Reaching the hard to reach: longitudinal investigation of adolescents’ attendance at an after-school sexual and reproductive health programme in Western Cape, South Africa

BMC Public Health

Research Article

Amanda J. Mason-Jones¹  Petrus J. de Vries²  Leif Edvard Aarø³  Sander Matthijs Eggers⁴  Hein De Vries⁴  Catherine Mathews⁵  Loraine Townsend⁵ 

[1] Adolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, 7700, Rondebosch, Cape Town, South Africa;Department of Health Sciences, University of York, Seebohm Rowntree Building, YO10 5DD, Heslington, York, UK;Adolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, 7700, Rondebosch, Cape Town, South Africa;Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, 7700, Rondebosch, Cape Town, South Africa;Department of Health Promotion and Development, University of Bergen, Bergen, Norway;Division of Mental Health, Norwegian Institute of Public Health Division of Mental Health, P.O Box 4404, NOR-0403, Nydalen, Oslo, Norway;Department of Health Promotion, Caphri Research Institute, Maastricht University, POB 616 6200 MD, Maastricht, The Netherlands;Health Systems Research Unit, South African Medical Research Council, PO Box 19070, 7505, Tygerberg, Cape Town, South Africa;Adolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, 7700, Rondebosch, Cape Town, South Africa;

关键词: Intimate Partner Violence;    Sexual Violence;    School Climate;    Intimate Partner Violence Perpetration;    School Connectedness;   

DOI  :  10.1186/s12889-015-1963-3

 received in 2014-09-28, accepted in 2015-06-23,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundAdolescents need access to effective sexual and reproductive health (SRH) interventions, but face barriers accessing them through traditional health systems. School-based approaches might provide accessible, complementary strategies. We investigated whether a 21-session after-school SRH education programme and school health service attracted adolescents most at risk for adverse SRH outcomes and explored motivators for and barriers to attendance.MethodsGrade 8 adolescents (average age 13 years) from 20 schools in the intervention arm of an HIV prevention cluster randomised controlled trial in the Western Cape Province of South Africa, were invited to participate in an after-school SRH program and to attend school health services. Using a longitudinal design, we surveyed participants at baseline, measured their attendance at weekly after-school sessions for 6 months and surveyed them post-intervention. We examined factors associated with attendance using bivariate and multiple logistic and Poisson regression analyses, and through thematic analysis of qualitative data.ResultsThe intervention was fully implemented in 18 schools with 1576 trial participants. The mean attendance of the 21-session SRH programme was 8.8 sessions (S.D. 7.5) among girls and 6.9 (S.D. 7.2) among boys. School health services were visited by 17.3 % (14.9 % of boys and 18.7 % of girls). Adolescents who had their sexual debut before baseline had a lower rate of session attendance compared with those who had not (6.3 vs 8.5, p < .001). Those who had been victims of sexual violence or intimate partner violence (IPV), and who had perpetrated IPV also had lower rates of attendance. Participants were motivated by a wish to receive new knowledge, life coaching and positive attitudes towards the intervention. The unavailability of safe transport and domestic responsibilities were the most common barriers to attendance. Only two participants cited negative attitudes about the intervention as the reason they did not attend.ConclusionsReducing structural barriers to attendance, after-school interventions are likely to reach adolescents with proven-effective SRH interventions. However, special attention is required to reach vulnerable adolescents, through offering different delivery modalities, improving the school climate, and providing support for adolescents with mental health problems and neurodevelopmental academic problems.Trial registrationCurrent Controlled Trials ISRCTN56270821; Registered 13 February 2013.

【 授权许可】

CC BY   
© Mathews et al. 2015