Carol Underwood, Ph.D. & Hilary Schwandt, Ph.D. Johns Hopkins University
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Transcript of Carol Underwood, Ph.D. & Hilary Schwandt, Ph.D. Johns Hopkins University
Validation of the Supportive Community Index: survey
research on Girls’ Vulnerability to HIV/AIDs from Botswana, Malawi, and Mozambique
Carol Underwood, Ph.D. & Hilary Schwandt, Ph.D.Johns Hopkins University
Go Girls! Initiative: Goal & Social-ecological conceptual frameworkGOAL: To reduce HIV
prevalence among adolescent girls aged 10-17 in Botswana, Malawi & Mozambique
Social ecology & combined preventionSE approach posits interrelated roles of
intrapersonal, interpersonal, institutional, community, and structural levels
SE interventions encompass the three elements of combined prevention – biomedical (individual level), behavioral (individual & social normative), and structural interventions
Model 1:Individual & community level
Life SkillsOut-of-school
Community Mobilization
Adult-Child Communication
Reality Radio
Model 2:Multi-level: individual, community & structural approach
School Personnel Training
Economic Strengthening
Extended families:Adult-child communicationEconomic strengthening
GGI’s whole-
community approach Safe schools:
Teacher training
Girls: School-based and community-based life skills
Communities:Community mobilizationRadio program
Formative research
1. Literature review of “vulnerable girls”
2. Qualitative study to examine community perspectives’ of “vulnerable girls”
Results informed and helped to refine 3 indices in advance of the baseline survey
Evaluation timelineBase-line
Endline
Aug 2010Sep 2009
Community Mobilization
Teacher Training
Life Skills
Economic Strengthening
Reality Radio
Adult-Child Communication
Supportive Community IndexWhat is it?
A community/structural level measurement tool How can it be utilized?
Measure the level, and change in, community/structural support in a community – emphasizing vulnerable girls’ support
Why is it important?Communities/structures have a large impact on
individual behaviors yet they are rarely addressed or evaluated
Measurement allows for evaluation of structural interventions
Why focus on structural factors?Research shows that structural factors –
access to educational, employment, & financial opportunties as well as policies that affect the distribution of resources – are key to HIV reduction
Yet, structural interventions lag behind biomedical and individual-level behavioral interventions
Nonetheless, community members prioritize structural interventions
Practitioners argue that structural effects are difficult to measure
Baseline Supportive Community Index (SCI)
From three populations:1. Key Informants2. Adults3. Adolescents
SCI Domains – Key Informants1) Access to health
services2) Concerns about
alcohol abuse3) Regulation of alcohol4) Community cohesion5) Community groups6) Community safety
7) Economic opportunities
8) Community support9) Gender and community10)School safety11)Sexual abuse concerns12)Regulation of sexual
abuse
Community Action (Outcome) Domains – Key Informants
1. Alcohol action“In the past 12 months, has the community taken any
action to address the issue of outlets selling alcohol to people younger than 18 years?”
2. Sexual abuse action3. Vulnerable girls support4. Community health
“In the last year, has the impact of HIV/AIDS on the community improved, worsened, or stayed the same?”
Correlation of the SCI and Community Action – Key InformantsBotswana (n=21)
Range: 67-146Correlation = 0.79
Malawi (n=40)Range: 60-135Correlation = 0.73
Mozambique (n=82)Range: 43-138Correlation = 0.55
Baseline Supportive Community Index (SCI)
From three populations:1. Key Informants2. Adults3. Adolescents
SCI Domains - Adults1) Alcohol regulation
“How likely do you think it is that an adolescent younger than 18 years of age will obtain alcohol in this community if he or she tries?”
2) Community cohesion“When conflicts or disagreements arise between community members, they are always resolved quickly.”
3) Community safety4) Economic opportunities5) School safety6) Sexual abuse regulations
Community Action Outcome Domains - Adults
1. Community supportExample: “In the last 12 months, have people in your community worked together to address HIV/AIDS?”
2. Vulnerable girls supportExample: “In the last 12 months, has any
action been taken in the community to improve the well-being of adolescent girls?”
SCI and Outcome - AdultsLinear Regression
Main predictor: SCIage, marital status, parity, and residence
Botswana (n=530)β = 0.22; 95% CI (0.17, 0.27)*
Malawi (n=615)β = 0.17; 95% CI (0.14, 0.21)*
Mozambique (n=529)β = 0.14; 95% CI (0.095, 0.18)*
*p = 0.000
Baseline Supportive Community Index (SCI)
From three populations:1. Key Informants2. Adults3. Adolescents
SCI Domains - Adolescents1) Poverty 2) Food security3) Home security4) Alcohol access & regulation5) Community cohesion6) Community safety7) Economic opportunities8) School safety9) Sexual abuse regulations
Outcome Variable - Adolescents
Sexual experience “Have you ever had sexual intercourse?”
SCI and Sex - AdolescentsLogistic Regression
Main predictor: SCIAge, current schooling status, orphan status, &
residenceBotswana (n=560)
OR = 0.81; p = 0.000Malawi (n=752)
OR = 0.93; p = 0.041Mozambique (n=427)
OR = 0.91; p = 0.017
Measuring Structural ChangeMeasurement of the SCI at 2 time points
BaselineEndline
Comparing changeAnalyze the % change in community aggregate
scores
Hypothesis+ % SCI change SCI Model II > SCI Model I
ConclusionsSCI is strongly associated with hypothesized
outcomesIn 3 countriesIn 3 populations
Cross-country validation of the SCI
ImplicationsMost behavior change research and
programs focus on the individual – ignoring the structures outside the individual influence
GGI (research & program) has been designed with a community and structural level focus
GGI is implementing a structural level intervention in three countriesAs well as measuring the structural change
through the SCIFuture researchers and programs can use
these tools to design and test structural level interventions
Contact detailsCarol Underwood, PhDJohns Hopkins Bloomberg School of Public HealthCenter for Communication Programs111 Market Place, Suite 310Baltimore, MD 21202, USATel: 410-659-6300 Fax: 410-659-6266 Web: http://www.jhuccp.org Email: [email protected]