Doctoral Degrees (Family Medicine and Primary Care)

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Browsing Doctoral Degrees (Family Medicine and Primary Care) by Author "Mash, Rachel A."

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    Agents of change : the implementation and evaluation of a peer education programme on sexuality in the Anglican church of the Western Cape
    (Stellenbosch : Stellenbosch University, 2011-12) Mash, Rachel A.; De Villiers, Pierre J. T.; Mash, Robert J.; Kapp, Chris; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Family Medicine and Primary Care.
    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.