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.

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.

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.

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!

Lessons Learned: Logistics

Since I’ve been back in the States, I’ve been making lists of what I should remember to do differently next time. I thought I would share for anyone who’s planning to do similar work in a similar place.

I’ll start with the most practical. One of the biggest surprises in Muhuru was how much time I spent figuring out how to do seemingly simple tasks. Without access to electricity, banks, and an office supply closet, I often felt lost.

7 Logistics changes I will make next time:

1) Take out plenty of cash ahead of time (a trip to the closest ATM took at least half a day).

2) Pay research staff every two weeks (not weekly); Getting correct change is not easy and not fun, so minimizing the frequency would help. For a little extra fee, I might also pay through MPESA (money transfer service associated with the cell phone company).

3) Give research staff cell phone airtime on a regular basis, and ask them to do as much scheduling and arranging logistics as possible (e.g., transportation for fieldwork). They were much better at it and more efficient… things happened much more quickly (and often less expensively) when negotiations were made in the local language.

4) Pack office supplies – tape, folders, paperclips, envelopes, etc…I’ll think ahead about what will make organization easier to make up for limited office and storage space.

5) Print and copy ahead of time.

6) Use text messages and written letters to invite people to meetings or events; communication over the phone was more difficult than in writing or in person, so scheduling based on only phone conversations often led to confusion.

7) Ask for ideas about logistical challenges (scheduling, planning, etc.) from people who are from the community before racking my brain to figure it all out. Often there were systems in place already and/or things to consider that never would have occurred to me.

The Research Teams...Delayed Recognition

Because I had a hard time uploading photos and video in Muhuru, it was difficult to show you who was working on this project. My research team from Muhuru Bay and Egerton University collected all of the data for the qualitative and survey components.

For the qualitative phase, I hired 5 interviewers from Egerton and 5 interviewers from the Muhuru Community. For the survey phase, I hired 5 additional enumerators from Muhuru for a local team of 10.

A glance at some of their work...

Egerton University students translating part of the qualitative interviews, trying to figure out how to say "personal questions" in Dholuo, the local language in Muhuru.




Preparing for a focus group on the WISER site (before there was a roof on our "office"):

Conducting focus groups...but having to build the shelters first

The Muhuru Team traveled ALL OVER Muhuru by motorbike to conduct surveys...hours of riding, walking, coordinating with schools, and searching for homes.

Asking teachers to direct us to homes

Surveys under trees


All of us - Kanyakala ("together" in Dholuo)

Ero Kamano Ahinya!

Back Home...With Data

I am back in the U.S., unpacking and looking forward to analyzing data from the summer. Our hectic schedule with data collection and the DukeEngage program kept me from posting during the last month of fieldwork. So here are a few updates:

1) We completed 325 youth surveys and 324 caregiver surveys (we just couldn't catch that last mom at home!). We were excited to reach our goal - this number will give us enough statistical power to look at the relationships between mental health / family factors and HIV risk behavior. Our high-tech chart here kept us motivated...

2) After calculating some descriptive results from the survey, we held a community results meeting to share preliminary findings. The turn out was good, and people seemed genuinely interested. The meeting ended with a suprisingly animated debate about Voluntary Counseling and Testing...not directly related to our findings, but at least people are passionate about the issues.

3) I formed a Community Advisory Committee to help analyze the data and generate ideas for the intervention strategies we will begin designing over the next 6 months. The group includes health care workers, teachers, pastors, and leaders of community-based organizations that work on issues related to HIV. We held two training meetings covering the basics of HIV prevention, and we will now start a long-distance collaboration. The committee will provide feedback on analysis, generate intervention ideas, and plan for intervention piloting in 2010. Here is the committee at our final planning meeting: