This document summarizes a mixed methods study conducted in KwaZulu-Natal, South Africa to design and evaluate an intervention program aimed at improving the health, economic, and social capabilities of adolescents at high risk for HIV/AIDS, teenage pregnancy, and other issues. The intervention incorporated life skills education into the school day and was evaluated using longitudinal surveys, focus groups, and interviews with participants, guardians, and facilitators. The mixed methods approach allowed for iterative improvement of the program and instruments as well as triangulation across data sources. Preliminary results were promising and the Department of Education was interested in scaling up the program.

1. 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 Network
November 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

2. Mixed methods at each stage
• Planning
• Program design
• Program implementation
• Measurement of outcomes

3. 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

4. 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

5. *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*

6. 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

7. Extensive engagement
with stakeholders
• Traditional leaders
• Department of education
• Schools
• Guardians

8. Intervention purpose
Improve 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 parents
lack of knowledge of further employment and training opportunities

9. 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

10. 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

11. 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

12. Randomized
intervention
HIV education,
social support
+ financial
literacy
HIV
education
and social
support Delayed
intervention

13. 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

14. 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

15. 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

16. Advantages of mixed methods
Triangulation
• Sheds light on “confusing” results; reveals
complexities
• Research is more policy relevant and responsive
• New research issues emerge

17. 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

18. 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

19. Thank you!
Our funders: ESRC/Hewlett Joint Scheme
& DFID via the ABBA RPC
photos by Ms.
Eva Roca