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Kelly Hallman, Kasthuri Govender, Eva Roca, Cecilia Calderon,Emmanuel Mbatha, Mike Rogan, and Hannah Taboada
Population Council, Isihlangu HDA, University of KwaZulu-Natal\
Using mixed methods to study the relationship between reproductive health and poverty: Lessons from the field
A methods workshop, PovPov Research NetworkNovember 4-5, 2010, London
Building economic, health and social capabilities among adolescents
threatened by HIV and AIDS
The Siyakha Nentsha (“Building with Young People”)
program in KwaZulu-Natal
Mixed methods at each stage
• Planning
• Program design
• Program implementation
• Measurement of outcomes
Strategic planning -Mixed methods to learn
Which adolescents vulnerable - Identify highest concentrations of vulnerable by gender, age & geography (quant w mapping)Whether at-risk adolescents reached by “youth” initiatives (IDIs w programmes)What components missing from existing programs (IDIs w programmes)How to reach/target a programme
Survey and quantitative analysis
Structural factors associated with adolescent HIV risk behaviors
• Residing in relative poverty• Fewer social connections• Non-cohesive community• Orphanhood
Source: Hallman 2004, 2005, 2007, 2008, 2010; Hallman & Roca 2007
*of those currently ages 20-24 (2005 Ethiopia DHS)
Source: “The Adolescent Experience In-Depth: Using Data to Identify and Reach the Most Vulnerable Young People: Ethiopia 2005.” New York: Population Council, 2009. http://www.popcouncil.org/publications/serialsbriefs/AdolExpInDepth.asp
Highest rates (48%) in the Amhara region
Girls married by age 15: Ethiopia*
Pilot programme
– Via state-funded not-for-profit child welfare organization
– Consultations with traditional leaders – FGDs with grandparents, parents, young men,
young women– Local education expert and social workers
developed the curriculum – Longitudinal survey
Extensive engagementwith stakeholders
• Traditional leaders
• Department of education
• Schools
• Guardians
Intervention purposeImprove functional capabilities and well-being of
adolescents at high risk for:HIV and STIs teenage pregnancy early unplanned parenthood
school dropout loss of one or both parentslack of knowledge of further employment and training opportunities
Intervention content • Knowledge and skills for pregnancy and HIV
prevention and AIDS mitigation; accessing preventive, treatment and care services
• Skills for: – managing personal and familial resources – Accessing social benefits, education and training opportunities– planning and aspiring for the future – building savings/assets over time
• Building and strengthening social networks and support
Intervention delivery - 1• Incorporated into school day
• Least selective sample in this context• Saturation of geographic area• Timing of “life orientation” as examinable
• Females and males• Responding to local needs• Male attitudes, behaviors and future prospects
• National accreditation of– Curriculum– Implementing organization as training providers
Sound programming methodology
• Maximum use of existing infrastructure– Tap & build local human and physical capacity
• Make consistent with local reality – Facilitator pay rate same as government
auxiliary social worker– Local residence: no absences; know local
realities– National accreditation of program
→ cache and door opener for graduates– Curriculum geared to local opportunity
structures• Designed with an eye toward scale-up
– DOE decision-making from Day 1
Randomized intervention
HIV education,
social support + financial literacy
HIV education and social support Delayed
intervention
Research Methods• Longitudinal survey w participants• Household-based
interview – Data quality– Tracking (household GIS)
• FGDs to assess experience with intervention: participants (by gender & grade) & guardians
• IDIs with program facilitators• School quality assessments
Implementation challenges• Working within existing local program
– School or NGO• Mandates, priorities• Ownership (programme; facilities; personnel)• Time and resource constraints
• Managing local expectations of what programme will deliver
• Explaining why programme is randomised• Rationale for control schools
Advantages of mixed methods
• Ongoing partnership between researchers and programme implementers– Allows for iterative, dynamic process
• “Course correction” during intervention• Improved research instruments
• Ability to select qualitative study participants purposefully from survey, based on designated characteristics
Advantages of mixed methodsTriangulation
• Sheds light on “confusing” results; reveals complexities
• Research is more policy relevant and responsive
• New research issues emerge
Way forward
• Assessing differential impact of two experimental arms
• DOE eager to scale programme out
• Need to follow participants to assess longer-term impact of intervention
Selected resources• Hallman, K. 2010, in press. “Social exclusion: The gendering of
adolescent HIV risks in KwaZulu-Natal, South Africa,” in J. Klot and V. Nguyen eds., The Fourth Wave: An Assault on Women - Gender, Culture and HIV in the 21st Century. Social Science Research Council and UNESCO.
• Hallman, K. 2008.“Researching the determinants of vulnerability to HIV amongst adolescents,” IDS Bulletin, 39(5), November 2008.
• Bruce, J. and Hallman, K. 2008. “Reaching the girls left behind,” Gender & Development, 16(2): 227-245.
• Hallman, K and Roca, E. 2007. “Reducing the social exclusion of girls,” www.popcouncil.org/pdfs/TABriefs/PGY_Brief27_SocialExclusion.pdf
• Hallman, K. 2007. “Nonconsensual sex, school enrollment and educational outcomes in South Africa,” Africa Insight (special issue on Youth in Africa), 37(3): 454-472.
• Hallman, K. 2005. “Gendered socioeconomic conditions and HIV risk behaviours among young people in South Africa,” African Journal of AIDS Research 4(1): 37–50. Abstract: http://www.popcouncil.org/projects/abstracts/AJAR_4_1.html
Thank you!
Our funders: ESRC/Hewlett Joint Scheme& DFID via the ABBA RPC
photos by Ms. Eva
Roca
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