Survey: Attrition Learner refusals • 7 learner refusals Absent learners • 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

  7. Follow-up 1 Survey: Attrition continued Left school • 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 • Total of 136 (3.9%) learners were lost to follow-up

  8. Follow-up 1 Survey: Retention Atotal of 3319 (96.1%) learners completed the questionnaire !!!!! !!!!!!!!!!!!!!☻♫☺♪☺☻

  9. Selected Baseline Findings

  10. Demographics • Mean Age: 13.71 years • Sex: 58.7% females and 38.7% males

  11. Sexual health quiz • 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

  12. Primary Outcomes • 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

  13. IPV victimization (Secondary Outcome) • 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

  14. IPV perpetration (Secondary Outcome) • 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

  15. Other findings • 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 • Alcohol and drug use in the past 3 months among learners • 6% said they had drunk more than one drink of alcohol on the same day • 3% said they had used dagga (marihuana) • 1% said they used tik (methamphetamine)

  16. Learners’ experiences of participingin the survey Positive experiences • 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 • 12.7% said it made them feel distressed (sad, upset, angry) • 32% said the questions were too private/personal

  17. PREPARE Intervention Comprised of 3 components • PREPARE curriculum/After school sessions • School based health service (SBHS) • School safety and Photo-voice project

  18. Implementation Preparation • 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

  19. School safety training

  20. Nurses’ Training

  21. After school sessions -curriculum • Aimed to prepare learners to prevent IPV and HIV and to have healthy relationships • Activity based sessions • Once a week over 10 weeks • By PREPARE facilitators

  22. Student attendance at afternoon sessions • Mean session attendance was 8.2 • Facilitating factors: Facilitators Loyalty cards and incentives • Barriers: Transport Turn-over of facilitators

  23. Certificates and vouchers

  24. School Health Service • Aimed to give learners access to preventive SRH services • Nurses visited school for one hour • Referrals were made to more specialist services as necessary • 17 out of 19 intervention schools had this service • 21% of learners in intervention sample consulted the nurse • HIV/STI and condom line up PREPARE curriculum session given by nurses in classroom

  25. SHS package • Screening • Blood pressure, height and weight, vision, dental and hearing • SRH • R U Ready” guidance on relationships aimed at delaying sexual debut • Advice on contraception/condoms as deemed appropriate • Other • Minor ailments • Abuse/relationships • Referrals

  26. School safety program • To reduce acceptability and prevalence of violence in school especially sexual violence • 17 of 20 schools participated in the training • 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 • Facilitators -Existing relationships prior to the project

  27. Photo-voice project • 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

  28. Corporal Punishment

  29. Gangsterism

  30. Sexual Harassment

  31. PREPARE INTERVENTION Process evaluation

  32. Pre- and post-training: Nurses, police & school personnel, facilitators • 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

  33. Facilitator’s daily “logs” • 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

  34. Facilitator observations • AIM: To assess intervention fidelity • Unannounced observations of sessions • 2 observers (inter-rater scores) coupled with assessments = objective data • Each facilitator observed twice • Facilitation skills • Coverage of content / activities • Interaction with learners • General comments

  35. Learner evaluations • 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

  36. Post-intervention interviews: nurses • 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

  37. Post-intervention interviews: school principals / staff • 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

  38. Post-intervention interviews: facilitators • 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