Mixed methods study of SKILLZ Girl among adolescent girls in South Africa

Brief Summary

Background

Adolescent girls in South Africa face heightened HIV risk due to both biological vulnerability and social inequality. Single-sex HIV prevention programs have shown promise in reaching and empowering young women.

What Grassroot Soccer did

Grassroot Soccer implemented SKILLZ Girl (called SKILLZ Street at the time of the study) across five peri-urban communities in South Africa. Over two years, more than 4,200 adolescent girls participated in 10 sessions integrating soccer, life skills, and HIV counseling and testing, facilitated by trained female community coaches.

What the study found

Participants showed improvements in HIV knowledge, self-confidence, communication about HIV with peers, and support for gender-equitable norms. Girls also reported valuing their relationships with coaches and greater awareness of the importance of HIV testing.

Why this matters

SKILLZ Girl may help adolescent girls access HIV testing and information while building self-confidence and community. Female coaching played a meaningful role in that process.

DETAILED SUMMARY

Importance

Women are physiologically more vulnerable to HIV than men, and at higher risk for HIV due to cultural and societal norms. Research has shown that single-sex HIV prevention programming is effective. Grassroot Soccer (GRS) developed SKILLZ Street (SS) (later SKILLZ Girl) to improve self-efficacy, HIV-related knowledge, and HIV counseling and testing (HCT) uptake for adolescent girls.

Objective

To understand the effects of SKILLZ Street in implementing HCT events into single-sex HIV prevention intervention (rather than mixed-sex) among adolescent girls in five different peri-urban areas in South Africa
- To evaluate the impacts of female coaching/mentorship
- To increase self-efficacy in avoidance of risky sexual behavior
- To increase belief in gender-equitable norms
- To facilitate access to and uptake of HCT services

Study details

Study design: Mixed methods design; pre/post survey analysis; no comparison group.
Data collection tools: Attendance registers, pre- and post-questionnaires, focus group discussions (FGDs) with transcription analyses
Participants: Adolescent girls (average of 12.3 years of age in 2011, 13.5 years of age in 2012; range of 12-16 years); female community leaders (“Coaches”); community HCT testing partners
Implementation setting: 5 peri-urban sites in Alexandra, Khayelitsha, Kimberly, Port Elizabeth, and Soweto in South Africa
Study period: January 2011 – December 2012 (24 months)

Intervention

SKILLZ Street (later called SKILLZ Girl): 10 two-hour sessions that integrate soccer, life skills activities, and voluntary HCT. “Coaches” are young, volunteer female role models found through local schools who facilitate the sessions. Coaches participated in ≥ 80 hours of GRS-led training to build HIV and SRHR knowledge, facilitation techniques, and skills working with youth before implementing SS.

Results

4,260 participants enrolled in SS in 2011 and 2012. 86% (3,678) of participants graduated (attended ≥ 7 sessions). Significant pre/post improvement in communication about HIV with a peer (p<0.001), gender-equitable responses (p<0.001), self-efficacy to avoid risky sexual behavior (p<0.01), and HIV prevention knowledge (p<0.01).
Focus group discussions (FGDs) suggest participants valued Coach/participant relationship; improved self-efficacy, HIV-related knowledge, and communication; changed perception of soccer as a male-only sport; increased awareness of the importance of testing

Conclusions and implications

Results suggest SS helps at-risk girls access HCT and HIV-related knowledge while promoting self-confidence
Girls may develop a better network of people to talk to about reproductive health and feel more confident in pursuing soccer

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Citation

DOI

Year: 2015

Authors: Hershow RB, Gannett K, Merrill J, Kaufman EB, Barkley C, DeCelles J, Harrison A

Hershow RB, Gannett K, Merrill J, Kaufman EB, Barkley C, DeCelles J, Harrison A. Using soccer to build confidence and increase HCT uptake among adolescent girls: a mixed-methods study of an HIV prevention programme in South Africa. Sport in Society. 2015 Sep 14;18(8):1009-22. DOI: 10.1080/17430437.2014.997586.