The need to promote behaviour change at the cultural level: one factor explaining the limited impact of the MEMA kwa Vijana adolescent sexual health intervention in rural Tanzania. A process evaluation

BMC Public Health

Research Article

David Ross¹  Daniel Wight²  Mary Plummer² 

[1] London School of Hygiene and Tropical Medicine, 1 Keppel Street, WC1E 7HT, London, UK;Medical Research Council Social and Public Health Sciences Unit, 4 Lilybank Gardens, G12 8RZ, Glasgow, UK;

关键词: Behavioural interventions;    Young people/adolescents;    Sexual health;    HIV/AIDS;    Sub-Saharan Africa;    Process evaluation;    Culture;    Tanzania;    Structural barriers;   

DOI  :  10.1186/1471-2458-12-788

 received in 2012-04-16, accepted in 2012-08-23,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundFew of the many behavioral sexual health interventions in Africa have been rigorously evaluated. Where biological outcomes have been measured, improvements have rarely been found. One of the most rigorous trials was of the multi-component MEMA kwa Vijana adolescent sexual health programme, which showed improvements in knowledge and reported attitudes and behaviour, but none in biological outcomes. This paper attempts to explain these outcomes by reviewing the process evaluation findings, particularly in terms of contextual factors.MethodsA large-scale, primarily qualitative process evaluation based mainly on participant observation identified the principal contextual barriers and facilitators of behavioural change.ResultsThe contextual barriers involved four interrelated socio-structural factors: culture (i.e. shared practices and systems of belief), economic circumstances, social status, and gender. At an individual level they appeared to operate through the constructs of the theories underlying MEMA kwa Vijana - Social Cognitive Theory and the Theory of Reasoned Action – but the intervention was unable to substantially modify these individual-level constructs, apart from knowledge.ConclusionThe process evaluation suggests that one important reason for this failure is that the intervention did not operate sufficiently at a structural level, particularly in regard to culture. Recently most structural interventions have focused on gender or/and economics. Complementing these with a cultural approach could address the belief systems that justify and perpetuate gender and economic inequalities, as well as other barriers to behaviour change.

【 授权许可】

CC BY   
© Wight et al.; licensee BioMed Central Ltd. 2012