Interventions aimed at improving adolescent developmental outcomes are more likely to be successful if the young people they target find them acceptable. However, no standard definitions or indicators exist to assess acceptability,... more
Interventions aimed at improving adolescent developmental outcomes are more likely to be successful if the young people they target find them acceptable. However, no standard definitions or indicators exist to assess acceptability, acceptability research with adolescents in LMICs is still limited, and no known reviews synthesise the evidence from Africa.We conducted a systematic review of peer-reviewed studies assessing intervention acceptability with young adults (aged 10-24) in Africa, published between January 2010 and June 2020. This paper maps and qualitatively synthesizes the scope, characteristics, and findings of these studies, including definitions of acceptability, methods used, the type and objectives of interventions assessed, and overall findings on adolescent acceptability.The review was carried out in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Key word searches generated 4692 unique records and 55 final eligible studies,...
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Research Interests: Child abuse and neglect, Child protection, Child and adolescent mental health, Children and Families, Health Services Research, and 15 moreAccess to health services, Adolescent, Child Protection Social Work, Children, Humans, Child, Business and Management, Child Sexual Abuse, Child Abuse, Female, Male, Emotional Abuse, Child and Adolescent Mental Health, Health Services Accessibility, and Help seeking behavior
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HIV, both directly and indirectly, impacts child development outcomes. The most severe impacts are for children infected with HIV, and those exposed but uninfected are also shown to have challenges–though less severe. However, little is... more
HIV, both directly and indirectly, impacts child development outcomes. The most severe impacts are for children infected with HIV, and those exposed but uninfected are also shown to have challenges–though less severe. However, little is known regarding the development of children born to adolescent mothers affected by HIV. This study aims to examine cognitive development for children born to adolescent mothers, comparing those children living with HIV, those HIV exposed and uninfected (HEU) and those HIV unexposed (HU). Analyses utilise cross-sectional data from 920 adolescent mother (10–19 years)-first born child dyads residing in the Eastern Cape Province, South Africa. Participants completed detailed study questionnaires inclusive of validated and study specific measures relating to sociodemographic characteristics, HIV, and maternal and child health. Trained assessors administered standardised child development assessments (using the Mullen Scales of Early Learning) with all chi...
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Objectives: We examined associations between accelerators (interventions impacting ≥2 SDG targets) and SDG-aligned well-being indicators among adolescents 16–24 years old in Zambia.Methods: We surveyed adults from 1,800 randomly sampled... more
Objectives: We examined associations between accelerators (interventions impacting ≥2 SDG targets) and SDG-aligned well-being indicators among adolescents 16–24 years old in Zambia.Methods: We surveyed adults from 1,800 randomly sampled households receiving social cash transfers. We examined associations between accelerators (social cash transfers, life-long learning, mobile phone access) and seven well-being indicators among adolescents using multivariate logistic regressions.Results: The sample comprised 1,725 adolescents, 881 (51.1%) girls. Mobile phone access was associated with no poverty (adjusted Odds Ratio [aOR] 2.08, p < 0.001), informal cash transfers (aOR 1.82, p = 0.004), and seeking mental health support (aOR 1.61, p = 0.020). Social cash transfers were associated with no disability-related health restrictions (aOR 2.56, p = 0.004) and lesser odds of seeking mental health support (aOR 0.53, p = 0.029). Life-long learning was associated with informal cash transfers (a...
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Background Mental health problems may impact adherence to anti-retroviral treatment, retention in care, and consequently the survival of adolescents living with HIV. The adolescent-caregiver relationship is an important potential source... more
Background Mental health problems may impact adherence to anti-retroviral treatment, retention in care, and consequently the survival of adolescents living with HIV. The adolescent-caregiver relationship is an important potential source of resilience. However, there is a lack of longitudinal research in sub-Saharan Africa on which aspects of adolescent-caregiver relationships can promote mental health among adolescents living with HIV. We draw on a prospective longitudinal cohort study undertaken in South Africa to address this question.Methods The study traced adolescents aged 10-19 initiated on antiretroviral treatment in government health facilities (n = 53) within a health district of the Eastern Cape province. The adolescents completed standardised questionnaires during three data collection waves between 2014 and 2018. We used within-between multilevel regressions to examine the links between three aspects of adolescent-caregiver relationships (caregiver supervision, positive ...
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Background: To stem AIDS-morbidity and stop HIV transmission, UNAIDS recommends that 90% of HIV-positive people know their status by 2020, including adolescents. HIV-positive adolescents who engage in unsafe sex are at risk of... more
Background: To stem AIDS-morbidity and stop HIV transmission, UNAIDS recommends that 90% of HIV-positive people know their status by 2020, including adolescents. HIV-positive adolescents who engage in unsafe sex are at risk of transmitting HIV to partners and children. Little is known about linkages between knowing and disclosing one’s HIV-positive status and practicing safe sex among adolescents. Methods: This study tests whether (1) knowledge of one’s own HIV-positive status, (2) disclosure of HIV-positive status to partners, and (3) knowledge of partner HIV-status – positive or negative – are associated with protective sexual practices. The study interviewed n=1,527 HIV-positive and negative adolescents (10-19 years old, 57% female) in a health district in South Africa’s poorest province. N=1,425 adolescents who were either HIV-positive status aware or status-unaware (positive or negative) were included in the analyses, N=794 of whom were HIV-positive status-aware adolescents. In...
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Introduction: The World Health Organization recommends full disclosure of HIV-positive status to adolescents who acquired HIV perinatally (APHIV) by age 12. However, even among adolescents (aged 10-19) already on antiretroviral therapy... more
Introduction: The World Health Organization recommends full disclosure of HIV-positive status to adolescents who acquired HIV perinatally (APHIV) by age 12. However, even among adolescents (aged 10-19) already on antiretroviral therapy (ART), disclosure rates are low. Caregivers often report the child being too young and fear of disclosure worsening adolescents mental health as reasons for non-disclosure. Evidence is limited about predictors of disclosure and its association with adherence, viral suppression, and mental health outcomes among adolescents in sub-Saharan Africa. Methods: Analyses included three rounds (2014-2018) of data collected among a closed cohort of adolescents living with HIV in Eastern Cape, South Africa. We used logistic regression with respondent random-effects to identify factors associated with disclosure, and assess differences in ART adherence, viral suppression, and mental health symptoms between adolescents by disclosure status. We also explored differe...
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Background: The advent of the COVID-19 pandemic presented many challenges for parenting. Parenting was severely affected by lockdown, school closure, illness, shortages, movement restrictions and the many sudden changes wrought by the... more
Background: The advent of the COVID-19 pandemic presented many challenges for parenting. Parenting was severely affected by lockdown, school closure, illness, shortages, movement restrictions and the many sudden changes wrought by the global emergence of COVID-19. Responding to the need for a rapid emergency response to support parents and caregivers, a consortium of providers developed a suite of COVID-19 parenting resources based on evidence-based parenting interventions. Launched in March 2020, these were adapted for online use, with versions in over 100 languages, and the possibility for downloading, radio, and oral provision. A rapid qualitative evaluation initiative was conducted from September 2020 to February 2021 to inform the procedure, understand the impact and to drive future provision.Methods: The evaluation collected open-ended responses surveys (n=495 participants) and in-depth interviews with parents, providers and adolescent children (n=22) from 14 countries and one...
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Background Eliminating violence against children is a prominent policy goal, codified in the Sustainable Development Goals, and parenting programs are one approach to preventing and reducing violence. However, we know relatively little... more
Background Eliminating violence against children is a prominent policy goal, codified in the Sustainable Development Goals, and parenting programs are one approach to preventing and reducing violence. However, we know relatively little about dissemination and scale-up of parenting programs, particularly in low- and middle-income countries (LMICs). The scale-up of two parenting programs, Parenting for Lifelong Health (PLH) for Young Children and PLH for Parents and Teens, developed under Creative Commons licensing and tested in randomized trials, provides a unique opportunity to study their dissemination in 25 LMICs. Methods The Scale-Up of Parenting Evaluation Research (SUPER) study uses a range of methods to study the dissemination of these two programs. The study will examine (1) process and extent of dissemination and scale-up, (2) how the programs are implemented and factors associated with variation in implementation, (3) violence against children and family outcomes before and...
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IntroductionAntiretroviral treatment (ART) adherence rates are lower among adolescents living with HIV (ALHIV) than among adults and children, but more evidence is needed on long‐term sustained ART adherence among ALHIV. This study... more
IntroductionAntiretroviral treatment (ART) adherence rates are lower among adolescents living with HIV (ALHIV) than among adults and children, but more evidence is needed on long‐term sustained ART adherence among ALHIV. This study assesses rates of sustained ART adherence in a cohort of adolescents in South Africa.MethodsA prospective cohort of adolescents (10‐19 years) living with HIV (baseline sample N = 1 046, 55% female, mean age 13.6) in the Eastern Cape Province in South Africa were interviewed at baseline (2014‐15) and followed‐up twice (2015‐16, 2017–18). All adolescents ever initiated on treatment in 52 government health facilities were traced (with 90% uptake, 94% retention at Wave 2, and 97% retention at Wave 3, 3.4% mortality) and their clinic records were extracted where available. We investigate sustained ART adherence among adolescents interviewed at all three waves of data collection (N = 933). To quantify adherence at each study wave, we used self‐reported past‐wee...
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Adolescent (10–19 years) mental health remains an overlooked global health issue. Rates of adolescent pregnancy within sub-Saharan Africa are some of the highest in the world and occur at the epicentre of the global HIV epidemic. Both... more
Adolescent (10–19 years) mental health remains an overlooked global health issue. Rates of adolescent pregnancy within sub-Saharan Africa are some of the highest in the world and occur at the epicentre of the global HIV epidemic. Both experiencing adolescent pregnancy and living with HIV have been found to be associated with adverse mental health outcomes, when investigated separately. Poor mental health may have implications for both parent and child. The literature regarding mental health within groups experiencing both HIV and adolescent pregnancy is yet to be summarised. This systematic review sought to identify (1) the prevalence/occurrence of common mental disorder amongst adolescents who are living with HIV and have experienced pregnancy, (inclusive of adolescent fathers) in sub-Saharan Africa (2) risk and protective factors for common mental disorder among this group, and (3) interventions (prevention/treatment) for common mental disorder among this group. A systematic searc...
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Background Mental health problems may impact adherence to anti-retroviral treatment, retention in care, and consequently the survival of adolescents living with HIV. The adolescent-caregiver relationship is an important potential source... more
Background Mental health problems may impact adherence to anti-retroviral treatment, retention in care, and consequently the survival of adolescents living with HIV. The adolescent-caregiver relationship is an important potential source of resilience. However, there is a lack of longitudinal research in sub-Saharan Africa on which aspects of adolescent-caregiver relationships can promote mental health among adolescents living with HIV. We draw on a prospective longitudinal cohort study undertaken in South Africa to address this question. Methods The study traced adolescents aged 10–19 initiated on antiretroviral treatment in government health facilities (n = 53) within a health district of the Eastern Cape province. The adolescents completed standardised questionnaires during three data collection waves between 2014 and 2018. We used within-between multilevel regressions to examine the links between three aspects of adolescent-caregiver relationships (caregiver supervision, positive...
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The mental health of adolescents (10–19 years) remains an overlooked global health issue, particularly within the context of syndemic conditions such as HIV and pregnancy. Rates of pregnancy and HIV among adolescents within South Africa... more
The mental health of adolescents (10–19 years) remains an overlooked global health issue, particularly within the context of syndemic conditions such as HIV and pregnancy. Rates of pregnancy and HIV among adolescents within South Africa are some of the highest in the world. Experiencing pregnancy and living with HIV during adolescence have both been found to be associated with poor mental health within separate explorations. Yet, examinations of mental health among adolescents living with HIV who have experienced pregnancy/parenthood remain absent from the literature. As such, there exists no evidence-based policy or programming relating to mental health for this group. These analyses aim to identify the prevalence of probable common mental disorder among adolescent mothers and, among adolescents experiencing the syndemic of motherhood and HIV. Analyses utilise data from interviews undertaken with 723 female adolescents drawn from a prospective longitudinal cohort study of adolescen...
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Background: Substance use is a major public health concern worldwide. Alcohol and drug use have risen over recent decades in many low and middle-income countries, with South Africa among the highest globally.Despite effectiveness of... more
Background: Substance use is a major public health concern worldwide. Alcohol and drug use have risen over recent decades in many low and middle-income countries, with South Africa among the highest globally.Despite effectiveness of family-based interventions on reducing substance use among adolescents, less is known about the effectiveness of family-based programs on substance use among parents and caregivers, in particular, among families in low- and middle-income countries (LMIC).This study investigated mediators of change in a parenting programme (Parenting for Lifelong Health -PLH) on reduction of substance use among parents and their children through three potential mediators: parental depression, parenting stress and family poverty. In addition, the study examined the correlation between parental substance use and adolescent substance use.Methods: The current study draws on a pragmatic cluster randomized controlled trial design; the total sample comprised 552 parents\caregive...
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IntroductionThere is a growing interest in adolescent motherhood and HIV among policymakers and programme implementers. To better shape services and health outcomes, we need evidence on reproductive aspirations and contraception use in... more
IntroductionThere is a growing interest in adolescent motherhood and HIV among policymakers and programme implementers. To better shape services and health outcomes, we need evidence on reproductive aspirations and contraception use in this high‐risk group, including the effect of motherhood and HIV status. We report data from a large survey of adolescent girls and young women conducted in a mixed rural‐urban district in South Africa.MethodsQuantitative interviews were conducted with 1712 adolescent girls and young women (ages 10 to 24): 336 adolescent mothers living with HIV (AMLHIV), 454 nulliparous adolescent girls living with HIV (ALHIV), 744 HIV‐negative adolescent mothers (control adolescent mothers) and 178 HIV‐negative nulliparous adolescent girls (nulliparous controls) in 2018 to 2019. Standardized questionnaires included socio‐demographic measures, reproductive health and contraception experiences. Reproductive aspirations were measured as the number of children participan...
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BackgroundParenting programs suitable for delivery at scale in low‐resource contexts are urgently needed. We conducted a randomized trial of Parenting for Lifelong Health (PLH) for Young Children, a low‐cost 12‐session program designed to... more
BackgroundParenting programs suitable for delivery at scale in low‐resource contexts are urgently needed. We conducted a randomized trial of Parenting for Lifelong Health (PLH) for Young Children, a low‐cost 12‐session program designed to increase positive parenting and reduce harsh parenting and conduct problems in children aged 2–9.MethodsTwo hundred and ninety‐six caregivers, whose children showed clinical levels of conduct problems (Eyberg Child Behavior Inventory Problem Score, >15), were randomly assigned using a 1:1 ratio to intervention or control groups. At t0, and at 4–5 months (t1) and 17 months (t2) after randomization, research assistants blind to group assignment assessed (through caregiver self‐report and structured observation) 11 primary outcomes: positive parenting, harsh parenting, and child behavior; four secondary outcomes: parenting stress, caregiver depression, poor monitoring/supervision, and social support. Trial registration: ClinicalTrials.gov (NCT02165...
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Purpose: Violence against children increases in adolescence, but there is a research and practice gap in research-supported child abuse prevention for the adolescent years. A pilot program for low-resource settings was developed in... more
Purpose: Violence against children increases in adolescence, but there is a research and practice gap in research-supported child abuse prevention for the adolescent years. A pilot program for low-resource settings was developed in collaboration with nongovernmental organizations, government, and academics in South Africa, using research-supported principles. Method: This study used a pre-post design to test initial effects of a 10-session parenting program with 60 participants (30 caregiver–adolescent dyads) in high-poverty rural South Africa. Areas requiring further testing and adaptation were also identified. Results: Pre-post findings show medium to large program effects in reducing child abuse and adolescent problem behavior, as well as large effects in improvements of positive parenting, and perceived parent and adolescent social support. Discussion: There is potential to reduce child abuse, improve parenting, and reduce adolescent problem behavior in rural South Africa throug...
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This report summarises the study findings and impact of a research project implemented jointly by the Universities of Oxford and Cape Town: Pathways to survival: identifying psychosocial, family and service mechanisms to improve... more
This report summarises the study findings and impact of a research project implemented jointly by the Universities of Oxford and Cape Town: Pathways to survival: identifying psychosocial, family and service mechanisms to improve anti-retroviral adherence amongst HIV-positive adolescents in Southern Africa (hereafter: Mzantsi Wakho – Your South Africa – its locally used name). The core source of funding for this high-impact and successful study came from the Nuffield Foundation. This study was also supported by supplementary co-funding. This study was the first to systematically examine potential causes of ART non-adherence and non-retention in HIV care amongst adolescents (10-19 years old) in Sub-Saharan Africa. Through additional funding awarded to the research team, additional research aims were also examined. The research project was implemented by a team of more than 50 researchers, including capacity-building for early-career academics and students in South Africa and the UK. I...
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AimThis study aims to investigate associations of formal childcare with maternal and child outcomes in a large sample of adolescent mothers.BackgroundForty percent of adolescent girls in Africa are mothers. Increasing evidence shows... more
AimThis study aims to investigate associations of formal childcare with maternal and child outcomes in a large sample of adolescent mothers.BackgroundForty percent of adolescent girls in Africa are mothers. Increasing evidence shows positive impacts of formal childcare use for adult women, but no known studies in the Global South examine associations for adolescent mothers and their children.MethodsWe interviewed 1046 adolescent mothers and completed developmental assessments with their children (n = 1139) in South Africa's Eastern Cape between 2017 and 2019. Questionnaires measured childcare use, maternal and child outcomes and socio‐demographic background variables. Using cross‐sectional data, associations between formal childcare use and outcomes were estimated in multivariate multi‐level analyses that accounted for individual‐level and family‐level clustering.ResultsChildcare use was associated with higher odds of being in education or employment (AOR: 4.01, 95% CIs: 2.59–6....
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This study explores the cognitive development of children born to adolescent mothers within South Africa compared to existing reference data, and explores development by child age bands to examine relative levels of development.... more
This study explores the cognitive development of children born to adolescent mothers within South Africa compared to existing reference data, and explores development by child age bands to examine relative levels of development. Cross‐sectional analyses present data from 954 adolescents (10–19 years) and their first‐born children (0–68 months). All adolescents completed questionnaires relating to themselves and their children, and standardized child cognitive assessments (Mullen Scales of Early Learning) were undertaken. Cognitive development scores of the sample were lower than USA reference population scores and relative performance compared to the reference population was found to decline with increasing child age. When compared to children born to adult mothers in the sub‐Saharan African region, children born to adolescent mothers (human immunodeficiency virus [HIV] unexposed; n = 724) were found to have lower cognitive development scores. Findings identify critical periods of d...
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Objective: We are failing to reach 95–95–95 for adolescents living with HIV (ALHIV). Sexual abuse and intimate partner violence (IPV) may impact antiretroviral therapy (ART) adherence, with high rates of 17.4 and 29.7%, respectively,... more
Objective: We are failing to reach 95–95–95 for adolescents living with HIV (ALHIV). Sexual abuse and intimate partner violence (IPV) may impact antiretroviral therapy (ART) adherence, with high rates of 17.4 and 29.7%, respectively, across the southern sub-Saharan African region. However, evidence on their associations with adolescent ART adherence remains limited, with only three cross-sectional studies globally. Design: A prospective cohort of ALHIV (sample N = 980, 55% female individuals, baseline mean age 13.6 years) were recruited from 53 health facilities in South Africa's Eastern Cape Province and responded to a structured questionnaire at 18-month and 36-month follow-up (2015–2016, 2017–2018). Methods: A repeated-measures random effects model assessed multivariable associations of self-reported sexual abuse and IPV with past-week ART adherence, controlling for individual, socioeconomic, and HIV-related factors. Past-week adherence was defined based on currently taking A...
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Objectives. We explore how organisations working on parenting programmes and other types of family support and violence prevention in low-resource settings experienced the pandemic. Methods. In August 2020 - May 2021, we interviewed (1)... more
Objectives. We explore how organisations working on parenting programmes and other types of family support and violence prevention in low-resource settings experienced the pandemic. Methods. In August 2020 - May 2021, we interviewed (1) staff from three community-based organisations delivering evidence-informed parenting interventions and other psychosocial services for families in Cape Town, South Africa, (2) staff from a parenting programme training organisation, and (3) staff from two international organisations supporting psychosocial services in South Africa. Interviews (22) were thematically analysed, with findings in three areas. Results. First, respondents noted changes in the context, including the job losses, food insecurity, and stress experienced by local communities, and reductions in organisational funding. Second, we found that in response to these context changes, the organisations shifted their focus to food provision and COVID prevention. Parenting and psychosocial...
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The Scale-Up of Parenting Evaluation Research Study is designed to study the dissemination and scale-up of the suite of Parenting for Lifelong Health programmes for families with young children and adolescents. For more, see... more
The Scale-Up of Parenting Evaluation Research Study is designed to study the dissemination and scale-up of the suite of Parenting for Lifelong Health programmes for families with young children and adolescents. For more, see https://www.spi.ox.ac.uk/parenting-for-lifelong-health-SUPER and https://www.who.int/violence_injury_prevention/violence/child/plh/en/ This is a page with our research tools. If you have questions or find any of the materials useful, we would love to hear from you! You can contact us at parentinglh@gmail.com
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Objective: This mixed-methods process evaluation examined the feasibility of a parenting program delivered by community facilitators to reduce the risk of child maltreatment in low-income families with children aged 3–8 years in Cape... more
Objective: This mixed-methods process evaluation examined the feasibility of a parenting program delivered by community facilitators to reduce the risk of child maltreatment in low-income families with children aged 3–8 years in Cape Town, South Africa ( N = 68). Method: Quantitative measures included attendance registers, fidelity checklists, satisfaction surveys, and engagement in home practice activities. Qualitative data included parent interviews, facilitator focus groups, and transcripts from parent groups and facilitator supervision sessions. Results: Quantitative results show high levels of participant involvement, implementation, and acceptability. Thematic analyses identified seven themes related to program feasibility: (a) supporting participant involvement, (b) engagement in collaborative learning, (c) strengthening facilitator competency, (d) delivering nonviolent discipline skills, (e) contextualizing content, (f) receptivity to existing practices, and (g) resistance t...
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Ending all violence against children by 2030 is a core part of Sustainable Development Goals 5 and 16. A number of promising violence reduction strategies have been identified in research studies. However, we lack an understanding of the... more
Ending all violence against children by 2030 is a core part of Sustainable Development Goals 5 and 16. A number of promising violence reduction strategies have been identified in research studies. However, we lack an understanding of the implementation and impact of these programs in respect to their delivery at a large scale or within existing service systems, particularly in low- and middle-income countries (LMICs). We advocate for greater collaboration between researchers, policymakers, donors, governments, non-governmental organizations, and program managers and staff to study how violence prevention programs operate on a large scale. We describe a new initiative aiming to foster such collaborations in the field of family strengthening programs.
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Background: Violence against children increases in adolescence, but there is a research and practice gap in evidence-based child abuse prevention for the adolescent years. A pilot programme for low-resource settings was developed in... more
Background: Violence against children increases in adolescence, but there is a research and practice gap in evidence-based child abuse prevention for the adolescent years. A pilot programme for low-resource settings was developed in collaboration with NGOs, government and academics in South Africa, using evidence-based principles. Methods: This study used a pre-post design to test initial effects of a 10-session parenting programme with 60 participants (30 caregiver-adolescent dyads) in high-poverty rural South Africa. Areas requiring further testing and adaptation were also identified. Results: Pre-post findings show significant reductions in child abuse, violent discipline, adolescent problem behaviour, poor supervision and acceptance of violence. Improvements were seen in positive and involved parenting, and parent and adolescent social support. Conclusions: There is potential to reduce child abuse, improve parenting, and reduce adolescent problem behaviour in rural South Africa ...
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Purpose: This study investigated process and outcomes of the Parenting for Lifelong Health (PLH) for Young Children and for Adolescents programs implemented as part of routine service delivery in postconflict settings. Methods: These... more
Purpose: This study investigated process and outcomes of the Parenting for Lifelong Health (PLH) for Young Children and for Adolescents programs implemented as part of routine service delivery in postconflict settings. Methods: These group-based programs were delivered by trained facilitators to 97 caregivers (PLH for Young Children) and 108 caregiver–adolescent dyads (PLH for Adolescents) over 12 or 14 (respectively) weekly sessions. Routine monitoring data were collected by the implementing partners using standardized self-report measures. Reducing harsh discipline was specified as the primary outcome, with secondary outcomes including improvements in positive parenting and reductions in poor parental supervision and parental inefficacy. Results: Analyses were intention to treat. Both PLH programs retained effectiveness in routine conditions in a postwar setting, with moderate to large effect sizes. The programs also had high enrollment and attendance rates, indicating high accept...
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In response to its constitutional commitments and social welfare provisions in the era of democracy, the post-apartheid South African state is increasingly called upon to provide for the lives and livelihoods of its citizens. These... more
In response to its constitutional commitments and social welfare provisions in the era of democracy, the post-apartheid South African state is increasingly called upon to provide for the lives and livelihoods of its citizens. These demands have intensified amid escalating joblessness and the highest numbers of people living with HIV worldwide. Over the past decade, antiretroviral treatment (ART) has been incorporated into an ever-expanding welfare bureaucracy , in which access to state assistance is mediated by the collection and monitoring of biometric, bureaucratic data. Drawing on 18 months of ethnographic research in the Eastern Cape, this article explores how state documents bring young people on ART into an ambiguous relationship with the state — one that is at once subordinating and enabling. While social research on ART addresses both the empowering and coercive aspects of treatment taking, less attention has been given to how these modes of participation might be mutually constitutive. In this article, the authors examine how the same technologies that discipline youth on ART might also support and protect them; how welfare dependencies entail paradoxical forms of agency; and how the state's ability to control and to 'care for' citizens might be reciprocally dependent.
Research delineates two epidemiological categories among HIV-positive adolescents: those who contract the virus sexually and those who inherit it as infants. In this article, we are interested in how tacit inferences about adolescents'... more
Research delineates two epidemiological categories among HIV-positive adolescents: those who contract the virus sexually and those who inherit it as infants. In this article, we are interested in how tacit inferences about adolescents' mode of infection contribute to their experiences of HIV-related blame, and their ability to achieve care, in their intimate, everyday settings. The analysis arises from ethnographic research with 23 HIV-positive adolescents living in South Africa's Eastern Cape. From these, we draw particularly on the narratives of four HIV-positive teenage girls and their HIV-positive mothers. The article explores the social stakes entailed in ascriptions of adolescents' mode of infection, particularly in terms of how blame was allocated between mothers and daughters. It further considers how these families have sought to negotiate repudiation and thereby sustain in-tergenerational care. The article furthers limited research on the life projects and dilemmas of this HIV-positive adolescent cohort. [HIV/AIDS, adolescents, blame, South Africa, intergenerational care]
Background: The Sustainable Development Goals (SDGs) commit to strengthening collaborations between governments and civil society. Adolescents are among the key target populations for global development initiatives, but research studies... more
Background: The Sustainable Development Goals (SDGs) commit to strengthening collaborations between governments and civil society. Adolescents are among the key target populations for global development initiatives, but research studies and programmes rarely include their direct perspectives on how to promote health and wellbeing. This article explores how both the methods and the findings of participatory research provide insights into adolescents’ aspirations across the domains of health and social development. It investigates how adolescents conceive of health and social services as interconnected, and how this reflects the multisectoral objectives of the SDGs.
Methods: This research was conducted within a longitudinal, mixed methods study of HIV-positive adolescents (n = 80 qualitative participants, n = 1060 quantitative interviews). Between November 2013 and February 2014, a participatory exercise – the “dream clinic” – was piloted with 25 adolescents in South Africa’s Eastern Cape. Key themes were identified based on the insights shared by participants, and through visual and thematic analysis. These findings were explored through a second participatory exercise, “Yummy or crummy? You are the Mzantsi Wakho masterchef!,” conducted in January 2016. Findings are described in relation to emerging quantitative results.
Results: Mixed methods explored associations between access to food, medicines, clean water and sanitation in HIV-positive adolescents’ aspirations for development. The exercises produced practicable recommendations for innovations in development, based on associations between healthcare, food security, clean water and sanitation, while illustrating the value of partnership and collaboration (the objective of SDG17). Findings capture strong interlinkages between SDGs 2, 3 and 6 – confirming the importance of specific SDGs for HIV-positive adolescents. Study results informed the objectives of South Africa’s National and
Adolescent and Youth Health Policy (2017).
Conclusions: Participatory research may be used to leverage the perspectives and experiences of adolescents. The methods described here provide potential for co-design and implementation of developmental initiatives to fulfil the ambitious mandate of the SDGs. They may also create new opportunities to strengthen the engagement of adolescents in policy and programming.
Methods: This research was conducted within a longitudinal, mixed methods study of HIV-positive adolescents (n = 80 qualitative participants, n = 1060 quantitative interviews). Between November 2013 and February 2014, a participatory exercise – the “dream clinic” – was piloted with 25 adolescents in South Africa’s Eastern Cape. Key themes were identified based on the insights shared by participants, and through visual and thematic analysis. These findings were explored through a second participatory exercise, “Yummy or crummy? You are the Mzantsi Wakho masterchef!,” conducted in January 2016. Findings are described in relation to emerging quantitative results.
Results: Mixed methods explored associations between access to food, medicines, clean water and sanitation in HIV-positive adolescents’ aspirations for development. The exercises produced practicable recommendations for innovations in development, based on associations between healthcare, food security, clean water and sanitation, while illustrating the value of partnership and collaboration (the objective of SDG17). Findings capture strong interlinkages between SDGs 2, 3 and 6 – confirming the importance of specific SDGs for HIV-positive adolescents. Study results informed the objectives of South Africa’s National and
Adolescent and Youth Health Policy (2017).
Conclusions: Participatory research may be used to leverage the perspectives and experiences of adolescents. The methods described here provide potential for co-design and implementation of developmental initiatives to fulfil the ambitious mandate of the SDGs. They may also create new opportunities to strengthen the engagement of adolescents in policy and programming.