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