Evaluating programs reaching very young adolescents

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  • FAM Project – 5 yr global project with a main aim of taking modern, NFPs that were developed and tested by IRH (SDM and LAM) and have been introduced at small scale into public and private sector programs - to full scale integration into national-level FP programs in selected countries. Global partnerships on the slide but many other partnerships at country level including Ministries of Health and others BUT TODAY we are talking about another area that IRH is working in - ASRH
  • START OFF WHERE WE ARE IN THE CONTEXT OF ASRH MORE GENERALLY The societal messages that children acquire about their bodies and body functions influence them throughout their lifetime. LOOK AT PICTURE TO REMIND YOURSELVES OF JUST HOW LITTLE ARE 10-12 YR OLDS • The resulting knowledge, social awareness, and skills facilitate safe passage through puberty and prepare youth to care for their health and that of their partners FOCUS OF TODAY”S PRESENTATION – SHARE A VYA COURSE BEING TESTED IN GUATEMALA AND RWANDA, APPROACHES AND RESULTS OF FORMATIVE RESEARCH - GET INTO THE HEARTS AND MINDS OF VYAs A BIT. TALK ABOUT CHALLENGES AND ISSUES IN DEVELOPING PROGRAM CONTENT THAT IS RELEVANT TO 10-14 YR OLDS TALK ABOUT CHALLENGES IN EVALUATING PROGRAMS REACHING VYAs.
  • “ My Changing Body” (MCB) addresses gaps in life skills and materials for use in these programs (originally developed with FHI but never field tested) Recently revised to more explicitly integrate gender and sexuality concepts as well as include parents so they can better support their children (based on formative research I’ll talk about next). With USAID support, it is being field tested and evaluated Can help lead to improved knowledge, awareness, self care and eventually to more equitable sexual and reproductive relationships between partners
  • Approaches: how to maximize reflection and self-awareness within, among peers, and with parents to develop healthy, more gender-equitable attitudes and skills that lay the foundation for future sexual and reproductive health and well being Games and other action-oriented strategies designed around real-life issues of young people Homework activities to promote child-parent dialogue
  • Sharing logic model so you can see what we think this course will achieve – Not just knowledge and behavior changes but other changes less easy to measure yet critically important in terms of laying a foundation for healthy SRH and well-being
  • Understanding what the course is trying to achieve, would like to spend a few minutes on research findings that guided tue integration of gender and sexuality as well as guided first efforts to use participatory methods to conduct assessments Presenting results of research in Guat and Mada, but last month, added Rwanda
  • Application of PLA exercise more typically used with older people Drawing important assessment information and equally /more important is the dialogue – where VYAs are knowledgeable about their changing body – outside and inside, where they are concerned or uncomfortable.
  • Quotes to highlight poor FA/BL and how gender and sexual norms influence responses to changes during puberty
  • AGREE OR DISAGREE: Can you you think of a rule that is different for boys and girls? Is the difference fair to girls? To boys? (record verbatim) Ex: A boy can ride the buse alone, but gilrs must be accompanied by an older brother or parent. Dear X I am 12 years old. All my friends have already started developing breasts, but I am flat as a board. What should I do? Signed: Worried TRUE OR FALSE: Boys usually experience their first ejaculation between the ages of 10 and 14. ================================================ Which picture seems most like you? Which girl would you most like to be? Can you think of a time when one of your close friends ever teased somone in a way that was hurfult? What did you do? Would you react differently now that you have done MCB? How?
  • Girl rolling the dice and then choosing fact/opinion/advice cards. Boys sorting the words that they generated into categories
  • For parents and youth, significant changes and improve knowledge
  • Interesting and mixed results of attitude shifts. Needs further exploration. From the formative research in all countries, there was wide variation in attitudes about masturbation, which may be influencing the results we see on the slide.
  • The first person the adol named when asked this question is reflected here.
  • Again, looking at whether MCB helped improve communication between parents and their children. More parents and youth after MCB talked more about sexuality and puberty -related issues. Although the change was significant only for parents regarding changing bodies of their children.
  • Adolescsents are often really uncomfortable with their changing bodies – partly because they may not understand what is going on, partly because they DO understand what is going on and are having to adjust to the changes. Parents gained a lot of comfort after MCB, but youth made very few gains.
  • If gender norms start to shift, we would want to see most attributes (except physical) to the center (that is, they are considered either masculine or feminine). You can see that parents more often are thinking gender-neutrally than youth after MCB
  • At end line, we asked participants to remark on changes they observed in themselves, after having gone through MCB. There were open-ended questions and the responses that were given are categorized above.
  • Knowing / learning this does raise questions on what programs should be covering in terms of immediate knowledge needs and future sexual and reproductive health and well-being Clear that programs targeting older adolescents don’t necessarily have content relevant to this age group Really does point to the need for formative, culturally-specific research to develop program content
  • Our research should be completed by September of this year. So will have more to share in the future. But leave you with some thoughts The societal messages that children acquire about their bodies and body functions influence them throughout their lifetime Between the ages of 10 and 14, boys and girls are beginning to solidify their sexual and gender identities and develop attitudes and skills that lay the foundation for future sexual and reproductive health and well being Need for more programs that can facilitate safe passage through puberty and prepare youth to care for their health and that of their partners Parents need and want information – helping alleviate their own fears for their children, laying a base for helping all children as they navigate puberty and clarifying their own expectations about their children Need for more evaluation of programs with tools and methodologies appropriate for collecting info from VYAs
  • Evaluating programs reaching very young adolescents

    1. 1. Evaluating programs reaching very young adolescents Experiences and lessons from My Changing Body , a body literacy and fertility awareness course Susan Igras, Rebecka Lundgren, Sujata Bijou, Marie Mukabatsinda* Kampala, November 09
    2. 2. Institute for Reproductive Health Georgetown University Abt Associates Inc. | Futures Group International IntraHealth International| Jhpiego | Macro International Inc. Population Council |Population Services International | WHO/ExpandNet
    3. 3. Remaining gaps in ASRH programs and research <ul><li>ASRH recognized as critically important issue worldwide but little progress yet on programs for very young adolescents </li></ul><ul><li>Ages 10 to 14 a critical developmental period </li></ul><ul><ul><li>solidifying sexual and gender identities, </li></ul></ul><ul><ul><li>developing attitudes and skills that lay the foundation for future sexual and reproductive health and well being </li></ul></ul><ul><li>Better program practices and research/evaluation tools and methodologies are nascent </li></ul>
    4. 4. My Changing Body <ul><li>Addresses gaps in life skills and materials for use in VYA programs </li></ul><ul><li>Centered on </li></ul><ul><ul><li>Fertility awareness - the basis of understanding SRH </li></ul></ul><ul><ul><li>Body literacy - Enabling young people to recognize physical /emotional change plus how gender and social norms influence their sexual and reproductive selves </li></ul></ul><ul><ul><li>Self care </li></ul></ul>
    5. 5. Themes relevant to this age group <ul><li>PARENTS </li></ul><ul><ul><li>Sexuality & gender - -Why talk about it? </li></ul></ul><ul><ul><li>Are you an ‘askable’ parent? </li></ul></ul><ul><ul><li>Fertility awareness </li></ul></ul>YOUTH AND PARENTS Take home activities to encourage communication <ul><li>YOUTH </li></ul><ul><ul><li>Puberty: My Body, My Self, Others </li></ul></ul><ul><ul><li>Female and Male Fertility </li></ul></ul><ul><ul><li>Concerns about my fertility </li></ul></ul>
    6. 6. LOGIC MODEL
    7. 7. Formative research to contextualize MCB to Guatemala, Madagascar, and Rwanda <ul><li>Participatory research with 440 boys and girls (10-14 year olds) and their parents and teachers </li></ul><ul><li>Tools included community and body mapping, story telling, video clips, and collages </li></ul><ul><li>Findings helped contextualize exercises including gender focus found in MCB </li></ul>
    8. 8. Formative Research 10-12 year old male & female adols - body mapping
    9. 9. Formative Research 13 - 14 year old boys & girls - Collages
    10. 10. Findings from Formative Research Poor fertility awareness and body literacy “ If you haven’t ejaculated by the time you are 25, the sperm enters your head and you could become crazy or die”. 10-12 year old boy, Madagascar Parents and older youth recognize that masturbation is a common way to deal with sexual desire, but disagree on whether it is moral or healthy. Madagascar and Guatemala Gender and sexual norms influence responses to changes during puberty “ I almost fainted when I saw the blood.” 13-14 year old girl, Guatemala “ If you ejaculate and you don’t know what it is, you’re wondering what is this? 1 0-12 year old boy, Madagascar
    11. 11. Parents want to teach their children about reproduction and puberty but they…
    12. 12. Concerns of parents <ul><li>Girls and boys have the same desires, but girls are taught not to express them. </li></ul><ul><ul><li>Mother, Guatemala </li></ul></ul>When they were little, they didn’t need clear information, they didn’t ask for explanations, they didn’t give opinions. Now they ask more, they want to know more.” Mother, Guatemala
    13. 13. Evaluation of My Changing Body Sessions
    14. 14. Sample Evaluation tools <ul><li>Card game </li></ul><ul><li>My universe </li></ul><ul><li>Living with my changing body </li></ul>OPINION CARDS FACT CARDS ADVICE CARDS
    15. 15. Quantitative evaluation – Card game and pile sort (BOYS! GIRLS! GENDER! GAME)
    16. 16. Qualitative evaluation – My Universe
    17. 17. CHANGES IN FERTILITY AWARENESS
    18. 18. Knowledge of menstrual cycle among youth and parents before and after MCB Menstrual cycle Fertile days p<.01
    19. 19. Knowledge of male fertility among youth and parents before and after MCB Nocturnal ejaculation normal Fertile every day p<.01
    20. 20. Sexuality attitudes among youth and parents before and after MCB Romantic feelings normal Masturbation not dangerous p<.01
    21. 21. CHANGES IN PARENT -CHILD COMMUNICATION
    22. 22. Who do you talk with about the changes you are experiencing as you grow up? PRE (n=57) POST (n=57) Mother 53% 79% Father 33% 17.5% Other 8% 3.5% No one 8% -
    23. 23. Parent-child communication before and after MCB Talked about crushes last month Talked about changes in body last month p<.01
    24. 24. Degree of comfort with changes in child’s/own body during puberty p<.01
    25. 25. CHANGES IN GENDER NORMS
    26. 26. Parents hold less stereotyped gender norms than youth (n=52)
    27. 27. Parents shift towards less stereotyped gender norms (n=52)
    28. 28. Youth shift towards less stereotyped gender attitudes after MCB (n=57)
    29. 29. PARTICIPANT COMMENTS
    30. 30. Have you noticed any changes in your relationship with your children since participating in these sessions? Parents % (34 responses) Better able to communicate, more confidence 29% Good/happy 41% More accepting/try to understand and help 21% No change 9%
    31. 31. Have you noticed any changes in your relationship with your parents since participating in MCB? Youth % (27 responses) No change 33.3% Greater communication 22.2% More confidence/less shy to talk 14.8% Get along better 11.1% Parents explain more/ask questions 11.1% Happier 7.4%
    32. 32. How do you feel about your body after participating in MCB? Youth % (n=41 responses) Learned a lot/new things 29% Feel good about my body 22% More prepared 15% I understand my body now 12% Happy/content 10% More confident 7% How to care for my body 5%
    33. 33. Conclusions <ul><li>Similar levels of poor fertility awareness among youth and parents at baseline </li></ul><ul><li>Core gender stereotypes based on physical traits, parents less likely to classify based on traditional gender roles </li></ul><ul><li>VYA identify parents as key resource for puberty information </li></ul>
    34. 34. After participating in MCB … <ul><li>Fertility awareness increases among youth and parents </li></ul><ul><li>More accepting attitudes towards youth sexuality </li></ul><ul><li>Parents consider themselves more accepting and knowledgeable (but no significant changes seen by youth) </li></ul><ul><li>Trend towards greater parent-child communication, but only significant among parents </li></ul>
    35. 35. <ul><li>Parents and youth report greater confidence and </li></ul><ul><li>ability to communicate </li></ul><ul><li>Shift towards more equitable gender attitudes among both </li></ul><ul><li>Parents more comfortable with changes in children during puberty, but no significant changes among youth </li></ul>
    36. 36. <ul><li>Further analysis (statistical tests, composite indicators, scales) </li></ul><ul><li>Analysis of qualitative data </li></ul><ul><li>Testing in Rwanda </li></ul>Next steps
    37. 37. Final thoughts on progams reaching VYAs <ul><li>CONTENT: Six sessions can provoke significant changes in some areas and not others – VYA-serving programs may need to revisit certain themes and engage VYAs and parents again in discussions. </li></ul><ul><li>GENDER: Gender awareness critical for health and well being – challenge is how to make discussions relevant and practical. </li></ul>

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