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Summary Psychology 348 Part 2
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- Stellenbosch University (SUN)
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Psychology 348 exam summary Rebecca Jansen van Rensburg 19980329@sun.ac.zaWeek 11: Group Interventions
Article summary
Visser (2005): Life skills training as HIV/AIDS preventative strategy in secondary schools: Evaluation
of a large-scale implementation process
Introduction
➢ HIV/AIDS has reached epidemic proportions in SA and has serious consequences. According
to the latest national statistics, an estimated 12-15% of the population was already HIV-
infected by the end of 2002. The largest percentage of HIV-infected people was in the age
group 15-29 years. Of pregnant women under the age of 20 years attending public antenatal
clinics, 16.1 tested positive in 2000 and 14.8% in 2002. Although exact figures are not
available, findings show that many youths engage in high-risk sexual behaviour including
early sexual onset, infrequent condom use and multiple sexual partners. 49% of a stratified
sample of learners from secondary schools indicated that they were sexually experienced.
Half of these indicated that they had used a condom during their last sexual experience. The
average age of becoming sexually experienced was 13 years. These results confirm
behaviour patterns that have been identified over the past decade. Studies showed that
secondary school learners have basic knowledge of HIV/AIDS, but knowledge is not enough
to assure ‘safe’ sexual behaviour.
➢ The prevention of HIV/AIDS among South African school-going young people is therefore a
priority. Prevention of the spread of the virus is the only way to combat the disease.
HIV/AIDS awareness programmes that focus on the delay of sexual activity and on
behavioural change towards ‘safe’ sexual practices are priorities and remain the only means
of primary prevention.
➢ Various preventive efforts have been implemented in SA. The development of theoretical
approaches in conceptualisation of preventive interventions also seen in the development of
conceptualisation, focus and strategies of HIV/AIDS prevention programmes. Preventive
efforts started as mere dissemination of information and developed to more participative
community-based interventions. Each preventive strategy has specific goals and advantages:
❖ Educational programmes and media campaigns focus on creating awareness of
HIV/AIDS and the dissemination of information. It was found that awareness and
knowledge about HIV/AIDS do not necessarily encourage changed behaviour
patterns.
❖ Cognitive behaviour change programmes are often based on the health belief model
and social learning theory and focus on the evaluation of personal risk, motivational
and hindering factors in behavioural change. Training in life skills such as
interpersonal skills, decision-making skills, assertiveness and personal control, which
are presented in small-group context.
❖ Based on the ecological theory, preventive programmes also focus on changing the
perception or impact of social norms on risk behaviour. When people expected their
social group to approve of condom use, the use increased. The change in social
norms involves the support of leaders, the visibility of HIV through more disclosure
of HIV status as well as open discussions and commitment to overcome the
problem.
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,Psychology 348 exam summary Rebecca Jansen van Rensburg 19980329@sun.ac.za
❖ Community interventions involve multiple systems and the use of community
resources to restructure communities with the aim of changing the context in which
the illness flourishes. Interventions focus on understanding the underlying reasons
for risk behaviour and how to change these processes. This often involves changes in
health policy, enhancement of quality of life, empowerment of women, and the
forming of social networks to support health protective behaviour.
➢ A life skills approach to the prevention of HIV/AIDS will be discussed. The focus is on primary
prevention of risk behaviour, as well as change in lifestyle of individuals who already engage
in risk behaviour. The focus is on the individual and behavioural change, the strategy used to
implement the intervention involves various sectors of community networks.
Life skills training as HIV/AIDS prevention strategy
➢ Life skills can be described as the ability for adaptive and positive behaviour that enables
individuals to deal effectively with the demands and challenges of everyday life.
Innumerable life skills are necessary for different situations, ages and cultures, but it is
suggested that there is a core set of skills at the heart of the skills-based initiative for the
promotion of health and well-being of children and adolescents. In the context of the
HIV/AIDS epidemic the aim of life skills training is to develop knowledge, and the skills
needed for healthy relationships, effective communication and responsible decision-making
that will protect them and optimise their health.
➢ Life skills training originated from an educational perspective and is based on a humanistic,
cognitive and behavioural frame of reference. An individual is seen as consisting of multiple
sub-systems such as the physical, affective, cognitive, interpersonal, moral and behavioural –
all in close relationship – functioning within a family and social context. Life skills
programmes focus on the development of various subsystems of the individual with the aim
of facilitating change, often observed through behavioural processes. Life skills training can
contribute to the development of an individual’s capacity for adaptation and the
development of new interactional patterns. Life skills training can therefore also impact on
risk behaviour related to HIV/AIDS, which is associated with various processes at the
individual, interpersonal and community and cultural levels.
➢ There is growing evidence that preventive life skills programmes have a positive impact on
the lives of children and adolescents. Related to HIV/AIDS, it was found in meta-analyses
that life skills programmes contributed to some extent to change in risk behaviours. In
evaluations done in Southern Africa, it was found that life skills and HIV/AIDS education
programmes for school children contributed to increased levels of knowledge, more
assertiveness, more positive attitudes and some indications of delayed sexual activity, more
condom use and fewer sexual partners.
➢ In the evaluation of HIV/AIDS programmes, methodological shortcomings limit the
conclusions that can be made about the impact. Most evaluations focus on the impact of
knowledge, attitudes and reported behaviour. Little information is available about the
impact on actual behaviour and sustainability of change. Little information is available about
the impact of different prevention messages on different cultural groups. Political and moral
agendas often form barriers in the implementation in diverse communities because different
skills and values are emphasised in different contexts. Evaluations are often done on small-
scale and pilot projects in controlled situations. Little research has been done on the
dissemination and implementation of school-based HIV/AIDS programmes on a community-
wide level.
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,Psychology 348 exam summary Rebecca Jansen van Rensburg 19980329@sun.ac.za
Description of the national life skills and HIV/AIDS education intervention
➢ The SA department of Education, Health and Welfare embarked on a national programme to
implement life skills training, sexuality and HIV/AIDS education in secondary schools in 1995.
The goal was to increase knowledge and skills needed for healthy relationships, effective
communication and responsible decision-making, and to promote positive and responsible
attitudes towards people with HIV/AIDS. In the planning, a position was taken to maintain a
balance between the time needed to follow a scientific approach and the urgency of the
HIV/AIDS crisis. Various sub-committees were formed to deal with curriculum development,
teacher training, marketing and liaison and co-ordinating of provincial efforts in
implementing nationally. The national committee agreed to the following content, training
and implementation process to be implemented by the provincial departments:
➢ Content of the intervention
❖ A sub-committee developed guidelines for the content aimed at the enhancement
of health-protective behaviour and recommended that the following aspects should
be included:
- Information about sexuality and HIV/AIDS, to facilitate critical assessment of
personal risk
- The development of life skills that would enable the learners to take up
health-protective behaviour such as self-awareness, decision-making,
assertiveness, communication and negotiation skills
- The enhancement of a positive attitude among youth towards people with
HIV/AIDS as preparation for interaction with and caring for infected people.
❖ The programme was not developed as a single prepared manual. The guidelines
formed the core and the programme material was provided to assist teachers in the
development of interventions that addressed the needs in their own cultural
context. A single programme would not be able to address the diverse needs of
diverse cultural groups. Not a single programme implemented nationally, but
various programmes were compiled by the teachers using a set of guidelines and
provided resources.
➢ Process of implementation
❖ The decision to implement in schools was cascaded down in the educational system
using a train-the-trainer approach. The provinces could decide if they wanted to be
responsible for the training of teachers to implement the programme or if they
wanted a non-governmental agency to be responsible. The research reported on
was done in Gauteng, where project teams at provincial and district levels were
trained as master trainers and co-ordinators of the intervention. Nationally 840
master trainers were trained during a series of workshops.
❖ The master trainers trained 2 teachers in every secondary school in the country to
present life skills and HIV/AIDS education in their schools. Done in small groups in
each educational district, presented in the afternoons after school. The 10 - 20-hour
training focused on knowledge and attitudes related to HIV/AIDS and how to use
experiential learning techniques.
❖ The role of the 2 trained teachers in each school was agreed to be the following:
- To develop a context-specific programme for their school according to the
needs of the learners and the values of the community
- To present the programme to learners in their schools
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, Psychology 348 exam summary Rebecca Jansen van Rensburg 19980329@sun.ac.za
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To act as change agents in the school by involving other teachers and
parents in a change process to integrate life skills training and HIV/AIDS
education as part of the school curriculum
❖ Implementation started in 1998/1999. In each province a different procedure was
followed and was evaluated accordingly. In the research reported, the
implementation of the life skills and HIV/AIDS education programme was monitored
during the first 2 years of implementation in 2 educational districts in Gauteng
Province.
Aim of the research
➢ The aim was to monitor the implementation of the life skills and HIV/AIDS education
programme and to evaluate the impact of the intervention in terms of the knowledge,
attitudes and reported behaviour patterns. The aim of the intervention was to prevent risk
behaviour and to contribute to the decrease of already existing risk behaviour.
Method of the research
➢ The researcher became involved as an external evaluator to monitor the effectiveness. An
action research approach was used to monitor the implementation involves the
implementation of an intervention and observation of the impact. The advantage is that
feedback about the process can be provided after each step, and that adjustments can be
made immediately. The study involved both process and outcome evaluations, using a multi-
method approach, integrating qualitative and quantitative research methods. Done over a
period of 2 years and involved the perspectives of the different role-players. A systems
approach was used as a theoretical framework to understand the interaction between
various sub-systems and the processes involved in implementing the intervention.
➢ Sample used
❖ The evaluation was limited to 2 educational districts in urban areas, where all 24
secondary schools in the districts were initially included. After the initial interviews,
the research continued in 5 of the schools, selected as a stratified sample to
represent the population composition. 5 schools were selected to gain in-depth
understanding of the implementation process from the perspective of various role-
players. An evaluation of the impact on learners’ behaviour patterns was also done
in these schools.
➢ Process of programme implementation in schools
❖ After the training, it was expected that they would develop programmes and
present them. 3 Months after the training, the researcher interviewed the teachers
about their experience. It was found that although the teachers were enthusiastic
and were motivated to implement it, they experienced, any obstacles in the
functioning of their schools that made it almost impossible to implement the
programme. As part of the action research approach, the feedback was used to
inform further planning.
❖ To address some of the obstacles, the following further interventions were put into
place in the schools in the area:
- Workshops to inform the principals of the necessity. Suggestions on how to
organise school activities to enable the implementation
- HIV/AIDS awareness programme implemented in the schools. This involved
a team of professionals from outside the schools presenting a 2-day
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