Measuring change in vulnerable adolescents: Findings from a peer education evaluation in South Africa

Introduction: In the context of poverty and HIV and AIDS, peer education is thought to be capable of providing vulnerable youth with psychosocial support as well as information and decision-making skills otherwise limited by scarce social and material resources. As a preventative education intervention method, peer education is a strategy aimed at norms and peer group influences that affect health behaviours and attitudes. However, too few evaluations of peer-led programmes are available,and they frequently fail to reflect real differences between those who have been recipients of peer education and those who have not. This article reports on an evaluation of a pilot peer-led intervention, entitled Vhutshilo, implemented on principles agreed upon through a collaborative effort in South Africa by the Harvard School of Public Health and the Centre for theSupport of Peer Education (the Rutanang collaboration). Vhutshilo targeted vulnerable adolescents aged 14–16 years living in some of South Africa’s under-resourced communities. Methodology: The research design was a mixed-method (qualitative and quantitative), longitudinal, quasi-experimental evaluation. Tools used included a quantitative survey questionnaire (n ¼ 183) and semi-structured interviews (n ¼ 32) with beneficiaries of peer education. Surveys were administered twice forbeneficiaries of peer education (n ¼ 73), immediately after completion of the programme (post-test) and 4 months later (delayed post-test), and once for control group members (n ¼ 110). The three main  methodological limitations in this study were the use of a once-off control group assessment as the baseline for comparison, without a pre-test, due to timing and resource constraints; a small sample size (n ¼ 183), which reduced the statistical power of the evaluation; and the unavailability of existing tested survey questions to measure the impact of peer education and its role in behaviour change. Findings: This article reports on the difficulties of designing a comprehensive evaluation within time and financial constraints, critically evaluates survey design with multi-item indicators, and discusses six statistically significant changes observed in Vhutshilo participants out of a 92-point survey. Youth struggling with poor quality education and living in economically fraught contexts with little social support, nonetheless, showed evidence of having greater knowledge of support networks and an expanded emotional repertoire by the end of the Vhutshilo programme, and 4 months later. At both individual and group level, many with low socio-economic status showed great improvement with regard to programme indicator scores. Conclusion: For the poorest adolescents, especially those living in the rural parts of South Africa, peer education has the potential to change future orientation, attitudes and knowledge regarding HIV and AIDS, including an intolerance for multiple concurrent partnerships. When well organised and properly supported, peer education programmes (and the Vhutshilo curriculum, in particular) provide vulnerable youth with opportunities to develop  psychosocial skills and informational resources that contribute to the changing of norms, attitudes and behaviours. However, the article also flags the need for effective peer education evaluations that take into account limited financial resources and that possess tested indicators of programme effectiveness

Implementing a rural programme of Prevention of Mother-to-Child Transmission of HIV in Nkangala, South Africa: a baseline evaluation

Report for PMTCT, Mpumalanga, JulyHIV related health problems have robbed about 2 million lives. About 1.9 million of the 2.7 million new infections that have documented occurred in sub-Saharan Africa (UNAIDS, 2008). Women and children bear a disproportionate share of the burden, and in many settings continue to experience high rates of new HIV infections and of HIV-related illness and death. In 2008 alone, an estimated 430 000 children were newly infected with HIV, with about 91% of these infections occurring in sub-Saharan Africa (UNAIDS, 2009). In high income countries, PMTCT interventions have led to new HIV infections in children becoming increasingly rare. Globally, renewed efforts are required urgently to increase access to comprehensive, integrated programmes to prevent HIV infection in infants and young children. These programmes also serve as a unique entry point for women to access the services they need to improve their own health and to prevent transmission of HIV to their infants (WHO, 2003). Several recent initiatives have presented an opportunity for countries to increase the coverage and effectiveness of PMTCT programmes

'Think for yourself - Think for tomorrow': Exploring the impact of peer-led HIV intervention and psychosocial support groups for vulnerable youth in South Africa

Report prepared for the Harvard School of Public Health and the Centre for the Support of Peer EducationThis report, building on Swartz, Van der Heijden, Makoae et al. (2009), offers a contribution towards understanding three important phenomena in South Africa: the widespread effect of HIV/AIDS, the ongoing needs of orphaned and vulnerable children (OVC1) living in poverty and made extraordinarily vulnerable by the AIDS pandemic, and the promise of peer education to contribute towards meeting their psychosocial and HIV/AIDS educational needs. In partnership with the Harvard School of Public Health, the study examines, on a formative level, the impact that a structured, time-limited, curriculum-based peer-led intervention (entitled Vhutshilo 2) has on a group of vulnerable youth in periurban and rural areas. Since this is the first time the programme has been implemented and evaluated, apart from the impact measured, this evaluation set out to learn what parts of the curriculum and strategy work well; how to improve delivery and supervision; how best peer educators might be supported and their connection to group members promoted; and how or whether to engage parents and other community members. In other words, the goal was to demonstrate, and move towards institutionalizing an intervention that would be an affordable, practical, sustainable mechanism for meaningful prevention education and psychosocial support which we could reasonably expect to produce changes in attitudes, norms, intentions and behaviour as we improved both our intervention and our ability to measure it (Deutsch, 2010, personal communication). Before turning to the results of the study, including recommendations for curriculum improvement; comments on peer education as a strategy; the impact on youth participants, peer educators, and the organisations that implement the programme; and responses from community members including parents, this chapter seeks to place the study in context. It will consider youth vulnerabilities in general and in the context of poverty and HIV/AIDS; describe peer education as practiced in this study and elsewhere; and briefly situate peer education intervention in the context of policy frameworks locally and internationally

Measuring change in vulnerable adolescents: findings from a peer education evaluation in South Africa

Introduction: In the context of poverty and HIV and AIDS, peer education is thought to be capable of providing vulnerable youth with psychosocial support as well as information and decision-making skills otherwise limited by scarce social and material resources. As a preventative education intervention method, peer education is a strategy aimed at norms and peer group influences that affect health behaviours and attitudes. However, too few evaluations of peer-led programmes are available, and they frequently fail to reflect real differences between those who have been recipients of peer education and those who have not. This article reports on an evaluation of a pilot peer-led intervention, entitled Vhutshilo, implemented on principles agreed upon through a collaborative effort in South Africa by the Harvard School of Public Health and the Centre for the Support of Peer Education (the Rutanang collaboration). Vhutshilo targeted vulnerable adolescents aged 14-16 years living in some of South Africa's under-resourced communities. Methodology: The research design was a mixed-method (qualitative and quantitative), longitudinal, quasi-experimental evaluation. Tools used included a quantitative survey questionnaire (n = 183) and semi-structured interviews (n = 32) with beneficiaries of peer education. Surveys were administered twice for beneficiaries of peer education (n = 73), immediately after completion of the programme (post-test) and 4 months later (delayed post-test), and once for control group members (n = 110). The three main methodological limitations in this study were the use of a once-off control group assessment as the baseline for comparison, without a pre-test, due to timing and resource constraints; a small sample size (n = 183), which reduced the statistical power of the evaluation; and the unavailability of existing tested survey questions to measure the impact of peer education and its role in behaviour change. Findings: This article reports on the difficulties of designing a comprehensive evaluation within time and financial constraints, critically evaluates survey design with multi-item indicators, and discusses six statistically significant changes observed in Vhutshilo participants out of a 92-point survey. Youth struggling with poor quality education and living in economically fraught contexts with little social support, nonetheless, showed evidence of having greater knowledge of support networks and an expanded emotional repertoire by the end of the Vhutshilo programme, and 4 months later. At both individual and group level, many with low socio-economic status showed great improvement with regard to programme indicator scores. Conclusion: For the poorest adolescents, especially those living in the rural parts of South Africa, peer education has the potential to change future orientation, attitudes and knowledge regarding HIV and AIDS, including an intolerance for multiple concurrent partnerships. When well organised and properly supported, peer education programmes (and the Vhutshilo curriculum, in particular) provide vulnerable youth with opportunities to develop psychosocial skills and informational resources that contribute to the changing of norms, attitudes and behaviours. However, the article also flags the need for effective peer education evaluations that take into account limited financial resources and that possess tested indicators of programme effectiveness.