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

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dc.contributor.authorMathews, Catherineen_ZA
dc.contributor.authorEggers, Sanderen_ZA
dc.contributor.authorde Vries, Petrusen_ZA
dc.contributor.authorMason-Jones, Amandaen_ZA
dc.contributor.authorTownsend, Loraineen_ZA
dc.contributor.authorAaro, Leifen_ZA
dc.contributor.authorDe Vries, Heinen_ZA
dc.date.accessioned2015-12-07T08:48:54Z
dc.date.available2015-12-07T08:48:54Z
dc.date.issued2015en_ZA
dc.description.abstractBACKGROUND: Adolescents 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. METHODS: Grade 8 adolescents (average age 13years) 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 6months 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. RESULTS: The 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. CONCLUSIONS: Reducing 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 REGISTRATION:Current Controlled Trials ISRCTN56270821; Registered 13 February 2013.en_ZA
dc.identifier.apacitationMathews, C., Eggers, S., de Vries, P., Mason-Jones, A., Townsend, L., Aaro, L., & De Vries, H. (2015). Reaching the hard to reach: longitudinal investigation of adolescents' attendance at an after-school sexual and reproductive health programme in Western Cape, South Africa. <i>BMC Public Health</i>, http://hdl.handle.net/11427/15636en_ZA
dc.identifier.chicagocitationMathews, Catherine, Sander Eggers, Petrus de Vries, Amanda Mason-Jones, Loraine Townsend, Leif Aaro, and Hein De Vries "Reaching the hard to reach: longitudinal investigation of adolescents' attendance at an after-school sexual and reproductive health programme in Western Cape, South Africa." <i>BMC Public Health</i> (2015) http://hdl.handle.net/11427/15636en_ZA
dc.identifier.citationMathews, C., Eggers, S. M., de Vries, P. J., Mason-Jones, A. J., Townsend, L., Aarø, L. E., & De Vries, H. (2015). 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, 15(1), 608.en_ZA
dc.identifier.ris TY - Journal Article AU - Mathews, Catherine AU - Eggers, Sander AU - de Vries, Petrus AU - Mason-Jones, Amanda AU - Townsend, Loraine AU - Aaro, Leif AU - De Vries, Hein AB - BACKGROUND: Adolescents 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. METHODS: Grade 8 adolescents (average age 13years) 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 6months 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. RESULTS: The 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. CONCLUSIONS: Reducing 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 REGISTRATION:Current Controlled Trials ISRCTN56270821; Registered 13 February 2013. DA - 2015 DB - OpenUCT DO - 10.1186/s12889-015-1963-3 DP - University of Cape Town J1 - BMC Public Health LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - Reaching the hard to reach: longitudinal investigation of adolescents' attendance at an after-school sexual and reproductive health programme in Western Cape, South Africa TI - Reaching the hard to reach: longitudinal investigation of adolescents' attendance at an after-school sexual and reproductive health programme in Western Cape, South Africa UR - http://hdl.handle.net/11427/15636 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15636
dc.identifier.urihttp://dx.doi.org/10.1186/s12889-015-1963-3
dc.identifier.vancouvercitationMathews C, Eggers S, de Vries P, Mason-Jones A, Townsend L, Aaro L, et al. 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. 2015; http://hdl.handle.net/11427/15636.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentWomen's Health Research Uniten_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2015 Mathews et al.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourceBMC Public Healthen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcpublichealth/en_ZA
dc.subject.othersexual and reproductive health (SRH) interventionsen_ZA
dc.subject.otherAdolescentsen_ZA
dc.titleReaching the hard to reach: longitudinal investigation of adolescents' attendance at an after-school sexual and reproductive health programme in Western Cape, South Africaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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