Nothing as Practical as a Good Theory? The Theoretical Basis of HIV Prevention Interventions for Young People in Sub-Saharan Africa: A Systematic Review

Abstract

This paper assesses the extent to which HIV prevention interventions for young people in sub-Saharan Africa are grounded in theory and if theory-based interventions are more effective. Three databases were searched for evaluation studies of HIV prevention interventions for youth. Additional articles were identified on websites of international organisations and through searching references. 34 interventions were included; 25 mentioned the use of theory. Social Cognitive Theory was most prominent (n = 13), followed by Health Belief Model (n = 7), and Theory of Reasoned Action/Planned Behaviour (n = 6). These cognitive behavioural theories assume that cognitions drive sexual behaviour. Reporting on choice and use of theory was low. Only three articles provided information about why a particular theory was selected. Interventions used theory to inform content (n = 13), for evaluation purposes (n = 4) or both (n = 7). No patterns of differential effectiveness could be detected between studies using and not using theory, or according to whether a theory informed content, and/or evaluation. We discuss characteristics of the theories that might account for the limited effectiveness observed, including overreliance on cognitions that likely vary according to type of sexual behaviour and other personal factors, inadequately address interpersonal factors, and failure to account for contextual factors.

Does Facility Based Sexual and Reproductive Health Services Meet the Needs of Young Persons? Views from Cross Section of Ghanaian Youth

“…This shows the need to access youth friendly reproductive health services at hospitals or clinic has not been recognised by most youth in the present study area. The reason for the lower turn-in for accessing health services could be in line with Senderowitz and others [34] finding that the essence of accessing reproductive health services are because of specific biological and psychological needs of the youth, the high risks of STIs, HIV, and pregnancy, disproportionately high risk of sexual abuse, importance of behaviour related risks which are all subjectively related to every youth. In this study, parental and partners permission have been found to be determinants in youth subsequent visit to health centre.…”

“…There is often the question of limitedness in evaluation designs for interventions in the Sub-Saharan region. A few evaluations on sexual and reproductive health have reported ability of such interventions to reduce risky sexual behaviours and resulting HIV and STIs [8].…”

“…Youth friendly reproductive health services influences service utilization positively [8]. It is widely acknowledged among reproductive service health providers throughout the world that "Youth Friendly" services are needed if the youth are to be adequately provided with reproductive health care [5] [9]- [11].…”

“…Evidence suggests however that, sessions of youth within the community struggled to maintain attendance over a period of time, with other commitments often getting in the way [23] [34]. This calls for an integrative service approach to increase service uptake.…”

Lessons learned from a decade implementing Comprehensive Sexuality Education in resource poor settings:The World Starts With Me

“…Many authors have stressed the limitations of educational programmes promoting behaviours and attitudes where application is strongly hampered by disabling normative, cultural and political environments, notably in the global South (e.g. Michielsen et al 2012;Wood and Rolleri 2014). But the global North still experiences challenges in this respect as well.…”