A process evaluation of a school-based adolescent sexual health intervention in rural Tanzania: the MEMA kwa Vijana programme

Abstract

This study is a process evaluation of the school component of the adolescent sexual health programme MEMA kwa Vijana (MkV), which was implemented in 62 primary schools in rural Mwanza, Tanzania from 1999 to 2001. The MkV curriculum was a teacher-led and peer-assisted programme based on the Social Learning Theory. Process evaluation included observation of training sessions, monitoring and supervision, annual surveys of implementers, group discussions and 158 person-weeks of participant observation. Most teachers taught curriculum content well, but sometimes had difficulty adopting new teaching styles. Peer educators performed scripted dramas well, but were limited as informal educators and behavioural models. The intervention appeared successful in addressing some cognitions, e.g. knowledge of risks and benefits of behaviours, but not others, e.g. perceived susceptibility to risk. MkV shared the characteristics of other African school-based programmes found to be successful, and similarly found significant improvements in self-reported behaviour in surveys. However, a substantial proportion of MkV survey self-reports were inconsistent, there was no consistent impact on biological markers and extensive process evaluation found little impact on several key theoretical determinants of behaviour. Improvements in self-reported survey data alone may provide only a very limited-and perhaps invalid-indication of adolescent sexual health programme success.

Facts, Attitudes, and Health Reasoning About HIV and AIDS: Explaining the Education Effect on Condom Use Among Adults in Sub-Saharan Africa

“…The recent observations that formal education prevents new infections among younger adults in SSA are most likely due to the reasoning ability that education strengthens, rather than the heavy focus of NGO-based prevention programs on fact acquisition and attitude change [18,29,[64][65][66][67][68].…”

Scaling up Adolescent Sexual and Reproductive Health Interventions Through Existing Government Systems? A Detailed Process Evaluation of a School-Based Intervention in Mwanza Region in the Northwest of Tanzania

“…MkV remains one of the few interventions in sub-Saharan Africa to have been evaluated through the rigor of a community-randomized trial (MkV1) [3,8,11,12]. Its design, process [11,12] and effect [3] are described elsewhere.…”

“…With some notable exceptions [7][8][9], many evaluations overlook the process aspect in favor of outcome evaluations [7]. The process of scaling up is likely to lead to changes in coverage and quality of the intervention implementation, and such changes could subsequently dilute the effect of the intervention [10].…”

Implementation strategy for the school-based sex education program Long Live Love

“…Teachers who followed the guidelines of the LLL program more closely (fidelity) also completed more of the program (completeness). These findings are similar to a process evaluation study of a schoolbased adolescent sexual health intervention in rural Tanzania, where teachers delivered the program to primary school students with remarkable integrity and this fidelity was enhanced by a training course (Plummer et al, 2007). Teacher curriculum related beliefs and information source variables are therefore essential for implementation (Borko, Livingstone, & Shavelson, 1990;Schaalma, Kok, & Poelman, 1994).…”