Agents of change : the implementation and evaluation of a peer education programme on sexuality in the Anglican church of the Western Cape

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dc.contributor.advisor De Villiers, Pierre J. T. en_ZA
dc.contributor.advisor Mash, Robert J. en_ZA
dc.contributor.advisor Kapp, Chris en_ZA
dc.contributor.author Mash, Rachel A. en_ZA
dc.contributor.other Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Family Medicine and Primary Care. en_ZA
dc.date.accessioned 2011-11-21T10:04:03Z en_ZA
dc.date.accessioned 2011-12-05T13:03:26Z
dc.date.available 2011-11-21T10:04:03Z en_ZA
dc.date.available 2011-12-05T13:03:26Z
dc.date.issued 2011-12 en_ZA
dc.identifier.uri http://hdl.handle.net/10019.1/17836 en_ZA
dc.description Thesis (PhD)--Stellenbosch University, 2011. en_ZA
dc.description.abstract ENGLISH ABSTRACT: INTRODUCTION Religion is important in Africa and many churches are involved in HIV ministry. Prevention programmes, however, are less frequent in the church setting and there is little evaluation of them. If an effective model is found, it can contribute to HIV prevention efforts in Sub-Saharan Africa. This study was conducted in the Cape Town Diocese of the Anglican Church. Fikelela, an HIV/AIDS project of the Diocese, developed a 20-session peer education programme (Agents of Change) aimed at changing the risky sexual behaviour of youth. Workshops were also aimed at parents. A literature review was conducted looking at three areas: 'theories of behaviour change', 'adolescent sexual relationships' and 'religion and HIV'. A conceptual framework for the programme was developed by integrating findings from the literature review. The aim of this research was to evaluate the effectiveness and functioning of the programme, to develop a best practice model and to make recommendations for the use of the programme in the wider church. METHODS Outcome mapping was used to integrate an approach to the design, monitoring and evaluation of the programme. Changes in project partners, key project strategies and organisational practices were all monitored. Project partners were defined as peer educators, facilitators, young people, clergy and parents. Monitoring allowed an in-depth understanding of which aspects of the programme worked. Evaluation was designed as a quasi-experimental study that compared non-randomly chosen intervention and control groups. 1352 participants took part at base-line, 176 returned matched questionnaires in the intervention groups and 92 in the control groups. Reported changes in attitudes, knowledge and sexual behaviour were compared between the two groups. RESULTS The main factors leading to the success of the programme were: a well developed curriculum and programme, effective training camps, the support given by facilitators to peer educators, ongoing mentoring and training, role modelling by peer educators, a participatory style of education and positive peer pressure within a strong church based social network. Challenging the church.s negative attitude to condoms was also important. The weakest areas of the programme were amongst clergy and parents and in challenging media messages and norms on gender. The project impact evaluation showed significant differences at baseline between genders in terms of sexual beliefs and behaviour. There was no significant impact of religiosity on sexual activity. The programme was successful at increasing condom usage (Condom use score 3.5 vs. 2.1; p=0.02) and reduced sexual debut (9.6% vs. 22.6%; p=0.04). There was increased abstinence amongst the intervention group, but it did not reach statistical significance (22.5% vs. 12,5%; p=0.25). There was no effect on the number of partners (Mean 1.7 vs. 1.4; p=0.67). CONCLUSIONS Implementation: The programme should be promoted as a youth development programme rather than an HIV prevention programme. Priority should be given to churches in communities with the highest HIV rates. The target group should include younger teens. Peer educators should be selected by peers not by adults. Strategies: The strategies of training camp and quarterly gatherings are effective, but a new strategy needs to be devised to impact the parents. Content: The programme should build self-efficacy amongst the youth, develop a critical consciousness about sexual health, provide positive messages rather than fear-inducing ones, address sexual coercion and persuasion, explore the linking of condom use with trust, address inter-generational sex and promote community outreach and advocacy activities. The programme is effective and meets the threshold of evidence required to be rolled out. It should be rolled out through the Anglican Church with its estimated membership of two million and could be adapted for other denominations as well. en_ZA
dc.description.abstract AFRIKAANSE OPSOMMING: INLEIDING Godsdiens is belangrik in Afrika en talle kerke is betrokke by HIV-bediening. Voorkomingsprogramme is egter ongewoon in die kerkomgewing en die evaluering daarvan vind selde plaas. Indien 'n effektiewe voorkomingsprogram model gevind kan word, behoort dit 'n belangrike bydrae te lewer tot HIV infeksie voorkomingspogings in Sub-Sahara Afrika. Hierdie studie is gedoen onder die lidmate van die Kaapstadse Biskoplike gebied van die Anglikaanse Kerk. 'n Bestaande HIV/VIGS projek van die Biskoplike gebied, genaamd Fikelela, het 'n 20-sessie portuurgroepopvoedingsprogram (Agente van Verandering) ontwikkel wat gemik is op die verandering van riskante seksuele gedrag onder die jeug. Daar was ook werkswinkels gemik op ouers. 'n Voorstellingsraamwerk vir die program is ontwikkel deur die integrasie van gedragsveranderingsteorieë met bewyse ten opsigte van verandering van seksuele gedrag onder adolossente en die invloed van godsdiens op adolossente seksualiteit. Die doelwit van hierdie navorsing was om die doeltreffendheid en funksionering van die program te evalueer, 'n optimale praktiese model te ontwikkel en aanbevelings vir die gebruik van die program aan 'n wyer sirkel van kerke te maak. METODES Uitkomskartering is gebruik om 'n benadering tot die ontwerp, waarneming en evaluering van die program te integreer. Alle veranderinge in projekvennote, sleutelprojekstrategieë en organisatoriese handelinge is waargeneem. Projekvennote is gedefinieër as portuurgroepopvoeders, fasiliteerders, jongmense, leraars en ouers. 'n Diepgaande begrip van watter aspekte van die program gewerk het, is bewerkstellig. Die evaluasie was ontwerp as 'n prospektiewe bykans-eksperimentele studie wat nie-lukraak gekose intervensiegroepe en kontrolegroepe vergelyk het. Daar was1352 deelnemers by aanvang, 176 afgepaarde vraelyste is teruggestuur in die intervensiegroepe en 92 in die kontrolegroepe. Veranderings in houdings, kennis en seksuele gedrag wat gerapporteer is, is tussen die twee groepe vergelyk. RESULTATE Die hooffaktore wat tot die sukses van die program gelei het, was: 'n goed ontwikkelde kurrikulum en program, effektiewe opleidingskampe, ondersteuning aan portuurgroepopvoeders deur die fasiliteerders, deurlopende raadgewing en opleiding, portuurgroepopvoeders as rolmodelle, 'n deelnemende styl van opvoeding en positiewe groepsdruk binne 'n sterk kerkgebaseerde sosiale netwerk. Die uitdaging van die kerk se negatiewe houding teenoor kondome was ook belangrik. Die swakste areas van die program was onder die leraars en ouers en in die uitdaging van media boodskappe en norme aangaande geslagskwessies. Die evaluering van die projekimpak het betekenisvolle verskille op grondslag tussen geslagte in terme van seksuele geloof en gedrag getoon. Daar was geen betekenisvolle impak van godsienstigheid op seksuele aktiwiteit nie. Die program was wel suksesvol in die toename van kondoomgebruik (p=0.02) en verhoging in ouderdom van eerste seksuele optrede (p =0.04), maar het geen impak in toename van geheelonthouding onder dié wie alreeds seksueel aktief is (p=0.25) of op die aantal seksmaats (p=0.67) gewys nie. GEVOLGTREKKING Implementering: Die program moet eerder as 'n jeug-ontwikkelingsprogram, as 'n HIV-voorkomingsprogram bemark word. Kerke in gemeenskappe met die hoogste HIV-koers moet voorkeur geniet. Die teikengroep moet jonger tieners insluit. Portuurgroepopvoeders moet deur portuurgroepe self aangewys word en nie deur volwassenes nie. Strategieë: Die strategieë van opleidingskampe en kwartaalikse byeenkomste is effektief, maar nuwe strategieë word benodig om 'n impak op ouers te maak. Inhoud: Die program behoort self-doeltreffendheid onder die jeug te bou, 'n kritiese bewustheid oor seksuele gesondheid te ontwikkel, eerder positiewe as vrees-gebaseerde boodskappe aan te bied, seksuele dwang en oorreding aan te spreek, die verband tussen kondoomgebruik en vertroue te verken, intergenerasie-seks aan te spreek en gemeenskapsuitreik- en aanbevelingsprogramme te bevorder. Die program is effektief en voldoen aan die verlangde bewyse ten einde aangewend te kan word.Met sy geskatte lidmaatskap van twee miljoen behoort die Anglikaanse Kerk dit aan te wend en kan dit ook vir ander denominasies aangepas word. af
dc.format.extent 413 p. : ill.
dc.language.iso en_ZA en_ZA
dc.publisher Stellenbosch : Stellenbosch University en_ZA
dc.subject Youth --Sexual behavior -- South Africa -- Cape Town en_ZA
dc.subject Church work with youth -- Anglican Church -- Cape Town en_ZA
dc.subject Aids (Disease) -- Pastoral counceling en_ZA
dc.subject Theses -- Family medicine and primary care en_ZA
dc.subject Dissertations -- Family medicine and primary care en_ZA
dc.title Agents of change : the implementation and evaluation of a peer education programme on sexuality in the Anglican church of the Western Cape en_ZA
dc.type Thesis
dc.rights.holder Stellenbosch University


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