Cohort study of SKILLZ Total Health offering comprehensive sexual and reproductive health programming among adolescents in Zambia and Zimbabwe

DETAILED SUMMARY

Importance

• Many adolescents in low- and middle-income countries experience poor sexual and reproductive health (SRH) outcomes related to unplanned pregnancy, STIs, and HIV.

Objective

• To understand adolescents’ knowledge, attitudes, and beliefs about SRH including contraceptives and HIV testing and treatment services at baseline and examine changes before and after SKILLZ program implementation.

Study details

• Study design: Cohort study with baseline/endline survey
• Data collection tools: Baseline surveys (December 2018) and endline surveys (late 2021); key informant interviews; in-depth interviews; and focus group discussions with GRS staff, Coaches, health workers, teachers, and adolescent participants.
• Participants: Mixed gender adolescents aged 10-14 years; Coaches, staff, and collaborators
• Implementation setting: Peri-urban and urban sites in Zambia (Lusaka and Eastern Provinces) and urban and rural sites in Zimbabwe (Bulawayo, Matabeleland South and North)
• Study period: December 2018 to December 2021 (3 years)

Intervention

• SKILLZ Total Health: A sport-based comprehensive SRH education intervention consisting of up to three integrated GRS programs (SKILLZ Core, SKILLZ Guyz/Girl, and SKILLZ Teen Clubs)

Results

• Endline response rates were low (~54% retention across cohorts)
• Improvements were observed in adolescents’ knowledge of HIV, pregnancy, and gender-based violence (GBV) support services
  • Zimbabwe school-based cohort: improved knowledge of HIV support services (69.7% baseline, 84.5% endline, p<.001).
• Attitudes toward the friendliness of health staff improved across cohorts.
  • Zimbabwe school-based cohort: 55.3% baseline vs. 69.3% endline, p=.004.
• Perceptions of health staff’s ability to maintain confidentiality also improved.
  • Zimbabwe school-based cohort: 56.1% baseline vs. 71.2% endline, p=.008.

Conclusions and implications

• Participation in SKILLZ Health was associated with improvements in adolescents’ SRH knowledge, perceptions of youth-friendly services, and engagement with SRH information and services.
• Findings suggest the importance of:
  • Expanding youth-friendly, community- and media-based outreach;
  • Strengthening referral systems and confidential service access; and
  • Increasing engagement around GBV prevention, adolescent empowerment, and decision-making skills to further improve SRH outcomes.