HIV prevention in churches?!

When I describe the READY program to colleagues, they are often surprised that we chose churches as our site for the intervention, especially when they learn that READY promotes condom use. "Will they let you talk about that?!" Yes.

We chose churches for several reasons: (1) Our formative surveys showed that most adolescents attend church regularly, (2) Churches are the most organized social structures we identified in Muhuru that include women and youth (e.g., community meetings held by Chiefs and other social gatherings are often attended by men only), and (3) Pastors and other church leaders are widely respected as role models and sources of social support in the community. 

When we piloted the program in February, churches showed willingness and openness to HIV prevention education in their churches. We allowed the church leaders to decide whether or not we could include information about condom use. To facilitate conversations about this and other issues where religious beliefs could conflict with the content of READY, READY includes church leader discussion groups each week before the session. These discussions relate to the topics planned for the week, and leaders are encouraged to debate and think through the issues and to decide what can be presented to their church. These discussion groups are led by a pastor from the community who is also a trained READY facilitator. 

Many leaders were reluctant to talk about condoms at first, but all came to the conclusion that they wanted to face the reality that many youths are not remaining abstinent - and that condoms were a good option in order to save their lives. After pastors decided to allow teaching about condoms, we also asked them to be the ones to introduce the topics to their churches. We are hopeful that church leaders will reach the same conclusions in the full intervention trial we are starting now. 

We completed recruitment in the 4 randomly selected churches this week. All of the churches welcomed us, and we spent a lot of time singing and dancing with them in addition to registering families into the program. Spending time with these congregations made me excited about starting the intervention in a couple weeks! Here are a few pictures from our visit to a church this weekend. 

Giving the Luo translation of what READY means

Scheduling survey times

Zilpa and Jessica scheduling

Beautiful view on our walk back to the car

Introducing Research Staff and Future Blog Contributors

I would like to introduce two key members of the READY research team. First, Jessica Pian, is our Research Coordinator. Jessica is from Bethesda, Maryland and graduated in 2007 from the University of Maryland with a degree in Psychology. She then spent two years as a research assistant at Boston University. Now we are lucky to have Jessica at the Duke Global Health Institute working with the READY Project in Muhuru. Jessica plays a large role in project planning, staff training and supervision, data management, and just about anything else that comes up. Jessica will be sharing her perspectives on READY throughout the year as a contributor to this blog.



John Ombajo is our Research Assistant who is taking a leadership role with our local research team. John is currently completing a post-graduate diploma in Project Planning and Management from Nairobi University. He is from Muhuru Bay and therefore has an excellent command of the local language and culture. John is an invaluable member of our team, and I have asked him also to share his observations on this blog in the future.

Introducing the READY Study to Churches

This weekend, we visited two of the four randomly selected churches for the intervention trial. We first reviewed the benefits we hope the program will provide for participants and then explained the purpose of the research study. In the video, you can see part of my explanation. I think the most illuminating part of the video is the number of people, mostly women, on the right side of the church who had never heard of "research" before. It is difficult to explain the ways that a research design effects participants in a way that qualifies as actual informed consent when some potential participants have never been exposed to the ideas of testing a hypothesis through research. For example, it is a bit complicated to understand the purpose of random selection - that randomly choosing participants increases the probability of a representative sample. While complicated, it was important for everyone in these churches s to understand the rationale since we were planning to draw names out of a bag to participate if more than 25 families, or 120 people, were interested. Otherwise the process could be confusing and may seem exclusive and unfair. I haven't devised the perfect explanation yet, but the strategy that seemed most effective was to allow my research assistant, John Ombajo, who is translating in the video, to explain the process in the local language as often as possible - instead of asking him to translate directly. He emphasized that the random selection process protects against unfairness and bias and that it makes sure we have a variety of types of families and individuals in the program. We also emphasized throughout the ways that participating in research can be beneficial to your own community, as well as other communities.

Learning something new - easier in your own accent

The survey enumerators for our project are learning to enter survey data electronically on pda devices, thanks to programming help from Eric Green . One of the most difficult things in teaching such a detailed process is that our American accents seem to disguise some words, even with enumerators who speak excellent English. Jack, one team member, is always reminding us, "Shape your mouth more clearly so I can understand what you are saying." My research coordinator, Jessica Pian, discovered that asking one of our team members to explain some of the steps was a more efficient way of making sure everyone is on the same page - or screen. This is Hellen, one of our team members, who caught on quickly to the pda. She is explaining to the others how to input the correct identifying information of an interviewee.

A New Survey Team...Practice Underway

This is training week for the new survey enumerators for the READY project. We have a strong team of men and women from Muhuru, and they have been spending this week practicing interviews they will conduct with youth and their caregivers in the community. Their work will be a large part of how we evaluate the READY intervention.

Here is just a glimpse of our practice today. We have community volunteers here so that the interviews are a bit more realistic. (Both have agreed for this video to be put online, and the volunteer is playing a role - not answering questions about his own life).

Random Selection...from a trash can

We are beginning a randomized controlled pilot trial of the READY intervention - a family and church-based program to prevent HIV and improve mental health of youth in Muhuru. Only 4 out of the 57 churches in Muhuru will receive the intervention, so we needed to be careful how those were selected. So yesterday we invited the Chiefs from across Muhuru to participate in the random selection by drawing slips of paper with the church names. After my explanation, they understood and accepted the process - but they were not at all satisfied with our carefully prepared envelopes from which we asked them to draw. These envelopes, they explained, would not allow us to "mix them thoroughly." I had to agree. So the head chief looked around the room for an acceptable container and decided the trash can was perfect. He emptied it and it indeed allowed us to mix thoroughly, thereby making sure the process was fair.

Good thing we called the chiefs together, as random selection resulted in only two of the four geographic locations of Muhuru represented among the churches. I will definitely do it this way again in the future - I will just bring along a big enough hat to pull from.

"A Brand New Kenya"

“It is time for a new brand of a brand new Kenya,” said Caroline Nderitu
in her poem at the promulgation ceremony for the new Kenyan Constitution. Even I could feel the excitement as I watched through my apartment television a few miles from Uhuru Park. I was amazed by the enormous crowd as the camera showed sections of people breaking into excited dancing and others climbing trees to catch a glimpse of the excitement.

All weekend since the ceremony, I’ve been asking cab drivers and Kenyan co-workers how they feel about the new Constitution…

“We are so happy – you will now find us all smiling here in Kenya.”
“Now we are really happy – there are so many good changes. Now even a normal Kenyan can finally get something.”
“Now we can go and see our Ministers, tell them what we want.”

In each response – hope, optimism, empowerment.

I rarely see direct, concrete examples of how structural-level change at the policy level can truly affect individuals’ mental health and well-being. But I think that this Constitution has the potential to do that in a very tangible way. People are waiting and hoping for increased support from their leaders – and this hope is already translating into improved moods and renewed motivation to reach goals in individuals and families.

I am traveling to Muhuru Bay again this week and I will be excited to hear what they have to say.