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Validation of the Supportive Community Index: survey research on Girls’ Vulnerability to HIV/AIDs from Botswana, Malawi, and Mozambique. Carol Underwood, Ph.D. & Hilary Schwandt, Ph.D. Johns Hopkins University. Go Girls! Initiative: Goal & Social-ecological conceptual framework.

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Validation of the Supportive Community Index: survey research on Girls’ Vulnerability to HIV/AIDs from Botswana, Malawi, and Mozambique

Carol Underwood, Ph.D. & Hilary Schwandt, Ph.D.

Johns Hopkins University


Go girls initiative goal social ecological conceptual framework
Go Girls! Initiative: Goal & Social-ecological conceptual framework

GOAL: To reduce HIV prevalence among adolescent girls aged 10-17 in Botswana, Malawi & Mozambique


Social ecology combined prevention
Social ecology & combined prevention

  • SE approach posits interrelated roles of intrapersonal, interpersonal, institutional, community, and structural levels

  • SE interventions encompass the three elements of combined prevention – biomedical (individual level), behavioral (individual & social normative), and structural interventions


Model 1 individual community level
Model 1:Individual & community level

Life Skills

Out-of-school

Adult-Child Communication

Community Mobilization

Reality Radio


Model 2 multi level individual community structural approach
Model 2:Multi-level: individual, community & structural approach

School Personnel Training

Economic Strengthening


Ggi s whole community approach
GGI’s whole-community approach

Communities:

Community mobilization

Radio program

Safe schools:

Teacher training

Girls:

School-based and community-based life skills

Extended families:

Adult-child communication

Economic strengthening


Formative research
Formative research

  • Literature review of “vulnerable girls”

  • Qualitative study to examine community perspectives’ of “vulnerable girls”

    Results informed and helped to refine 3 indices in advance of the baseline survey


Evaluation timeline
Evaluation timeline

Sep 2009

Aug 2010

Community Mobilization

Teacher Training

Life Skills

Adult-Child Communication

Economic Strengthening

Reality Radio


Supportive community index
Supportive Community Index

  • What is it?

    • A community/structural level measurement tool

  • How can it be utilized?

    • Measure the level, and change in, community/structural support in a community – emphasizing vulnerable girls’ support

  • Why is it important?

    • Communities/structures have a large impact on individual behaviors yet they are rarely addressed or evaluated

    • Measurement allows for evaluation of structural interventions


Why focus on structural factors
Why focus on structural factors?

  • Research shows that structural factors – access to educational, employment, & financial opportunties as well as policies that affect the distribution of resources – are key to HIV reduction

  • Yet, structural interventions lag behind biomedical and individual-level behavioral interventions

  • Nonetheless, community members prioritize structural interventions

  • Practitioners argue that structural effects are difficult to measure


Baseline supportive community index sci
Baseline Supportive Community Index (SCI)

From three populations:

Key Informants

Adults

Adolescents


Sci domains key informants
SCI Domains – Key Informants

  • Access to health services

  • Concerns about alcohol abuse

  • Regulation of alcohol

  • Community cohesion

  • Community groups

  • Community safety

  • Economic opportunities

  • Community support

  • Gender and community

  • School safety

  • Sexual abuse concerns

  • Regulation of sexual abuse


Community action outcome domains key informants
Community Action (Outcome) Domains – Key Informants

  • Alcohol action

    “In the past 12 months, has the community taken any action to address the issue of outlets selling alcohol to people younger than 18 years?”

  • Sexual abuse action

  • Vulnerable girls support

  • Community health

    “In the last year, has the impact of HIV/AIDS on the community improved, worsened, or stayed the same?”


Correlation of the sci and community action key informants
Correlation of the SCI and Community Action – Key Informants

  • Botswana (n=21)

    • Range: 67-146

    • Correlation = 0.79

  • Malawi (n=40)

    • Range: 60-135

    • Correlation = 0.73

  • Mozambique (n=82)

    • Range: 43-138

    • Correlation = 0.55


Baseline supportive community index sci1
Baseline Supportive Community Index (SCI) Informants

From three populations:

Key Informants

Adults

Adolescents


Sci domains adults
SCI Domains - Adults Informants

  • Alcohol regulation

    “How likely do you think it is that an adolescent younger than 18 years of age will obtain alcohol in this community if he or she tries?”

  • Community cohesion

    “When conflicts or disagreements arise between community members, they are always resolved quickly.”

  • Community safety

  • Economic opportunities

  • School safety

  • Sexual abuse regulations


Community action outcome domains adults
Community Action Outcome Domains - Adults Informants

  • Community support

    Example: “In the last 12 months, have people in your community worked together to address HIV/AIDS?”

  • Vulnerable girls support

    Example: “In the last 12 months, has any action been taken in the community to improve the well-being of adolescent girls?”


Sci and outcome adults
SCI and Outcome - Adults Informants

  • Linear Regression

    • Main predictor: SCI

    • age, marital status, parity, and residence

  • Botswana (n=530)

    • β = 0.22; 95% CI (0.17, 0.27)*

  • Malawi (n=615)

    • β=0.17; 95% CI (0.14, 0.21)*

  • Mozambique (n=529)

    • β=0.14; 95% CI (0.095, 0.18)* *p = 0.000


Baseline supportive community index sci2
Baseline InformantsSupportive Community Index (SCI)

From three populations:

Key Informants

Adults

Adolescents


Sci domains adolescents
SCI Domains - Adolescents Informants

  • Poverty

  • Food security

  • Home security

  • Alcohol access & regulation

  • Community cohesion

  • Community safety

  • Economic opportunities

  • School safety

  • Sexual abuse regulations


Outcome variable adolescents
Outcome Variable - Adolescents Informants

Sexual experience

“Have you ever had sexual intercourse?”


Sci and sex adolescents
SCI and Sex - Adolescents Informants

  • Logistic Regression

    • Main predictor: SCI

    • Age, current schooling status, orphan status, & residence

  • Botswana (n=560)

    • OR = 0.81; p = 0.000

  • Malawi (n=752)

    • OR = 0.93; p = 0.041

  • Mozambique (n=427)

    • OR = 0.91; p = 0.017


Measuring structural change
Measuring Structural Change Informants

  • Measurement of the SCI at 2 time points

    • Baseline

    • Endline

  • Comparing change

    • Analyze the % change in community aggregate scores

  • Hypothesis

    • + % SCI change

    • SCI Model II > SCI Model I


Conclusions
Conclusions Informants

  • SCI is strongly associated with hypothesized outcomes

    • In 3 countries

    • In 3 populations

  • Cross-country validation of the SCI


Implications
Implications Informants

  • Most behavior change research and programs focus on the individual – ignoring the structures outside the individual influence

  • GGI (research & program) has been designed with a community and structural level focus

  • GGI is implementing a structural level intervention in three countries

    • As well as measuring the structural change through the SCI

  • Future researchers and programs can use these tools to design and test structural level interventions


Contact details
Contact details Informants

Carol Underwood, PhD

Johns Hopkins Bloomberg School of Public Health

Center for Communication Programs

111 Market Place, Suite 310

Baltimore, MD 21202, USA

Tel: 410-659-6300

Fax: 410-659-6266

Web: http://www.jhuccp.org

Email: [email protected]


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