We piloted the first session of the READY program today at a Seventh Day Adventist Church in Muhuru. We focused on Family Communication in the context of Economic Empowerment. Our Community Advisory Committee felt strongly that economic issues should be discussed FIRST because poverty is a main source of family stress and also an underlying factor related to HIV risk.
Fifty people attended - half youth and half adults. Most came together as families, which was important for the emphasis on family communication. It was clear that asking families to talk with one another during a group program was a new approach, but families participated and reported they enjoyed it. Families talked together to plan "small steps of hope" related to making an economic plan for their family.
Men among the participants brought up an interesting issue several times during the discussion. They expressed reluctance to share the amount of their salaries with their wives, saying that their wives may "plan big budgets" if they are aware of the amount of money available. The facilitator for the male caregivers said that there was some disagreement on this point, however, which opened the door to discuss the possible benefits of having open communication about money within a marriage.
Saturday, January 30, 2010
Saturday, January 23, 2010
READY Workshops to Develop Intervention
This week, the READY advisory committee and other community members – men, women, and youth - have been meeting in evening workshops to develop the first sessions of the READY program. We have 3 intervention development groups: (1) Building Strength in Sexuality and Relationships, (2) Building Economic Strength, (3) Building Emotional and Family Strength.
One advantage of a participatory approach to program development is that examples and activities are more likely to be relevant. Another is that people from the community know the appropriate limits in discussing sensitive issues - they know how and when to push new ideas.
Three ideas from the workshops:
#1 Challenge to use Local Resources
The economic empowerment group asked participants to list local resources and posed the question, “Are we REALLY poor?” They asked families to choose a local, free resource and to generate ideas for taking small steps to make money with that resource.
#2 Role of Fathers in Supporting Healthy Sexuality
One group presented a skit in which two young girls try to share with their fathers a song about private body parts they learned in school. One father rejected and dismissed the child, while the other took the opportunity to teach the child that sexuality can be positive within the context of a loving relationship – and after finishing school.
#3 Fish Net Illustration for Family Communication
Muhuru is a fishing community. One group worked on the session, “Building Encouraging Families.” They drew posters of two scenes in which groups of people were trying to pull in the two sides of a very large fishing net. In the first, trees were blocking the fishermen from communicating as they pulled in the net – therefore, the net was uneven and the fish escaped. In the second, the men were able to communicate easily and they caught many fish. The lesson: Families who communicate to solve problems together can reach their goals.
Sunday, January 17, 2010
Families and Churches...Are they READY?
Our Community Advisory Committee (CAC) has met twice since I've been back in Kenya, and we have developed a plan to pilot a church-based intervention for families with three main goals: (1) Prevent HIV risk behavior among youth, (2) Improve mental health and coping among youth, and (3) Provide caregivers with skills to provide positive support for youth.
We are now forming intervention development teams to contribute to specific intervention content. Teams include our CAC members paired with caregivers and youth from the community. I'll share more on our teams' progress this week.
Our name for the program:
READY - Resilience Education And skill Development for Youth and Families.
The READY Community Advisory Committee working on intervention strategy ideas.
We are now forming intervention development teams to contribute to specific intervention content. Teams include our CAC members paired with caregivers and youth from the community. I'll share more on our teams' progress this week.
Our name for the program:
READY - Resilience Education And skill Development for Youth and Families.
The READY Community Advisory Committee working on intervention strategy ideas.
Monday, January 11, 2010
The Pilot Metaphor
On Saturday, I met with Madame Beatrice, the Chairlady of the Community Advisory Committee that has been working on our HIV prevention research while I was in the U.S. We planned to discuss the logistics of the group, but instead talked for four hours about her ideas for supporting youth in the community to protect them from HIV.
Psychologists and public health professionals often talk about ecological systems theory (developed by Urie Bronfenbrenner) that emphasizes the ways that a child's development is influenced by both proximal and distal factors in his or her environment -- from the immediate family to the economic climate of the environment.
Madame Beatrice is not a psychologist and has no public health training, but she shared with me a metaphor she developed that's surprisingly like Bronfenbrenner's theory.
She said, "We must tell youth they are the pilot of their own life." (Sidenote: tons of kids here want to be pilots when they grow up) Then she went on to describe others' roles:
Caregivers = the geographer sitting beside the pilot to show them the map
Teachers = the fuel that provide the energy and resources for the pilot to fly
Community Members = the parts of the plane that work together to fly with the pilot
Community Leaders and Pastors = the weather that can provide either a good or bad environment for the pilot to fly (i.e., the cultural and religious climate of the community)
I think she’s developed one of the first parts of the introduction to our intervention.
Psychologists and public health professionals often talk about ecological systems theory (developed by Urie Bronfenbrenner) that emphasizes the ways that a child's development is influenced by both proximal and distal factors in his or her environment -- from the immediate family to the economic climate of the environment.
Madame Beatrice is not a psychologist and has no public health training, but she shared with me a metaphor she developed that's surprisingly like Bronfenbrenner's theory.
She said, "We must tell youth they are the pilot of their own life." (Sidenote: tons of kids here want to be pilots when they grow up) Then she went on to describe others' roles:
Caregivers = the geographer sitting beside the pilot to show them the map
Teachers = the fuel that provide the energy and resources for the pilot to fly
Community Members = the parts of the plane that work together to fly with the pilot
Community Leaders and Pastors = the weather that can provide either a good or bad environment for the pilot to fly (i.e., the cultural and religious climate of the community)
I think she’s developed one of the first parts of the introduction to our intervention.
Saturday, January 9, 2010
WISER School Opened
On Friday, WISER – the host NGO for my research in HIV prevention – officially opened a secondary school for girls in Muhuru Bay. In Muhuru, girls’ education has not been prioritized. Most girls drop out of primary school to get married or finish primary school with grades that are much too low to qualify for a good secondary school education. WISER worked with the students to increase their test performance and then accepted girls with passing marks.
The opening ceremony was inspiring. As the girls’ names were called, they each ran forward, literally surrounded by their parents, teachers, and village chiefs – all jumping, hugging, and screaming. It was clear they all shared in their girl’s joy and recognized their role in supporting her to earn this opportunity.
Wednesday, January 6, 2010
Back in Kenya…Research Results: HIV Risk and Psychosocial Well-Being
Over the past four months, we have been analyzing survey data to identify ways that mental health and family interactions/support may be related to HIV risk behavior among youth in Muhuru. A paper with full results is forthcoming, but I wanted to share some of the main findings.
HIV Risk Behavior in Muhuru:
• 29.9 % of girls and 51.3 % of boys surveyed reported that they have had sex.
• Average age of first sex was 13.1 for girls and 12.2 for boys
• 82.6 % of boys and 45.2 % of girls who have had sex did not use a condom the most recent time they had sex
• 49.3 % of Boys and 23.8 % of Girls who are sexually active have had more than 1 partner in the past year
We looked at factors related to HIV risk in two ways:
First, we looked at factors related to whether a youth had ever had sex at all. The following youth were more likely to be sexually active.
• Older youth
• Boys
• Youth experiencing more symptoms of emotional problems
• Youth who believe risky behaviors are not risky and that condoms don’t work
• Boys with more social support from family and community members
Second, among sexually active youth, we looked at factors related to whether they engaged in “high risk behavior” defined as multiple partners OR not using a condom the most recent time they had sex. The following youth were more likely to have high risk behavior:
• Younger sexually active youth
• Boys
• Youth with less monitoring / supervision from their caregivers
• Youth showing more conduct problems (e.g., aggression, getting into trouble, etc.)
In sum, results suggest that mental and behavioral health problems could be risk factors for HIV risk behavior. Support and monitoring of youth by family and the community also seem to influence HIV risk. For boys, it is interesting that being sexually active is related to more social support. Perhaps boys who are more outgoing and socially skilled also have more opportunity for sexual relationships. Or perhaps sexual activity is socially reinforced for boys.
Our Community Advisory Committee in Muhuru has been reviewing these results and related literature in preparation for developing an intervention to address the above factors. I just arrived in Kenya to work with them on intervention development, so I will be blogging about our progress. Comments and thoughts are welcome!
HIV Risk Behavior in Muhuru:
• 29.9 % of girls and 51.3 % of boys surveyed reported that they have had sex.
• Average age of first sex was 13.1 for girls and 12.2 for boys
• 82.6 % of boys and 45.2 % of girls who have had sex did not use a condom the most recent time they had sex
• 49.3 % of Boys and 23.8 % of Girls who are sexually active have had more than 1 partner in the past year
We looked at factors related to HIV risk in two ways:
First, we looked at factors related to whether a youth had ever had sex at all. The following youth were more likely to be sexually active.
• Older youth
• Boys
• Youth experiencing more symptoms of emotional problems
• Youth who believe risky behaviors are not risky and that condoms don’t work
• Boys with more social support from family and community members
Second, among sexually active youth, we looked at factors related to whether they engaged in “high risk behavior” defined as multiple partners OR not using a condom the most recent time they had sex. The following youth were more likely to have high risk behavior:
• Younger sexually active youth
• Boys
• Youth with less monitoring / supervision from their caregivers
• Youth showing more conduct problems (e.g., aggression, getting into trouble, etc.)
In sum, results suggest that mental and behavioral health problems could be risk factors for HIV risk behavior. Support and monitoring of youth by family and the community also seem to influence HIV risk. For boys, it is interesting that being sexually active is related to more social support. Perhaps boys who are more outgoing and socially skilled also have more opportunity for sexual relationships. Or perhaps sexual activity is socially reinforced for boys.
Our Community Advisory Committee in Muhuru has been reviewing these results and related literature in preparation for developing an intervention to address the above factors. I just arrived in Kenya to work with them on intervention development, so I will be blogging about our progress. Comments and thoughts are welcome!
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