The impact of Laduma, a health education intervention, on the knowledge, attitudes, beliefs, and practices regarding sexually transmitted infections among secondary school learners in KwaZulu-Natal.
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Date
2005
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Abstract
Purpose
To evaluate the impact of Laduma, a health education intervention, on the
knowledge, attitudes, beliefs and practices regarding sexually transmitted infections
among secondary school learners in KwaZulu-Natal.
Objectives
The objectives of the study were to determine knowledge, attitudes, beliefs,
perceptions and practices of secondary school learners regarding sexually transmitted
infections at baseline and post-exposure to Laduma; assess intended behaviour change
regarding sexually transmitted infections and condom use as well as the awareness of
skills to achieve such behaviour; assess learners' perceived vulnerability to sexually
transmitted infections; assess comprehension, acceptability and appeal of the photonovella
among learners and to assess whether learners can identify with the characters and
situations in the photo-novella.
Design
This was an experimental study design.
Setting
Nineteen randomly selected secondary schools in the Midlands district of
KwaZulu-Natal.
Subjects
Grade 11 learners, n = 1168, from randomly selected schools that
were further randomised into intervention and control groups.
Outcome Measures
The learners had to complete three sets of questionnaires that elicited information
about their biographical profile, knowledge, attitudes, beliefs, perceptions and practices
regarding sexually transmitted infections, intention to change their behaviour with regard
to sexually transmitted infections and condom use, as well as their skills to achieve such
behaviour, their perceived vulnerability to sexually transmitted infections and their
perceptions of Laduma. All of these outcomes were assessed at baseline (Tl), following
the learners' exposure to Laduma (T2, three weeks after the baseline), as well as six weeks
later (T3) in the case of the intervention group. With respect to the control group they had
to answer the baseline questionnaire on all three occasions.
Results
The mean age of the respondents was 16.8 years with almost two thirds of the
learners being between the ages of 15 - 18 years. Seventy percent were primarily Zulu
speaking. Learners reported feeling personally scared of getting a sexually transmitted
infection with 17.8% responding that they thought they could get a sexually transmitted
infection in the next two years. There was a significant gender difference between male
and female learners in their topics of communication to friends, parents and partners
regarding HIV/AIDS, condom use, having sex or not having sex (p < 0.01). Although
learners had adequate knowledge about the spread of sexually transmitted infections at
baseline, the mean scores for the spread for the group exposed to Laduma differed
significantly from the mean scores of the control group, both immediately after the
intervention (p < 0.01) and six weeks thereafter (p < 0.001). Learners in the intervention
group responded more positively towards condom use at time 2 (T2) than the control
group and maintained this change six weeks later. Sexual activity and condom use at time
3 (T3) was not influenced by the intervention but was significantly predicted by past
sexual activity (p< 0.001) and past condom use (p < 0.001) respectively.
At time 3 (T3) significantly more learners in the intervention group intended to
have sex with a condom (65.1 %) compared to the control group (52.3%, p < 0.05). Overall
learners had a positive response to Laduma and appreciated it as a health education
intervention.
Conclusion and Recommendation
The findings of this study provided important information about adolescent
sexuality on a range of outcomes related to knowledge, attitudes and sexual behaviour.
The findings also provided information on learners' gender differences about what they
communicate and to whom, as well as their sexual behaviour.
After a single reading of Laduma learners showed an increase in knowledge about
the spread of sexually transmitted infections, a change in their attitude to condom use as
well as an increased intention to practice safer sex. Laduma did not influence
communication about sexually transmitted infections, sexual behaviour nor condom use.
These are complex behaviours and indicate that interventions focussing on preventive
sexual behaviour need to move beyond awareness and information dissemination towards
being more intensive and skills focussed. Such interventions need to address the gaps
between knowledge and practice and be facilitated in a context that supports such
implementation.
The specific recommendations made from the findings of this study therefore
include, the development of a systematic health promotion programme that addresses the
issues related to personal vulnerability, knowledge related to treatment of and protection
against sexually transmitted infections as well as skills that promote safer sexual choice.
Description
Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2005.
Keywords
Health education., Preventive health services., AIDS (Disease)., HIV infections., Sexually transmitted diseases., Sexually transmitted diseases--Study and teaching., Theses--Family medicine.