Understanding adolescent behaviour and communication towards Total Health: baseline findings from a longitudinal study of a soccer-based sexual health programme
Summary:
In order to respond to adolescents' health challenges in Zambia and Zimbabwe, Grassroot Soccer (GRS) designed a new comprehensive sexual and reproductive health (SRH) strategy called Total Health. Using engaging soccer-based programs, and partnerships with high-impact service providers, Total Health aims to build the SRH and life skills assets of young people, increase their access to high quality health services, and improve adherence to healthy behaviours and medical treatment. GRS is conducting a mixed-methods longitudinal evaluation of Total Health, following a cohort of adolescents as they participate in three GRS interventions from 2018-2021: SKILLZ Health, a mixed sex program for adolescents aged 10-14; SKILLZ Boy or SKILLZ Girl, designed for ages 15-19; and SKILLZ Teen Clubs for ongoing promotion of healthy behaviours. Baseline data was collected at schools (Zambia n=396; Zimbabwe n=441) and health facilities (Zambia n=210; Zimbabwe n=99). Results from quantitative surveys indicated that participants had fair knowledge of SRH services, such as where to access to HIV testing, but uptake was low. Reported sexual activity and condom use among sexually active adolescents were also low. Adolescents perceived a lack of confidentiality among health workers, limited available SRH information, and challenges in communicating about such topics with trusted adults. Adult key informants also expressed a lack of confidence in addressing SRH topics with adolescents. These baseline findings indicate a need to address adolescent concerns about confidentiality of health services and to engage adults to build their capacity to discuss SRH topics with adolescents.
Background/Objectives:
Young people in Zambia and Zimbabwe face numerous sexual and reproductive health (SRH) challenges during adolescence, a critical developmental period for gaining health knowledge and assets and building healthy habits that influence outcomes throughout the life course. Grassroot Soccer (GRS) uses soccer-based programs to build the assets of adolescents critical health knowledge and the confidence to use it; increase access to high quality health services; and improve adherence to healthy behaviours and medical treatment. GRS is implementing a new strategy called Total Health, partnering with government and service providers in Zambia and Zimbabwe to improve adolescent SRH outcomes.
Description of Intervention and/or Methods/Design:
GRS is conducting a mixed methods evaluation of Total Health from 2018 to 2021, following a cohort of adolescents as they take part in three GRS interventions: SKILLZ Health, a mixed sex program designed for adolescents aged 10-14; SKILLZ Boy or SKILLZ Girl, designed for ages 15-19; and SKILLZ Teen Clubs for continuing support of healthy behaviours. Prior to undergoing SKILLZ Health, baseline data for the evaluation was collected in Zambia and Zimbabwe at both school (Zambia n=396; Zimbabwe n=441) and health facility sites (Zambia n=210; Zimbabwe n=99). Adolescents completed quantitative surveys and took part in participatory focus group discussions, and key informant interviews were conducted with teachers and health workers.
Results/Lessons Learned:
School-based participants had fair knowledge of SRH services, but low uptake: about 2/3 reported knowing where to access HIV services, but only had ever tested for HIV. 75% of facility-based adolescents reported knowing where to access HIV services and had tested for HIV. Few adolescents reported ever having sex: 6.8% of school-based adolescents in Zambia vs. 3.2% in Zimbabwe, compared to 27.6% of facility-based participants in Zambia and 11.8% in Zimbabwe. Participants reported barriers to SRH information and service uptake: lack of confidentiality among health workers, limited SRH information, and challenges in communicating about SRH with adults. Adult key informants similarly reported lacking confidence to address these topics with adolescents. Gender attitudes of participants were generally equitable, but some participants justified violence against women. Using sport for SRH and life skills development was new to most participants, but viewed favourably as a unique program strategy.
Discussion/Implications for the Field:
Results from this baseline survey for Total Health indicate numerous barriers to adolescent SRH and well-being. The gap between adolescents' knowledge and uptake of services indicates a need to increase familiarity with health services, while also addressing their concerns about confidentiality and accessibility. Adolescent participants also indicated a desire to discuss SRH topics with adults such as parents and teachers, therefore interventions must engage adults to build their comfort and capacity to do so. Finally, the use of sport for promoting adolescent health was well-regarded by participants; GRS is considering strategies for scaling with government and other partners.
Abstract submitted by:
Devyn Lee - Grassroot Soccer
Primrose Dube - Grassroot Soccer
Carol Manyele - Grassroot Soccer
Chelsea Coakley - Grassroot Soccer
Joseph Zulu
Chama Mulubwa
In order to respond to adolescents' health challenges in Zambia and Zimbabwe, Grassroot Soccer (GRS) designed a new comprehensive sexual and reproductive health (SRH) strategy called Total Health. Using engaging soccer-based programs, and partnerships with high-impact service providers, Total Health aims to build the SRH and life skills assets of young people, increase their access to high quality health services, and improve adherence to healthy behaviours and medical treatment. GRS is conducting a mixed-methods longitudinal evaluation of Total Health, following a cohort of adolescents as they participate in three GRS interventions from 2018-2021: SKILLZ Health, a mixed sex program for adolescents aged 10-14; SKILLZ Boy or SKILLZ Girl, designed for ages 15-19; and SKILLZ Teen Clubs for ongoing promotion of healthy behaviours. Baseline data was collected at schools (Zambia n=396; Zimbabwe n=441) and health facilities (Zambia n=210; Zimbabwe n=99). Results from quantitative surveys indicated that participants had fair knowledge of SRH services, such as where to access to HIV testing, but uptake was low. Reported sexual activity and condom use among sexually active adolescents were also low. Adolescents perceived a lack of confidentiality among health workers, limited available SRH information, and challenges in communicating about such topics with trusted adults. Adult key informants also expressed a lack of confidence in addressing SRH topics with adolescents. These baseline findings indicate a need to address adolescent concerns about confidentiality of health services and to engage adults to build their capacity to discuss SRH topics with adolescents.
Background/Objectives:
Young people in Zambia and Zimbabwe face numerous sexual and reproductive health (SRH) challenges during adolescence, a critical developmental period for gaining health knowledge and assets and building healthy habits that influence outcomes throughout the life course. Grassroot Soccer (GRS) uses soccer-based programs to build the assets of adolescents critical health knowledge and the confidence to use it; increase access to high quality health services; and improve adherence to healthy behaviours and medical treatment. GRS is implementing a new strategy called Total Health, partnering with government and service providers in Zambia and Zimbabwe to improve adolescent SRH outcomes.
Description of Intervention and/or Methods/Design:
GRS is conducting a mixed methods evaluation of Total Health from 2018 to 2021, following a cohort of adolescents as they take part in three GRS interventions: SKILLZ Health, a mixed sex program designed for adolescents aged 10-14; SKILLZ Boy or SKILLZ Girl, designed for ages 15-19; and SKILLZ Teen Clubs for continuing support of healthy behaviours. Prior to undergoing SKILLZ Health, baseline data for the evaluation was collected in Zambia and Zimbabwe at both school (Zambia n=396; Zimbabwe n=441) and health facility sites (Zambia n=210; Zimbabwe n=99). Adolescents completed quantitative surveys and took part in participatory focus group discussions, and key informant interviews were conducted with teachers and health workers.
Results/Lessons Learned:
School-based participants had fair knowledge of SRH services, but low uptake: about 2/3 reported knowing where to access HIV services, but only had ever tested for HIV. 75% of facility-based adolescents reported knowing where to access HIV services and had tested for HIV. Few adolescents reported ever having sex: 6.8% of school-based adolescents in Zambia vs. 3.2% in Zimbabwe, compared to 27.6% of facility-based participants in Zambia and 11.8% in Zimbabwe. Participants reported barriers to SRH information and service uptake: lack of confidentiality among health workers, limited SRH information, and challenges in communicating about SRH with adults. Adult key informants similarly reported lacking confidence to address these topics with adolescents. Gender attitudes of participants were generally equitable, but some participants justified violence against women. Using sport for SRH and life skills development was new to most participants, but viewed favourably as a unique program strategy.
Discussion/Implications for the Field:
Results from this baseline survey for Total Health indicate numerous barriers to adolescent SRH and well-being. The gap between adolescents' knowledge and uptake of services indicates a need to increase familiarity with health services, while also addressing their concerns about confidentiality and accessibility. Adolescent participants also indicated a desire to discuss SRH topics with adults such as parents and teachers, therefore interventions must engage adults to build their comfort and capacity to do so. Finally, the use of sport for promoting adolescent health was well-regarded by participants; GRS is considering strategies for scaling with government and other partners.
Abstract submitted by:
Devyn Lee - Grassroot Soccer
Primrose Dube - Grassroot Soccer
Carol Manyele - Grassroot Soccer
Chelsea Coakley - Grassroot Soccer
Joseph Zulu
Chama Mulubwa
Source
Approved abstract for the postponed 2020 SBCC Summit in Marrakech, Morocco. Provided by the International Steering Committee for the Summit. Image credit: © Cory D'Orazio/Grassroot Soccer